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United Arab Emirates

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our Customs Information.

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

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

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

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our information on Criminal Penalties.

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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: Thu, 23 Jan 2020 14:43:33 +0100 (MET)

Barcelona, Jan 23, 2020 (AFP) - The death toll from a violent storm which has wrought havoc on huge swathes of Spain's eastern and southern coastline rose to nine on Thursday as rescuers pressed the hunt for at least five missing people.    The latest death was that of a man whose body was found in a flooded river near Jorba, some 70 kilometres (45 miles) northwest of Barcelona, the emergency services said.    Rescuers in Catalonia had been searching for a missing person in the same area but said it was too early to confirm if it was him.

Catalan rescuers had late on Wednesday found another body of a man who died after falling into the water in Palamos, a port town about 100 kilometres up the coast from Barcelona.    They are also searching for a man who went missing from a merchant ship in the same area, as well as a person in Cadaques near the French border.   Earlier on Thursday, regional officials confirmed the death of a 75-year-old woman whose house collapsed because of heavy rain in Alcoi, a town in the eastern Alicante region.

Storm Gloria hit the region on Sunday, bringing strong winds, torrential rains and heavy snow, battering Spain's southern and eastern flanks before moving north.   Gale-force winds and huge waves smashed into seafront towns, with dramatic images showing massive flooding that has damaged shops, houses and restaurants.   National weather agency Aemet had on Wednesday said the storm was starting to abate although it kept Catalonia and the Balearic Islands on alert.   As the storm eased, Prime Minister Pedro Sanchez was on Thursday visiting some of the worst-hit areas, overflying parts of Catalonia before heading to the Balearic Islands which on Tuesday were hit by record waves, the port authority said.

Rescuers on the islands are still searching for three people, including a 25-year-old Briton who went missing on a beach in northern Ibiza, and a 27-year-old Spaniard who disappeared in Mallorca while practising canyoning -- a mix of rappelling, climbing and watersliding through deep gorges.   Rescuers had found three other bodies on Wednesday, including that of a 67-year-old man who went missing in his car near the southeastern resort town of Benidom.    They also found two bodies in the southern Andalusia region, one of a 77-year-old man who died when a greenhouse collapsed on him in a hailstorm in Nijar as well as that of a homeless man who died of hypothermia.
Date: Fri, 17 Jan 2020 17:48:09 +0100 (MET)

Barcelona, Jan 17, 2020 (AFP) - Spain's Balearic Islands passed a bill Friday aimed at clamping down on alcohol-fuelled holidays in the Mediterranean archipelago which bans happy hours when drinks are offered a discount and open bars.   "This is the first law adopted in Europe which restricts the sale and promotion of alcohol in certain touristic areas," the regional government of the Balearic Islands which have long been a magnet for young German and British tourists, who often drink heavily and enjoy rowdy late-night clubbing.

The restrictions will apply to three areas with a reputation for excess: San Antoni on the island of Ibiza and El Arenal and Magaluf -- which has been nicknamed "Shagaluf" because of its reputation for drunken casual sex -- on Mallorca, the largest of the Balearic's four islands.   The law, which was drawn up in consultation with the tourism industry also bans pub crawls and two-for-one drink offers, prohibits the sale of alcohol in shops between 9:30 pm and 8 am and forbids advertising party boats in the designated areas.   Establishments that break the new rules risk fines of up to 600,000 euros ($669,000) and the threat of being closed down for three years.

The new law also takes aim at the so-called "balconing" craze, the term given to holidaymakers who decide to jump into a swimming pool from a hotel or apartment balcony, a stunt which claims several lives every year.   It bans "balconing" across the entire archipelago and requires hotels to evict anyone who does it. Those caught jumping from balconies face fines of up to 60,000 euros ($67,000).   Up until now only some resorts on the Balearics imposed fines for "balconing".

The regional government of the Balearics said the law, which stiffens measures already introduced in 2015, will "fight excesses in certain tourist zones" and "force a real change in the tourism model of those destinations".   Magaluf made global headlines in 2014 after a video showing a young woman performing oral sex on several men on the dance floor of a nightclub went viral.   Local shops sell souvenir T-shirts with the catchphrase "On it 'till we vomit".

The four islands which make up the Balearics -- Palma de Mallorca, Ibiza, Menorca and Formentera, received nearly fourteen million tourists in 2018, drawn by their crystal clear waters, and in many cases by all-inconclusive package holidays.   The archipelago is Spain's second most visited region. Spain is the world's second most visited country after France.
Date: Wed, 15 Jan 2020 20:53:05 +0100 (MET)

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

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

The airport serves the eastern region of Valencia, which is home to several popular resorts such as Benidorm. It handled just under 14 million passengers last year, making it Spain's fifth busiest airport.   Aena recommended in a tweet that passengers contact their airline before heading to Alicante airport to see what the status of their flight was.   "We are coordinating with airlines. Consult your company to know if your flight is cancelled or will operate from an alternative airport," it said.
Date: Tue 17 Dec 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/ciguatera-outbreak-reported-in-the-canary-islands-56254/>

Health officials with the Government of the Canary Islands have reported a possible outbreak of ciguatera after finding 6 cases of food poisoning [that occurred] after consuming black medregal (amberjack) in La Victoria de Acentejo, according to an El Dia report (computer translated). Ciguatera is not unknown in the Canary Island[s], [which report] several cases annually [including] some 20 outbreaks in the past decade.

More than 400 species of fish, including barracuda, black grouper, blackfin snapper, cubera snapper, dog snapper, greater amberjack, hogfish, horse-eye jack, king mackerel, and yellowfin grouper, have been implicated in this food-borne illness that is relatively common in several areas of the world.

The toxin causing the illness is produced by marine algae and passed up through the food chain. These marine algae hang on to dead coral and seaweed. They are then eaten by herbivore fish that are subsequently eaten by predatory reef fish, which concentrates the toxin in its tissue.

People get this food-borne toxin from eating these contaminated larger fish. The reef fish are more likely to get contaminated during storms and other turbulence. After eating the affected fish (the fish does not get sick from the toxin and actually tastes good), [cases will find] in as little as a couple of hours symptoms may appear.

Gastrointestinal symptoms like diarrhOea, nausea and vomiting tend to appear early. Then a feeling of weakness and hypertension may occur, in addition to complaints of intense itching. Some mild to severe neurological symptoms are common with ciguatera; dizziness, impaired coordination, blurred vision and even coma may be seen in severe cases.

An unusual characteristic that is common in ciguatera is temperature reversal. This may be seen from 2 to 5 days after eating the fish. Hot objects seem cold and cold objects can give a shock-like sensation. There have been serious injuries because a person was unable to recognize extremely hot sensations.

Other odd symptoms are food may taste metallic and teeth may seem painful or loose. The gastrointestinal symptoms usually resolve in a couple days; however, neurological symptoms may last for months or years. Symptoms may come back after ingesting certain foods and drinks: alcohol, caffeine, nuts and fish.

There are no laboratory tests to diagnose this disease, and [diagnosis] is based on clinical symptoms and a history of eating an offending fish. Some studies have shown that IV mannitol is effective in providing relief and recovery if taken within the first 72 hours of intoxication. Other than that, most treatment is for the various symptoms the person may have.

