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United Arab Emirates

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our Customs Information.

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

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

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

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our information on Criminal Penalties.

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Niue

No Profile is available at present

Travel News Headlines WORLD NEWS

20th July 2012

- Niue Island. 20 Jul 2012. Two tourists visiting Niue have been taken to hospital with dengue fever. More than 100 people, or about 8 percent of the population, are believed to be suffering from the fever, and visitors are being warned to use insect repellent during early morning and evening. Dengue, which does not often occur on Niue, has been afflicting  the island since February [2012]. It was originally confined to a small area of Niue's main village but has now spread throughout the island. One local man recently died from a serious form of the virus.
==================
[A HealthMap/ProMED-mail interactive map showing the location of Niue Island in the Pacific Ocean can be accessed at <http://healthmap.org/r/1ZWb>. - ProMed Mod.TY]
Monday 30th April 2012
A ProMED-mail post
<http://www.promedmail.org>

- Niue Island. 24 Apr 2012. The Niue Health Department says it believes the dengue outbreak has peaked. The department says there have been 47 recorded cases of dengue fever, but only one case has been picked up in the last 7 days. The Acting Director of Health, Manila Nosa, says it's a relief to see the wane in cases, but it's too early to say that dengue is completely gone. He said that there has been a lot of rain lately, and it's hoped this won't contribute to a further spread.
======================
[A HealthMap/ProMED-mail interactive map of Niue Island can be accessed at <http://healthmap.org/r/1ZWb>. - ProMed Mod.TY]
Monday 16th April 2012
A ProMED-mail post
<http://www.promedmail.org>

- Niue Island. 12 Apr 2012. Health authorities on Niue are confident that they are on top of the latest dengue outbreak that has infected 20 people to date. The chief medical officer, Dr Eddie Akau'ola, says this outbreak began about 3 weeks ago but they believe they have been able to contain it. He says it is peaking now and they expect a decline in a week or 2. Dr Akau'ola says none of the cases have been too serious.
====================
[A HealthMap/ProMED-mail interactive map showing the location of Niue Island in the Pacific can be accessed at <http://healthmap.org/r/2bMz>. - ProMed Mod.TY]
Tuesday 13th March 2012
A ProMED-mail post
<http://www.promedmail.org/>

- Niue Island. 6 Mar 2012. Niue health authorities are hopeful they've contained a rare outbreak of dengue fever on the island where 3 people were reported with dengue last week, with 2 admitted to hospital.
======================
[A HealthMap/ProMED-mail interactive map showing the location of Niue Island in the Pacific can be accessed at <http://healthmap.org/r/1ZWb>. - ProMed Mod.TY]
Date: Sun, 24 Jul 2011 10:42:49 +0200 (METDST)
by Neil Sands

ALOFI, Niue, July 23, 2011 (AFP) - In a once-thriving village on the Pacific island of Niue, homes lie abandoned, their stucco-clad walls mildewed and crumbling as the jungle slowly reclaims them. "These villages used to be bustling with people -- now you go there in the afternoon and there's no one," says the Niue Tourism Authority chairman Hima Douglas. The number of people living on the lush coral atoll, about 2,500 kilometres (1,550 miles) northeast of New Zealand, has been declining for decades as inhabitants seek a better life overseas.

The population, which peaked at more than 5,000 in the mid-1960s, has dwindled to just 1,200, according to a New Zealand parliamentary report, raising doubts about the island nation's economic viability.  Douglas said a major cyclone in 2004, which destroyed much of Niue's infrastructure, accelerated the exodus, and the threat of future natural disasters was discouraging people from returning. "Of course it's concerning but it's not something we can do too much about until we can build an economy that will give them the confidence to come back," Niue's Premier Toke Talagi told reporters this month. "There aren't simple and easy answers to people leaving. We've got to build a strong economy and hope to attract them back." Known locally as "The Rock", Niue was settled by Polynesian seafarers more than 1,000 years ago and the palm-dotted island's name in the local language means "behold, the coconut".

The British explorer captain James Cook tried to land there three times in 1774 but was deterred by fearsome warriors, eventually giving up to set sail for more welcoming shores and naming Niue "savage island" on his charts. But modern day Niueans are desperate for visitors, with Talagi unveiling plans this month to turn it into a boutique tourism destination in a bid to put his nation on a sound economic footing. Using aid from New Zealand, with which Niue has a compact of free association giving its people dual citizenship, Talagi has overseen construction of a new tourism centre and expansion of the island's Matavai Resort.

Paths have also been cut through the jungle to give visitors access to swimming spots on the rugged limestone coastline, and cruise liners are being encouraged to include Niue on their itineraries. "We can become self-sustaining in the long term (and) reduce New Zealand assistance to Niue," Talagi said, estimating that visitor numbers could quadruple to 20,000 a year in the next decade. Addressing a visiting delegation of New Zealand business executives this month, Talagi acknowledged doubts about the nation's ability to meet the challenge. "I know some of you are a bit sceptical about our ability to become self sustaining... (but) tourism is not going to fail and I don't expect it to fail given the numbers that are being generated," he said.

