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United Arab Emirates

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

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

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

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

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

Visit the Embassy of the United Arab Emirates web site at http://uae-embassy.org for the most current visa information.

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Basic modern medical care and medicines are available in the principal cities of the UAE, but not necessarily in outlying areas.

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

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning the United Arab Emirates is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

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

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

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

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

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

SPECIAL CIRCUMSTANCES: The UAE government does not recognize dual nationality.
Children of UAE fathers automatically acquire UAE citizenship at birth and must enter the UAE on UAE passports. UAE authorities have confiscated U.S. passports of UAE/U.S. dual nationals in the past. This act does not constitute loss of U.S. citizenship, but should be reported to the U.S. Embassy in Abu Dhabi or the U.S. Consulate General in Dubai. In addition to being subject to all UAE laws, U.S. citizens who also hold UAE citizenship may also be subject to other laws that impose special obligations on citizens of the UAE.
For additional information, please refer to our Dual Nationality flyer.

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

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

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

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

Please see our Customs Information.

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

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

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

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

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

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

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

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

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

REGISTRATION/EMBASSY AND CONSULATE LOCATION:
Americans living or traveling in the United Arab Emirates are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within the United Arab Emirates. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy in Abu Dhabi is located at Embassies District, Plot 38, Sector W59-02, Street No. 4, P.O. Box 4009. The telephone number is (971) (2) 414-2200, and the Consular Section fax number is (971) (2) 414-2241. The email address for American Citizens Services inquiries, including passport questions, is abudhabiacs@state.gov. The after-hours telephone number is (971) (2) 414-2500. The Embassy Internet web site is http://uae.usembassy.gov.

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

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

Travel News Headlines WORLD NEWS

Date: Thu 26 Sep 2019
Source: Gulf Business [edited]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our information on Criminal Penalties.

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Spain

Spain and Andorra US Consular Information Sheet
January 13, 2009
Spain and Andorra are both advanced stable democracies and modern economies. Spain is a member of North Atlantic Treaty Organization (NATO) and the European Union.
Read the D
partment of State Background Notes on Spain and Andorra for additional information.

ENTRY/EXIT REQUIREMENTS:
Spain is a party to the Schengen agreement.
As such, U.S. citizens may enter Spain for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our Schengen Fact Sheet.

In an effort to prevent international child abduction, many governments have initiated procedures at entry/exit points.
These often include requiring documentary evidence of relationship and permission for the child's travel from the parent(s) or legal guardian not present.
Having such documentation on hand, even if not required, may facilitate entry/departure.
For further information concerning entry requirements for Spain, travelers should contact the Embassy of Spain at 2375 Pennsylvania Avenue NW, Washington, DC 20037, telephone (202) 452-0100, or the nearest Spanish Consulate in Boston, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, San Francisco, or San Juan.
Spanish government web sites with information about entry requirements (in Spanish) can be found at http://www.mae.es and http://www.mir.es.
Additional information may be obtained from the Tourist Office of Spain in New York, telephone (212) 265-8822, or online at http://www.spain.info/.
For further information on entry requirements to Andorra, travelers should contact the Andorran Mission to the UN, 2 U.N. Plaza, 25th floor, New York, NY 10018, telephone (212) 750-8064 or online at http://www.andorra.ad.
Visit the Embassy of Spain and Andorra web sites 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:
Spain and Andorra share with the rest of the world an increased threat of international terrorist incidents.
Like other countries in the Schengen area, Spain's open borders with its Western European neighbors allow the possibility of terrorist groups entering and exiting the country with anonymity.
Spain’s proximity to North Africa makes it vulnerable to attack from Al Qaeda terrorists in the Maghreb region.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

In the deadliest terrorist attack in recent European history, in March 2004, Islamist extremists bombed four commuter trains entering Madrid, causing 191 deaths and over 1,400 injuries.
Spanish authorities tried the suspected terrorists and their co-conspirators in February 2007 and convicted in October 2007.
The Basque Fatherland and Liberty (ETA) terrorist organization remains active in Spain.
ETA has historically avoided targeting foreigners, directing their attacks against the police, military, local politicians, and Spanish government targets as well as attempts to disrupt transportation and daily life. However, foreigners have been killed or injured collaterally in ETA attacks.
Two examples of this are the Barajas Airport bombing in December 2006, in which two Ecuadorian nationals were killed and the bombing at the University of Navarre in October 2008, in which 17 students were injured including one American student.
In addition, bombs have been used as part of criminal extortion of businesses, particularly in the Basque region. The risk of “being in the wrong place at the wrong time” in event of an ETA action is a concern for foreign visitors and tourists.
U.S. tourists traveling to Spain should remain vigilant, exercise caution, monitor local developments, and avoid demonstrations and other potentially violent situations.

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

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.
CRIME:
Andorra has a low rate of crime.
While most of Spain has a moderate rate of crime and most of the estimated one million American tourists have trouble free visits to Spain each year, street crimes against tourists occur in the principal tourist areas.
Madrid and Barcelona, in particular, report incidents of pick-pocketing, mugging and occasional violent attacks, some of which require the victim to seek medical attention.
Although crimes occur at all times of day and night and to people of all ages, older tourists and Asian Americans seem to be particularly at risk.
Criminals frequent tourist areas and major attractions such as museums, monuments, restaurants, outdoor cafes, Internet cafes, hotel lobbies, beach resorts, city buses, subways, trains, train stations, airports, and ATMs.

In Madrid, incidents have been reported in all major tourist areas, including the area near the Prado Museum, near Atocha train station, in Retiro Park, in areas of old Madrid including near the Royal Palace and in Plaza Mayor.
There have been a number of passport and bag thefts reported at Madrid’s Barajas Airport, local hotels, as well as in El Rastro (Madrid’s flea market) and in the Metro.

In Barcelona, the largest number of incidents reported also occurred in major tourist areas, on Las Ramblas, Barcelona’s El Prat airport, Sants train station, Metro stations, in the Sagrada Familia Area, in the Gothic Quarter, in Parc Güell, in Plaza Real, and along Barcelona’s beaches.
There has been a rise in the number of thefts reported at the Port Olimpic Area and nearby beaches.

Travelers should remain alert to their personal security and exercise caution. Travelers are encouraged to carry limited cash, only one credit card, and a copy of their passport; leaving extra cash, extra credit cards, passports and personal documents in a safe location.
When carrying documents, credit cards or cash, you are encouraged to secure them in a hard-to-reach place and not to carry all valuables together in a purse or backpack.
Thieves often work in teams of two or more people.
In many cases, one person distracts a victim while the accomplices perform the robbery.
For example, someone might wave a map in your face and ask for directions, “inadvertently” spill something on you, or help you clean-up bird droppings thrown on you by a third unseen accomplice.
While your attention is diverted, an accomplice makes off with the valuables.
Thieves may drop coins or keys at your feet to distract you and try to take your belongings while you are trying to help.
Attacks are sometimes initiated from behind, with the victim being grabbed around the neck and choked by one assailant while others rifle through or grab the belongings.
A group of assailants may surround the victim in a crowded popular tourist area or on public transportation, and only after the group has departed does the person discover he/she has been robbed.
Purse-snatchers may grab purses or wallets and run away, or immediately pass the stolen item to an accomplice.
A passenger on a passing motorcycle sometimes robs pedestrians.
There have been reports of thieves posing as plainclothes police officers, beckoning to pedestrians from cars and sometimes confronting them on the street asking for documents, or to inspect their cash for counterfeit bills, which they ultimately “confiscate” as evidence.
The U.S. Embassy in Madrid has received reports of cars on limited access motorways being pulled over by supposed unmarked police cars.
The Spanish police do not operate in this fashion.
American citizens are encouraged to ask for a uniformed law enforcement officer if approached.
Theft from vehicles is also common.
“Good Samaritan" scams are unfortunately common, where a passing car or helpful stranger will attempt to divert the driver’s attention by indicating there is a flat tire or mechanical problem.
When the driver stops to check the vehicle, the “good Samaritan” will appear to help the driver and passengers while the accomplice steals from the unlocked car. Drivers should be cautious about accepting help from anyone other than a uniformed Spanish police officer or Civil Guard.
Items high in value like luggage, cameras, laptop computers, or briefcases are often stolen from cars. Travelers are advised not to leave valuables in parked cars, and to keep doors locked, windows rolled up, and valuables out of sight when driving.
While the incidence of sexual assault is statistically very low, attacks do occur.
Spanish authorities warn of the availability of so-called "date-rape" drugs and other drugs, including "GBH" and liquid ecstasy.
Americans should not lower their personal security awareness because they are on vacation.
A number of American citizens have been victims of lottery or advance fee scams in which a person is lured to Spain to finalize a financial transaction. Often the victims are initially contacted via Internet or fax and informed they have won the Spanish Lottery (El Gordo), inherited money from a distant relative, or are needed to assist in a major financial transaction from one country to another.
For more information, please see the Bureau of Consular Affairs web site on International Financial Scams.

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.
The Embassy’s U.S. Commercial Service receives reports of a type of scam targeting U.S. businesses, utilizing the name of a legitimate Spanish concern and legitimate-appearing Spanish bank references.
The scam usually involves a temptingly large order or business proposal.
The U.S. Commercial Service in Spain at http://www.buyusa.gov/spain/en/ stands ready to counsel any U.S. firm which would like to verify the legitimacy of an unsolicited business proposal purporting to come from a Spanish firm.