So how can you prevent getting this potentially serious toxin?
Prevention can be difficult since the toxin in the fish cannot be killed by cooking and there is no offensive odour or appearance to the fish. So the only way to truly try to prevent this intoxication is to avoid eating large reef fish or getting your fish through a reputable supplier.
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[A recent open access review of ciguatera fish poisoning (CFP) has been published in Marine Drugs (Friedman MA , Fernandez M, Backer LC, et al: An updated review of ciguatera fish poisoning: clinical, epidemiological, environmental, and public health management. Mar Drugs 2017;15:pii:E72. <http://www.mdpi.com/1660-3397/15/3/72/htm>). The description of the acute illness with the citations intact (the citations can be found at the URL above) has been extracted below: "CFP is characterized by gastrointestinal, neurological, and cardiovascular symptoms. In addition, after the initial or acute illness, neuropsychological symptoms may be reported. Clinical features can vary depending on elapsed time since eating the toxic meal, and whether the geographic source of the implicated fish was the Caribbean Sea, Pacific, or Indian Ocean [17,36,52-58]. Gastrointestinal symptoms and signs usually begin within 6-12 hours of fish consumption and resolve spontaneously within 1-4 days. Gastrointestinal symptoms may include nausea, vomiting, abdominal pain, and diarrhea. The neurologic symptoms usually present within the first 2 days of illness. They often become prominent after the gastrointestinal symptoms (particularly in CFP events from Caribbean fish), although they may present concurrently with gastrointestinal symptoms (K Schrank, written communication, April 2016) [59]. The neurologic symptoms vary among patients and include paresthesias (that is, numbness or tingling) in the hands and feet or oral region, metallic taste, sensation of loose teeth, generalized pruritus (itching), myalgia (muscle pain), arthralgia (joint pain), headache, and dizziness. A distinctive neurologic symptom is cold allodynia, sometimes referred to as 'hot-cold reversal,' an alteration of temperature perception in which touching cold surfaces produces a burning sensation or a dysesthesia (that is, unpleasant, abnormal sensation) [60]. One study revealed that intra-cutaneous injection of CTX in humans elicited this sensation [61]. Cold allodynia is considered pathognomonic of CFP, although not all patients report experiencing it and it can be seen with other human seafood poisoning syndromes (such as neurotoxic shellfish poisoning). Less commonly, severe central nervous system symptoms, such as coma or hallucinations, have been reported [54,62,63]. Neuropsychological symptoms, which often become apparent in the days or weeks after the initial or acute illness, include subjectively reported cognitive complaints such as confusion, reduced memory, and difficulty concentrating [64-67], depression or irritability [64,65,68], and anxiety [65]. Fatigue or malaise have been reported and may be debilitating [6,62,69,70]. Cardiac symptoms and signs may manifest, generally in the early stage of the illness. When present, they usually occur in combination with gastrointestinal and/or neurologic signs and symptoms [71,72]. Cardiac signs often include hypotension and bradycardia which may necessitate emergency medical care." - ProMED Mod.LL]

[HealthMap/ProMED-mail map: Canary Islands, Spain:
<http://healthmap.org/promed/p/203>]
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:
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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.
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Togo

Togo US Consular Information Sheet
September 10, 2008
COUNTRY DESCRIPTION:
Togo is a small West African country with a stagnant economy in a state of political uncertainty.
French is the official language, but Ewe and Mina are commonl
spoken as well.
Tourism facilities are limited, especially outside the capital city, Lomé.
Read the Department of State Background Notes on Togo for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
Travelers are encouraged to obtain visas prior to arrival due to recent difficulties with requesting them at the airport in Lomé or at some of the land borders.
Visas issued in Togo are limited to 7 days and can take an hour or more to be issued.
Travelers applying for visa extensions can also experience significant delays.
Vaccination against yellow fever is required before entry.
U.S. citizens should carry copies of their U.S. passports and vaccination records with them at all times while traveling in Togo so that, if questioned by local officials, they have proof of identity, U.S. citizenship, and required vaccinations readily available.

Travelers may obtain the latest information and details from the Embassy of the Republic of Togo, 2208 Massachusetts Avenue NW, Washington, DC
20008; telephone (202) 234-4212.
Overseas, inquiries should be made at the nearest Togolese embassy or consulate.

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

SAFETY AND SECURITY:
U.S. citizens are urged to avoid political rallies, street demonstrations, and maintain security awareness at all times.
Togo has experienced periodic violence, strikes, and political tensions since 1990.
Following the death of President Eyadema in February 2005, political activists took to the streets and held demonstrations throughout the country that resulted in more than 500 deaths.
Land borders with Ghana and Benin are routinely shut down during elections. The October 2007 legislative elections were non-violent with only minor incidents reported during the single post-election demonstration. The next major elections are the presidential elections scheduled for 2010.

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

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

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

CRIME:
Over the past year, Togo has seen a marked increase in incidents of violent crime throughout the country, including several recent machete attacks in poorly lit areas of Lomé.
Rapid inflation and food shortages have contributed to increases in already critical crime levels in urban areas.
Particular areas for Americans to avoid within Lomé, especially during the hours of darkness, include the Grand Marché area, the beach road, and the Ghana-Togo border areas.
Travelers should avoid the beach even during daylight hours as purse-snatchings and muggings occur there regularly.
Pick pocketing and theft are common in Togo, especially along the beach and in the market areas of Lomé.
While incidents of residential burglary are less common against foreigners, carjacking is on the rise, and even western diplomats have been victims of carjacking. Theft while riding in taxis is also increasing, as thieves steal bags, wallets, and passports.
Taxicabs should not be shared with strangers.
Perpetrators of business fraud often target foreigners, including Americans.
Formerly associated with Nigeria, these fraud schemes are now prevalent throughout western Africa, including Togo, and pose a danger of both financial loss and physical harm.
An increasing number of Americans have been the targets of such scams, losing anywhere from several thousand to several hundred thousand dollars.
Typically, these scam operations begin with an unsolicited communication, usually by e-mail, from an unknown individual who describes a situation that promises quick financial gain, often by assisting in the transfer of a large sum of money or valuables out of the country.
The scenarios vary:
an American must pretend to be the next-of-kin to a recently deceased Togolese who left a fortune unclaimed in a Togolese bank, or a person claiming to be related to present or former political leaders needs assistance in transferring large sums of cash, or even a business deal that appears to be legitimate.
The requests are usually for the payment of advance fees, attorneys’ fees, or down payments on contracts.
The final payoff does not exist; the purpose of the scam is to get any money possible and to gain information about the American’s bank account.
The best way to avoid becoming a victim of advance-fee fraud is common sense – if it looks too good to be true, it probably is.
You should carefully check out any unsolicited business proposals originating in Togo before you commit any funds, provide any goods or services, or undertake any travel.
Please check the Embassy web site at http://togo.usembassy.gov/ for the most current information on fraud in Togo.
For additional information, please see the Department of State brochure on International Financial Scams.

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.

The local equivalent to the “911” emergency line in Togo is: 117 or 171 for police, 172 for Gendarmerie, 242 for the Pharmacy on Duty, and 118 for Fire Services.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Togo are limited and of very poor quality, with no adequate emergency medical care.
Availability of medications through local pharmacies is unreliable, and travelers should carry all necessary medications, properly labeled, with them.
Malaria, a serious and sometimes fatal disease, is prevalent in Togo.
For additional information on malaria, including protective measures, see the CDC travelers’ health web site at http://www.cdc.gov/malaria/.

For information on avian influenza (bird flu), please refer to the Department of State's Avian Influenza Fact Sheet.
According to the Togolese Ministry of Foreign Affairs and Ministry of Health, there are no HIV/AIDS entry restrictions for visitors to or foreign residents of Togo.

