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United Arab Emirates

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our Customs Information.

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

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

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

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More information from knowledgeable sources would be greatly appreciated.

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

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

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

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

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

Overnight visitors in Dubai spent almost USD 11 billion in 2014

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

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

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

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

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

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: 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:
Date: Thu, 25 Jan 2018 03:25:17 +0100

Asuncion, Jan 25, 2018 (AFP) - Authorities in Paraguay's capital Asuncion on Wednesday declared a state of emergency for a month after the Paraguay River burst its banks, leaving at least 20,000 people homeless.   The unseasonal high waters have washed over many poor neighbourhoods built along the banks.    About a half million people are in the capital, and 2.2 million in its metro area. The South American country has seven million people in total.

The capital city's council said it was moving to get food and water to the people hit by flooding.   Many of the displaced have been moved to higher areas of the low-lying capital, the national emergency office said.   Hundreds more of the displaced were setting up makeshift camps in plazas of the capital and on any small unoccupied spot they could find.   Forecasters said heavy rains in recent weeks were behind the river's rise.
Date: Wed 10 Jan 2018, 11:12 AM
Source: Ultima Hora, Paraguay [in Spanish, machine trans., edited]

The Institute of Tropical Medicine confirmed 76 suspected cases of brucellosis in recent days while the fully confirmed cases remain at 21. They are mostly students and teachers of Veterinary UNA.

Miguel Cardozo, of the Institute of Tropical Medicine, explained that in the last days there were 76 cases that are under suspicion of brucellosis, after the clinical consultations of people who manifested some symptoms. Of the total, 4 people are in treatment for high suspicion of being carriers of the disease [see below - ProMED Mod.LL]. Cardozo indicated that brucellosis is a slow-growing bacterial disease that can appear 2 to 3 months after having been in contact with infected animals, so he urged people who were exposed to clinical examinations.

Those affected are mostly students and professors of the Faculty of Veterinary Sciences of the National University of Asuncion (UNA). Several months ago, an outbreak of brucellosis was detected in the institution where students, teachers and officials of the house of studies were exposed. The fact cost him the international academic accreditation he had. Finally, the case that occurred due to apparent negligence ended with the resignation of the dean of the Faculty of Veterinary Sciences of UNA. Cabrera was also charged for the crime of marketing harmful food, since it is presumed that the institution sold the milk of the infected animals.
===================
[The organism involved has been previously reported to be _B. melitensis_. Symptoms and signs of brucellosis may develop from days to months after the initial exposure to the organism. While some individuals may develop mild symptoms, others may go on to develop long-term chronic symptoms. It is not clear if the 4 individuals noted as "carriers" have been diagnosed as chronic brucellosis and if so what organs are involved. Additionally, a previous ProMED report noted a fatality which is not mentioned in this posting.

The signs and symptoms of brucellosis are extensive and they can be similar to many other febrile illnesses, so recognition of potential exposure -- from ingestion of unpasteurized milk or cheese, employment as a veterinarian or veterinary student, in a slaughter house or meat processing plant, or working in a microbiology lab -- is vital.

The following is a recent review of caprine brucellosis:
Rossetti CA, Arenas-Gamboa AM and Maurizio E: Caprine brucellosis: A historically neglected disease with significant impact on public health. PLoS Negl Trop Dis. 2017 Aug 17;11(8):e0005692, available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560528/>.

Abstract
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"Caprine brucellosis is a chronic infectious disease caused by the gram-negative cocci-bacillus _Brucella melitensis_. Middle- to late-term abortion, stillbirths, and the delivery of weak offspring are the characteristic clinical signs of the disease that is associated with an extensive negative impact in a flock's productivity. _B. melitensis_ is also the most virulent _Brucella_ species for humans, responsible for a severely debilitating and disabling illness that results in high morbidity with intermittent fever, chills, sweats, weakness, myalgia, abortion, osteoarticular complications, endocarditis, depression, anorexia, and low mortality. Historical observations indicate that goats have been the hosts of _B. melitensis_ for centuries; but around 1905, the Greek physician Themistokles Zammit was able to build the epidemiological link between "Malta fever" and the consumption of goat milk. While the disease has been successfully managed in most industrialized countries, it remains a significant burden on goat and human health in the Mediterranean region, the Middle East, Central and Southeast Asia (including India and China), sub-Saharan Africa, and certain areas in Latin America, where approximately 3.5 billion people live at risk. In this review, we describe a historical evolution of the disease, highlight the current worldwide distribution, and estimate (by simple formula) the approximate costs of brucellosis outbreaks to meat- and milk-producing farms and the economic losses associated with the disease in humans. Successful control leading to eradication of caprine brucellosis in the developing world will require a coordinated Global One Health approach involving active involvement of human and animal health efforts to enhance public health and improve livestock productivity."

Maps of Paraguay can be seen at
and <http://healthmap.org/promed/p/4191>.

The City of Asuncion, Ciudad de Asuncion (<https://es.wikipedia.org/wiki/Asunci%C3%B3n>), is an autonomous capital district, not a part of any department. The metropolitan area, called Gran Asuncion, includes the cities of San Lorenzo, Fernando de la Mora, Lambare, Luque, Mariano Roque Alonso, Nemby, San Antonio, Limpio, Capiata, and Villa Elisa, which are part of the Central Department. The Asuncion metropolitan area has around 2 million inhabitants. - ProMED Mod.LL]
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Honduras

Honduras - US Consular Information Sheet
May 19, 2008

COUNTRY DESCRIPTION:
Honduras is a democracy with a developing economy. The national language is Spanish, although English is often spoken in the Bay Islands. The climate is genera
ly pleasant and temperate, with dry and wet seasons. During the dry season from February into May, widespread forest fires and agricultural burning can lead to severely degraded air quality throughout the country possibly causing respiratory problems and airport closures. The terrain includes mountainous areas, coastal beaches, and jungle lowlands. Facilities that would normally be used by tourists, including hotels and restaurants, are generally adequate in the capital city of Tegucigalpa, in San Pedro Sula, Tela, La Ceiba, the Bay Islands, and near the Copan ruins. Large sections of the country, however, lack basic public services or even a governmental presence. Currency exchange is readily available at banks and hotels in the major cities. Read the Department of State Background Notes on Honduras for additional information.

ENTRY/EXIT REQUIREMENTS: A U.S. passport valid for at least three months from the date of entry is required to enter Honduras. Though not required by law, some travelers have reported difficulty departing Honduras using a passport with less than three months of validity beyond the date of departure. A visa is not required, but tourists must provide evidence of return or onward travel. Parents should not rely on birth certificates for their children’s travel; rather, prior to travel they should obtain U.S. passports for infants and minors born in the United States. U.S. citizens are encouraged to carry a photocopy of their U.S. passports with them at all times, so that if questioned by local officials proof of identity and U.S. citizenship are readily available.