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, help you find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Spain does have a Crime Victim’s Assistance program.
More information can be obtained at http://www.mjusticia.es/Directorio/Victimas?menu_activo=1057821035144&lang=es_es.

The local equivalent to the “911” emergency line in Spain is 112.
Please see our information on Victims of Crime, including possible victim compensation programs.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Good medical care is available in both Spain and Andorra.
Regulations regarding medications may vary from those in the United States; Americans with need for specific medications are encouraged to bring a supply sufficient for their anticipated period of stay, as the medication may not be available and customs regulations may prohibit certain medications to be mailed from the United States to Spain or Andorra.
The Department of State strongly urges Americans to consult with their medical insurance companies prior to traveling abroad to confirm whether their policy applies overseas and if it will cover emergency expenses such as a medical evacuation.
U.S. medical insurance plans may not cover health costs incurred outside the United States unless supplemental coverage is purchased.
Further, U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States. You should contact your insurance provider before departure so appropriate arrangements can be made.
Many travel agents and private companies offer insurance plans that will cover health care expenses incurred overseas, including emergency services such as medical evacuations.

When making a decision regarding health insurance, Americans should consider that many foreign doctors and hospitals require payment in cash prior to providing service and that a medical evacuation to the United States may cost well in excess of $50,000.
Uninsured travelers who require medical care overseas often face extreme difficulties, whereas travelers who have purchased overseas medical insurance have found it to be life saving when a medical emergency has occurred.
When consulting with your insurer prior to your trip, please ascertain whether payment will be made to the overseas healthcare provider or if you will be reimbursed later for expenses that you incur.
Some insurance policies also include coverage for psychiatric treatment and for disposition of remains in the event of death.

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

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

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning name of country is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Traffic in Madrid and Barcelona is faster-paced than in U.S. cities and can be unnerving due to unfamiliar signs or motorbikes weaving between traffic lanes.
Drivers should always obey the closest traffic light, as there are separate pedestrian lights in the city.
Drivers should be alert when driving at night in urban areas, due to the possibility of encountering drivers or pedestrians under the influence of alcohol.
Night driving in isolated rural areas can be dangerous because of farm animals and poorly marked roads.
Rural traffic is generally heavier in July and August as well as during the Christmas and Easter seasons.
Traffic regulations in effect in Spain include the prohibition on the use of a mobile phone without a hands-free device while driving a car.
There is a fine of 300 euros for violation of this regulation and loss of driving privileges.
In addition, all drivers and passengers are required to carry a reflective vest and put it on if they need to stop on the roadside.
A reflective triangle warning sign for a vehicle stopped on the side of the road is also mandatory.
Those renting vehicles are encouraged to check with the rental company about traffic regulations and safety equipment.
U.S. citizens using U.S. issued drivers licenses must obtain International Driving Permits prior to their arrival if they plan to drive in Spain.
Pedestrians should use designated crossing areas when crossing streets and obey traffic lights.
Public transportation in large Spanish cities is generally excellent.
All major cities have metered taxis, in which extra charges must be posted in the vehicle.
Travelers are advised to use only clearly identified cabs and to ensure that taxi drivers always switch on the meter.
A green light on the roof indicates that the taxi is available.
Rail service is comfortable and reliable, but varies in quality and speed. Intercity buses are usually comfortable and inexpensive.
Please refer to our Road Safety page for more information.
For specific information concerning Spanish driving permits, vehicle inspection, road tax and mandatory insurance, please contact the Spanish National Tourist Organization offices in New York at http://www.spain.info/us/TourSpain.
For information about driving in Andorra, refer to http://www.andorra.ad/en-US/Pages/default.aspx.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Spain’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Spain’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.

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 offences.
Persons violating the laws of Spain or Andorra, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Spain and Andorra are severe, and convicted offenders can expect long jail sentences and heavy fines. The cities of Madrid and Barcelona and The Balearics Regional Government have banned the consumption of alcohol in the street, other than in registered street cafes and bars.
Visitors to Madrid, Barcelona, Mallorca, Ibiza, and Menorca should be aware that failure to respect this law might result in the imposition of fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Spain or Andorra are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site to obtain updated information on travel and security within Spain or Andorra.
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 Serrano 75; telephone (34) (91) 587-2200, and fax (34) (91) 587-2303. U.S. citizens who register in the Consular Section at the U.S. Embassy, Consulate General, or one of the Consular Agencies listed below can obtain updated information on travel and security within Spain or Andorra.
Additional information and appointments for routine services are available through the U.S. Embassy’s home page at http://madrid.usembassy.gov.
Appointments are required for routine Consular Services.
To make an appointment, go to https://evisaforms.state.gov/acs/default.asp?postcode=MDD&appcode=1.
The U.S. Consulate in Barcelona is located at Paseo Reina Elisenda 23-25; telephone (34) (93) 280-2227 and fax (34) (93) 205-5206.
Visitors to Barcelona can access additional information from the Consulate General’s web page at http://madrid.usembassy.gov/barcelonaen.html.
There are six consular agencies in Spain, which provide limited services to American citizens, but are not authorized to issue passports.
Anyone requesting service at one of the consular agencies should call ahead to verify that the service requested will be available on the day you expect to visit the agency.
Fuengirola (in Malaga Province), at Avenida Juan Gomez Juanito #8, Edificio Lucia 1C, Fuengirola 29640 Spain. Telephone (34) (952) 474-891 and fax (34) (952) 465-189.
Hours 10:00 a.m. to 2:00 p.m.
La Coruna, Calle Juana de Vega 8, 5º Piso, Oficina I, La Coruna 15003 Spain.
Telephone (34) (981) 213-233 and fax (34) (981 22 28 08).
Hours 10:00 a.m. to 1:00 p.m.

Las Palmas, at Edificio Arca, Calle Los Martinez de Escobar 3, Oficina 7, Las Palmas, Gran Canaria 35007 Spain.
Telephone (34)(928) 222-552 and fax (34)(928) 225-863.
Hours 10:00 a.m. to 1:00 p.m.
Palma de Mallorca, Edificio Reina Constanza, Porto Pi, 8, 9-D, 07015 Palma de Mallorca 07015 Spain.
Telephone (34) (971) 40-3707 or 40-3905 and fax (34) (971) 40-3971.
Hours 10:30 a.m. to 1:30 p.m.
Seville, at Plaza Nueva 8-8 duplicado, 2nd Floor, Office E-2 No.4, Sevilla, 41101 Spain. Telephone: (34) (65) 422-8751 and fax (34) (91) 422-0791.
Hours: 10:00 a.m. to 1:00 p.m.
Valencia, at Doctor Romagosa #1, 2-J, 46002, Valencia 46002 Spain.
Telephone (34) (96)-351-6973 and fax (34) (96) 352-9565.
Hours 10:00 a.m. to 2:00 p.m.
For Andorra, please contact the U.S. Consulate in Barcelona.
*

*

*
This replaces the Country Specific Information for Spain and Andorra dated July 15, 2008, to update sections on Safety and Security and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Tue 3 Dec 2019
Source: Animals Health, Espana [in Spanish, machine trans. edited]

A total of 9 people have been treated in Health Centers of La Rioja for an outbreak of Q fever, and 3 of them have been admitted, according to various local media. This disease is a zoonosis that is transmitted by inhalation of the bacteria present in infected animals.

In addition, 3 citizens of the Basque Country, specifically from Biscay, are also admitted with Q fever, and a 4th person is waiting for bacteriological results. The patients would have acquired the disease after a visit to La Rioja, where they would have been infected by having contact with infected animals. They spent a weekend in La Rioja, and all of them, during a rural stay, maintained direct contact with newborn goats.

The spread of Q fever does not occur from person to person but only occurs through direct contact with sick animals. Therefore, the disease, caused by the bacterium _Coxiella burnetii_, has implications for animal health, especially for livestock, and infections can also be caused by the inhalation of bacterial spores that can be transported long distances by dust and wind.

Acute cases of Q fever are often mild, with symptoms similar to those of the flu, and can be treated with antimicrobials. However, chronic cases can cause dangerous infections in the heart and blood vessels and have a poor prognosis.

Recently, the Valencian Ministry of Health reported the existence of another outbreak of Q fever in Villajoyosa (Alicante), with 6 cases declared, all of them now in good health.
=====================
[Q fever is due to _Coxiella burnetii_, an obligate intracellular rickettsia-like bacterial pathogen. It is highly resistant to drying and heat, which enables the bacteria to survive for long periods in the environment. Its survival is attributed to a small cell variant of the organism that is part of its biphasic developmental cycle.

Q fever is a zoonosis. Although it has a wide and diverse host range, in animals this organism is primarily known as a cause of reproductive losses in domesticated ruminants. Clinical cases seem to be most significant in sheep and goats, with sporadic losses and occasional outbreaks that may affect up to 50-90% of the herd. Infected animals can be difficult to recognize: nonpregnant animals do not seem to have any obvious clinical signs, and seropositivity is not always correlated with shedding of the bacteria. The organism is shed in urine, feces, milk, and especially birthing products; intermittent high-level shedding occurs at the time of parturition, with millions of bacteria being released per gram of placenta.

Humans usually become infected by inhaling aerosolized organisms,often when they are exposed to an animal that had aborted but also if birth was at term and seemed normal. Acute symptoms of a flu-like illness usually develop within 2-3 weeks of exposure, although as many as half of humans infected with _C. burnetii_ do not show symptoms (<http://www.cdc.gov/qfever/symptoms/index.html>). Although most persons with acute Q fever infection recover, others may experience serious illness with complications that may include pneumonia, granulomatous hepatitis, endocarditis (especially in patients with previous cardiac valvulopathy), myocarditis, and central nervous system involvement. Pregnant women who are infected may be at risk for pre-term delivery or miscarriage.