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 Togo is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

While some major thoroughfares in urban parts of Togo are paved, many secondary streets are not, and become severely flooded every time it rains.
Driving conditions are hazardous throughout Togo due to the presence of pedestrians, large numbers of small motorcycles, disorderly drivers (moped, car and truck drivers), livestock on the roadways, and the poor condition of the roads, including deep potholes.
Overland travel off the main network of roads generally requires a four-wheel-drive vehicle.
Many drivers in Togo do not obey traffic laws and most traffic signals do not function properly.
Drivers should be prepared for other vehicles to run red lights or stops signs and drive in the wrong direction on one-way streets.
Nighttime travel on unfamiliar roads is dangerous.
Poorly marked checkpoints, often manned by armed, undisciplined soldiers, exist throughout the country, including in the capital.
Banditry, including demands for bribes at checkpoints, has been reported on major inter-city highways, including the Lomé-Cotonou coastal highway.
Travelers are advised to be aware of their surroundings and to drive defensively.
At official checkpoints, Togolese security officials prefer that you approach with your dome light on, and have your driver’s license, registration, and proof of insurance ready.
Americans should be aware of the staged-accident ploy when driving in Lomé.
In this scam, a motorbike will cut in front of you, cause a collision, and draw a crowd, which can turn hostile if you attempt to leave the scene of the so-called accident.
Such encounters appear designed to extort money from the vehicle driver.
Pedestrians also cause staged accidents.
Genuine accidents can also draw hostile crowds.
Travelers should drive with their car doors locked and windows closed, and have a cell phone in the vehicle.
If you are involved in this kind of accident and can drive away, you should leave the scene, drive to a safe location, and alert both the police and the U.S. Embassy.
Violent carjackings are periodically reported in Togo and tend to increase during the summer months and holiday season. Travelers are advised to exercise caution when using any form of local public transportation.
Never get into a taxi with unknown passengers and always agree on the fare before getting in.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s tourist office at http://www.togo-tourisme.com/.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Togo, the U.S. Federal Aviation Administration (FAA) has not assessed Togo’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Power outages, voltage fluctuations, and water shortages are common throughout the country.
Only certain U.S. credit cards are accepted in Togo.
Most major hotels and their restaurants accept American Express, MasterCard, and Visa, while smaller hotels and restaurants do not.
Travelers planning to use credit cards should know which cards are accepted before they commit to any transaction.
Travelers should keep all credit card receipts, as unauthorized card use and overcharging are common.
There are some Automatic Teller Machines that dispense local currency in major banks and they are generally considered safe.
Well-known money transfer firms, including Western Union, operate in Togo.
Photographing places affiliated with the government of Togo, including official government buildings, border crossings, checkpoints, police stations, military bases, utility buildings, airports, government vehicles, and government or military personnel, is strictly prohibited, and local authorities will confiscate film and cameras.
Government buildings are not always clearly identifiable, as they vary from being very well marked to being not marked at all.
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 Togo’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Togo are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.

Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Togo 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 Togo.
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 on Boulevard Eyadema, Neighborhood Lomé II, Lomé; telephone (228) 261-5470, fax (228) 261-5499. The local mailing address is B.P. 852, Lomé.
The web site is http://togo.usembassy.gov/
* * *
This replaces the Country Specific Information for Togo dated March 3, 2008, to update the sections on Crime, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed, 15 Jan 2020 03:48:17 +0100 (MET)
By Emile Kouton with Celia Lebur in Lagos

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

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

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

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

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

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

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

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

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

Medsaf works to ensure the quality control of thousands of products at over 130 hospitals and pharmacies in Nigeria. It looks forward to expanding deeper into Nigeria as well as Ivory Coast and Senegal.   The company uses technology, database management and analytics to monitor the movement of medications and verifies their official registration number, the expiry dates and storage conditions.   "Technology we use can help to solve most of the issues related to fake drugs," Nwakah said. "People die for nothing. We can change that."
Date: Mon 7 Jan 2019
Source: Outbreak News Today [edited]

The Togo government confirmed last week [week of 1 Jan 2019] a Lassa fever case reported in Doufelgou district [Kara region] in the north of the country, according to a Agence de Presse Africaine report (computer translated).

This was a haemorrhagic fever case according to officials.

Lassa fever is a rare but potentially life-threatening viral haemorrhagic disease. The risk of infection is low but can occur if someone comes into contact with an infected person's blood or bodily fluids. Lassa fever cannot be spread through casual contact, including skin to skin contact, without exchange of bodily fluids. Those at highest-risk would be health care workers treating patients in facilities known to have Lassa fever and family members caring for infected patients.

Early diagnosis and supportive care are essential. One should consult a medical professional if he or she has been in direct contact with an infected person within the past 3 weeks and have symptoms of Lassa fever, which include: fever, chest, stomach or back pain, cough, vomiting, diarrhoea, or mucosal bleeding.
=========================
[Lassa fever virus is endemic in much of northwest Africa, including Benin, Togo, and Burkina Faso. There have been cases of Lassa fever in Togo as recently as 2017. In the 2017 report, health authorities in Togo implemented the following measures to respond to these Lassa fever cases, including:
- deployment of rapid response teams to the affected areas for epidemiological investigation;
- identification of contacts and follow-up;
- strengthening of infection prevention and control measures in health facilities and briefing of health workers;
- strengthening of cross border collaboration and information exchanges between Togo, Burkina, Mali, and Benin.

It seems odd that the case report above does not mention contact with rodent reservoirs of the virus or their excrement as a source of infection. Lassa fever virus is transmitted to humans from contact with food or household items contaminated with excreta of multimammate rats (_Mastomys_ spp), the reservoir host. Public education is an important measure to prevent infections in the home.

Images of the rodent reservoirs of Lassa fever virus can be seen as follows:
_Mastomys natalensis_:
_M. erythroleucus_ and _Hylomyscus pamfi_:

[Maps of Togo:
Date: Mon, 24 Sep 2018 21:11:35 +0200

Lome, Sept 24, 2018 (AFP) - A former lawmaker in Togo was on Monday on hunger strike to call for the release of opposition supporters who were arrested during anti-government demonstrations.   Nicodeme Ayao Habia, head of the Democrats party, began his protest six days ago in front of Ghana's embassy in the Togolese capital, Lome.   "I am on hunger strike to demand the release of all people who were arrested during protests by the opposition coalition who are still languishing in prison," he told AFP.   "I won't move from here as long as these people are in prison," he said, holding a small sign with photos of three of those detained.   "This morning, police tried to move me along but I refused as I am within my rights. They even tried to rough me up."

Habia held a two-day hunger strike previously this month in front of the US Embassy in Lome.   Some 44 people who were arrested during opposition protests against President Faure Gnassingbe and his government remain in prison, according to the coalition.   The oppositions wants the re-introduction of a two-term limit for presidents, applied retroactively, which would prevent Gnassingbe from standing for re-election in 2020.   The government has agreed to the two-term limit but not the retroactive element, which would allow the president to  stand at polls in 2020 and 2025.   He has already been in power since the death of his father, Gnassingbe Eyadema, in 2005. The army general seized power of the West African state in 1967.

As well as the release of opposition detainees, Habia said he also wanted the government to stick to the roadmap set out by leaders of the West African bloc ECOWAS.   "The regime must absolutely respect the recommendations contained in the ECOWAS roadmap," he added.   On Sunday, the government and opposition finally agreed common ground in the composition of the country's independent national electoral commission (CENI).   Lack of agreement about the make-up of the body had delayed an announcement of the date of local and parliamentary elections.    Local polls and a referendum on the proposed constitutional reforms will now take place on December 16, with parliamentary elections four days later.
Date: Wed, 31 Jan 2018 16:22:49 +0100

Lome, Jan 31, 2018 (AFP) - Togo's government was facing fresh turbulence on Wednesday as healthcare workers went on strike, joining thousands of demonstrators holding opposition protests on the streets.   The two-day nationwide strike was called by the National Union of Hospital Practitioners of Togo (SYNPHOT) who are demanding better equipment and more nursing staff.   "The strike is well-followed throughout the country. We will take stock tomorrow evening to know what to do in the coming days," SYNPHOT secretary-general Atchi Walla told AFP.