In June 2006, Honduras entered a “Central America-4 (CA-4) Border Control Agreement” with Guatemala, El Salvador, and Nicaragua. Under the terms of the agreement, citizens of the four countries may travel freely across land borders from one of the countries to any of the others without completing entry and exit formalities at Immigration checkpoints. U.S. citizens and other eligible foreign nationals who legally enter any of the four countries may similarly travel among the four without obtaining additional visas or tourist entry permits for the other three countries. Immigration officials at the first port of entry determine the length of stay, up to a maximum period of 90 days. Foreign tourists who wish to remain in the four country region beyond the period initially granted for their visit are required to request a one-time extension of stay from local immigration authorities in the country where the traveler is physically present, or travel outside the CA-4 countries and reapply for admission to the region. Foreigners “expelled” from any of the four countries are excluded from the entire “CA-4” region. In isolated cases, the lack of clarity in the implementing details of the CA-4 Border Control Agreement has caused temporary inconvenience to some travelers and has resulted in others being fined more than one hundred dollars or detained in custody for 72 hours or longer.

Dual Nationality: Honduran law permits dual nationality only for minors under the age of 21 and those Honduran-born citizens who have become naturalized citizens of other countries. U.S. citizens who become Honduran citizens by naturalization are not considered to have dual nationality under Honduran law. However, becoming a Honduran citizen will not cause U.S. citizens to lose their U.S. citizenship and all the accompanying rights and privileges. Dual nationals, in addition to being subject to all Honduran laws affecting U.S. citizens, may be subject to other laws that impose special obligations on Honduran citizens. For more information, please contact Honduran Immigration in Tegucigalpa (telephone 504-238-5613), San Pedro Sula (telephone 504-550-3728), Roatan (telephone 504-445-1226), La Ceiba (telephone 504-442-0638), or Puerto Cortes (telephone 504-665-0582).

For further information on dual nationality for U.S. citizens, see the Bureau of Consular Affairs dual nationality flier.

SAFETY AND SECURITY:
Political demonstrations sometimes disrupt traffic, but they are generally announced in advance and are usually peaceful. Travelers should avoid areas where demonstrations are taking place, and they should stay informed by following the local news and consulting hotel personnel and tour guides. Demonstrators frequently block public roads to press for concessions from the government of Honduras. These demonstrations may last several hours and the government rarely seeks to disperse the demonstrators. U.S. citizens should never try to pass such roadblocks. While the Honduran side of the Honduras-Nicaragua border has been largely cleared of land mines, travelers should exercise caution there. For more information, we strongly encourage travelers to visit the U.S. Embassy's web site at http://honduras.usembassy.gov/ and click on Crime and Security Matters. For the latest security information, American citizens 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 United States, or for callers outside the United States and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME: Crime is endemic in Honduras and requires a high degree of caution by U.S. visitors and residents alike. U.S. citizens have been the victims of a wide range of crimes, including murder, kidnapping, rape, assault, and property crimes. Sixty-two U.S. citizens have been murdered in Honduras since 1995; only twenty cases have been resolved. Four U.S citizens were murdered in Honduras in 2007, six in 2006, and ten in 2005. Kidnappings of U.S. citizens have occurred in Honduras, including two incidents in 2007. Poverty, gangs, and low apprehension and conviction rates of criminals contribute to a critical crime rate, including horrific acts of mass murder. With a total of 3,855 murders in 2007, and a population of approximately 7.3 million people, Honduras has one of the world’s highest per capita murder rates.

U.S. citizens are encouraged to follow local news reports and seek additional information in the resources listed above. Criminals and pickpockets also target visitors as they enter and depart airports and hotels, so visitors should consider carrying their passports and valuables in a concealed pouch. Two-man teams on medium-size motorcycles often target pedestrians for robbery. There have also been reports of armed robbers traveling in private cars targeting pedestrians on isolated streets. The Honduran government conducts occasional joint police /military patrols in major cities in an effort to reduce crime. Problems with the judicial process include corruption and an acute shortage of trained personnel, equipment, staff, and financial resources. The Honduran law enforcement authorities' ability to prevent, respond to, and investigate criminal incidents and prosecute criminals remains limited. Honduran police generally do not speak English. The government has established a special tourist police in the resort town of Tela and other popular tourist destinations, including Tegucigalpa, San Pedro Sula, La Ceiba, and Roatan, but the number deployed is small and coverage is limited. The San Pedro Sula area has seen occasional armed robberies against tourist vans, minibuses, and cars traveling from the airport to area hotels, even sometimes targeting the road to Copan. Armed men have forced vehicles transporting tourists off the road and robbed the victims, occasionally assaulting the driver or passengers. In past years, several U.S. citizens have been murdered in San Pedro Sula and La Ceiba shortly after arriving in the country. Assaults in these areas may be based on tips from sources at airport arrival areas, so visitors are strongly urged to exercise caution in discussing travel plans in public.

Copan, Roatan/Bay Islands, and other tourist destinations have a lower crime rate than other parts of the country, but thefts, break-ins, assaults, and murders do occur. Exercise particular caution walking on isolated beaches, especially at night. Coxen Hole on the island of Roatan should be avoided after dark.

The Government of Honduras has a very limited presence in Northern Olancho, Colon and Gracias a Dios Departments, which are well known for lumber and narcotics smuggling and violence. Travelers in those areas should use extra caution. See the description of highways/areas to be avoided in the Traffic Safety and Road Conditions section below for details.

Incidents of crime along roads in Honduras are common, including carjacking and kidnapping. There have been frequent incidents of highway robbery on a number of roads including Limones to La Union, Olancho (route 41) via Salama and northward to Esquipulas Del Norte. For more information, please see the section below on Traffic Safety and Road Conditions.

Travelers should always drive with their doors locked and windows rolled up to avoid potential robberies at traffic lights and other places, such as congested downtown streets. Avoid driving at night. All bus travel should be during daylight hours and on first-class conveyances, not on economy buses. Please choose taxis carefully, and note the driver's name and license number. Instruct the driver not to pick up other passengers, agree on the fare before you depart, and have small bills available for payment, as taxi drivers often do not make change.

Do not resist a robbery attempt. Most criminals have weapons, and most injuries and deaths have resulted when victims have resisted. In 2004, an American citizen was murdered while attempting to flee an armed robbery in progress and another American was shot while resisting a carjacking. Two American citizens were murdered while resisting armed robberies in 2005.

Do not hitchhike or go home with strangers, particularly from nightspots. Whenever possible, travel in groups of two or more persons. Use the same common sense while traveling in Honduras that you would in any high crime area in the United States: do not wear excessive jewelry; do not carry large sums of money, or display cash, ATM/credit cards, or other valuables you do not need.

Avoid walking at night in most areas of Honduras. Do not hike alone in backcountry areas, or walk alone on beaches, historic ruins, or trails.

Individuals and groups should register their travel plans with the State Department via the Internet at the Department’s secure travel registration web site, https://travelregistration.state.gov/. Travelers may also register by sending passport, date of birth, and emergency contact information to the American Citizens Services Unit of the U.S. Embassy in Tegucigalpa via fax at 011-504-238-4357, or e-mail at usahonduras@state.gov prior to travel. Individuals as well as groups should always keep in their possession a photocopy of their U.S. passport data page, carry an additional copy in their suitcase, and leave a copy at home with a friend or family member.