Q fever is frequently an occupationally acquired illness; people most at risk include workers from the meat and livestock industries, shearers, veterinarians, laboratory personnel performing _C. burnetii_ cultures, as well as the general population in close proximity to infected animals in stockyards, feedlots, processing plants, or farms. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Mon, 11 Nov 2019 10:39:09 +0100 (MET)

La Jonquera, Spain, Nov 11, 2019 (AFP) - Catalan separatist activists blocked traffic on Monday on a motorway linking Spain and France, in a fresh protest against the sentencing last month of nine of their leaders to lengthy jail terms.   Demonstrators cut the AP7 motorway at La Jonquera near the city of Girona in eastern Spain, a day after a repeat general election in which Prime Minister Pedro Sanchez's Socialist emerged as winners but weakened, while far-right party Vox surged to third place on the back of its hardline stance against separatism.   Dozens of vehicles blocked the motorway near the border with France while some 300 people set up a barricade, according to an AFP photographer at the scene.   Some demonstrators began to set up a stage and speakers which they brought to the scene in vans.   Catalonia's regional road department confirmed the motorway was cut in both directions at La Jonquera.

The protest was called by a new, mysterious organisation called "Democratic Tsunami" which last month sent thousands of people to block access to Barcelona airport in a protest which ended in clashes between demonstrators and police.   "This mobilisation is a cry to the international community so that it makes the Spanish state understand that the only possible path is to sit down and talk," the group said in a message sent to its followers on encrypted messaging service Telegram.   Radical separatist group CDR also called on its supporters to head to La Jonquera to block the highway.   Catalonia was rocked by days of mass, sometimes violent, pro-independence rallies after Spain's Supreme Court on October 14 sentenced nine politicians and activists to jail for up to 13 years for their role in a failed secession bid in 2017.   Demonstrators have frequently cut road and rail links between Spain and France while many shops in downtown Barcelona have been shut during the rallies and there are growing concerns about the impact of the unrest on business in Spain's second largest city.
Date: Fri, 8 Nov 2019 19:25:02 +0100 (MET)

Madrid, Nov 8, 2019 (AFP) - Spanish health authorities confirmed Friday a case of a man spreading dengue through sex, a world first for a virus which until recently was thought to be transmitted only by mosquitos.   The case concerns a 41-year-old man from Madrid who contracted dengue after having sex with his male partner who picked up the virus from a mosquito bite during a trip to Cuba, said Susana Jimenez of the Madrid region's public health department.

His dengue infection was confirmed in September and it puzzled doctors because he had not travelled to a country where the disease, which causes severe flu-like symptoms such as high fever and body aches, is common, she added.   "His partner presented the same symptoms as him but lighter around ten days earlier, and he had previously visited Cuba and the Dominican Republic," Jimenez said.   "An analysis of their sperm was carried out and it revealed that not only did they have dengue but that it was exactly the same virus which circulates in Cuba."

A "likely' case of sexual transmission of dengue between a man and a woman was the subject of a recent scientific article in South Corea, Jimenez said.   In an e-mail sent to AFP, the Stockholm-based European Centre for Disease Prevention and Control (ECDC), which monitors health and disease in Europe, said this was "to our knowledge, the first sexual transmission of the dengue virus among men who have sex with men."

According to the World Health Organization's website, dengue is transmitted mainly by the Aedes Aegypti mosquito, which thrives in densely-populated tropical climates and breeds in stagnant pools of water.    It is most serious -- and deadly -- in children, especially young girls though scientists don't know why.

Dengue is most commonly caught by people travelling to hotter climates such as southeast Asia, Africa, Australia, the Caribbean and South and Central America.
Date: Tue, 29 Oct 2019 20:47:34 +0100 (MET)

Barcelona, Oct 29, 2019 (AFP) - Rescuers on Tuesday found the body of a man swept away last week by flash floods in Catalonia, purportedly while inside a mobile home, raising to four the number of people who died when storms lashed north-eastern Spain.

Torrential rains hit Catalonia last Tuesday night, sparking major flooding which left one person dead in a beach town north of Barcelona and another five missing in a badly-hit area inland from the coastal city of Tarragona.   The Catalan Civil Protection service said the body had been "identified by police as the man who disappeared in Vilaverd when he was supposedly inside a mobile home", referring to a village on the Francoli river some 30 kilometres north of Tarragona.   "The provisional toll (from the storms) now stands as four dead, all of whom have been identified, and three others still missing," rescuers wrote on Twitter.

The storm also lashed the island of Mallorca, where rescuers on Tuesday said they had found a body. But they could not immediately confirm whether it was one of two young people who were seen being swept away by a huge wave.   Last week's flooding and landslides forced the closure of nearly 50 roads and halted train services, as well as forcing the diversion of 37 flights, mostly in Mallorca, officials said.

The first victim was a man found on October 22 in Caldes d'Estrac, north of Barcelona, while another man's body was found two days later at Tarragona port where the Francoli enters the sea.    A third body, that of a homeless man, was found on Monday although he was not one of those listed as missing.   Southern France was also hit by major flooding which left three people dead, one of them a British woman.
Date: Wed, 23 Oct 2019 23:18:23 +0200 (METDST)

Barcelona, Oct 23, 2019 (AFP) - One man died and another five people were missing Wednesday after a night of torrential rain triggered flash flooding in north-eastern Spain, cutting off roads and disrupting air travel, officials said.    Police said they found a man's body late on Tuesday on the beach in Caldes d'Estrac, some 40 kilometres (25 miles) north of Barcelona, while further south, rescuers were engaged in the hunt for five other people, all of whom disappeared in a badly-hit area inland from the coastal city of Tarragona.   Aerial footage from the affected zone, which lies about 30 kilometres north of Tarragona, showed villages swamped by floodwaters and mud, with trees and even bridges swept away by the force of the water.

During the evening, regional police confirmed they were looking for a Belgian lorry driver whose empty vehicle had been found in the Francoli river, after earlier saying they were also hunting for two people, reportedly a woman and her adult son whose prefab home was swept away by floodwaters in Vilaverd.    They were also looking for another two people whose empty car was found near l'Espluga de Francoli in the same area.   Flooding and landslides forced the closure of nearly 50 roads and halted train services in the region, as well as forcing the diversion of 37 flights, most of them in Palma on the holiday island of Mallorca, regional transport authorities said.   And nearly 25,000 homes across the region were left without power due to the high winds and heavy rain, although by mid-afternoon that number had fallen to 10,000, officials said. 

As rescuers in Catalonia continued the search for those reported missing inland from the coastal city of Tarragona, the stormy weather shifted towards the Cantabria region on Spain's northern coast, forecasters said.    The heavy rainfall also battered southern France, where roads were flooded, train services interrupted, and people evacuated from their homes.    In the southwestern Beziers region, two metres of water fell in less than six hours -- the equivalent of two-and-a-half months worth of rain, Meteo France said, warning that gale-force winds raised the possibility of high waves swamping parts of the coastline. 

The bad weather also shut down the rail lines from Montpelier and Toulouse in southern France and from Montpelier across the border into Spain, until at least November 4, French rail operator SNCF announced.   Passengers who have bought tickets for journeys no longer available will be reimbursed within 60 days, SNCF added.   In September, seven people died in storms and flooding following days of record rainfall in southeastern Spain.    Last year, intense rain in Mallorca caused the deaths of 13 people as rivers burst their banks, flooding streets and sweeping away cars.
More ...

Lithuania

Lithuania US Consular Information Sheet
May 19, 2008
COUNTRY DESCRIPTION:
Lithuania is a stable democracy undergoing rapid economic growth. Tourist facilities in Vilnius, the capital, and to a lesser extent in Kaunas and Klaipeda, are simi
ar to those available in other European cities. In other parts of the country, however, some of the goods and services taken for granted in other countries may not be available. Read the Department of State Background Notes on Lithuania for additional information.
ENTRY/EXIT REQUIREMENTS: A valid passport is required to enter Lithuania. As there are no direct flights from the U.S. to Lithuania, U.S. citizens should be aware of passport validity requirements in transit countries. American citizens do not need a visa to travel to Lithuania for business or pleasure for up to 90 days. That 90-day period begins with entry to any of the “Schengen Group” countries: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Poland, Portugal, Slovakia, Spain, and Sweden. Multiple visits to Schengen countries may not exceed 90 days in any 6 month period. Travelers remaining in Lithuania for more than 90 days within any six-month period must apply for temporary residency.