The New Zealand parliamentary report, released last December, estimates that about 50,000 Niueans and their children now live in Australia and New Zealand, creating a shortage of skilled labour in one of the world's smallest states. "Niue is caught in a vicious cycle, with its economic difficulties both exacerbated by, and reflected in, the long-term decline of its population," it said, adding that 40 years of New Zealand aid "has yielded almost no return". The report's authors suggested Niue should concentrate on promoting itself as a retirement destination for elderly New Zealanders, who could help revitalise the economy. "The climate is excellent, existing buildings could be brought into service, and health facilities are satisfactory," it said. "Retirees would bring steady cash flow and contribute to stable employment options."

Asked about the suggestion, Talangi said "we'll look at everything", although one long-time resident, who asked not to be named, was unenthusiastic at the prospect. "How depressing to think that we might be turned into a major geriatric ward," she said. "Not that I have anything against old people, mind." Another resident said that whatever steps Niue took to improve its economy must result in major changes, pointing out people could earn more by moving to New Zealand and claiming unemployment benefits than working on the island. "It's pretty hard when your cuzzies (cousins) call you and say 'we're getting more on the dole in Auckland than you're getting paid'," he said.
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Aruba

Aruba US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
Aruba is an autonomous part of the Kingdom of the Netherlands. Tourist facilities are widely available. Read the Department of State Background Notes on Aruba for addi
ional information.

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

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

In addition visitors to Aruba may be asked to show onward/return tickets, proof of sufficient funds and proof of lodging accommodations for their stay. Length of stay for U.S. citizens is granted for thirty days and may be extended to 180 days by the office of immigration.
For further information, travelers may contact the Royal Netherlands Embassy, 4200 Linnean Avenue NW, Washington, DC
20008, telephone (202) 244-5300, or the Dutch Consulate in Los Angeles, Chicago, New York, Houston or Miami.
Visit the web site for the Embassy of the Netherlands at http://www.netherlands-embassy.org and the Aruban Department of Immigration at http://www.aruba.com/about/entryrequirements.php 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: There are no known extremist groups, areas of instability or organized crime on Aruba, although drug trafficking rings do operate on the island.
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 Worldwide Caution, Travel Warnings, and Travel Alerts can be found.

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

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

CRIME: The crime threat in Aruba is generally considered low although travelers should always take normal precautions when in unfamiliar surroundings.
There have been incidents of theft from hotel rooms and armed robberies have been known to occur. Valuables left unattended on beaches, in cars and in hotel lobbies are easy targets for theft.
Car theft, especially that of rental vehicles for joy riding and stripping, can occur. Vehicle leases or rentals may not be fully covered by local insurance when a vehicle is stolen or damaged.
Be sure you are sufficiently insured when renting vehicles and jet skis.

Parents of young travelers should be aware that the legal drinking age of 18 is not always rigorously enforced in Aruba, so extra parental supervision may be appropriate. Young female travelers in particular are urged to take the same precautions they would when going out in the United States, e.g. to travel in pairs or in groups if they choose frequenting Aruba’s nightclubs and bars, and if they opt to consume alcohol, to do so responsibly.

Anyone who is a victim of a crime should make a report to Aruban police as well as report it immediately to the nearest U.S. consular office.
Do not rely on hotel/restaurant/tour company management to make the report for you.

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 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.

Please see our information for American Victims of Crime Overseas.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is good in Aruba. There is one hospital, Dr. H.E. Oduber Hospital, whose medical standards can be compared with an average small hospital in the U.S. The hospital has three classes of services and patients are accommodated according to the level of their insurance (i.e. first class: one patient to a room, TV, better food; second class: two to three patients to a room, shared bathroom, etc; third class: 15 to 20 people in one hall). There is a small medical center in San Nicolas. The many drug stores, or “boticas” provide prescription and over the counter medicine. Emergency services are usually quick to respond.
There are no country-specific health concerns.

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

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. 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 Aruba is provided for general reference only and may not be totally accurate for a particular location or circumstance.

Driving in Aruba is on the right-hand side of the road. Local laws require drivers and passengers to wear seat belts and motorcyclists to wear helmets. Children under 5 years of age should be in a child safety seat; older children should ride in the back seat. Right turns on red are prohibited in Aruba.

Aruba's main thoroughfare, L.G. Smith Boulevard, is well lit and most hotels and tourist attractions can be easily located.
There is a speed limit in Aruba and driving while intoxicated may result in the loss of a driver’s license and/or a fine.
However, these are not consistently enforced.
Drivers should be alert at all times for speeding cars, which have caused fatal accidents.
In the interior areas of the island, drivers should be alert for herds of goats or donkeys that may cross the roads unexpectedly.
Buses provide convenient and inexpensive service to and from many hotels and downtown shopping areas.
Taxis, while expensive, are safe and well regulated.
As there are no meters, passengers should verify the price before entering the taxi.
The emergency service telephone number is 911. Police and ambulance tend to respond quickly to emergency situations.

Please refer to our Road Safety page for more information. Also, travelers may wish to visit the web site of the country’s national tourist office and national authority responsible for road safety in Aruba for information: http://www.aruba.com/pages/traffictips.htm.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Aruba’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Aruba’s air carrier operations. For more information, travelers may visit the FAA web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: The time-share industry and other real estate investments are two of the fastest-growing tourist industries in Aruba. Time-share buyers are cautioned about contracts that do not have a "non-disturbance or perpetuity protective clause" incorporated in the purchase agreement.
Such a clause gives the time-share owner perpetuity of ownership should the facility be sold.
Americans have also sometimes complained that the time-share units are not adequately maintained, despite generally high annual maintenance fees.