INFORMATION FOR VICTIMS OF CRIME: If you are the victim of a crime while in Honduras, contact local authorities immediately, either directly or through the national police emergency number: *199. In addition to reporting to the local police, please contact the U.S. Embassy in Tegucigalpa or the Consular Agency in San Pedro Sula for assistance. The theft of a U.S. passport should be reported immediately. The Embassy and Consular Agency staff can provide you with information about medical care, contacting family members or friends and explaining how funds could be transferred. Although the investigation and prosecution of most crimes are solely the responsibility of local authorities, Consular staff can provide you with a list of attorneys if needed. See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in Honduras varies greatly in quality and availability. Outside Tegucigalpa and San Pedro Sula, medical care is inadequate to address complex situations. Support staff facilities and necessary equipment and supplies are not up to U.S. standards anywhere in Honduras. Facilities for advanced surgical procedures are not available. Wide areas of the country, including the popular tourist areas of the Bay Islands, do not have a general surgery hospital. Ambulance services are limited in major cities and almost non-existent elsewhere. Emergency services may be contacted directly through their local numbers.

Scuba diving is popular in the Bay Islands, but the limited medical facilities there pose a special risk in the event of an emergency. There is a decompression chamber on Roatan and Utila for divers, but no advanced medical care on either island for diving related accidents.

MEDICAL INSURANCE: The Department of State strongly urges American citizens 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. U.S. medical insurance plans seldom cover health costs incurred outside the U.S. unless supplemental coverage is purchased. Furthermore, U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States. However, many travel agents and private companies offer insurance plans that will cover health care expenses incurred overseas including emergency services such as medical evacuations. It is important to ensure that you have adequate medical evacuation coverage prior to your trip to Honduras.

When making a decision regarding health insurance, American citizens should consider that many foreign doctors and hospitals require payment in cash prior to providing service and that a medical evacuation to the U.S. may cost tens of thousands of dollars. Uninsured travelers who require medical care overseas often face extreme difficulties. When consulting with your insurer prior to your trip, ascertain whether payment will be made to the overseas healthcare provider or whether you will be reimbursed later for expenses you incur. Some insurance policies also include coverage for psychiatric treatment and for disposition of remains in the event of death.

Useful information on medical emergencies abroad, including overseas insurance programs, is provided in the Department of State's Medical Information for Americans Traveling Abroad.

OTHER HEALTH INFORMATION: Mosquito-borne illnesses are an ongoing problem in Honduras. All persons traveling in Honduras, even for a brief visit, are at risk of contracting malaria. Take a prophylactic regimen best suited to your health profile. The country regularly suffers from outbreaks of dengue fever. Unlike traditional mosquito-borne illnesses, there is no medicinal prophylactic or curative regimen for dengue fever. Travelers should take precautions against being bitten by mosquitoes to reduce the chance of contracting such illnesses, such as avoiding standing water even in the home, wearing long sleeves and pants in both day and night, and applying insect repellent regularly.

Severe air pollution, which can aggravate or lead to respiratory problems, is common throughout the country during the dry season due in large part to widespread forest fires and agricultural burning. Travelers with respiratory or cardiac conditions and those who are elderly or extremely young are at greatest risk for complications from air pollution, which may include coughing, difficulty breathing, wheezing, or chest pain. Acute respiratory infections are also widespread; more than 100,000 cases are reported annually.

Individuals traveling to Honduras should ensure that all their routine vaccinations are up to date. Vaccination against Hepatitis A, Hepatitis B, and Typhoid is strongly recommended for those traveling to Honduras from the United States. Honduras requires vaccination against Yellow Fever for those traveling to Honduras from countries where there is the risk of transmission. Travelers taking prescription medications should bring an adequate supply with them when coming to Honduras and ensure that they are properly labeled.

Honduras also has the highest adult HIV/AIDS prevalence rate in the region. Over 63,000 people in Honduras have HIV/AIDS.

Honduras lacks a substantial infrastructure for maintaining water purity. Travelers are strongly encouraged to avoid drinking tap water or a beverage that contains ice from an unknown source (even alcoholic drinks). Bottles and bags of purified water are widely available. It is also recommended that individuals traveling to Honduras avoid eating untreated raw vegetables, fruits that can’t be peeled on the spot, raw fish like ceviche and undercooked shellfish and products containing mayonnaise, pastry icing, and unpasteurized dairy products. Hot cooked food, fresh bread, dry foods such as crackers, bottled carbonated beverages, coffee, tea, and beer are usually safe, provided such food items are not purchased from street vendors. All fruits and vegetables should be washed thoroughly with detergent and running water. Those that will be cooked or peeled can then be stored in a sealed container until used. Those that will be eaten raw and will not be peeled should be soaked for 15 minutes in a solution of chlorine bleach (or 5% household bleach) in water (one tablespoon of Clorox per gallon of water), rinsed with potable water, and allowed to air dry.

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 web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.

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

Because of crime and poor road conditions, driving can be very dangerous, and travelers should carry a cellular phone in case of an emergency. Travelers should exercise extreme caution while driving on isolated stretches of road and passing on mountainous curves. Rockslides are common, especially in the rainy season (May through December). Traffic signs, even on major highways, are often inadequate, and streets in the major cities are often unmarked. Travelers should always drive with their doors locked and windows rolled up to avoid potential robberies at traffic lights and other places such as congested downtown streets. Please refer to our Road Safety page for more information.

Honduran roads are poorly lit and marked. Vehicles are often driven at night without adequate illumination, and animals and people wander onto the roads at all hours. For these reasons, and because of the high incidence of crime, the U.S. Embassy strongly discourages car and bus travel after dark.

Major cities are connected by an inconsistently maintained, two-lane system of paved roads. Many secondary roads in Honduras are unpaved. During the rainy season, even major highways are often closed due to rockslides and flooding from heavy rains. In the event of an accident, contact the Honduran Transit Authority (“Transito”) immediately. They may be contacted either directly through their local numbers, or through their national emergency number, *189. Honduran law requires that no vehicles involved in an accident be moved until Transit Agents arrive, not even to clear a traffic obstruction, unless you are in serious physical danger.

Some of the most dangerous stretches for road travel include: Tegucigalpa to Choluteca, because of dangerous mountain curves; El Progreso to La Ceiba, because of animal crossings and the poor condition of bridges from flooding; Route 39 through northern Olancho Department between Gualaco and San Esteban; and Limones to La Union, Olancho (route 41) via Salama and northward to Saba. Locals also refer to this latter stretch of road as the “Corridor of Death” because of frequent incidents of highway robbery. In March of 2008, 27 persons died when a bus overturned and rolled down a ravine in La Esperanza, Intibuca, on another infamous stretch of road called “Flight of the Angel.”