Lithuanian authorities recommend applying or a residency permit through a Lithuanian embassy or consulate before initial entry into Lithuania, as processing times can run beyond 90 days. All foreigners of non-European Union countries seeking entry into Lithuania must carry proof of a medical insurance policy contracted for payment of all costs of hospitalization and medical treatment in Lithuania. Visitors unable to demonstrate sufficient proof of medical insurance must purchase short-term insurance at the border from a Lithuanian provider for roughly $1.00 per day. The number of days will be calculated from the day of entry until the date on the return ticket. Children residing in Lithuania must have written permission to travel outside the country from at least one parent if their parents are not accompanying them on their trip. This policy is not applicable to temporary visitors. See our Foreign Entry Requirements brochure for more information on Lithuania and other countries. Visit the Embassy of Lithuania web site at www.ltembassyus.org for the most current visa information.
Note: Although European Union regulations require that non-EU visitors obtain a stamp in their passport upon initial entry to a Schengen country, many borders are not staffed with officers carrying out this function. If an American citizen wishes to ensure that his or her entry is properly documented, it may be necessary to request a stamp at an official point of entry. Under local law, travelers without a stamp in their passport may be questioned and asked to document the length of their stay in Schengen countries at the time of departure or at any other point during their visit, and could face possible fines or other repercussions if unable to do so.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information abut customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY: Civil unrest is not a problem in Lithuania, and there have been no incidents of terrorism directed toward American interests. Incidents of anti-Americanism are rare.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: Lithuania is a relatively safe country. Visitors should maintain the same personal security awareness that they would in any metropolitan U.S. city. Large amounts of cash and expensive jewelry should be secured in a hotel safe or left at home. Crimes against foreigners, while usually non-violent, do occur. Pickpocketing and thefts are problems, so personal belongings should be well protected at all times. Theft from cars and car thefts occur regularly. Drivers should be wary of persons indicating they should pull over or that something is wrong with their car. Often, a second car or person is following, and when the driver of the targeted car gets out to see if there is a problem the person who has been following will either steal the driver’s belongings from the vehicle or get in and drive off with the car. Drivers should never get out of the car to check for damage without first turning off the ignition and taking the keys. Valuables should not be left in plain sight in parked vehicles, as there have been increasing reports of car windows smashed and items stolen. If possible, American citizens should avoid walking alone at night. ATMs should be avoided after dark. In any public area, one should always be alert to being surrounded by two or more people at once. Additionally, criminals have a penchant for taking advantage of drunken pedestrians. Americans have reported being robbed and/or scammed while intoxicated.
Following a trend that has spread across Eastern and Central Europe, racially motivated verbal, and sometimes physical, harassment of foreigners of non-Caucasian ethnicity has been reported in major cities. Incidents of racially motivated attacks against American citizens have been reported in Klaipeda and Vilnius.
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 these serious problems 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 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. For more information about assistance for victims of crime in Lithuania, please visit the Embassy’s web site at http://vilnius.usembassy.gov/service/crime-victim-assistance.html.
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in Lithuania has improved in the last 15 years, but medical facilities do not always meet Western standards. There are a few private clinics with medical supplies and services that nearly equal Western European or U.S. standards. Most medical supplies are now widely available, including disposable needles, anesthetics, antibiotics and other pharmaceuticals. However, hospitals and clinics still suffer from a lack of equipment and resources. Lithuania has highly trained medical professionals, some of whom speak English, but their availability is decreasing as they leave for employment opportunities abroad. Depending on his or her condition, a patient may not receive an appointment with a specialist for several weeks. Western-quality dental care can be obtained in major cities. Elderly travelers who require medical care may face difficulties. Most pharmaceuticals sold in Lithuania are from Europe; travelers will not necessarily find the same brands that they use in the United States. Serious medical problems requiring hospitalization and/or medical evacuation can cost thousands of dollars or more. Doctors and hospitals often expect immediate cash payment for health services, particularly if immigration status in Lithuania is unclear.

Tick-borne encephalitis and lyme disease are widespread throughout the country. Those intending to visit parks or forested areas in Lithuania are urged to speak with their health care practitioners about immunization. Rabies is also increasingly prevalent in rural areas.
The Lithuanian Government does not require HIV testing for U.S. citizens. However, sexually transmitted diseases are a growing public health problem.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747); or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. All foreigners of non-European Union countries seeking entry into Lithuania must carry proof of a medical insurance policy contracted for payment of all costs of hospitalization and medical treatment in Lithuania (please see entry/exit requirements above). 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 Lithuania is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The Police allow Americans to drive in Lithuania with an American driver’s license for up to 90 days. Americans who reside in Lithuania for 185 days or more in one calendar year and who wish to continue driving in Lithuania must acquire a Lithuanian driver's license. The foreign license must be given to the Lithuanian Road Police to be processed by the Consular Department of the Lithuanian Ministry of Foreign Affairs, which in turn sends it to the U.S. Embassy’s Consular Section, where the owner is expected to claim it.
Roads in Lithuania range from well-maintained two- to four-lane highways connecting major cities to small dirt roads traversing the countryside. Violation of traffic rules is common. It is not unusual to be overtaken by other automobiles, traveling at high speed, even in crowded urban areas. Driving at night, especially in the countryside, can be particularly hazardous. In summer, older seasonal vehicles and inexperienced drivers are extra hazards. Driving with caution is urged at all times. Driving while intoxicated is a very serious offense and carries heavy penalties. The speed limit is 50 km/hr in town and 90 km/hr out of town unless otherwise indicated. The phone number for roadside assistance is 8-800-01414 from a regular phone and 1414 from a GSM mobile phone.
Seatbelts are mandatory for the driver and all passengers except children under the age of 12. During the winter, most major roads are cleared of snow. Winter or all-season tires are required from November 10th through April 1st. Studded tires are not allowed from April 10th through October 31st. Drivers must have at least their low beam lights on at all times while driving. Public transportation is generally safe.
Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office and national authority responsible for road safety at www.tourism.lt and at www.lra.lt/index_en.html.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Lithuania, the U.S. Federal Aviation Administration (FAA) has not assessed Lithuania’s Civil Aviation Authority for compliance with International Civil Aviation Organization ICAO aviation safety standards. For more information, travelers may visit the FAA’s web site at www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: Lithuanian customs authorities may enforce strict regulations concerning the temporary importation into or export from Lithuania of items such as firearms and antiquities. Please see our Customs Information.
Telephone connections are generally good. American 1-800 numbers can be accessed from Lithuania but not on a toll-free basis; the international long distance rate per minute will be charged. Local Internet cafes offer computer access. ATMs are widely available. Most hotels and other businesses accept major credit cards.
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 Lithuanian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Lithuania are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or possessing or disseminating child pornography in a foreign country is a crime prosecutable in the United States. For more information about arrest procedures in Lithuania, please visit the Embassy’s web site at http://vilnius.usembassy.gov/arrests.html. 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 page.
REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Lithuania 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 Lithuania. 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 Akmenu Gatve 6, tel. (370) (5) 266-5500 or 266-5600; fax (370) (5) 266-5590. Consular information can also be found on the Embassy Vilnius web site at http://vilnius.usembassy.gov/.
* * *
This replaces the Consular Information Sheet dated November 5, 2007 to update sections on Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed 7 Aug 2019 01:17:58 EEST
Source: Xinhua News Agency [edited]

The rate of tick-borne encephalitis in Lithuania remains the highest in Europe, announced the country's Center for Communicable Diseases and AIDS (ULAC) on [Tue 6 Aug 2019].

According to ULAC, the rate of tick-borne encephalitis cases was 16.6 cases per 100 000 population in 2017, based on the latest data provided by the European Center for Disease Prevention and Control (ECDC) in its latest annual epidemiological report.  "In Lithuania the rate of encephalitis remains the highest in Europe," said ULAC.

Lithuania was followed by the Czech Republic and Estonia with the rate of 6.4 cases per 100 000 population, according to ULAC.  ULAC notes the largest proportion of tick-borne encephalitis cases is at the age group of 45-64 years and the lowest among the children of the age of 0-4 years.  "ULAC medics remind vaccination is the most reliable protection from tick-borne encephalitis," said ULAC in the announcement, noting vaccines have a reliability rate of 98 percent.

ULAC's warning comes amid increasing number of tick-borne encephalitis cases this year [2019] in Lithuania, a Baltic country with a population of around 3 million.  More than 90 cases of tick-borne encephalitis were reported during the 1st half of the year [2019] in Lithuania, 1/3 more compared to the same period last year [2018], according to local data by ULAC.

According to the ECDC's report, the highest prevalence of tick-borne encephalitis historically is found in the Baltic countries. Tick-borne encephalitis usually reaches its seasonal peak during the warmest months -- July and August.

Tick-borne encephalitis is a human viral infectious disease of central nervous system caused by infected ticks, usually found in woodland habitats. The disease manifests itself with symptoms similar to fever, fatigue, headache, nausea, and can cause meningitis.
=====================
[Cases of tick-borne encephalitis (TBE) have been reported before (see ProMED mail archive Tick-borne encephalitis - EU (Czech Rep., Latvia, Lithuania) http://promedmail.org/post/20040624.1677). Given the high rate of TBE cases in Lithuania reported above, there doubtless have been cases occurring there annually in recent years.

A report in Eurosurveillance Weekly in 2004 stated, "Tick-borne encephalitis (TBE) is endemic in virtually all countries in Central and Eastern Europe. It is caused by several closely related but distinct flaviviruses. 3 subtypes are recognised at present: a Far-Eastern subtype, a Siberian subtype and a European subtype. The Siberian subtype is associated with Russian spring-summer encephalitis and is transmitted predominantly by the tick _Ixodes persulcatus_, whereas the European subtype causes central European encephalitis and is transmitted by _Ixodes ricinus_.

The clinical spectrum of acute TBE ranges from symptoms of mild meningitis to severe meningoencephalitis with or without myelitis. The incubation period of central European TBE is 7-14 days. Onset is generally biphasic. The 1st phase involves a non-specific influenza-like illness with fever, headache, nausea, and vomiting, lasting about a week. After a period of remission lasting a few days, the fever returns with aseptic meningitis or encephalomyelitis. The case fatality rate is 1-5 percent and about 20 percent of survivors have neurological sequelae. Residual motor defects are rare." - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Lithuania:
Date: Wed, 3 Jul 2019 15:49:43 +0200

Vilnius, July 3, 2019 (AFP) - Lithuania declared an emergency on Wednesday as a severe drought hit the Baltic EU state, threatening to slash this year's harvest by up to half.   Apart from jeopardising crops, scant rainfall has also drastically reduced water levels in some rivers, threatening fish stocks and shipping activities.