At Sylvanus Olympio university hospital, the country's largest health care centre, several departments were closed, according to an AFP journalist.   "We are here only for very urgent cases. The other patients will be rescheduled," said a worker at the entrance to the emergency surgery department.   There was a similar situation in the operating room and at reception, where only one person was working.   "This situation is tiring. I came to get treatment but nobody can help because they are on strike," said Albert Kudju, a retired civil servant.    "The authorities should meet the demands of the workers."

Primary and public school teachers are also on strike, demanding an increase in their wages, while students are protesting against a sharp rise in tuition fees.   The walk-outs come against a backdrop of widespread discontent with the government and opposition calls for the resignation of President Faure Gnassingbe.   Gnassingbe has been in power since 2005 and took over from his father, General Gnassingbe Eyadema, who himself ruled Togo for 38 years.   A coalition of 14 opposition parties has been organising almost weekly marches for the past five months.
Date: Wed, 20 Sep 2017 17:23:54 +0200

Lome, Sept 20, 2017 (AFP) - Thousands thronged the streets of Togo's seaside capital Wednesday after the ruling party asked supporters to march at the same time as planned opposition protests demanding the removal of President Faure Gnassingbe, the scion of Africa's oldest political dynasty.   The rival demonstrations in Lome came a day after the opposition boycotted a vote on constitutional reform which would have included a presidential term limit, arguing that it was a ploy to let Gnassingbe remain in power till 2030.

The opposition wanted the limit to apply retroactively so that Gnassingbe, who has been in power since 2005, could not run again in 2020. His father Gnassingbe Eyadema ruled from 1967 till his death in 2005.   The opposition marches began at around 11:00 am (1100 GMT) at three meeting points.   They came after giant rallies on September 6 and 7 seeking the president's ouster that drew more than 100,000 people on the streets -- a record in a country which has been widely criticised for stifling democracy.    The protesters held up posters declaring "Faure must go" and "Free my country, 50 years is enough".

Police and soldiers armed with heavy machine guns flanked the streets in pick-up trucks. Mobile  phone networks and 3G services appeared to have been severed.   "We are not jihadists, we are not rebels," said Abdallah, 42, a supporter of the Panafrican National Party (PNP). "We just want democracy, we are tired."   Communications Minister Guy Lorenzo condemned what he called a "coup d'etat" on the streets.   The government meanwhile asked the opposition to show "responsibility and restraint" and warned that "people of foreign nationalities were looking to participate in acts of violence"  during the marches.

- 'Explosive situation' -
More protests are planned on Thursday against what veteran opposition leader Jean-Pierre Fabre called "the monstrous machine that has been crushing Togo's people for more than 50 years".   He said there would be "no let-up" as long as Gnassingbe remains in power.   Comi Toulabor, head of research at the Institute of Political Studies in Bordeaux, called the counter-rallies by the ruling Union for the Republic (UNIR) party "a strategy to disrupt the opposition protest".   "It's very amateurish but it shows the party isn't ready to give way," he told AFP, calling the situation "explosive".

About one thousand UNIR supporters quietly gathered on the beach in Lome on Wednesday, some sitting in the shade of palm trees.   "It is a pleasure to be here," UNIR supporter Georgia, 34, told AFP. "We are peaceful."   One young protester said he received 5,000 CFA francs (7.50 euros, $9) to participate in the pro-government rally.   "You think we're here for politics?" asked Justin, 17, as his friends nodded approval.   The failure to pass the constitutional reform bill in parliament forced a referendum, which a member of the government said will be held in the coming months.   Gnassingbe has now won three elections, the results of which have been contested by the opposition.   Half of Togo's population lives below the poverty line, according to the United Nations, despite a GDP growth rate of five percent over the last three years.
More ...

Thailand



*****
Travel in Health in Thailand
*****
General Introduction:
Irish travellers are going to Thailand in great numbers. The relatively cheap cost and also the contrast in culture has captured many hearts. Some are travelli
g for a once off 2 week trip and for others the exploration of Thailand will take longer. It is truly a beautiful country and the people have a charm all of their own but nevertheless your journey can be so very easily ruined by taking health risks.
Water-Borne Disease:
In most of the major cities of Thailand the water supply is well chlorinated and so the risks associated with drinking mains tap water are limited. However many of the bedrooms will not be supplied with mains water so take care. Smell the water and if there is a distinct chlorine odour then it should be safe. Also remember that when you travel around the country, especially around the northern regions, the water supply may be grossly contaminated and so never drink the water or use it for brushing your teeth. Also no ice in your drinks under these circumstances.
Food-Borne Disease:
There is a good selection of food in Thailand and you should have no great difficulty in finding food to suit your taste. In the majority of the restaurants the food is well cooked and maintained in a healthy sterile fashion. These are the places to eat. As you walk around the cities you will see many street traders selling food stuffs from their carts. The level of hygiene is very low and frequently the food will be contaminated. Never indulge yourself by eating from street vendors.
Mosquito-Borne Disease:
Under this title most travellers will only consider the possibility of developing malaria. This is of course one of the most important illnesses transmitted via mosquitoes but by no means the only one in Thailand. For most travellers to Thailand there will be no need to take malarial prophylaxis as the cities are deemed to be free of malaria. This does not mean that you will not be bitten by mosquitoes and develop some of the other diseases such as Dengue Fever or perhaps Japanese Encephalitis. Many travellers also develop a very severe reaction to the mosquito bite and so for all these reasons it is prudent to avoid being bitten whenever possible.
Entertainment-Borne Disease:
It would be wrong not to emphasize the very high risk which travellers face if they are unwise enough to indulge in any form of sexual activity in Thailand. The percentage of street girls with the Aids virus is rising each year and is now thought to be over 80%. This figure may be an underestimate. Be especially careful if you have taken any alcohol. The cities of Bangkok and Pattaya are thought to be among the main centres of HIV transmission throughout the world and within the next few years the extent of the Aids problem in S.E. Asia will have exceeded Africa. There is limited availability of condoms.
Road-Borne Disease:
The traffic situation in Thailand is severe. The motorbikes have no insurance as they are too often involved in accidents. Use only regular taxi cabs and fix your price before you leave.
Vaccination Schedule:
There are no compulsory vaccines for entry into Thailand from Ireland. Nevertheless the usual recommended vaccines include Polio, Typhoid, Tetanus and Hepatitis A cover. For those trekking or staying for longer periods then cover against Hepatitis B and Rabies would be worth discussing.
Most travellers should start their vaccines about 4 to 5 weeks before they leave Ireland.
Note:
For the vast majority of Irish travellers a holiday in Thailand will be a time of great pleasure and, later, fond memories of the people, their customs and the countryside. Just remember that illness can occur so follow some good common sense rules and so you can enjoy yourself
and Travel in Health.

Thailand

Travel News Headlines WORLD NEWS

Date: Mon, 13 Jan 2020 16:12:29 +0100 (MET)
By Nina LARSON

Geneva, Jan 13, 2020 (AFP) - A new virus from the same family as the deadly SARS disease has spread beyond China's borders for the first time with a case emerging in Thailand, UN and Thai officials said on Monday.   Thai doctors diagnosed a Chinese traveller with mild pneumonia on January 8 later confirmed to have been caused by the so-called novel coronavirus -- which has already given rise to 41 pneumonia-like cases and one death in China.   The outbreak has caused alarm because of the link with SARS (Sudden Acute Respiratory Syndrome), which killed 349 people in mainland China and another 299 in Hong Kong in 2002-2003.