The Embassy has received reports of robberies on the road from Tegucigalpa to Danlí. The only recommended route to the north coast from the south is CA-5 to route 21 to CA-13 via Tela to La Ceiba and Trujillo. Hijackings of private and commercial vehicles from the United States to Honduras have occurred. While Honduras and the United States have signed and ratified a Stolen Vehicle Treaty, existing Honduran laws protect good faith buyers (even of stolen vehicles) so the recovery and return of these vehicles to their original owners is not guaranteed. Vehicle insurance may mitigate loss; please check with the National Insurance Crime Bureau at https://www.nicb.org, private insurance carriers, and our Embassy web site information on Commercial Vehicle Hijackings at http://honduras.usembassy.gov/english/mission/sections/RSO/comveh_highsec.htm for more information.

For additional general information about road safety, please see our Road Safety page, which includes links to foreign government sites. For specific information concerning Honduran driving permits, vehicle inspection, road tax, and mandatory insurance, please contact the Honduran National Tourist Organization offices in New York via the Internet at http://www.hondurastips.honduras.com/.

MARINE SAFETY AND OVERSIGHT: The areas off both coasts of Honduras are the subject of maritime border disputes between Honduras and its neighbors. The Honduran Navy patrols these areas, and all private vessels transiting Honduran territorial waters should be prepared to be hailed and possibly boarded by Honduran military personnel to verify documentation. While the Honduran Navy previously used private vessels as patrol vessels, this is no longer the case. In the event that any vessel is hailed in Honduran waters in the Caribbean by a non-military vessel or any suspicious vessel and directed to prepare for boarding, the vessel should immediately contact the U.S. Coast Guard Operations Center by radio or INMARSAT at 305-415-6800. Anyone needing more information can also contact the U.S. Embassy during working hours and request to speak with the U.S. Military Group (USMILGP) office.

There have been incidents of armed assaults against private sailing vessels by criminals posing as fishermen off the northeast coast of Honduras, particularly in the numerous small islands northeast of the Department of Gracias a Dios. Sailors should contact the Coast Guard and yacht facility managers in their areas of travel for current information.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Honduras’ Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Honduras’ air carrier operations. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

Severe air pollution often leads to the closing of some or all of Honduras’ four international airports during the dry season. Some travelers have been compelled to travel by bus to neighboring countries in order to catch onward flights.

SPECIAL CIRCUMSTANCES:

Real Estate Investment: U.S. citizens should exercise extreme caution before entering into any form of commitment to invest in real property, particularly in coastal areas and the Bay Islands. Honduran laws and practices regarding real estate differ substantially from those in the United States, and fraudulent deeds and titles are common; U.S. citizens considering investing or buying real estate in Honduras should be aware that rights to such property do not enjoy the same level of protection as in the United States. Historically, title insurance has not been available in Honduras. Recently, some American insurance companies have begun offering title insurance in cooperation with Honduran attorneys. However, approximately 80 percent of privately held land is untitled. In addition, there are complaints that the Honduran judicial system often prolongs disputed cases for many years before resolution. American citizens have spent thousands of dollars in legal fees and years of frustration trying to resolve property disputes, even in cases in which local attorneys and Honduran and U.S. real estate agents had given assurances to the investor. Violence has been used against American citizens involved in disputed property cases. Potential investors should engage competent local legal representation before making any commitments. Investors should thoroughly check references of attorneys and real estate agents.

Honduran law places certain restrictions on land ownership by foreigners in coastal and border areas. Squatters claim a number of properties owned by U.S. citizens. U.S. Government officials may not act as agents, attorneys, or in a fiduciary capacity. U.S. citizens who own property abroad and who thereby have assumed responsibilities concurrent with ownership of property in a foreign country should take steps on their own initiative to safeguard their interests and to employ private legal counsel when the need arises. For further information on investing in property in Honduras, please review the State Department’s Investment Climate Statement, part of the Country Commercial Guide at http://www.buyusa.gov/honduras/en/14.html. For information on contracting Honduran legal representation, please check with other investors. You may also refer to the list of attorneys available on the Embassy's home page at http://honduras.usembassy.gov/attorneylistoct07.pdf.

Financial Market Investment: Due to poor regulation and lack of guarantees, investment in the Honduran "Bolsa de Valores," or securities market, as well as banking institution bonds, “fideicomisos” (trusts), and certificates of deposit from uninsured financial institutions pose high risk to investors. Extreme caution should be exercised before and while undertaking such activities, as American citizens have lost large sums of money through investments in such precarious markets. For further information on investing in Honduras, please review the State Department’s Investment Climate Statement, part of the Country Commercial Guide at http://www.buyusa.gov/honduras/en/14.html.

Corruption: Many U.S. firms and citizens operating in Honduras have found corruption to be a serious problem and a constraint to successful investment. While some U.S. firms have satisfactorily resolved cases through the courts, the majority have difficulty navigating the legal system. There are complaints that the Honduran judicial system caters to favoritism, external pressure and bribes. Corruption appears to be most pervasive in government procurement, government permits, and in the buying and selling of real estate (land titling).

Customs Regulations: U.S. citizens who intend to stay in Honduras for an extended period of time and who bring vehicles or household goods into the country should consult Honduran customs officials prior to shipment. With the exception of “antique” cars, all vehicles imported into Honduras by foreigners must be less than ten (10) years old. For specific information regarding customs requirements, please contact the Embassy of Honduras in Washington, DC at http://www.hondurasemb.org/ for more information.

Honduran customs authorities may enforce strict regulations concerning temporary import and export of items such as antiquities, medications, and business equipment. For example, Honduran law prohibits the export of antiques and artifacts from pre-colonial civilizations. To protect the country's biodiversity, it is illegal to export certain birds, feathers, and other flora and fauna. For specific information regarding exportation requirements, please contact the Embassy of Honduras in Washington, DC at http://www.hondurasemb.org/.

The Government of Honduras is strictly enforcing the law that requires a Honduran permit for the importation of firearms into Honduras. Travelers must obtain a firearm importation permit from a Honduran Embassy, Consulate General, or Consulate located in the United States prior to bringing firearms into the country. Please note that a U.S. government-issued or airline-issued permit is not valid for importation of firearms into Honduras. Firearms that arrive without the requisite Honduran permit will be confiscated and the bearer will be prosecuted to the full extent of Honduran law.

For further information about customs regulations, please read our Customs Information sheet.

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 under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Honduran laws, even unknowingly, may be fined, expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Honduras are severe, and convicted offenders can expect long jail sentences and heavy fines. Assisting or participating in the distribution of illegal drugs is also a crime prosecutable in the United States, and may lead to fines, property seizure, or imprisonment. Anyone offering you illegal drugs should be considered extremely dangerous – there is no “safe” source of illegal drugs.

"Sexual tourists" travel alone or in groups to Honduras for the purpose of purchasing sexual favors from minors. This activity violates Honduran law, and American citizens are imprisoned in Honduras for sexual offenses involving minors. In addition, U.S. citizens and residents charged with these crimes are subject to prosecution upon their return to the United States, regardless of the outcome of the judicial proceedings overseas. Moreover, the prevalence of HIV/AIDS in sex workers in Honduras is estimated to be in excess of 10%. Using or disseminating child pornography in a foreign country is also a crime prosecutable in the United States. Please see our information on Criminal Penalties.