The formal declaration of an "emergency situation" will allow the government to compensate farmers for some losses as well as help them to avoid EU financial sanctions should they fail to reach production goals.   "Farmers believe their harvest can be slashed by 40 percent or 50 percent, while fish stocks are also endangered," environment minister Kestutis Mazeika told AFP.

Mazeika said "nobody has any doubt" that global climate change is behind the prolonged and more intensive dry spells and heatwaves in recent years.   He also appealed to neighbouring Belarus to increase the water level in the Neris river by allowing more water to flow from its reservoirs.   Last month was the hottest June ever recorded with soaring temperatures worldwide capped off by a record-breaking heatwave across Western Europe, satellite data showed Tuesday.   Lithuania also registered its hottest-ever June, with a peak of 35.7 degrees Celsius (96.2 degrees Fahrenheit) recorded on June 12.

Over the last week, firefighters have fought wildfires triggered by the heat in peat bogs in western Lithuania and neighbouring Latvia.   Elsewhere in Central Europe, Polish authorities said this week that varying degrees of drought have put grain crops at risk in 14 of the EU country's 16 regional districts.   The Czech Academy of Sciences said it expects drought to affect the entire country, with 80 percent of the territory facing "exceptional to extreme drought".
Date: Thu, 13 Jun 2019 15:12:32 +0200

Vilnius, June 13, 2019 (AFP) - Lithuanian temperatures have hit record June highs, meteorologists said Thursday, as a heatwave forced school closures and threatened to reduce harvests in the draught-hit Baltic region.   Kaisiadorys in central Lithuania was the hottest place at 35.7 degrees Celsius (96.2 degrees Fahrenheit) on Wednesday, the highest-ever temperature recorded for June in the country, weather forecaster Paulius Starkus told AFP.   Six people drowned in the Baltic EU state on Wednesday, the deadliest day of the year to date, while some schools put classes on hold or cut lessons short due to the heatwave.

Scientists say the extreme weather is in part a result of climate change.   "Lithuania used to have heatwaves but now they occur more often and are more intense due to climate change," Vilnius University climatologist Donatas Valiukas told AFP.   Starkus said a downpour with thunder and hail could follow in some areas on Thursday afternoon.   Agriculture Minister Giedrius Surplys told lawmakers that some areas were experiencing "a real climatic draught" threatening harvests, while hydrologists warned that river water levels posed a threat to fish.   Demand for air-conditioning has also soared in recent weeks.   Lithuania's hot weather is expected to last through the week, then temperatures may ease below 30 degrees Celsius starting Monday.   Fellow Baltic state Latvia is also experiencing unusual heat for June, with temperatures over 32 degrees Celsius.

In recent days, Latvia's western region of Kurzeme saw thunderstorms with hail damaging buildings, smashing greenhouses and tearing power lines.   Two people have been hospitalised in the northern Latvian town of Cesis after a tree fell on their camper van while they were inside.    Fellow Baltic state Estonia had a heatwave last week and is now experiencing rainy and windy weather.   Poland has also been experiencing high temperatures this month, which has resulted in increased air-conditioner use. The power transmission system operator PSE said that on Wednesday there was record electricity demand for a summer morning at nearly 24.10 gigawatts (GW).   Forty-two people have already drowned in Poland this month, according to the government security centre RCB.
Date: Sat 30 Mar 2019
Source: PM News Nigeria [abridged, edited]

Measles in Lithuania is up to 310 cases this year [2019] compared to 30 cases for 2018 in total. The number of measles cases is projected to increase further in Lithuania, as people have lost their collective immunity to this highly contagious viral disease, Director of Lithuania's Centre for Communicable Diseases and AIDS (ULAC), Saulius Caplinskas, said on Fri [29 Mar 2019].  "The collective immunity has been lost, as a 95 per cent measles vaccination coverage rate is considered as minimum to prevent an outbreak. There are new suspected cases of measles; blood samples are being examined. I have no doubt that in the nearest future, there will be new cases,'' Caplinskas was quoted as saying by local news website lrt.lt.

Recent data from ULAC shows that the proportion of children vaccinated against measles in the country has decreased from 97 per cent in 2009 to 92.2 per cent in 2018 due to parents' reluctance to vaccinate their kids.  According to ULAC, every year, some 5000 children are not vaccinated in Lithuania. "Measles outbreaks feature certain upswings and descents, yet we will have to live under the threat of measles for a while,'' Caplinskas said.

In total, 310 cases of measles have been registered as of Fri [29 Mar 2019] in Lithuania this year [2019], compared to 30 cases for the whole of 2018, ULAC data showed.  The largest number of cases, 149, was registered in Kaunas, Lithuania's 2nd largest city. In Vilnius, the capital, 39 measles cases have been registered to date. Measles is a highly contagious, serious disease caused by a virus, says the World Health Organization.
Date: Thu, 11 Oct 2018 13:38:41 +0200

Vilnius, Oct 11, 2018 (AFP) - Lithuania's parliament on Thursday passed a law that will allow doctors to prescribe marijuana-based medicine in the Baltic EU state.   The lawmakers voted 90-0 with three abstentions in favour of the legislation that will now go to President Dalia Grybauskaite to be signed into law.   "It is a historic decision to ensure that patients can receive the best possible treatment," said lawmaker Mykolas Majauskas who tabled the bill.

Other European countries have legalised cannabis for medical purposes including Austria, Britain, Croatia, Finland, France, Germany, Greece and Italy among them.   "Of course, it does not mean cannabis will be available to get at a drugstore to smoke before going to a nightclub," Majauskas said.   The law will come into force in May next year. Selling the drugs will require a licence from the state regulator.    Recreational use of marijuana remains illegal in Lithuania, a Baltic state of 2.8 million people.
More ...

Cocos Islands

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

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

Travel News Headlines WORLD NEWS

More ...

World Travel News Headlines

Date: Fri, 6 Dec 2019 10:30:54 +0100 (MET)

Moscow, Dec 6, 2019 (AFP) - More than 50 polar bears have gathered on the edge of a village in Russia's far north, environmentalists and residents said, as weak Arctic ice leaves them unable to roam.   The Russian branch of the World Wildlife Fund said climate change was to blame, as unusually warm temperatures prevented coastal ice from forming.   The WWF said 56 polar bears had gathered in a one-square-kilometre (0.4-square-mile) area near the village of Ryrkaipy in Chukotka on the north-eastern tip of Russia.

There were concerns they could enter the village, home to fewer than 1,000 people, and patrols had been set up to monitor their movements.   "The number of human and predator encounters in the Arctic is increasing," the WWF said in statement.    "The main reason is the decline of sea ice area due to the changing climate. In the absence of ice cover, animals are forced to go ashore in search of food."

Residents had gathered walrus carcasses in the area to try to keep the bears from wandering into the village.   "We have created a feeding point with walrus carcasses that we gathered along the coast," Tatyana Minenko of the local "Bear Patrol" told news agency RIA Novosti.   "As long as there is no big freeze, the sea ice will not form and the bears will stay on the coast," she said.

Russia's weather service said temperatures in the region should fall from Saturday and that coastal ice should freeze by December 11.    Polar bears regularly visit areas inhabited by humans in Arctic Russia to search for food, often in rubbish tips.   But the number of visits has been growing as the melting of Arctic ice from climate change forces the bears to spend more time on land where they compete for food.
Date: Fri, 6 Dec 2019 10:28:26 +0100 (MET)
By Joseph Schmid

Paris, Dec 6, 2019 (AFP) - Travellers across France endured a second day of chaos on Friday as unions vowed to keep up their strike until President Emmanuel Macron backs down on controversial pension overhauls.   Rail operator SNCF said 90 percent of high-speed TGV trains were again cancelled, and several airlines dropped flights including Air France, EasyJet and Ryanair.

Nine of the capital's 16 metro lines were shut and most others severely disrupted, sparking some 350 kilometres (220 miles) of traffic jams in the Paris region, well above the usual 200 km, the traffic website Sytadin reported.   Many employees were unable to get to work and several schools again provided only daycare, though fewer teachers were on strike compared with Thursday when some 800,000 people demonstrated across the country according to the interior ministry.   Bike paths were crowded with bikes and electric scooters, with metro operator RATP sponsoring special deals for commuters with a range of ride-hailing companies and other transportation alternatives.

The walkout is the latest test for Macron after months of protests from teachers, hospital workers, police and firefighters as well as the "yellow vest" movement demanding improved living standards.   Unions say his "universal" pension system, which would eliminate dozens of separate plans for public workers, forces millions of people in both public and private sectors to work well beyond the legal retirement age of 62.   Health Minister Agnes Buzyn said Friday that the government had "heard" the protesters' anger and would meet with union leaders to discuss the reform on Monday.   The government has yet to lay out the details of its plan, and Buzyn told Europe 1 radio that "there is indeed a discussion going on about who will be affected, what age it kicks in, which generations will be concerned -- all that is still on the table".

- Macron 'determined' -
Yves Veyrier, head of the hardline FO union, warned Thursday the strike could last at least until Monday if the government did not take the right action.   But it remains to be seen if the protests will match the magnitude of the 1995 strikes against pension overhauls, when France was paralysed for three weeks from November to December in an action that forced the government to back down.