The UN health agency (WHO) confirmed that the outbreak in the city of Wuhan was caused by a previously unknown type of corona virus, a broad family ranging from the common cold to more serious illnesses like SARS.   "Laboratory testing subsequently confirmed that the novel coronavirus was the cause," WHO spokesman Tarik Jasarevic told AFP in an email, referring to the case in Thailand.   WHO said it might soon host an emergency meeting on the spread of the new virus.   Thai Health Minister Anutin Charnvirakul stressed to reporters in Bangkok Monday that a 61-year-old Chinese woman who had travelled from Wuhan "was infected with the virus from outside Thailand".   Thai health officials said on Monday she was recovering.   Authorities in Wuhan said a seafood market in the city was the centre of the outbreak. It was closed on January 1.   There is so far no indication of human-to-human transmission of the virus.

- 'Not unexpected' -
Scientists in Hong Kong's Department of Health said on Saturday that genetic sequencing of the virus from a Wuhan patient, published online by a Chinese expert, indicated it was 80 percent similar to SARS found in bats.   WHO said on Monday it was not surprising that the virus had spread beyond China.   "The possibility of cases being identified in other countries was not unexpected, and reinforces why WHO calls for ongoing active monitoring and preparedness in other countries," it said in a statement.   Thai authorities have been on high alert, with airport officials checking all passengers coming from Wuhan to the kingdom's major airports.   An official from the Public Health Emergency Operation Center told AFP the infected woman travelling from Wuhan had been intercepted on arrival in Thailand, after airport officials determined she had a fever.

WHO said it had issued guidance on how to detect and treat people with the new virus and stressed that China's decision to rapidly share the genetic sequencing of the virus made it possible to quickly diagnose patients.   WHO has not recommended any specific measures for travellers or restrictions on trade with China, but stressed on Monday it was taking the situation seriously.   "Given developments, WHO Director-General Dr Tedros Adhanom Ghebreyesus will consult with Emergency Committee members and could call for a meeting of the committee on short notice," it said in a statement.   During such meetings, experts determine whether the UN health agency should declare an international health emergency -- a designation used only for the gravest epidemics.
Date: Mon, 23 Dec 2019 04:22:26 +0100 (MET)
By Sophie DEVILLER and Jonathan KLEIN

Ban Ta Klang, Thailand, Dec 23, 2019 (AFP) - Separated from their mothers, jabbed with metal hooks, and sometimes deprived of food -- many Thai elephants are tamed by force before being sold to lucrative tourism sites increasingly advertised as 'sanctuaries' to cruelty-conscious travellers.   Balanced precariously on hind legs, two-year-old Ploy holds a ball in her trunk and flings it towards a hoop, e of many tricks she is learning in Ban Ta Klang, a traditional training village in the east.   Here young elephants are "broken" to interact with tens of millions of tourists who visit Thailand every year, many eager to capture social media-worthy encounters of the kingdom's national animal playing sports, dancing and even painting.

Villagers in Ban Ta Klang who have been working with the large, gentle animals for generations say taming is necessary for safety reasons and that the force is not excessive.       "We do not raise them to hurt them... if they are not stubborn, we do nothing to them," said mahout Charin, as he stroked Ploy's head affectionately and spoke of her as part of his family.   Charin makes about $350 a month in a profession that was handed down from his father and grandfather.    "I have always lived with them," he added.   But animal welfare advocates argue the taming technique -- where babies are removed from the care of fiercely devoted mothers at the age of two -- is cruel and outdated.   It is also little-known, one of many murky aspects of an evolving elephant tourism trade often kept from view of tour operators and travellers.

- Big business -
Elephants were phased out of the logging industry about 30 years ago, leaving their mahouts unemployed.   So they turned to Thailand's flourishing tourism industry, a burgeoning sector of amusement parks offering elephant rides and performances.    A tamed elephant can now fetch up to $80,000, a colossal investment that then requires gruelling hours of work and increasingly bizarre stunts to be recouped.    Mae Taeng park in the northern city of Chiang Mai receives up to 5,000 visitors per day and charges an entrance fee of about $50.   Many come to see Suda, who holds a brush in her trunk and paints Japanese-style landscapes for visitors who can later buy the prints for up to $150 before taking an elephant ride through the hills.    As tourists become more aware of the potential cruelty of such activities, a growing number of places have opted to use the term 'sanctuary' or 'refuge'.

Many do not permit rides or animal performances. Instead tourists are encouraged to feed, groom and care for elephants, gaining an unforgettable experience with one of nature's most majestic creatures.   But charities warn that even seemingly benign options, like bathing them, could still be problematic.    "Bathing with elephants...is often stressful for elephants and mahouts especially when dealing with groups of excited young people," Jan Schmidt-Burbach of World Animal Protection told AFP.   "The best option is to leave it to the elephant to decide if and how to bath and ask tourists to stand back to observe and enjoy this moment without interference."   But even this may not be enough.    Some animal rights experts warn it can be hard to discern the treatment of the animals after the crowds have gone home. Some reported cases of elephants at so-called sanctuaries being chained for long hours, forced to sleep on concrete, and malnourished.

- Ethical tourism? -
Of the 220 elephant parks identified across the country, even if many promise ethical tourism, "only a dozen ensure truly satisfactory living conditions", according to WAP.   It is working with ChangChill, a small organisation near Chiang Mai, bordered by a river in the middle of rice terraces.    In a few months, it changed its methods to give elephants more space, fewer interactions, and an environment resembling life in the wild.     "We don't force them to do what they wouldn't instinctively do," says director Supakorn Thanaseth.    As a result, they are "less sick, calmer". 

The risk of accidents with tourists has decreased as the animals are less stressed, though mahouts still have a hook in a bag for emergencies.    ChangChill hopes to become profitable in the current high season, but it will only be able to receive around 40 tourists a day to visit its six elephants as part of its aim to put the creatures first.    That is a drop in the bucket when Thailand has nearly 4,000 "domesticated" elephants.   Thai authorities are reluctant to reintroduce them into natural habitats, as advocated by some NGOs, because of a lack of space and potential conflict with humans.

The compromise, some argue, is to better regulate the sector and improve standards.   But there is little impetus to enact more stringent rules that would cut into the Thai tourism industry, which welcomed more than 38 million visitors this year.    A committee of several animal welfare associations submitted recommendations to the government last year advocating stricter controls for elephants in captivity.   But according to activist Sovaida Salwala from Friends of the Asian Elephants, an NGO who helped compile the report, their requests "remain unanswered so far".   In fact, there is some evidence the animals' situation is getting worse.    Schmidt-Burbach said their last research in 2015 found some 1,771 elephants whose welfare was in question.    He explained: "There are 357  more elephants in poor conditions compared to our 2010 study."
Date: Thu, 21 Nov 2019 09:12:36 +0100 (MET)

Bangkok, Nov 21, 2019 (AFP) - A shallow 6.1-magnitude earthquake hit north-western Laos near the Thai border early Thursday, the United States Geological Survey reported, alarming locals who felt buildings shake as far away as Bangkok.  The quake hit at 6:50am (2350 GMT Wednesday), roughly three hours after a 5.7-magnitude earthquake in the same region triggered an immediate suspension to Laos' largest-capacity power plant located near its epicentre.    Tremors could be felt more than 700 kilometres (435 miles) away in the Thai capital, where Pope Francis is currently on a four-day visit.    "The shaking... was the main shock from a quake in Laos at 6:50 am and was felt in northern and northeastern Thailand and Bangkok and suburbs," said Sophon Chaila, an official at the Thai Meteorological Department.