CHILDREN'S ISSUES: International adoptions from Honduras are very complex. Current information on Honduran adoption procedures and the immigrant visa application process is available from the Consular Section of the U.S. Embassy. Prospective adoptive parents are urged to check with the Consular Section to ensure that all required documentation has been approved by the U.S. Bureau of Citizenship and Immigration Services (USCIS) of the Department of Homeland Security and to confirm that their child's adoption is complete before traveling to Honduras to apply for their child's immigrant visa. Adoptive parents are also urged to carry with them complete adoption paperwork when traveling with their adopted child to, from, and within Honduras.

Honduras is a signatory to the Hague Convention on the Civil Aspects of International Child Abduction, but the U.S. Department of State has determined that Honduras has failed to comply with its obligations under the Convention. No child has ever been returned to the United States from Honduras under the provisions of the Convention.

For information on international adoption of children and international parental child abduction, please refer to the Office of Children’s Issues web pages on intercountry adoption and international parental child abduction, or telephone Overseas Citizens Services at 1-888-407-4747. This number is available from 8:00 a.m. to 8:00 p.m. Eastern Standard Time, Monday through Friday (except U.S. federal holidays). Callers who are unable to use toll-free numbers, such as those calling from overseas, may obtain information and assistance during these hours by calling 1-202-501-4444.

REGISTRATION / EMBASSY LOCATION:
American citizens residing or traveling in Honduras are encouraged to register their presence through the State Department’s travel registration web site, and to obtain updated information on travel and security within Honduras. American citizens without Internet access may register directly with the U.S. Embassy in Tegucigalpa. By registering, whether via the Internet or in person at the Embassy, American citizens make it easier for the Embassy to contact them in case of emergency.

U.S. Embassy location:
Avenida La Paz in Tegucigalpa, Honduras
Internet site: http://honduras.usembassy.gov/
Telephone: 011-504-236-9320 or 011-504-238-5114
Office hours are Monday through Friday from 8:00 a.m. to 11:30 am.
American Citizens Services Unit Fax: 011-504-238-4357

Consular Agency in San Pedro Sula location:
Banco Atlantida Building – 11th Floor
San Pedro Sula, Honduras
Telephone: 011-504-558-1580
Office hours are Mondays, Wednesdays and Fridays from 1:00 p.m. to 4:00 p.m.

The Consular Agent is available during limited hours to perform notarial services, assist U.S. citizens with emergencies, and accept U.S. passport and U.S. Report of Birth applications for adjudication at the Embassy in Tegucigalpa. The Consular Agent does not provide visa information or services. For more details about all U.S. Embassy and consular services in Honduras, please see the Embassy web site at http://honduras.usembassy.gov/ or visit the Bureau of Consular Affairs web site at http://travel.state.gov/.
* * *
This replaces the Country Specific Information dated October 12, 2007, to update sections on
Entry/Exit Requirements, Crime, Medical Facilities and Health Information, Other Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Honduras. 21 Mar 2019. (Reported)

39 cases with 54% in children under 18 years; DHF/serious 12 cases in past week.

[An 18 Mar 2019 report indicates that there are 789 serious dengue cases with 12 deaths.
Date: Fri 18 May 2018 10:14 HS CST
Source: TVP [in Spanish, machine trans., edited]
<https://tvpacifico.mx/noticias/209149-honduras-acumula-diez-muertos-y-172-casos-confirmados-de-gripe-a>

Honduras has registered 10 deaths and 172 cases of influenza A, with 22 new infections confirmed in the last hours, reported today [18 May 2018] the national coordinator of Health Surveillance, Homer Meja. He also noted that 9 of the deceased patients had "more than one underlying disease, such as diabetes, hypertension, and heart disease." He added that the majority of these infections occurred in San Pedro Sula and Tegucigalpa, the 2 most important cities of the Central American country.

Meja indicated that there are also 2 people who are suspected of having contracted the disease in Comayagua, in the central region of Honduras, so they are being kept under surveillance. The official stressed that the influenza vaccination campaign began on [Mon 14 May 2018] in the main cities of the country, and recommended all pregnant women to be vaccinated because very few do so despite being at risk for the health of the baby. The official said that pregnant women should know that the disease can directly affect the baby, and insisted that these women should be vaccinated, regardless of the time of gestation.

People aged 59 and over, health workers, children under 5, the chronically ill, and pregnant women, are the most vulnerable groups who are receiving the dose first, he added. Mejía said that the vaccination centers have more than one million doses to vaccinate groups at risk and announced that in the 1st week of June [2018] the rest of the population will be vaccinated.

The main symptoms are fever of up to 39 deg C [102.2 deg F], chills, headache, muscle, sneezing, intense and persistent cough, runny nose, tearing, and mild pharyngitis, according to the authorities.
=========================
[There have been reports of increased influenza activity in various countries during the official influenza season in the southern hemisphere. The severity of the current season is similar to the trend seen in the northern hemisphere during the 2017-18 season. Vaccination, particularly for high risk groups, can help reduce morbidity and mortality, provided the vaccine strains are a close match to the circulating viruses. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map Honduras:
<http://healthmap.org/promed/p/22>]
Date: Wed, 10 Jan 2018 07:36:22 +0100

Tegucigalpa, Jan 10, 2018 (AFP) - A powerful 7.6-magnitude earthquake hit off Honduras late Tuesday, triggering tsunami threats and advisories for nearby Caribbean shores, but there were no immediate reports of damage or injuries.

The quake struck at 0251 GMT and its epicentre was located some 27 miles (44 kilometres) east of Great Swan Island, according to the US Geological Survey (USGS). It was provisionally considered to be shallow.   The Honduran emergency management agency known as COPECO issued a 10-hour tsunami alert for three coastal departments.

President Juan Orlando Hernandez said authorities had activated the country's emergency system but urged people to remain calm.   "Based on the preliminary earthquake parameters, hazardous tsunami waves are possible for coasts located within 1,000 kilometres of the earthquake epicentre," the US National Weather Pacific Tsunami Warning Center said. But it later said the tsunami threat had passed.

Cuba, Mexico, Honduras, Belize and Jamaica meanwhile were issued "threat" warnings of waves between 0.3 to one meter (a foot to 3.3 feet) high.   The USGS's PAGER algorithm assigned the event a "green alert," meaning a low likelihood of casualties and damage.   "Overall, the population in this region resides in structures that are vulnerable to earthquake shaking, though resistant structures exist," it said.
Date: Fri 13 Jan 2017
Source: Rare Disease Report [edited]
<http://www.raredr.com/news/curse-of-an-ancient-lost-city>

Douglass Preston and his crew of explorers and archaeologists planned for 3 years to visit an ancient lost city. They set out to adventure to the ruins of Ciudad Blanca, also known as the "City of the Monkey God" nestled deeply in the jungle of Mosquitia in Honduras and Nicaragua. The ruins have been dated between 1000 and 1500 AD and were thought to be filled with exciting ancient artefacts. The city's possible existence has tempted adventure seekers since the 1500s to go search for the ruins, including Douglas' partner in the journey, Steve Elkins.