Macron, a former investment banker, has largely succeeded in pushing through a series of controversial reforms, including loosening labour laws and tightening access to unemployment benefits.   But this is the first time the various disgruntled groups have come together in protest.   So far Macron has not spoken publicly on the stoppages though a presidential official, who asked not to be named, said Thursday that the president was "calm" and "determined to carry out this reform" in a mood of "listening and consultation".

While most of Thursday's rallies were peaceful, police fired tear gas to disperse dozens of black-clad protesters smashing windows and throwing stones during the Paris march, with one construction trailer set on fire. Sporadic clashes were also reported in some other cities.   Many people were bracing for further disruptions over the weekend, including the prospect of fuel shortages as unions blocked most of the country's eight oil refineries.

The minimum pension age in France is 62, one of the lowest among developed countries, but there are 42 "special regimes" for railway workers, lawyers, opera employees and others offering earlier retirements and other benefits.   The government says a single system will be fairer for everyone while ensuring its financial viability while acknowledging that people will gradually have to work longer.
Date: Fri, 6 Dec 2019 04:23:51 +0100 (MET)

Sydney, Dec 6, 2019 (AFP) - Three hundred animals have been evacuated from a wildlife park north of Sydney as massive bushfires encircled Australia's largest city and foreign firefighters arrived to relieve beleaguered local forces.   Walkabout Wildlife Park said it had shipped out lizards, dingoes, peacocks and marsupials, as firefighters battled more than 100 fires up and down the eastern seaboard.   "This fire has been doing some crazy things, so we have to be prepared," general manager Tassin Barnard told AFP.

Prolonged drought has left much of eastern Australia tinder dry and spot fires have raged every day for the past three months, leaving firefighters struggling to cope.   New South Wales rural fire chief Shane Fitzsimmons said Friday that some US and Canadian firefighters had arrived to help out, easing the strain on the exhausted largely volunteer Australian force.

The incident-management and aviation specialists will help ease "fatigue and crew rotations" he said.   "We are not only appreciative of their presence here today, but of their sacrifice," said Fitzsimmons -- who has become a fixture on Australian television screens for weeks, updating the public on blazes in towns, national parks and backwaters.    "They are volunteering to sacrifice time from loved ones, from families, to give up that special time of the year around Christmas and New Year to come down here and lend us a hand," he said.

More than 600 homes have been destroyed and six people have died since the crisis began in September. That is many fewer than Australia's deadliest recent fire season in 2009 when almost 200 people died, but 2019's toll belies the scale of devastation.    Millions of hectares have burned -- the size of some small countries -- across a region spanning hundreds of kilometres (miles).   Bushfires are common in Australia but scientists say this year's season has come earlier and with more intensity due to a prolonged drought and climatic conditions fuelled by global warming.

The fires have taken a toll in Sydney and other major cities, which have been blanketed in toxic smoke for weeks and occasionally sprinkled with snow-like embers.   Fitzsimmons said he could not "overstate the effect that this profound drought is having" as he warned of a long, painful summer ahead.   "There is an absolute lack of moisture in the soil, a lack of moisture in the vegetation... you are seeing fires started very easily and they are spreading extremely quickly, and they are burning ridiculously intensely."
Date: Fri, 6 Dec 2019 03:03:18 +0100 (MET)
By Pierre-Henry DESHAYES

Half Moon Island, Antarctica, Dec 6, 2019 (AFP) - The swimsuit-clad tourists leap into the icy water, gasping at the shock, and startling a gaggle of penguins.   They are spectators at the end of the world, luxury visitors experiencing a vulnerable ecosystem close-up.   And their very presence might accelerate its demise.   Antarctica, a vast territory belonging to no one nation, is a continent of extremes: the coldest place on Earth, the windiest, the driest, the most desolate and the most inhospitable.   Now, it's also a choice destination for tourists.

All around Half Moon Island, off the Antarctic Peninsula, blocks of ice of all sizes float by on a calm sea, their varying forms resembling weightless origami shapes.    On this strip of land, that juts out of the Antarctic Polar and towards South America, visitors can see wildlife normally only viewed in zoos or nature documentaries along with spectacular icy landscapes.   The ethereal shades of white that play across the pillowy peaks change with the light, acquiring pastel hues at dawn and dusk.   "Purity, grandeur, a scale that's out of this world," says Helene Brunet, an awestruck 63-year-old French pensioner, enjoying the scene.    "It's unbelievable, totally unbelievable. It's amazing just to be here, like a small speck of dust."

AFP joined the 430 passengers on board the Roald Amundsen, the world's first hybrid electric cruise ship, on its maiden voyage in the Southern Ocean.    "It's not your typical beach, but it's awesome to do it," says a numb Even Carlsen, 58, from Norway, emerging from his polar plunge in the three-degree C (37.4 F) water.   When tourists go ashore, bundled up in neon-coloured windbreakers and slathered in SPF50 sunscreen, they have to follow strict rules: clean your personal effects so you don't introduce invasive species, keep a respectful distance from wildlife to avoid distressing them, don't stray from the marked paths and don't pick up anything.   "We mucked up the rest of the world. We don't want to muck up Antarctica too," says an English tourist, as she vacuums cat hair off her clothes before going ashore.

- 'Heart of the Earth' -
The Antarctic peninsula is one of the regions on Earth that is warming the fastest, by almost three degrees Celsius in the past 50 years, according to the World Meteorological Organization -- three times faster than the global average.    In March 2015, an Argentinian research station registered a balmy 17.5 degrees Celsius, a record.    "Every year you can observe and record the melting of glaciers, the disappearance of sea ice... (and) in areas without ice, the recolonisation of plants and other organisms that were not present in Antarctica before," said Marcelo Leppe, director of the Chilean Antarctic Institute.

Antarctica is "like the heart of the Earth," he added, saying that it expands and contracts like a heart beating, while the mighty current which revolves around the continent is like a circulatory system as it absorbs warm currents from other oceans and redistributes cold water.   The Antarctic Treaty, signed 60 years ago by 12 countries -- it now has 54 signatories -- declared the area a continent dedicated to peace and science, but tourism has gradually increased, with a sharp rise in the past few years.   Tourism is the only commercial activity allowed, apart from fishing -- the subject of international disputes over marine sanctuaries -- and is concentrated mainly around the peninsula, which has a milder climate than the rest of the continent and is easier to access.

Cruise ships have roamed the region for around 50 years, but their numbers only started to increase from 1990, as Soviet ice-breakers found new purposes in the post-Cold War era.   Some 78,500 people are expected to visit the region between November and March, according to the International Association of Antarctica Tour Operators (IAATO).   That's a 40-percent increase from last year, due in part to short visits by a few new cruise ships carrying more than 500 passengers, too many to disembark under IAATO regulations.     "Some might say 'Well, 80,000 people, that doesn't even fill a national stadium'... (and that it) is nothing like Galapagos which welcomes 275,000 a year," says IAATO spokeswoman Amanda Lynnes.    "But Antarctica is a special place and you need to manage it accordingly."

- 'Leave Antarctica to the penguins' -
It is Antarctica's very vulnerability that is attracting more and more visitors.   "We want to see this fantastic nature in Antarctica before it's gone," Guido Hofken, a 52-year-old IT sales director travelling with his wife Martina, says.    They said they had paid a supplement to climate compensate for their flight from Germany.

But some question whether tourists should be going to the region at all.   "The continent probably would be better off being left to penguins and researchers, but the reality is, that is probably never going to happen," said Michael Hall, professor and expert on polar regions at the University of Canterbury in New Zealand.   "Vicarious appreciation never seems to be enough for humans. So with that being the case, it needs to be made as low risk to the Antarctic environment and as low carbon as possible," said Hall.    "However, when the average tourist trip to Antarctica is over five tonnes of CO2 emissions per passenger (including flights), that is a serious ask."

Soot or black carbon in the exhaust gases of the scientific and cruise ships going to the region is also of concern, said Soenke Diesener, transport policy officer at German conservation NGO Nabu.   "These particles will deposit on snow and ice surfaces and accelerate the melting of the ice because the ice gets darker and will absorb the heat from the sun and will melt much faster," he told AFP.   "So the people who go there to observe or preserve the landscape are bringing danger to the area, and leave it less pristine than it was," he added.

- Responsible tourism -
Antarctic tour operators insist they are promoting responsible tourism.   The trend is for more intimate, so-called expedition cruises, in contrast to popular giant cruise liners elsewhere which are criticised for being invasive and polluting.   With greener ships -- heavy fuel, the most commonly used for marine vessels, has been banned in Antarctica since 2011 -- cruise companies have sought to make environmental awareness a selling point, occasionally earning them accusations of greenwashing.

Global warming, pollution and microplastics are the result of human activities on other, faraway continents, say tour operators.   Here, their motto is "Take nothing but photographs, leave nothing but footprints, keep nothing but memories".   But before they've even set foot on the cruise ships departing from South America -- the most common itinerary -- visitors to Antarctica will already have flown across the world, causing emissions that harm the very nature they have come so far to admire.

Most visitors hail from the Northern Hemisphere, and almost half are from the United States and China, IAATO says.   "I'm a tourist who feels a little guilty about taking a flight to come here," admits Francoise Lapeyre, a 58-year-old globetrotter om France.   "But then again, there are priorities. There are some trips I just won't take, because they leave a big footprint and they're not worth it.   "Crisscrossing the planet to go to a beach for example," she says.