Potential investors should be aware that failed land development schemes involving time-share investments could result in financial losses. Interested investors may wish to seek professional advice regarding investments involving land development projects. Real estate investment problems that reach local courts are rarely settled in favor of foreign investors.

An unusually competitive fee to rent jet skis or other water sports equipment could indicate that the dealer is unlicensed or uninsured. Visitors planning to rent jet skis or other water sports equipment should carefully review all liability and insurance forms presented to them before signing any contracts or agreements. The renter is often fully responsible for replacement costs and fees associated with any damages that occur during the rental period. Visitors may be required to pay these fees in full before being allowed to leave Aruba, and may be subject to civil or criminal penalties if they cannot or will not make payment.

Dutch law in principle does not permit dual nationality. However, there are several exceptions to the rule. For example, American citizens who are married to Dutch citizens are exempt from the requirement to abandon their American nationality when they apply to become a Dutch citizen by naturalization. For detailed information, contact the Embassy of the Netherlands in Washington, DC, or one of the Dutch consulates in the U.S.
Please see our information on customs regulations.

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 Aruba’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Aruba are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues web pages.
REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Aruba 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 Aruba. 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. Consulate General is located at J.B. Gorsiraweg 1, Willemstad, Curaçao, telephone number (599-9) 461-3066; fax (599-9) 461-6489; e-mail address: acscuracao@state.gov
* * *
This replaces the Consular Information Sheet dated January 3, 2008, to update Entry/Exit Requirements and Crime sections.

Travel News Headlines WORLD NEWS

Date: Sat, 20 Jun 2009 10:52:09 +0200 (METDST)

MADRID, June 20, 2009 (AFP) - A Spanish cruise ship was turned away from three Caribbean islands after swine flu cases emerged among the crew and the 800-odd passengers finally got off in Aruba, the tour operator said Saturday.   The "Ocean Dream" docked in Aruba late Friday after being denied entry in Grenada, Saint Lucia and Barbados, Pullmantur said. Three swine flu cases were reported among the crew but the passengers were unaffected.

On Thursday, 376 Venezuelan passengers were allowed to disembark on the island of Margarita, which belongs to Venezuela.   The ship's nine-day cruise through the Caribbean was hampered by the flu outbreak and the ship could not dock at three destinations on the itinerary.   The A(H1N1) virus has infected more than 44,000 people around the world, resulting in 180 deaths since late March, WHO figures show.
Date: Wed 14 Jan 2009
Source: Amigoe.com [Dutch, machine trans., edited]

Department of Health has called an urgent press conference on Tuesday [13 Jan 2009] to issue a dengue update. The department has done this following the hundreds of calls that have come into Health, after media reports of a 53-year-old woman who died of dengue [virus infection].

According to Trevor Gellecum, Director of Health, it is still not clear that this woman indeed died of dengue. "First, certain tests can be carried out, and it will be 3 weeks before the results could be known," says Van Gellecum. "These tests should be carried out in a laboratory abroad."

According to Wilmer Salazar, microbiologist at Health, the woman had a fever at the weekend, but on Monday [12 Jan 2009] she felt better and she went to work. "Later that day, she was admitted to the hospital in shock. At night she died, "said Salazar. "Until now, there is no confirmed diagnosis of the cause of death, but dengue is suspected. Today [14 Jan 2009], an autopsy was performed so that the tests to be done abroad can take place."

Maribel Tromp, manager at the department of epidemiology and research of the Infectious Disease Service, has indicated that so far 612 suspected cases of dengue have been registered. "Of these, 218 cases [have been] confirmed as positive by the laboratory, and 394 are still under investigation, reports Tromp. "This does not mean that they are negative" [The dates over which these cases occurred are not specified. - ProMed Mod.TY].

 From the moment the news of a potentially fatal dengue victim arose lately, Charline Koolma, director of the Yellow Fever Fight Unit (GKMB), indicated that they have been overwhelmed with calls from people reporting family members possibly with dengue-like symptoms or who want information about the disease. "It is good that we now receive phone calls, although it also had previously been possible. These kinds of extreme cases can be avoided," according Koolman.

"From November last year [2008], the GKMB made several visits to monitor presence of [the dengue virus vector mosquito _Aedes_] breeding sites and adult mosquitoes. Often, the residents are not home, and then a letter was left with an invitation to make contact with the GKMB for the transmission of important information. But there is never a return call until something bad happens, and then it is often too late."