The adventure was made a lot easier with an expensive laser mapping technological device called LIDAR, which was funded for the adventure by documentary filmmaker Bill Benenson. LIDAR was capable of scanning hundreds of square miles of dense jungle in a matter of days. LIDAR found them the ancient lost city. While seeing many artefacts of the deserted city, the team concluded that the site could not be excavated at that time, and waited for intervention by the Honduran government.

Months after leaving the jungle, Douglass noticed a bite from a sand fly that just was not properly healing; so did another member of the team. After going to get it medically looked at, Douglass found that he had contracted a virulent strain of leishmaniasis, a parasitic disease that migrates to the mucous membranes of your mouth and your nose and eats them away.

Over the next few months, about half the team came down with the early symptoms and had to undergo treatment. Douglass and his team aren't sure they are ready to go back. Leishmaniasis is a parasitic disease that is found in parts of the tropics, subtropics, and southern Europe. It is classified as a Neglected Tropical Disease (NTD).

Leishmaniasis is caused by infection with leishmania parasites, which are spread by the bite of phlebotomine sand flies. [Byline: Andrew Black]
=========================
[For more information on La Ciudad Blanca, see:
<https://en.wikipedia.org/wiki/La_Ciudad_Blanca>.

The leishmania parasite is found in animals, usually small rodents, and is transmitted to humans by the sandfly vector. The area the adventurers explored just happened to have a high density of infected rodents and an abundance of the vectors.

Mucocutaneous leishmaniasis in Honduras is caused by _L. panamensis_ and _L. braziliensis_, and the reservoir is not known (Alvar J, Vélez ID, Bern C, Herrero M, Desjeux P, Cano J, et al. (2012) Leishmaniasis Worldwide and Global Estimates of Its Incidence. PLoS ONE 7(5): e35671. doi:10.1371/journal.pone.0035671. Annex 42).

The high infection rate underlines the importance of thorough prevention measures against insects using repellents, impregnated clothes and tents, and impregnated bed nets. - Mod.EP A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/22>.]
Date: Wed, 3 Aug 2016 18:37:39 +0200

Tegucigalpa, Aug 3, 2016 (AFP) - Honduras on Wednesday issued a red alert for its Bay Islands, popular with tourists in the Caribbean, as Tropical Storm Earl bore down on Central America.   A fishing vessel with 82 crew members capsized because of the storm, but they were all rescued, an official with Honduras' Copeco emergency services agency told the HCH television channel.   The red alert for the Bay Islands, an archipelago of eight main islands and smaller cays, was to last two days.

The islands' main airport in Roatan was closed, as were two others near the Caribbean coast on the mainland.    Schools were also shut in the north of the country.   Copeco said it had plans ready to evacuate residents at high risk from the storm.   Tropical Storm Earl, packing winds of up to 118 kilometres per hour, was expected to drive into northern Honduras, a coastal part of neighbouring Guatemala, and the small country of Belize.   Authorities have warned of high winds, heavy rain and flooding.
More ...

World Travel News Headlines

Date: Fri, 19 Apr 2019 04:57:44 +0200
By Fran BLANDY

Udier, South Sudan, April 19, 2019 (AFP) - By the time he was brought into the remote clinic in northeastern South Sudan, two-year-old Nyachoat was already convulsing from the malaria attacking his brain.   After being given medication he lies fast asleep, naked and feverish, attached to a drip, his anxious mother sitting on the bed next to him.   Nyachoat could be saved, but others are not so lucky.   In South Sudan mind-bending horrors abound of war, ethnic violence, rape, hunger and displacement.

But for civilians living in the shadow of conflict, the greatest danger is often being cut off from health services, whether due to violence or lack of development in the vast, remote areas that make up much of the country.   According to the International Committee of the Red Cross (ICRC), which supports the tiny clinic where Nyachoat is recovering in Udier village, 70 percent of all illness deaths are due to easily treatable malaria, acute watery diarrhoea and respiratory infections.   In case of more serious illness there is "no place" to go, said Nyachoat's 22-year-old mother Buk Gader.

A study by the London School of Hygiene and Tropical Medicine (LSHTM) last year showed almost 400,000 people had died as a result of South Sudan's nearly six-year war.   Half of these were due to violent deaths, and half because of the increased risk of disease and reduced access to healthcare as a result of the conflict.   ICRC health field officer Irene Oyenya said the Upper Nile region was particularly affected.   "There were (aid) organisations which were supplying primary healthcare, but then during the war, most of the organisations got evacuated" and pulled out of the country, she said.

- Blocked by swamps -
Udier is a village with a dirt airstrip whose sun-baked sand, which when not used by twice weekly ICRC flights bringing medicine and supplies, serves as a football pitch for youths. It is also a pedestrian highway for those who come from far flung huts and cattle camps to market.   In the tiny market, there is little fresh food available. Villagers can buy red onions or sit for a strong Sudanese coffee, infused with ginger, while in the dry season nomadic Falata herdswomen in flowing dresses sell milk from their cattle.   A brick building next to the airstrip, its roof long blown off in a storm, is the village school, but for several days in a row no teacher shows up.   In the surrounding villages, women are hard at work mudding their huts and re-thatching the roof in anticipation of the rains to come within weeks.

When they do come, swelling the swampy marshlands and rivers for miles around, roads will become impassable.    It becomes "difficult for young children to swim or women or men to carry patients to reach here," said Oyenya.   Marginalised for decades prior to independence from Sudan in 2011, and engulfed in war since 2013, South Sudan has seen little development. The healthcare sector is one of many propped up by international aid organisations.   However, the country is also the most dangerous for humanitarian workers with around 100 killed over the past five years, according to United Nations figures. Dozens of organisations have been forced to pull out of areas they served due to the conflict.

The Upper Nile region, where Udier is situated near the borders of Sudan and Ethiopia, was wracked by conflict in 2017 as government forces waged a major offensive to seize the opposition-held town of Pagak.   The ICRC was forced to evacuate patients and staff from its hospital and health centre in the village of Maiwut which was looted, leaving "not even a needle on the ground", according ICRC's Oyenya.   Many relocated to Udier, which was spared from fighting.   A year later in 2018, angry protesters looted around 10 humanitarian agency compounds in the town of Maban, 72 kilometres (44 miles) north of Udier.   ICRC's head of delegation in South Sudan, James Reynolds, said a peace deal signed in September 2018 "has improved security, mobility, and access for humanitarian workers".   But fresh fighting in the southern Equatorias region "has made access to certain areas very difficult."

- Women bear the burden -
In opposition-held Udier, the clinic supported by the ICRC provides crucial healthcare support to the region, where like throughout South Sudan, maternal and child mortality is sky-high.   Every day a small group of patients sits outside under a fragrant Neem tree, waiting to be helped, some from nearby while others have walked for a day or two.   Oyenya says a major challenge is that women, who do all the heavy work and take care of up to 10 children, may delay bringing them to the centre in time. That can be deadly.