- Don't mention climate change -
Like other expedition cruises where accessible science is part of their trademark, the Roald Amundsen, owned by the Hurtigruten company, has no dance floor or casino.  Instead, there are microscopes, science events and lectures about whales and explorers like Charles Darwin.   But they steer clear of climate change, which is only mentioned indirectly.   That's a deliberate decision as the subject has proven "quite controversial", said Verena Meraldi, Hurtigruten's science coordinator.   "We held several lectures dedicated specifically to climate change but it leads to conflicts. There are people who accept it as a fact, others who don't," she said.   Onboard, "passengers" are referred to as "guests" and "explorers" rather than "cruisers".   "Explorers" are typically older, well-heeled, often highly travelled pensioners who are handed walking sticks as they step ashore.   "My 107th country," says a Dane, stepping ashore onto Antarctica.

The Roald Amundsen "guests" choose between three restaurants, from street food to fine dining -- a far cry from the conditions endured by the Norwegian adventurer for whom the ship is named, who had to eat his sled dogs to survive his quest to reach the South Pole in 1911.   They have paid at least 7,000 euros ($7,700) each for an 18-day cruise in a standard cabin, and up to 25,000 euros ($27,500) for a suite with a balcony and private jacuzzi.   Other cruises are banking on ultra-luxury, with James Bond-like ships equipped with helicopters and submarines, suites of more than 200 square metres (2,153 square feet) and butler services.   With a seaplane to boot, the mega-yacht SeaDream Innovation will offer 88-day cruises "from Pole to Pole" starting in 2021. The two most expensive suites, with a price tag of 135,000 euros per person, are already booked.
 
- Worlds collide -
Outside, in the deafening silence, wildlife abounds.   All around are penguins, as awkward on land as they are agile in water. Massive and majestic whales slip through the waves, and sea lions and seals laze in the sun.   On Half Moon Island, chinstrap penguins -- so called because of a black stripe on their chin -- strut about in this spring breeding season, raising their beaks and screeching from their rocky nests.   "This is to tell other males 'This is my space' and also, maybe, 'This is my female'," ornithologist Rebecca Hodgkiss, a member of the Hurtigruten's scientific team, explains, as a group of tourists stroll around ashore.   The colony of 2,500 penguins has been gradually declining over the years, but it's not known if that is man's fault or they have just moved away, according to Karin Strand, Hurtigruten's vice president for expeditions.   Invisible to the naked eye, traces of humankind are however to be found in the pristine landscape.   Not a single piece of rubbish is in sight but microplastics are everywhere, swept in on ocean currents.   "We've detected them in the eggs of penguins for example," Leppe told AFP.

- Venice under water -
The Antarctic, which holds the world's largest reserve of freshwater, is a ticking time bomb, warn experts and studies.   They say that the future of millions of people and species in coastal areas around the world depends on what is happening here.   As a result of global warming, the melting ice sheet -- especially in the western part of the continent -- will increasingly contribute to rising sea levels, radically re-drawing the map of the world, says climate scientist Anders Levermann, of the Potsdam Institute for Climate Impact Research.   This meltwater will contribute 50 centimetres (almost 20 inches) to the global sea level rise by 2100, and much more after that, he said.   "For every degree of warming, we get 2.5 metres of sea level rise. Not in this century, but in the long run," he said.

Even if the international community meets its obligations under the Paris Agreement to limit global warming to under two degrees Celsius, sea levels will still rise by at least five metres.   "Which means that Venice is under water, Hamburg is under water, New York, Shanghai, Calcutta," he said.   It's impossible to predict when, but the scenario appears unavoidable, says Levermann.   In the same way that a cruise ship powering ahead at full speed can't immediately stop, sea levels will continue to rise even if all greenhouse gas emissions were to cease immediately, a study has said.

- Changing the world? -
The tourism industry says it hopes to make "ambassadors" out of Antarctica visitors.   "It's good for the animal life and for the protection of Antarctica that people see how beautiful this area is, because you cherish what you know and understand," said Hurtigruten chief executive Daniel Skjeldam.   Texan tourist Mark Halvorson, 72, says he is convinced.   "Having seen it, I am that much more committed to having a very high priority in my politics, in my own inner core convictions to being as environmentally friendly in my life as I can," he said.   So, do Guido and Martina Hofken see themselves as future "ambassadors of Antarctica"?    "Just a little bit, probably. But I don't think I will change the world," Guido Hofken concedes.    "The best thing would be for nobody to travel to Antarctica."
Date: Thu, 5 Dec 2019 16:37:37 +0100 (MET)

Paris, Dec 5, 2019 (AFP) - French rail operator SNCF said Thursday that it had cancelled 90 percent of all high-speed TGV trains and 70 percent of regional trains for Friday due to a strike over the government's pension reforms.   SNCF said that services would "still be very disrupted" on the second day of the biggest transport strike in the country in years, with the Eurostar service to Britain and the Thalys service to northern Europe set to be "very heavily disrupted".   In Paris, where only two of 16 metro lines were operating normally Thursday, public transport workers voted to remain on strike until Monday.

France's civil aviation authority meanwhile told airlines to cut 20 percent of their flights in and out of airports in Paris, Beauvais, Lyon, Marseille, Toulouse and Bordeaux on Friday, the same proportion as on Thursday.   Striking transport workers, air traffic controllers, teachers, fire fighters, lawyers and other groups all fear they will have to work longer or receive reduced pensions under the government's proposal to scrap 42 special pension schemes and replace them with a single plan.   Anticipating the worst travel chaos in years, many employees opted to work from home on Thursday. Those who did venture out travelled mainly by car, bicycle, electric scooter or on foot.
Date: Thu, 5 Dec 2019 12:19:45 +0100 (MET)
By Sofia CHRISTENSEN

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

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

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

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

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

But Silke still expected jobs to be cut as SAA attempted to reduce costs.   "Various divisions that make of SAA could be privatised," he said. "There will be a review of SAA aircraft and routes covered by SAA."   Unions had already demanded a three-year guarantee of job security following an announcement last month that almost 1,000 SAA employees could lose their jobs as part of another restructuring plan.   SAA pledged to defer that process to the end of January as part of the deal that ended the strike.
Date: Wed 4 Dec 2019
Source: Stock Daily Dish [edited]

Bihar Health Minister Mangal Pandey on [Sat 30 Nov 2019] said the state government is doing its best to save children, as the death toll due to acute encephalitis syndrome [AES] in Muzaffarpur mounted to 73.

Pandey said doctors and nurses are being called in from Patna for additional help. "We are trying everything and anything that can save children's lives. Everything is being made available from medicines to doctors. We have even called doctors and nurses from AIIMS in Patna," he said. "There is a protocol regarding what kind of medicines and facilities should be given and we are doing the same. We are monitoring things regularly and trying to save our children."

Recalling the situation that prevailed 5 years ago, Pandey said a team that was formed to ascertain the cause of this disease concluded that sleeping empty stomach at night, dehydration due to humidity and eating lychee on empty stomach were some of the causes of encephalitis.

"Our government has tried to spread awareness which will be beneficial as well. Advertisement in newspapers, radio jingles, pamphlets and mic [microphone] announcements are going to spread awareness regarding the disease. Health ministry is also working on it," he said.

On being asked about spread of ASE in Gorakhpur last year [2018], he said, "From Gorakhpur to Muzaffarpur region, this disease had spread last year and the Union government had worked on this and we will continue to fight it now."

"This incident in Muzaffarpur is very saddening and we also feel bad when children of our nation die like this. Not the whole district is affected but a large part is suffering from it," he added.

From [1 Jan 2019], until now [5 Dec 2019], 220 children were admitted in Sri Krishna Medical College and Hospital in Muzaffarpur due to AES, out of which 62 lost their lives.

As per the data of SKMCH hospital, 235 children were admitted, of which 89 died; in 2013 - 90 children were admitted, of which 35 died; in 2014 - 334 children were admitted, of which 117 died; in 2015 - 37 children were admitted, of which 15 died; in 2016 - 31 children were admitted, of which 6 died; in 2017 - 44 children were admitted, of which 18 died; and in 2018 - 43 children were admitted, of which 12 died.

Meanwhile, Minister of State for Union ministry for home affairs, Nityanand Rai, visited Sri Krishna Medical College and Hospital to review the situation after the outbreak of AES.

Encephalitis is a viral disease, which causes mild flu-like symptoms such as high fever, convulsions and headaches and has been claiming lives in the district for the past few weeks.
======================
[The dates within which these AES cases have occurred is not stated. The urgency that has prompted Behar health officials to request the aid of physicians and nurses from adjoining Patna suggests that the AES outbreak is going on currently. The uncertainty about the etiology of AES continues. It is curious that the above report makes no mention of negative or positive tests for Japanese encephalitis among the AES patients, although that virus is endemic in northeastern India, including Bihar state. Neighboring Uttar Pradesh state has had JE cases as well this summer (2019) but has intensified its JE vaccination program.

The issue of the aetiology of AES has been under discussion for a long time. Lychee fruit contain toxins. Encephalopathy and hypoglycaemia have been associated with consumption of lychee fruit contains phytotoxins, specifically alpha-(methylenecyclopropyl)glycine (see ProMED-mail archive no. http://promedmail.org/post/20150201.3132842). However, the current cases cannot be due to lychee consumption, since the season for that fruit has passed.

AES has continued to be attributed to a variety of aetiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in AES, but existing surveillance for AES does not include routine testing for dengue. Until the etiology (or etiologies) of these AES cases is determined, effective and efficient prevention of these cases will not be possible.