The more information and reports the GKMB gets, the better the service and their work, said Tromp. Finally, all speakers [at the press conference] called on the population and general practitioners to join forces against breeding of the _Aedes_ dengue vector mosquito. Health officials indicated that is the only way to avoid [virus] infection and prevent dengue.
------------------------
[A map showing the location of Aruba in the Caribbean can be accessed at <http://www.aruba-travelguide.com/map/index.html>. - ProMed Mod.TY]
Date: Sun, 2 Sep 2007 19:04:55 +0200 (METDST) MIAMI, Sept 2, 2007 (AFP) - Hurricane Felix barreled through the Caribban Sunday, with forecasters predicting a brush with Aruba and warning of its potential to strengthen into a devastating storm. Forecasters issued a tropical storm warning and hurricane watch for the islands of Aruba, Bonaire and Curacao -- popular tourist destinations in the Netherlands Antilles. A tropical storm watch also has been issued for Jamaica, which was gearing up for violence-marred elections Monday, after Felix was upgraded overnight to Category Two strength on the Saffir-Sampson scale, which peaks at five. At around 1500 GMT Felix's maximum sustained winds were 105 miles (165 kilometers) per hour, and its trek across the open waters of the Caribbean could allow it to attain "major hurricane" status, US forecasters said. "I see no reason why Felix will not become a major hurricane within 12 hours or so," said Richard Pasch, a hurricane specialist with the National Oceanographic and Atmospheric Administration. On Saturday, a weaker Felix passed close to Grenada, reportedly ripping roofs, downing power lines and knocking radio and TV stations off the air. No injuries were reported. The center of the hurricane around 1600 GMT Sunday was about 50 miles (75 kilometers) north of Aruba and about 550 miles (900 kilometers) southeast of Kingston, Jamaica. Felix was moving in a west-northwesterly direction at around 18 miles (30 kilometers) per hour, and was expected to follow the same course throughout Sunday. The storm was not expected to hit Jamaica directly, but its strong outer squalls could rock the island ahead of the elections on Monday. Jamaican officials had already postponed the general election from August 27, after the island was struck last month by Hurricane Dean. Last week, Dean swept through the southern Caribbean with severe winds and rains, leaving a wide swathe of damage and a death toll of 30 from Martinique to Mexico. Felix's track was expected to take it toward Belize or the Yucatan in Mexico, possibly making landfall as a major Category Three hurricane Wednesday. The storm could dump two to four inches (five to 10 centimeters) of rain over islands off the Venezuela coast and the Netherlands Antilles, US forecasters said. On its current path Felix is expected to graze the coastlines of Nicaragua and Honduras late Tuesday and make landfall in Belize on Wednesday. Felix is the second hurricane of the three-month-old Atlantic season, and the first in September, historically the busiest month for hurricanes.
Date: Thu, 9 Sep 2004 10:12:08 +0200 (METDST) CARACAS, Sept 9 (AFP) - Hurricane Ivan has killed at least 11 people in Tobago, Grenada and Venezuela as the it churned off Venezuela's coast Thursday, strengthening to the top Category 5 storm, officials and local media said. Ivan was 135 kilometers (85 miles) northeast of Aruba and 915 kilometers (570 miles) from Jamaica, the Miami-based National Hurricane Center said at 0600 GMT. Its category was raised to a Category 5 hurricane -the top level on the Saffir Simpson hurricane scale, with maximum sustained winds near 255 kilometers (160 miles) per hour. "Some fluctuations in strength are likely," the center said. The "extremely dangerous" hurricane was moving west-northwest at 28 kilometers (17 miles) per hour with urricane force winds extend outward from Ivan's eye up to 95 kilometers (60 miles). Storm surges of 1.0-1.5 meters (three to five feet) as well as rains of 13-18 centimeters (seven five to seven inches) are to be expected. The center issued hurricane warnings for Aruba, Bonaire and Curacao. A television station in Trinidad and Tobago said nine people had died in Grenada, a tiny island nation of 90,000 inhabitants, which Prime Minister Keith Mitchell said was 85 percent destroyed. Power lines were down and hundreds of persons have taken refuge in shelters. Mitchell, whose own house was destroyed, told a Trinidad radio station that the island is without electricity. Another woman was killed by a falling tree in Tobago, according to local media. Prime Minister Patrick Manning headed to Tobago to view the destruction. His government has promised 1.6 million dollars to St. Vincent to help with the construction. Hundreds were evacuated to shelters. Cuba has also begun preparing for the storm in 11 of its 14 provinces, although the island has not fully recovered from Hurricane Charley, which struck August 13. Children in the Netherlands Antilles were sent home from school, as were many workers. Several Venezuelan airports, including the oil-exporting country's main international airport, Maiquetia, which serves Caracas, suspended operations until conditions improve, Air Force colonel Francisco Paz Freitas told Union Radio. In Venezuela, a man was crushed to death when hurricane-force winds toppled a wall in a coastal town near Caracas, emergency service officials said, adding that another person was hurt and 150 people were affected by flooding. Along the low-lying Caribbean coast, authorities reported mudslides and road closings just as early rain bands from the storm unleashed the first downpours. The storm was expected to be off the central coast later in the day, triggering heavy rains and rough surf. The capital, Caracas, lies just a bit inland from there, protected somewhat by the El Avila mountain range. Though the storm is not expected to make landfall in Venezuela, Interior and Justice Minister Jesse Chacon was urging calm and said heavy winds and rain associated with the storm could last for 72 hours. Ivan was expected to pass just north of Aruba, Bonaire and Curacao on Friday as the Caribbean islands were under a hurricane warning, which means hurricane winds could hit them within 24 hours or less, the US hurricane center said. A hurricane watch and a tropical storm warning remain in effect for the Guajira peninsula of Colombia and for the entire northern coast of Venezuela, it noted. Haiti also issued a hurricane watch, meaning it could experience hurricane conditions within 36 hours.
Date: Wed, 8 Sep 2004 05:03:07 +0200 (METDST) PORT-OF-SPAIN, Trinidad Sept 7 (AFP) - Ivan, an "extremely dangerous" hurricane Tuesday knocked out power in Barbados and threatened eastern Caribbean islands, forecasters and emergency officials said. The eye of the powerful storm moved over Barbados Tuesday afternoon, and headed for the eastern Caribbean, where officials issued a hurricane warning for St Vincent, the Grenadines, Grenada and the Netherlands Antilles islands of Aruba, Bonaire and Curacao. Ivan packed sustained winds of 215 kilometers (135 miles) per hour, which made it "an extremely dangerous category four hurricane," the Miami-based National Hurricane Center (NHC) said. In Barbados, "there is an island-wide power outage, expect for the major health care facility, the Queen Elizabeth Hospital," the Caribbean Disaster Emergency Response Agency (CDERA) said. "There are also reports of roof loss, downed utility poles and trees," the agency said, adding that there were also reports of coastal damage from storm surge. Late Tuesday night, the center of the powerful hurricane, the second in just days, was located 175 kilometers (110 miles) west of Grenada. The Netherlands Antilles Tuesday morning put the islands of Aruba, Bonaire and Curacao under a hurricane watch, which means the storm could hit them within 36 hours. In central and eastern Venezuela, officials suspended all air and maritime traffic. Long-term forecasts, which have a wide margin of error, have the hurricane slamming into Jamaica on Friday and then into Cuba on Sunday. This would bring the storm dangerously close to Florida, which has just been pounded by Frances, the second hurricane to hit the southeastern US state in three weeks. The Bahamas islands also were severely impacted by the passage of Frances last week.
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North Korea