Sometimes the children come alone: a nine-year-old girl in a purple polka dot dress confidently tells Oyenya she is suffering from bloody diarrhoea and, she thinks, malaria. Her parents are nowhere in sight.   For anything more serious, such as pregnancy complications, blood transfusions and operations, the nearest hospital is in government-held Maban, a five-hour drive away or a three-day walk.   The other option is a three-day walk to Gambella in Ethiopia.   "They may reach there alive, or they may not reach there alive," said Oyenya.
Date: Fri, 19 Apr 2019 03:13:16 +0200
By Andrea PALASCIANO

Naftalan, Azerbaijan, April 19, 2019 (AFP) - Immersed up to her neck in a dark viscous liquid, Sulfiya smiles in delight, confident that the fetid substance will cure her painful condition.   Sulfiya, a Russian woman in her 60s, has travelled to Azerbaijan's north-western city of Naftalan in the hope that crude oil baths at a local sanatorium will end her years of suffering from polyarthritis, a disease affecting the joints.   "This is so pleasant," she enthuses, despite the reek of engine oil.

Her naked dip in oil heated to just above body temperature lasts 10 minutes, after which an attendant scrapes the brown oil off her skin and sends her into a shower.   The native of Russia's Tatarstan region said she and her friends "have long dreamed of coming" for treatment in Naftalan.   The petroleum spa resort in the oil-rich Caucasus country is a draw for visitors despite its proximity to Nagorny Karabakh, a region disputed between Azerbaijan and Armenia in a long-running armed conflict.

After 10 days of bathing in crude oil Sulfiya says she now feels "much better" and has even reduced her medication for the polyarthritis that she has had for 12 years.   "It is a gift from God," agrees 48-year-old Rufat, an Azerbaijani journalist and opposition party member who is undergoing treatment in the sanatorium called Sehirli, or "magic" in Azerbaijani.   Azerbaijan's vast oil deposits were discovered in the mid-19th century, making what was at the time part of the Russian Empire one of the first places in the world to start commercial oil production.

Oil exports to markets all over the world are the largest sector of Azerbaijan's economy, but the crude that comes from subsoil reservoirs in Naftalan is not suitable for commercial use.   Instead the local oil is used to treat muscular, skin and bone conditions as well as gynaecological and neurological problems.   According to a legend, which spa staff readily tell clients, the healing properties of Naftalan's "miraculous oil" were discovered by accident when a camel left to die near a pool of oil was cured.

The small town of Naftalan some 300 kilometres (185 miles) from the capital Baku became a popular health resort for Soviet citizens in the 1920s.   "In the past, when there weren't any hotels or sanatoriums, people would come to Naftalan and stay with locals," said one of the doctors at the Sehirli sanatorium, Fabil Azizov, sitting in her office under a portrait of strongman President Ilham Aliyev.   "But as time passed, sanatoriums were built and treatment methods developed."

- Controversial benefits -
Some specialists warn the method has dangerous side effects.   "Despite the stories of past cures, the use of crude oil for medicinal purposes has been condemned by Western doctors as potentially carcinogenic," former journalist Maryam Omidi wrote in a 2017 book published in Britain about Soviet-era sanatoriums.

In fact, the oil at Naftalan is almost 50 percent naphthalene, a carcinogenic substance found in cigarette smoke and mothballs that in large amounts can damage or destroy red blood cells.   But doctors and patients at Naftalan brush aside any misgivings and the sanatorium even has a small museum displaying crutches that once belonged to patients who have recovered from their illnesses.

- 'We heard gunshots' -
During its heyday in the 1980s, Naftalan would host more than 70,000 visitors a year.    But in 1988, a bloody war began with neighbouring Armenia for the control of Azerbaijan's separatist Nagorny Karabakh region, which unilaterally proclaimed independence from Baku in 1991.

The conflict claimed the lives of some 30,000 people from both sides and forced hundreds of thousands to flee their homes.   A 1994 ceasefire agreement ended hostilities, but the arch foes have yet to reach a definitive peace deal and there are frequent skirmishes along the volatile frontline.   During the war, the sanatoriums in Naftalan -- a few kilometres from the frontline -- were converted into hospitals for wounded soldiers and temporary accommodation for refugees.

Over the last two decades, the Azerbaijani authorities have worked hard to re-establish Naftalan's reputation as a health resort.    They resettled refugees in other regions, demolished decrepit Soviet-era sanatoriums and built brand-new tourist facilities.   Modern Naftalan is a blend of kitsch-looking high-end spas where a week's treatment costs some 1,000 euros, and modest sanatoriums where a week's treatment costs around 100 euros.   The simmering Karabakh conflict may be out of sight, but guests can still feel uncomfortably close to the military action.   During one of the deadliest recent bouts of fighting in April 2016, "we heard gunshots," said a member of staff at Naftalan's luxurious Garabag spa, adding quickly that "everyone stayed on."
Date: Fri, 19 Apr 2019 02:59:34 +0200

Montreal, April 19, 2019 (AFP) - Three world-renowned professional mountaineers -- two Austrians and an American -- were missing and presumed dead after an avalanche on a western Canadian summit, the country's national parks agency said Thursday.   American Jess Roskelley, 36, and Austrians Hansjorg Auer, 35, and David Lama, 28, went missing Tuesday evening in Banff National Park, according to media reports. Authorities launched an aerial search the next day.

The three men were attempting to climb the east face of Howse Pass, an isolated and highly difficult route, according to Parks Canada.   They were part of a team of experienced athletes sponsored by American outdoor equipment firm The North Face, the company confirmed to AFP.   Rescuers found signs of several avalanches and debris consistent with climbing equipment, Parks Canada said, leading them to presume that the climbers were dead.

Poor weather conditions have increased avalanche risks in the mountainous area on the border between Alberta and British Columbia, with the search halted for safety reasons.   It is unlikely the three men survived, John Roskelley, father of missing Jess Roskelley, told local media in the US state of Washington.   "This route they were trying to do was first done in 2000. It's just one of those routes where you have to have the right conditions or it turns into a nightmare. This is one of those trips where it turned into a nightmare," he told the Spokesman-Review.   Himself considered one of the best American mountaineers of his generation, John Roskelley climbed Mount Everest with his son in 2003, making then 20-year-old Jess Rosskelley the youngest person to have conquered the summit.
Date: Thu, 18 Apr 2019 17:35:41 +0200

London, April 18, 2019 (AFP) - Climate change activists on Thursday brought parts of the British capital to a standstill in a fourth consecutive day of demonstrations that have so far led to more than 400 arrests.   Hundreds of protesters continued to rally at several spots in central London, where they have blocked a bridge and major road junctions this week as part of a Europe-wide civil disobedience campaign over the issue.   The Metropolitan Police said, as of 0830 GMT on Thursday, that 428 people had been arrested since the protests began on Monday, with reports of further detentions during the day.   Meanwhile, a judge denied bail to three people who appeared in court charged with obstructing the transport system at financial hub Canary Wharf on Wednesday.