The department said the quake affected nine provinces in Thailand and there were four lesser aftershocks.    It also became a top trending topic on Twitter in Thailand, as locals shared videos of swaying overhead lights and rattling window blinds in office buildings.    Residents in the Vietnamese capital Hanoi also felt buildings sway.    "The ceiling lights were shaking quite strongly. I felt dizzy and scared," said Hanoi resident Tran Hoa Phuong, who felt the earthquake in her 27-storey apartment building.    After the first quake, the 1,878-megawatt Hongsa Power Plant -- Laos' largest-capacity thermal energy generator -- immediately suspended operations according to a statement from the Thai-owned company.

No "fundamental" damages or injuries have been found so far, "merely damages to the external texture of the buildings", it said, adding that Hongsa is expected to take 24 hours to complete its inspection.    Photos shared by Thai news showed portions of the power plant's walls had collapsed, and debris littered its premises.    Nearby Xayaburi dam project, one of Laos' largest hydropower dams, has seen "no impact" so far, and is continuing to generate electricity "as normal", said a statement from CK Power.   Information is slow to trickle out of the closed communist state, and there were similarly no official reports of injuries after the twin quakes hit early Thursday.

Impoverished Laos has ploughed ahead with ambitious dam-building projects that critics say lack transparency and stringent safety measures.   The cost was laid bare last year when a massive hydropower project collapsed in southern Laos, killing dozens and leaving thousands homeless.   Pope Francis arrived in Bangkok on Wednesday and has a busy agenda Thursday meeting officials and the Thai king before he leads a mass in the evening.    There was no word from his team on whether he felt the quake.    Powerful earthquakes occasionally strike hard in Southeast Asia.   In 2016 a 6.8-magnitude quake struck Myanmar, killing at least three people and damaging temples in the ancient temple town of Bagan.
Date: Fri, 15 Nov 2019 05:28:34 +0100 (MET)

Bangkok, Nov 15, 2019 (AFP) - A French tourist has died after falling from a waterfall while trying to take a selfie in Thailand, police said Friday.   The accident happened Thursday afternoon on the tropical island of Koh Samui, whose palm-fringed, white-sand beaches are a magnet for both backpackers and high-end tourists.   The 33-year-old man fell from Na Mueang 2 waterfall, the same spot where a Spanish tourist died in a fall in July, Lieutenant Phuvadol Viriyavarangkul of the island's tourist police told AFP.

"It took several hours to retrieve his body because the waterfall is slippery and steep," he said by phone, adding that the spot is roped off and there is a sign warning tourists of the danger.   "His friend said he was trying to take a selfie and then he slipped and fell."   Thailand is largely considered a safe destination for tourists and typically draws more than 35 million visitors each year.    But the industry took a hit in 2018 after a ferry carrying Chinese visitors in the country's south sank last year, killing 47 people.   The accident highlighted lax safety rules in the tourism sector and authorities have been scrambling to restore the country's image since.
Date: Sat, 26 Oct 2019 11:56:37 +0200 (METDST)

Bangkok, Oct 26, 2019 (AFP) - Hundreds of dead fish washed ashore on a luxury tourist resort on Thailand's south coast, officials said Saturday, blanketing a long stretch of pristine white sands in a rotting stench.   Some 300 metres (950 feet) of beach on Naka Yai island was littered with dead ponyfish, Phuket provincial fisheries chief Siripong Panasonthi told AFP, adding authorities were working to determine the cause of the deaths but had ruled out pollution in the water.   "We have checked the water quality... It cannot cause the fish to die en masse," Siripong said.   He said he believed the catch of ponyfish -- which, when caught alive are sold to make animal feed but are worthless when dead -- had been dumped by local fishing trawlers.
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World Travel News Headlines

Date: Mon, 27 Jan 2020 01:07:04 +0100 (MET)

Wuhan, China, Jan 27, 2020 (AFP) - China's central government said on Monday that the nationwide total of confirmed infections from a deadly respiratory virus had risen to 2,744, with 769 new cases coming to light.   However, it said no new deaths were confirmed outside of Hubei province, which had earlier reported 24 new fatalities to bring the national total to 80 dead.
Date: Sun, 26 Jan 2020 22:16:28 +0100 (MET)

Beijing, Jan 26, 2020 (AFP) - Chinese authorities have ordered the extension of a public holiday in an effort to contain an epidemic that has killed 56 people and infected nearly 2,000 worldwide, state-run media reported.   A working group chaired by Premier Li Keqiang to tackle the outbreak decided on Sunday "to reduce population flows" by extending the Spring Festival holiday which had been scheduled to end on January 30, state news agency Xinhua said.   It was not immediately clear how long the extension is.

The group also ordered changes to "the starting dates of schools" and "people to work from home by working online."   "The meeting stressed that the country is at a crucial time in the prevention and control of the novel coronavirus outbreak, urging Party committees and governments at all levels to take more 'decisive, powerful and orderly, scientific and well-planned' measures to effective curb the spread," Xinhua reported.   In a bid to slow the spread of the respiratory virus, the government had previously locked down hard-hit Hubei, a province in central China that is at the outbreak's epicentre, in an unprecedented operation affecting tens of millions of people.

The previously unknown virus has caused global concern because of its similarity to the Severe Acute Respiratory Syndrome (SARS) pathogen, which killed hundreds across mainland China and Hong Kong in 2002-2003.   Originating in Hubei's capital of Wuhan, the virus has spread throughout China and across the world -- with cases confirmed in around a dozen countries including as far away as the United States.   Several countries were making arrangements to evacuate their citizens from Wuhan, where an eery calm pervades as new restrictions prohibit most road traffic in the metropolis of 11 million.
Date: Sun, 26 Jan 2020 21:47:53 +0100 (MET)

Washington, Jan 26, 2020 (AFP) - US health authorities said Sunday there are now five confirmed cases of the coronavirus in the United States and more are expected.   Nancy Messonnier, head of the respiratory disease section at the Centers for Disease Control and Prevention, said around 100 people in 26 states are being investigated for the virus, which originated in the Chinese city of Wuhan.

Of the confirmed cases, all five people had travelled to Wuhan, Messonier said during a conference call with reporters.   "Every case we have had in the United States is someone who has had direct contact in Wuhan," she said.   Messonier said there are two cases in California and one each in Arizona, Illinois and Washington state. Until now the toll was three.   While Chinese officials have launched an extraordinary emergency response, Messonier insisted that the health risk for Americans in general remains low "at this time."
Date: Sun, 26 Jan 2020 13:44:57 +0100 (MET)

Lagos, Jan 26, 2020 (AFP) - Nigerian health authorities have announced stepped-up emergency measures to tackle a rise in Lassa fever cases after 29 people died this month.   "As at 24th of January 2020, 195 confirmed cases and 29 deaths had been reported in 11 states," the Nigeria Centre for Disease Control (NCDC) said in a statement Saturday.   A national emergency operations centre had been activated to coordinate the response "to the increasing number of Lassa fever cases" across the country.

Endemic to Nigeria, Lassa fever belongs to the same family as the Ebola and Marburg viruses, but is much less deadly.   The virus is spread by contact with rat faeces or urine. It starts with fever and can, in worst case scenarios, lead to severe bleeding and organ failure.   Nigeria declared an outbreak of Lassa fever a year ago and around 170 people died from the virus in 2019.

The number of cases usually climbs in January due to weather conditions during the dry season.    Almost 90 percent of the recent confirmed cases have been in Edo, Ondo and Ebonyi states in southern Nigeria, but their have also been deaths in the north.