Reference:
Ravi V, Hameed SKS, Desai A, et al. Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): results from a 4-year AES surveillance study of Japanese encephalitis in selected states of India. Int J Infect Dis 2019;84 Suppl:19-24. <https://doi.org/10.1016/j.ijid.2019.01.008>.

Available at:

[Maps of India:
HealthMap/ProMED maps available
at:<http://healthmap.org/promed/p/364>, and Bihar, India:
Date: Thu 5 Dec 2019 6:11 PM EET
Source: Enab Baladi [edited]

[Leishmaniasis] is spreading widely among residents of Deir ez-Zor, and especially children. Some of the areas affected are controlled by the Kurdish self-administration while others are under the control of the Syrian regime. Medical sources counted hundreds of infected civilians and confirmed the disease's rapid spread.

According to Atef al-Tawil, a manager of the Leishmania & Environmental Health Programme at the Syrian regime's Ministry of Health, most infections in eastern Deir ez-Zor are spread among school children.

In a Facebook comment on a post by Twasol agency, al-Tawil claimed that cases of leishmaniasis were detected, at the end of November [2019], in primary schools in eastern Deir ez-Zor and its surrounding villages (al-Jalaa, al-Salihiyah, al-Tawtha, al-Abbas, al-Mujawdeh, al-Hasarat, al-Saial, al-Ghabrah).

According to al-Tawil, 455 infections of children were detected. A treatment team of 10 members was formed in the affected locations, to help control the disease to aid in early detection.

The Syrian Ministry of Health acted after several appeals by civilians residing in the area as they noticed the disease spreading among their children. Al-Tawil said that this rapid spread was due to the fact that all the infected people have lately returned to their original areas which lack medical centers.

Autonomous administration areas
-------------------------------
According to Euphrates Post network, leishmaniasis is also widely spread in areas controlled by the Syrian Democratic Forces (SDF). In its post on [Sun 1 Dec 2019], the network claimed that the spread of leishmaniasis is mostly concentrated in the eastern countryside of Deir ez-Zor.

According to the network, unofficial statistics by the SDF-affiliated local council shows more than 7000 leishmaniasis infections among children in al-Baghouz, Hajin, Diban, al-Sha'afa, al-Kishkiye, Abu Hamam, and Gharanij. The local councils' attempts of controlling the disease are still substandard, according to the Euphrates Post.

The network also quoted doctors and nurses calling for international organizations to interfere and provide hospitals and clinics with the required vaccine [there is no vaccine for leishmaniasis; ed.], and to train specialized medical staff in each clinic to deal with the disease.

The autonomous-administration-affiliated media center in Deir ez-Zor also confirmed the spread of leishmaniasis and pointed out that the authorities took actions, by the end of November [2019], to provide treatments.

According to the media center, special medical teams and cadres were distributed among the clinics to provide 12,000 ampoules of the required [medicine] to treat leishmaniasis with the support of the World Health Organization.

Leishmaniasis is a parasitic disease transmitted by the bite of infected female phlebotomine sandflies -- a very small yellow fly that is active at night and makes no sound when it bites -- and the main cause for its spread is dirt and lack of hygiene.  [Byline: Enab Baladi]
========================
[Deir ez-Zor is east and south of the locations in the previous ProMED reports (see below), indicating further increase in cases of cutaneous leishmaniasis beyond its historical concentration in western Syria (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861536/>) and beyond the area of the MENTOR initiative in northern Syria (<https://wwwnc.cdc.gov/eid/article/24/11/17-2146_article>).

Cutaneous leishmaniasis is endemic in Syria with its reservoir in rodents. It has been a problem throughout the Syrian civil war and in ISIS controlled areas during the war due to a breakdown in rodent and vector control. - ProMED Mod.EP]

[Maps of Syria:
Date: Tue 3 Dec 2019
Source: Twitter feed in Arabic [machine trans., edited]

Taiz health official: 24 laboratory-confirmed cases of West Nile virus and more than 300 suspected cases. #Republic_Yemen
===================
[Any information on the actual number of WNV cases, their lab confirmation, and public health response activities in this regard will be highly appreciated. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map of Yemen:
Date: Tue 3 Dec 2019
Source: Cordoba Epidemiology Report and Los Tiempos news article [in Spanish, trans., edited]
<http://www.reporteepidemiologico.com/wp-content/uploads/2019/12/REC-2264.pdf>

Los Tiempos, Bolivia, 2 Dec 2019 Confirmation of the 1st case of the year (2019) of human rabies in Cochabamba After confirming the death of rabies of a 7-year-old girl in the southern area of Cochabamba, the Departmental Health Service (SEDES) and the Zoonosis Unit of the Mayor's Office intensified prevention actions to prevent the proliferation of the virus. This would be the 1st case confirmed so far this year [2019].

The head of the Epidemiology Unit of SEDES, Arturo Fernando Quiaones Lapez, reported that in the last rabies vaccination campaign for dogs more 1000 doses were given. "We suspected rabies in the case of this minor. She tested positive by laboratory both in cerebrospinal fluid as well as in brain tissue," according to lab results obtained on 2 Dec 2019. The victim died on 26 Nov 2019 after being hospitalized in intensive care of the Children's Hospital for 2 days with signs of rabies," said Dr Manuel Ascencio Villarroel.

The patient's relatives reported the girl had contact with a puppy which died a month ago. The dog did not receive rabies vaccines and belonged to someone the family knows. Quiñones mentioned the family members of the girl and the owners of the animal are receiving preventive treatment. Meanwhile, the head of Zoonosis of the Mayor's Office, Javier Humberto Rodraguez Herrera, stated on 2 Dec 2019 a "massive focus blockade" will be held with the participation of 8 health centers to prevent the circulation of the virus in the area.

He commented that, to date, 11 cases of canine rabies have been recorded in the municipality. In more than 11 months of 2019, SEDES identified 25 positive cases of canine rabies, the majority in the metropolitan region. Quiaones asked the population to report the death of their pets with signs of rabies at health centers for follow-up to fight the disease. Meanwhile, from the City Hall, the owners of dogs were urged to have their dogs vaccinated. Javier Rodra­guez added another risk factor is when animals are collected from the street and they are not vaccinated.
===================
[The rabies virus attacks the nervous system in animals.  When a rabid animal bites a human being, it can transfer the virus, contained in saliva, to that individual. "After inoculation, rabies virus may enter the peripheral nervous system directly and migrates to the brain or may replicate in muscle tissue, remaining sequestered at or near the entry site during incubation, prior to central nervous system invasion and replication. It then spreads centrifugally to numerous other organs. The case-fatality ratio approaches unity [100%], but exact pathogenic mechanisms are not fully understood. "Susceptibility to lethal infection is related to the animal species, viral variant, inoculum concentration, location and severity of exposure, and host immune status.

Both virus-neutralizing antibodies and cell-mediated immunity are important in host defense. "Early diagnosis is difficult. Rabies should be suspected in human cases of unexplained viral encephalitis with a history of animal bite. Unvaccinated persons are often negative for virus-neutralizing antibodies until late in the course of disease. Virus isolation from saliva, positive immunofluorescent skin biopsies or virus neutralizing antibody (from cerebrospinal fluid, or serum of a non-vaccinated patient), establish a diagnosis. "Five general stages of rabies are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death (or, very rarely, recovery).

No specific anti-rabies agents are useful once clinical signs or symptoms develop. The incubation period in rabies, usually 30 to 90 days but ranging from as few as 5 days to longer than 2 years after initial exposure, is more variable than in any other acute infection. Incubation periods may be somewhat shorter in children and in individuals bitten close to the central nervous system (such as the head).

Clinical symptoms are first noted during the prodromal period, which usually lasts from 2 to 10 days. These symptoms are often nonspecific (general malaise, fever, and fatigue) or suggest involvement of the respiratory system (sore throat, cough, and dyspnoea), gastrointestinal system (anorexia, dysphagia, nausea, vomiting, abdominal pain, and diarrhoea), or central nervous systems (headache, vertigo, anxiety, apprehension, irritability, and nervousness).

More remarkable abnormalities (agitation, photophobia, priapism, increased libido, insomnia, nightmares, and depression) may also occur, suggesting encephalitis, psychiatric disturbances, or brain conditions. Pain or paraesthesia at the site of virus inoculation, combined with a history of recent animal bite, should suggest a consideration of rabies. "The acute neurologic period begins with objective signs of central nervous system dysfunction.

The disease may be classified as furious rabies if hyperactivity (that is, hydrophobia) predominates and as dumb rabies if paralysis dominates the clinical picture. Fever, paraesthesia, nuchal rigidity, muscle fasciculations, focal and generalized convulsions, hyperventilation, and hypersalivation may occur in both forms of the disease. "At the end of the acute neurologic phase, periods of rapid, irregular breathing may begin; paralysis and coma soon follow. Respiratory arrest may occur thereafter, unless the patient is receiving ventilatory assistance, which may prolong survival for days, weeks, or longer, with death due to other complications.

"Although life support measures can prolong the clinical course of rabies, rarely will they affect the outcome of disease. The possibility of recovery, however, must be recognized, and when resources permit, every effort should be made to support the patient. At least 7 cases of human "recovery" have been documented." (<https://www.ncbi.nlm.nih.gov/books/NBK8618/>)

A very sad situation which could have been prevented if the animal had been vaccinated. Responsible owners vaccinate their animals. Condolences to the family. - ProMED Mod.TG]

[HealthMap/ProMED-mail map of Bolivia: <http://healthmap.org/promed/p/55162>]