Democratic People's Republic of Korea US Consular Information Sheet
April 29, 2008
Prior to departing the United States, U.S. citizens planning to transit China on their visit to North Korea are encouraged to register on line with the U.S. Emba
sy in Beijing; U. S. citizens transiting South Korea to take the Mount Kumgang or Kaesong City tours should register with the U.S. Embassy in Seoul.
U. S. citizens visiting North Korea should also register with the Swedish Embassy in Pyongyang (U.S. Protective Power).
Please see the Registration/Embassy Location section below.

COUNTRY DESCRIPTION: The Democratic People’s Republic of Korea (North Korea or the DPRK) is a highly militaristic Communist state located on the Korean Peninsula between northeast China and the Republic of Korea (South Korea or ROK), with land borders with China, Russia and South Korea.
The DPRK is one of the world’s most isolated countries.
The continuing dispute over North Korea’s development of nuclear programs and nuclear weapons has resulted in tensions in the region and between the United States and the DPRK.
North Korea limits trade and transportation links with other countries and tightly restricts the circumstances under which foreigners may enter the country and interact with local citizens.
Telephone and fax communications are unavailable in many areas of the country and foreigners can expect their communications to be monitored by DPRK officials.
In the past few years, North Korea has experienced famine, flooding, fuel and electricity shortages, and outbreaks of disease.
Many countries, including the United States, have contributed to international relief efforts to assist the people of North Korea.

Foreign tourists are a means for North Korea to earn much needed foreign currency, but an underdeveloped service sector, inadequate infrastructure, and political tensions with surrounding countries have stymied any significant tourist flow.
North Korean efforts to expand tourism have focused primarily on group tours from China, as well as from South Korea primarily to the Mount Kumgang tourist area and the city of Kaesong.

The United States does not maintain diplomatic or consular relations with the DPRK.
The Swedish Embassy located in Pyongyang acts as the United States’ interim consular protective power and provides basic consular services to U.S. citizens traveling in North Korea.
Please refer to Special Circumstances for additional information.

Read the Department of State Background Notes on North Korea for additional information.

ENTRY/EXIT REQUIREMENTS: North Korean visas are required for entry.
The U.S. Government does not issue letters to private Americans seeking North Korean visas, even though in the past such letters have sometimes been requested by DPRK embassies.
Prospective travelers entering and departing North Korea through China must also obtain a two-entry visa for China, as a valid Chinese visa is essential for departing North Korea at the conclusion of a visit or in an emergency.
While the ROK government is attempting to open direct travel routes to the DPRK, routine travel from the ROK to the DPRK is currently prohibited.
Travel across the demilitarized zone (DMZ) is allowed only infrequently for official and government-authorized cultural and economic exchanges, or aid shipments, and for tours limited to Mt. Kumgang and Kaesong City.
There are no regularly operating direct commercial flights from South Korea to North Korea.
U.S. citizens who arrive in North Korea without a valid U.S. passport and North Korean visa may be detained, arrested, fined or denied entry.
Travelers to North Korea report that fees for local travel costs (taxi, tolls, permits and the cost for security personnel assigned to escort foreigner visitors) can be high and arbitrary.

Where to obtain a North Korean visa: There is no DPRK embassy in the United States.
U.S. citizens and residents planning travel to North Korea must obtain DPRK visas in third countries, for example in Beijing, China.
For information about entry requirements and restricted areas, contact the DPRK Mission to the United Nations in New York.
Address inquiries to:

The Permanent Representative of the Democratic
People’s Republic of Korea to the United Nations
820 Second Avenue
New York, NY
10017
Tel: (212) 972-3105
Fax: (212) 972-3154

Americans living abroad can contact the DPRK embassy, if any, in their country of residence.
U.S. citizens traveling to North Korea may obtain their visas at the DPRK Embassy in Beijing, China, which will issue visas only after receiving authorization from the DPRK Foreign Ministry in Pyongyang.
Prior to traveling to the region, travelers may wish to confirm that authorization to issue their visa has been received from Pyongyang.
Americans can call the North Korean Embassy in Beijing prior to their travel by telephone at (86-10) 6532-1186 or (86-10) 6532-1189 (fax: (86-10) 6532-6056).