The NCDC said that compared to the same period last year the fatality rate had dropped from 23.4 percent to 14.8 percent.    It encouraged Nigerians to "practise good hygiene and take measures to protect themselves and their families".   Nigeria, Africa's most populous nation with a population of some 200 million, has five laboratories with the capability to diagnose Lassa fever.
Date: Sun, 26 Jan 2020 12:18:19 +0100 (MET)

Beijing, Jan 26, 2020 (AFP) - Two Chinese provinces and three cities have ordered citizens to wear face masks in public, to help control the spread of a deadly virus.   The measure is required in the provinces of Guangdong in the south and Jiangxi in the centre, plus the eastern city of Nanjing, Ma'anshan city in Anhui province, and Xinyang city in Henan, according to local authorities.   China's industry and information technology ministry has said it would "spare no effort in increasing supply" after demand for masks skyrocketed.
Date: Sun, 26 Jan 2020 04:03:51 +0100 (MET)

Hong Kong, Jan 26, 2020 (AFP) - Hong Kong's Disneyland announced it was shutting its doors on Sunday until further notice over the deadly virus outbreak in central China, a day after city authorities classified the crisis as an emergency.   "As a precautionary measure in line with prevention efforts taking place across Hong Kong, we are temporarily closing Hong Kong Disneyland park out of consideration for the health and safety of our guests and cast members," the park said in a statement.
Date: 26 Jan 2020
Source: MENAFN [edited]

Two more polio cases have surfaced from Landikotal tehsil in Khyber tribal district, after which the number of reported cases in Khyber Pakhtunkhwa has reached 4 this year [2020].

According to the Emergency Operations Centre (EOC), a 2-year-old [male child] from Nekikhel and another child from Torwela have been diagnosed with polio. The samples of these 2 children were sent for laboratory tests in 2019, so these cases will be counted in the tally of 2019, which stands at 141 now.

The 2 cases in Landiktoal were reported 2 days after the emergence of 3 new polio cases in Qambar, Dadu and Sajawal districts of Sindh. Among them, 2 children contracted the crippling disease in 2019, but the cases were confirmed on Friday [24 Jan 2020].

On [21 Jan 2020], the 1st case of polio in Pakistan in 2020 surfaced in Lakki Marwat, the district with the highest number of cases in 2019.

The year 2019 was worse for Pakistan in polio eradication efforts, as 141 cases surfaced in Pakistan, including 96 cases in KP. Most cases in KP surfaced in Lakki Marwat, where 32 children were diagnosed with the crippling disease. In 2018, only 12 cases were reported, while in 2017, 8 cases were reported.

Currently, Pakistan and Afghanistan are the only 2 countries in the world which have not fully eradicated polio. The main cause behind the emergence of so many polio cases is refusal of parents to cooperate with the vaccination teams. According to media reports citing Health Ministry data, over a million parents refused to cooperate with vaccination teams in 2019. Most of the refusal cases were reported in April last year [2019] when rumours spread in Peshawar that many children had fainted after consuming vaccination drops. A total of 1 089 087 parents refused to give vaccination drops to their children in 2019.

The emergence of so many polio cases in Pakistan, particularly in KP, has brought the federal and provincial governments under pressure over their performance and strategy to control the spread of disease.

Experts believe that polio vaccination efforts cannot succeed completely until the refusing parents are convinced to cooperate with vaccination teams.
==================
[The End Polio Pakistan website has not added all of the media reported cases as yet, so it's a bit difficult to follow at times and know which cases were 2019 onset and which were 2020 onset. The above media report clearly states 2019 onset and puts the tally for 2019 as 141 cases, but the media reports from Friday's [24 Jan 2020] report is less clear (see Poliomyelitis update (10): global, Pakistan (BA, SD) http://promedmail.org/post/20200124.6911971).

A good map of Pakistan showing districts and provinces can be found at:
Date: Fri 24 Jan 2020
Source: SciTechDaily [abridged, edited]

Citation: Amman BR, Bird BH, Bakarr IA, et al. Isolation of Angola-like Marburg virus from Egyptian rousette bats from West Africa. Nat Commun. 2020; 11:510.  <https://doi.org/10.1038/s41467-020-14327-8>

Scientists have detected Marburg virus in fruit bats in Sierra Leone, marking the 1st time the deadly virus has been found in West Africa. A total of 11 Egyptian rousette fruit bats tested positive for active Marburg virus infection. Research teams caught the bats separately in 3 health districts.

The presence of Marburg virus, a close relative to Ebola virus that also causes hemorrhagic disease in people, was detected in advance of any reported cases of human illness in Sierra Leone. However, the virus's presence in bats means people who live nearby could be at risk for becoming infected. No outbreaks have been reported to date.

The findings, based on PCR, antibody, and virus isolation data, were officially published today [24 Jan 2020] in the journal Nature Communications. Preliminary findings were announced earlier in December 2018 to ensure rapid notification to the citizens of Sierra Leone and the international health community.

The paper highlights the value of collaborating with government and key stakeholders across human, animal, and environmental sectors to engage at-risk communities about the discovery, address health concerns, and communicate risk-reduction strategies before recognized spillovers occur.

Marburg virus was detected by projects led by the Centers for Disease Control and Prevention, the USAID-funded PREDICT project led by the One Health Institute at the UC Davis School of Veterinary Medicine; Njala University, Sierra Leone; and the University of Makeni, Sierra Leone.

"Finding Marburg virus in bats in Sierra Leone before any known cases in people is a huge success, as public health officials and doctors can now include Marburg virus among the possible causes when diagnosing hemorrhagic fever cases in the region," said Tracey Goldstein, co-principal investigator and pathogen detection lead for the PREDICT project from the UC Davis One Health Institute.

To date, there have been 12 known outbreaks of Marburg virus, with the most recent in Uganda in 2017. The largest and deadliest outbreak occurred in Angola in 2005 when 227 people died. Five of the new strains identified among the Marburg-positive bats in Sierra Leone were genetically similar to the strain that caused the outbreak in Angola. This is the 1st time scientists have detected these Angolan-like strains in bats.

The virus-positive bats were all Egyptian rousette bats, the known reservoir for Marburg virus, which primarily feed on fruit. Infected bats shed the virus in their saliva, urine, and feces. Egyptian rousette bats are known to test-bite fruits, urinate, and defecate where they eat, potentially contaminating fruit or other food sources consumed by other animals or people, particularly children. These bats sometimes serve as a food source for local populations as well. People may be exposed to Marburg virus through bat bites as they catch the bats.

Following the announcement of the preliminary findings by the government of Sierra Leone, the PREDICT team worked with government partners, universities, and other key stakeholders to develop and implement evidence-based public health messaging across national, district, and local community levels in Sierra Leone.  "Over a year ago, we worked with our Sierra Leone government colleagues to inform people across the country as fast as possible of this new health risk and remind people not to harm or come in contact with bats," said Brian Bird from the UC Davis One Health Institute and global lead for Sierra Leone and Multi-Country Ebola operations for PREDICT-USAID. "I'm very proud of that work and our teams now that this full report is available."
----------------------------------------------
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
and
Mary Marshall
===========================
[The initial report of this finding, prior to this publication, was posted by ProMED-mail (Marburg virus disease - Sierra Leone (02): bats, additional information http://promedmail.org/post/20181223.6221436) when the virus was detected for the 1st time in fruit bats in Sierra Leone.

According to the CDC (<https://www.cdc.gov/vhf/marburg/index.html>), Marburg virus was 1st recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany, and in Belgrade, Yugoslavia (now Serbia). A total of 31 people became ill, initially laboratory workers followed by several medical personnel and family members who had cared for them; 7 deaths were reported. The 1st people infected had been exposed to imported African green monkeys or their tissues while conducting research. One additional case was diagnosed retrospectively.