District judge Julia Newton ordered the trio, who allegedly glued themselves to a train, be held in custody until their next court appearance on May 16.   Under pressure in the media to crackdown on the distruptive demonstrations, interior minister Sajid Javid warned "unlawful behaviour will not be tolerated" after meeting Met Commissioner Cressida Dick.   "No one should be allowed to break the law without consequence," he said in a statement, adding he expected police "to take a firm stance".   Protesters have been snaring traffic and setting up impromptu encampments at Waterloo Bridge, Parliament Square and at Oxford Circus in London's busy West End entertainment and shopping district.   They laid trees in pots along the bridge's length and also set up camps in Hyde Park in preparation for further demonstrations.

More than 1,000 officers were being deployed to the streets of the capital each day this week, according to the interior ministry.   The police have ordered the protesters to confine themselves to a zone within Marble Arch, a space at the junction of the park, Oxford Street and luxury hotel-lined Park Lane.   The protests are being spearheaded by the "Extinction Rebellion" activist group, which was established last year in Britain by academics and has become one of the world's fastest-growing environmental movements.   It has vowed to maintain the protests for weeks in a bid to force state action over climate change, with Heathrow Airport -- Europe's busiest flight hub -- the latest site to be targeted on Friday.

The group wants the British government to declare a climate and ecological emergency, reduce greenhouse gas emissions to zero by 2025, halt biodiversity loss and be led by new "citizens' assemblies on climate and ecological justice".   Its protesters say they are practising non-violent civil disobedience and aim to get arrested to raise awareness of their cause.    The majority arrested this week were detained for breaching public order laws and obstructing a highway.   However, police seized three men and two women outside the UK offices of energy giant Royal Dutch Shell on suspicion of criminal damage after they allegedly daubed graffiti and smashed a window there.
Date: Thu, 18 Apr 2019 07:40:27 +0200

Taipei, April 18, 2019 (AFP) - A 6.0-magnitude earthquake jolted Taiwan on Thursday, the US Geological Survey said, shaking buildings and disrupting traffic.   In the capital Taipei, highrises swayed violently while some panicked school children fled their classrooms in eastern Yilan county, according to reports.      Local media said the quake had been felt all over the island and a highway connecting Yilan and Hualien was shut down due to falling rocks.    The quake struck at 13:01 pm (0501 GMT) at a depth of 19 kilometres (11.8 miles) in eastern Hualien county. There were no immediate reports of casualties.

The island's central weather bureau put its magnitude at 6.1.   The Japan Meteorological Agency warned people living near the coast could notice some effects on sea levels, but said there would be no tsunami.   "Due to this earthquake, Japan's coastal areas may observe slight changes on the oceanic surface, but there is no concern about damage," the agency said.   Hualien was hit by a 6.4 magnitude earthquake last year that killed 17 people.    Taiwan lies near the junction of two tectonic plates and is regularly hit by earthquakes.    The island's worst tremor in recent decades was a 7.6 magnitude quake in September 1999 that killed around 2,400 people.
Date: Thu, 18 Apr 2019 03:07:58 +0200

Canico, Portugal, April 18, 2019 (AFP) - Twenty-nine German tourists were killed when their bus spun off the road and tumbled down a slope before crashing into a house on the Portuguese island of Madeira.   Drone footage of the aftermath of the accident showed the badly mangled wreckage of the bus resting precariously on its side against a building on a hillside, the vehicle's roof partially crushed and front window smashed.

Rescue workers attended to injured passengers among the undergrowth where the bus came to rest, some of them bearing bloodied head bandages and bloodstained clothes, others appearing to be more seriously hurt.   Local authorities said most of the dead were in their 40s and 50s.   They were among the more than one million tourists who visit the Atlantic islands off the coast of Morocco each year, attracted by its subtropical climate and rugged volcanic terrain.   "Horrible news comes to us from Madeira," a German government spokesman tweeted after the crash.   "Our deep sorrow goes to all those who lost their lives in the bus accident, our thoughts are with the injured," he added.

German holidaymakers were the second largest group after British tourists to visit the islands -- known as the Pearl of the Atlantic and the Floating Garden in the Atlantic -- in 2017, according to Madeira's tourism office.    The islands are home to just 270,000 inhabitants.    Filipe Sousa, mayor of Santa Cruz where the accident happened, said 17 women and 11 men were killed in the crash, with another 21 injured.    A doctor told reporters another woman died of her injuries in hospital.   "I express the sorrow and solidarity of all the Portuguese people in this tragic moment, and especially for the families of the victims who I have been told were all German," President Marcelo Rebelo de Sousa told Portuguese television.   He said he would travel to Madeira overnight.

- 'Profound sadness' -
Portuguese Prime Minister Antonio Costa added on Twitter that he had contacted German Chancellor Angela Merkel to convey his condolences   "It is with profound sadness that I heard of the accident on Madeira," he wrote on the government's Twitter page.   "I took the occasion to convey my sadness to Chancellor Angela Merkel at this difficult time," he added.  The regional protection service in Madeira confirmed 28 deaths in the accident that happened at 6:30 pm (1730 GMT) Wednesday, while hospital authorities said another woman later died of her injuries.

The bus had been carrying around 50 passengers.   Regional government Vice President Pedro Calado said it was "premature" to speculate on the cause of the crash, adding that the vehicle was five years old and that "everything had apparently been going well".   Judicial authorities had opened an investigation into the circumstances of the accident, the Madeira public prosecutor's office told the Lusa news agency.   Medical teams were being sent from Lisbon to help local staff carry out post-mortems on the dead.
Tanzania - National. 11 Apr 2019

Tanzania on Thursday [11 Apr 2019] confirmed an outbreak of dengue fever, saying the business capital, Dar es Salaam, has reported 252 cases and Tanga has 55 diagnosed cases.
- La Reunion. 10 Apr 2019

From 800 confirmed cases the previous week, the dengue epidemic increased to 904 cases in the week.
<https://la1ere.francetvinfo.fr/reunion/dengue-barre-900-cas-confirmes-semaine-est-depassee-698934.html> [in French, trans. ProMED Corr.SB]

- La Reunion. 12 Apr 2019. Dengue La Reunion (French overseas territory): dengue cases near 5000 in Q1 2019. New transmission zones have been identified in Saint-Andre, Saint-Denis, Sainte-Marie, and Sainte-Suzanne. In addition, the number of hospitalizations is increasing with 25-30 recorded weekly.

- La Reunion. 27 Mar 2019. The circulation of the dengue virus continues at a sustained level, say the prefecture and the ARS. From 11-17 Mar 2019, 682 cases of dengue fever were confirmed. Since the beginning of the year [2019], 153 emergency room visits have been recorded and 80 patients have been hospitalized. In addition, 5 deaths have been reported since the beginning of 2019, of which 2 have been considered, after investigation, as directly related to dengue fever. The most active households are located at: the Saint-Louis River, Saint Louis, Saint Pierre, the Etang-Sale Cabris Ravine.
- Cook Islands. 12 Apr 2019

As of Wednesday [10 Apr 2019], the Ministry for Health has 18 confirmed and 12 probable dengue fever cases. This is a total of 30 cases compared to 24 previously identified.
- Taihiti (French Polynesia). 13 Apr 2019

DEN-2 confirmation of several autochthonous cases