Information on dual nationality or the prevention of international child abduction can be found on our website.
For further information about customs regulations, please read our Customs Information sheet.
Please see those sections below under Special Circumstances.

SAFETY AND SECURITY: DPRK government security personnel closely monitor the activities and conversations of foreigners in North Korea.
Hotel rooms, telephones and fax machines may be monitored, and personal possessions in hotel rooms may be searched.
Photographing roads, bridges, airports, rail stations, or anything other than designated public tourist sites can be perceived as espionage and may result in confiscation of cameras and film or even detention.
DPRK border officials routinely confiscate visitors’ cell phones upon arrival, returning the phone only upon departure.
Foreign visitors to North Korea may be arrested, detained or expelled for activities that would not be considered criminal outside the DPRK, including involvement in unsanctioned religious and political activities, engaging in unauthorized travel, or interaction with the local population.
For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site
at where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on worldwide 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: The North Korean government does not release statistics on crime.
Violent crime is rare and street crime is uncommon in Pyongyang.
Petty thefts have been reported, especially at the airport in Pyongyang.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and to the Swedish Embassy.
If you are a victim of any crime while in North Korea, in addition to reporting to local police, please contact the Swedish Embassy for assistance (address and phone number below).

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Persons with medical problems should not travel to North Korea.
For decades, medical facilities in the DPRK have suffered from a lack of resources and electricity, as well as inadequate and often outdated skills among the medical staff.
Hospitals in Pyongyang can perform basic examinations and lifesaving measures but functioning x-ray facilities are not generally available.
Surgery should be avoided.
For accidents outside Pyongyang, transport back to the capital can be a lengthy trip without medical assistance.
Persons requiring regular medication are encouraged to bring sufficient stocks of drugs for personal use since most drugs are impossible to obtain locally.
Hospitals will expect immediate U.S. dollar cash payment for medical treatment.
Credit cards and checks have not been honored in the past, according to diplomatic personnel stationed in the DPRK.
Local DPRK hosts are often not aware of available evacuation options and might claim that no such options exist.
In case of serious medical problems, it is important to insist on immediate contact with the Swedish Embassy.
The Swedish Embassy can arrange a medical evacuation to Beijing within approximately 5-10 hours.

Vaccinations.
All necessary vaccinations should be received prior to traveling to North Korea.
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 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.
Travelers with special dietary requirements are advised to bring food with them to North Korea, as the restaurants available to foreigners may have limited menus that lack variety and nutritional adequacy.

Medical Vaccinations. In the case of a critical illness or accident, the Swedish Embassy will attempt to arrange flight clearances for air ambulances performing emergency medical evacuations.
Medical air evacuation costs vary, but average approximately $40,000 to $50,000 for medical, personnel, aircraft and clearance costs.
Clearances can usually be arranged within one day.
Medical evacuation by regularly scheduled airlines can be arranged, but is limited to the very few flights that operate from Pyongyang to Beijing, Dalian, Shenyang and Macau.
Chinese visas for injured foreigners and any escorts must be obtained prior to the evacuation from North Korea in order to transit China.
Even in the case of a medical emergency, transit visas may take several days to arrange.
Evacuation across the DMZ to South Korea is not allowed.

If an American citizen falls ill or is injured while traveling in the DPRK, accompanying travelers or family members should immediately contact the Swedish Embassy using the phone numbers listed below.

The Embassy of Sweden,
Munsu-Dong District,
Pyongyang, DPRK

Telephone and fax numbers for the Swedish Embassy (U.S. Protective Power) are:
Tel:
(850-2) 3817 485 (Reception)


(850-2) 3817 904, 907(First Secretary)


(850-2) 3817 908, 905 (Ambassador)
Fax:
(850-2) 3817 663
Email:
ambassaden.pyongyang@foreign.ministry.se
Notification also should be made to the U.S. Embassy’s American Citizen Services (ACS) Unit in Beijing, China, using the phone numbers listed below:

U.S. Embassy, Beijing
American Citizen Services
2 Xiushui Dong Jie
Beijing, China 100600
Telephone: (86-10) 6532-3431
Fax: (86-10) 6532-4153.

After hours, please call (86-10) 6532-3431 and ask for the Embassy duty officer.
Americans who wish to contact U.S. consular officials in China can e-mail amcitbeijing@state.gov
Companies that may be able to arrange evacuation services include, but are not limited to those listed below.
Travelers may wish to contact these or other emergency medical assistance providers for information about their ability to provide medical evacuation insurance and/or assistance for travelers to North Korea.

SOS International (www.intsos.com)
U.S. telephone:
(1-800) 468-5232
China telephone:
(86-10) 6462-9111/9118

Medex Assistance Corporation (www.medexassist.com)
U.S. telephone:
(410) 453-6300 / 6301
Toll free:
108888-800-527-0218 (call from China)
China telephone:
(86-10) 6595-8510)

Global Doctor (www.globaldoctor.com.au/default.php)
China telephone: (86-10) 83151914).