The reservoir host of Marburg virus is the African fruit bat, _Rousettus aegyptiacus_. Fruit bats infected with Marburg virus do not show obvious signs of illness. Primates (including humans) can become infected with Marburg virus, and may develop serious disease with high mortality.

Ebola virus is closely related to Marburg virus. "Ebola viral RNA fragments were found in an oral swab from a greater long-fingered bat (_Miniopterus inflatus_), captured in 2016 in Liberia's Sanniquellie-Mahn district, which borders Guinea. The bat, which lives in many parts of Africa, roosts in caves and feeds on insects. Scientists had previously found 2 other Ebola species in a related insect-eating bat, _M. schreibersii_. However, most other evidence has pointed to fruit bats as the carriers of Ebola Zaire, Epstein says [J Epstein, veterinary epidemiologist at EcoHealth Alliance in New York City and a member of the PREDICT consortium]. "What it really says to me is that this is a virus that has multiple hosts, and it might be regionally dependent as to which species carries it."

Supporting the variety of bat hosts for Ebola, the bat implicated in the initiation of the West African Ebola virus outbreak in December 2013 was _Mops condylurus_, long-tailed insect-eating bats, that were previously suspected in an outbreak of the Sudan strain of Ebola virus, which is related to the Zaire strain. - ProMED Mod.LK]

[HealthMap/ProMED-mail map:
Date: Sat, 25 Jan 2020 11:49:16 +0100 (MET)
By Su Xinqi, Jerome TAYLOR

Hong Kong, Jan 25, 2020 (AFP) - Hong Kong on Saturday declared a new coronavirus outbreak as an "emergency" -- the city's highest warning tier -- as authorities ramped up measures to reduce the risk of further infections.   The announcement came as city leader Carrie Lam faced criticism in some quarters over her administration's response to the crisis.

Of the five people who have tested positive for the virus in Hong Kong so far, four arrived via a newly built high-speed train terminal which connects with the mainland.   That led to calls from some medical experts and politicians to limit, or even halt, arrivals from China, the epicentre of the outbreak with 41 people dead.

Lam held emergency meetings with health officials on Saturday morning after returning from Davos.   "Today I declare the lifting of the response level to emergency," she told reporters.   Schools and universities, which are currently on a Lunar New Year break, would remain closed until 17 February, Lam said.   All mainland arrivals to Hong Kong will now need to sign health declaration forms, she added, while public events including a new year gala and next month's marathon, would also be called off.    "We haven't seen serious and widespread infections (in Hong Kong), but we are taking this seriously and we hope to be ahead of the epidemic," Lam said.

- Tragic past -
Hong Kong has a recent experience of deadly viral outbreaks.    Nearly 300 people were killed by SARS in 2003, a tragedy that left a profound psychological impact on one of the most densely populated places on earth.   The city's ability to combat the crisis was hampered by moves in mainland China to cover up and play down the outbreak, leaving a lasting legacy of distrust among many Hong Kongers.   Animosity towards the mainland has intensified in recent years as Beijing tightens political control over the semi-autonomous territory.

The outbreak also comes at a sensitive time for Lam, who currently boasts record low approval ratings after seven months of pro-democracy protests.   "We must stand united so that we can prevent and control the disease," she said, in a nod to the political unrest.   The often violent protests have battered Hong Kong's reputation for stability and helped tip it into recession, with the recent virus outbreak compounding the city's economic woes.

Hospitals are already struggling with the winter flu season, but officials are isolating anyone with a history of travel to central China and those exhibiting respiratory tract infections that look similar to the virus.   So far some 300 people have been tested and monitored for the virus. Quarantine centres have been set up in remote holiday parks for anyone found to have come into close contact with people who tested positive.   On Saturday, officials announced a newly built but still-empty public housing block would be used for medical staff on the frontline who did not want to risk returning to their families.
Date: Sat, 25 Jan 2020 06:46:59 +0100 (MET)
By Mahmut Bozarslan and Fulya Ozerkan in Istanbu

Elazig, Turkey, Jan 25, 2020 (AFP) - A powerful earthquake has killed at least 20 people and injured more than 1,000 in eastern Turkey, as rescue teams searched through the rubble of collapsed buildings for survivors on Saturday.    At least 30 people were missing following the magnitude 6.8 quake on Friday night, which had its epicentre in the small lakeside town of Sivrice in the eastern province of Elazig.   "It was very scary, furniture fell on top of us. We rushed outside," 47-year-old Melahat Can, who lives in the provincial capital of Elazig, told AFP.   President Recep Tayyip Erdogan said all steps were being taken to aid people affected by the quake, which caused widespread fear.   "We stand by our people," Erdogan said on Twitter.

The Turkish government's disaster and emergency management agency (AFAD) said the quake hit Sivrice at around 8.55 pm (1755 GMT). Turkey lies on major faultlines and is prone to frequent earthquakes.    Turkish television showed images of people rushing outside in panic, as well as a fire on the roof of a building.   Interior, environment and health ministers, who were in the quake zone, said the casulties were in Elazig province and in the neighbouring province of Malatya, which lies to the southwest.

At least 20 people died and 1,015 others were wounded, according to AFAD.   "There is nobody trapped under the rubble in Malatya but in Elazig search and rescue efforts are currently under way to find 30 citizens," Interior Minister Suleyman Soylu said on Friday.   Rescue teams were searching for survivors trapped in a five-storey collapsed building in a village some 30 kilometres from Elazig, according to AFP journalists at the scene. One person was pulled alive from the rubble.   Emergency staff and people waiting at the scene lit fires in the streets to stay warm in freezing temperatures.   Sports centres, schools and guest houses had been opened to accommodate quake victims in Malatya.

- 'Everybody is in the street' -
Sivrice -- a town with a population of about 4,000 people -- is situated south of Elazig city on the shores of Hazar lake -- one of the most popular tourist spots in the region and the source of the Tigris river.   The lake is home to a "Sunken City", with archaeological traces dating back 4,000 years in its waters.

The tremor was felt in several parts of eastern Turkey near the Iraqi and Syrian borders, the Turkish broadcaster NTV reported, adding that neighbouring cities had mobilised rescue teams for the quake area.   "Everybody is in the street, it was very powerful, very scary," said Zekeriya Gunes, 68, from Elazig city, after the quakes caused a building to collapse on her street.   "It lasted quite long, maybe 30 seconds," added Ferda, 39. "I panicked and was undecided whether to go out in this cold or remain inside."

The US Geological Survey assessed the magnitude as 6.7, slightly lower than AFAD, adding that it struck near the East Anatolian Fault in an area that has suffered no documented large ruptures since an earthquake in 1875.   "My wholehearted sympathy to President @RTErdogan and the Turkish people following the devastating earthquake that has hit Turkey. Our search and rescue teams stand ready to assist," Greek Prime Minister Kyriakos Mitsotakis wrote on Twitter.   In Athens, the Greek premier's office said later that Mitsotakis had spoken by phone to Erdogan.   "The Turkish president... said Turkish teams had the situation under control for now and that it would be re-evaluated in the morning," his office added.

In 1999, a devastating 7.4 magnitude earthquake hit Izmit in western Turkey, leaving more than 17,000 people dead including about 1,000 in the country's largest city Istanbul.    In September last year, a 5.7-magnitude earthquake shook Istanbul, causing residents to flee buildings in the economic capital.   Experts have long warned a large quake could devastate the city of 15 million people, which has allowed widespread building without safety precautions.