(86-24) 24330678 in Shenyang, Liaoning Province

Useful information on medical emergencies abroad, including overseas insurance programs, is provided in the Department of State’s Bureau of Consular Affairs brochure Medical Information for Americans Traveling Abroad , available via the Bureau of Consular Affairs home page.

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 if it will cover emergency expenses such as 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 North Korea is provided for general reference only, and may not be totally accurate in a particular location or situation.

Foreigners not holding a valid DPRK driver’s license are not allowed to drive in North Korea.
Foreigners generally are not allowed to use public buses or the subway.
North Korea has a functioning rail transport system; however delays occur often, sometimes for days.
On occasion, service may cease altogether before a traveler reaches his/her final destination.
Bicycles are unavailable for rental or purchase.
Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service between the United States and North Korea, the U.S. Federal Aviation Administration (FAA) has not assessed North Korea’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s Internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:

Interim Consular Protecting Power: The United States does not maintain diplomatic or consular relations with the DPRK.
The U.S. Government therefore cannot provide normal consular protective services to U.S. citizens in North Korea.
On September 20, 1995, a consular protecting power arrangement was implemented, allowing the Swedish Embassy in the DPRK capital of Pyongyang to provide basic consular protective services to U.S. citizens traveling in North Korea who are ill, injured, arrested or who have died while there.

Consular Access:
There is no United States diplomatic or consular presence in the DPRK.
Americans traveling in the DPRK may receive limited consular services from the Swedish Embassy in Pyongyang.
Please see section above on “Medical Insurance” for address and contact information for the Swedish Embassy in Pyongyang.
U.S. citizens are encouraged to carry photocopies of their passport data and photo pages with them at all times so that, if questioned by DPRK officials, evidence of their U.S. citizenship is readily available. The U.S.- DPRK Interim Consular Agreement provides that North Korea will notify the Swedish Embassy within four days of an arrest or detention of an American citizen and will allow consular visits within two days after a request is made by the Swedish Embassy.
However, consular access has not been readily granted in cases where American citizens have been reported as being detained or held against their will by DPRK officials.
Moreover, delegations with ethnic Korean individuals, or delegations representing Korean-affiliated organizations in the U.S., are handled by DPRK structures that are well beyond the reach of diplomatic missions in Pyongyang.
Hence, in case of a situation requiring consular assistance, the Embassy’s access is even more limited.

Customs Regulations:
DPRK authorities may seize documents, literature, audio and videotapes, compact discs and letters deemed by North Korean officials to be pornographic, political or intended for religious proselytizing.
Persons seeking to enter North Korea with religious materials in a quantity deemed to be greater than that needed for personal use can be detained, fined and expelled.
It is advisable to contact the DPRK Mission to the United Nations or a DPRK embassy or a DPRK consulate in a third country for specific information regarding customs requirements.
Please see our information on customs regulations.

Dual Nationality:
The DPRK does not recognize dual nationality.
U.S. citizens of Korean heritage may be subject to military obligations and taxes on foreign source income.
For further information see our dual nationality flyer.
Additional questions on dual nationality may be directed to Overseas Citizens Services, SA-29, 4th Floor, 2201 C Street NW, Washington, DC
20520 or by telephone at 1-888-407-4747.

U.S. Government Economic Sanctions Against North Korea:
At this time, goods of North Korean origin may not be imported into the United States either directly or indirectly without prior notification to and approval of the U.S. Treasury Department’s Office of Foreign Assets Control (OFAC).
Exports to North Korea may be subject to licensing requirements.
Check with the Commerce Department’s Bureau of Industry and Security.
Most financial transactions between U.S. and North Korean citizens are authorized, provided they meet the criteria outlined in the June 19, 2000, and subsequent amendments to OFAC regulations.
All transactions ordinarily incident to travel to, from and within North Korea and to maintenance within North Korea are authorized, and U.S. travel service providers are allowed to organize group travel to North Korea.
Commercial U.S. ships and aircraft carrying U.S. goods are allowed to call at North Korean ports with prior clearance.
In May 2006, OFAC began prohibiting U.S. persons from “owning, leasing, operating or insuring any vessel flagged by North Korea.”
Full text of the regulation can be found in the Federal Register at http://www.fas.usda.gov/info/fr/2000/061900-a.txt.

The U.S. maintains various export controls and other sanctions on North Korea for counter- terrorism, nonproliferation and other reasons.
Exports of military and sensitive dual-use items are prohibited, as are most types of U.S. economic assistance.
The U.S. also abides by multilateral restrictions and sanctions with respect to North Korea, including those contained in recent United Nations Security Council Resolutions in response to the North Korean missile launches and nuclear test in July and October 2006.

For additional information, consult the U.S. Department of the Treasury, Office of Foreign Assets Control (OFAC) home page on the Internet at http://www.treasury.gov/offices/enforcement/ofac/.

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.
Local laws also may not afford the protections available to U.S. citizens under U.S. law.
Penalties for breaking local laws can be more severe than those in the United States for similar offenses.
Persons violating the law, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession of, use of, or trafficking in illegal drugs are strict, and convicted offenders often face long jail sentences and heavy fines.
North Korean security personnel may view unescorted travel inside North Korea by Americans who do not have explicit official authorization as espionage, especially when the U.S. citizens are originally from South Korea or are thought to understand the Korean language.
Security personnel may also view any attempt to engage in unauthorized conversations with a North Korean citizen as espionage.
Foreigners are subject to fines or arrest for unauthorized currency transactions or for shopping at stores not designated for foreigners.
It is a criminal act in North Korea to show disrespect to the country's current and former leaders, Kim Jong-Il and Kim Il-Sung, respectively.
Foreign journalists have been threatened when questioning the policies or public statements of the DPRK or the actions of the current leadership.

Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see additional 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: There is no U.S. embassy or consulate in North Korea.

U.S. citizens planning to visit North Korea are encouraged to register prior to departing the United States with the U.S. Embassy in Beijing if entering North Korea from China.
U.S. citizens planning to visit the Mount Kumgang tourism area or Kaesong from South Korea should register with the U.S. Embassy in Seoul.
Registration can be done on line through the State Department's travel registration web site
or in person, by telephone or fax, at the U.S. Embassy.

The Embassy of Sweden (U.S. Protective Power).
Americans who have a medical or consular emergency and who wish to contact the Swedish Embassy are reminded first to communicate this need to their North Korean escorts or guides.
Do not attempt to travel to the Swedish Embassy unescorted.
The Swedish Embassy (U.S. Protective Power) is located at Munsu-Dong District, Pyongyang.
The telephone and fax numbers for the Swedish Embassy (U.S. Protective Power) are:

Tel:
(850-2) 3817 485 (reception)
Tel:
(850-2) 3817 904, (850-2) 3817 907 (First Secretary)
Tel:
(850-2) 3817 908, (850-2) 3817 905 (Ambassador)
Fax:
(850-2) 3817 663

U.S. Embassy Beijing.
The American Citizen Services Unit of the U.S. Embassy in Beijing, China, is located at:
2 Xiushui Dong Jie, Beijing.
The Embassy is located near Ritan Park.
Telephone: (86-10) 6532-3431.
Fax: (86-10) 6532-4153.
Email: amcitbeijing@state.gov.
The Embassy Beijing web site is http://beijing.usembassy-china.org.cn/.

For after-hours emergencies please call (86-10)6532-3431 and ask for the Embassy duty officer.
U.S. Embassy Seoul.
The American Citizen Services Unit of the U.S. Embassy in Seoul, South Korea, is located at:
32 Sejong-no, Jongno-gu, Seoul.
The Embassy is located across the street from Sejong Cultural Center and next to the Ministry of Information and Communication/KT Building.

Telephone: (82-2) 397-4114.
Fax: (82-2) 2-397-4101.
E-mail: seoul_acs@state.gov.
The Embassy Seoul web site is http://seoul.usembassy.gov/.

For after-hours emergencies please call (82-2) 721-4114 and ask for the Embassy duty officer.
*
*
*
*
This replaces the Consular Information Sheet dated October 15, 2007, to update the sections on Country Description, Medical Insurance, Special Circumstances, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon 23 Sep 2019
Source: Chosun [edited]

A paratyphoid fever epidemic has broken out recently in North Korea in the aftermath of Typhoon Lingling. The illness, which causes high fever and diarrhoea, has been spreading in South Hamgyong and South Pyongan provinces since typhoon Lingling hit the North, a source said Sunday [22 Sep 2019]. It is mainly transmitted by dirty water and human feces in the superannuated sewage systems and contaminated water supply.

The regime is reportedly restricting the movement of trains and vehicles to and from the 2 provinces. Meanwhile, the flooding of paddy and other grain fields in Hwanghae and Pyongan provinces is expected to devastate this year's [2019's] harvest.  [Byline: Kim Myong-song]
====================
[Paratyphoid fever is similar to typhoid fever in that both are enteric fever types of disease, although the former can be, but is not necessarily, less severe. The paratyphoid salmonellas are divided into A, B, and, rarely now, C. _Salmonella_ Paratyphi, also referred to as _S. enterica_ serotype Paratyphi, types B and C also have species, now serotypes, Schottmuelleri and Hirschfeldii, respectively. Like typhoid, paratyphoid is generally considered not to be a zoonosis, with [only] humans as the reservoir, but the paratyphoid bacillus has been isolated from domestic animals and fish.

In India, paratyphoid A has become an increasing problem, accounting for up to 45% of cases of enteric fever in 1998 (1). Although initially quite sensitive to antimicrobials, strains have become more resistant to quinolones; in contrast, _S._ Typhi has manifested resistance for some time.

In a report regarding differential risk factors for typhoid and paratyphoid in Indonesia, the authors found that the infections seemed to have distinct routes of transmission (2). Typhoid was associated with factors within a household (recent case in the house, no soap for handwashing, sharing of food from the same plate, no toilet in the house), whereas paratyphoid was associated with sources outside the household such as food from street vendors and flooding.

References
-------
1. Sood S, Kapil A, Dash N, et al.: Paratyphoid fever in India: an emerging problem. Emerg Infect Dis. 1999; 5: 483-4.
2. Vollaard AM, Ali S, van Asten Hagh, et al.: Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia. JAMA. 2004; 291: 2607-15.

A map of North Korea showing the location of these 2 adjacent provinces in the central part of the country can be seen at <http://annamap.com/north-korea/>. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
South Hamgyeong Province, North Korea:
South Pyongan Province, North Korea:
Date: Sun, 8 Sep 2019 14:18:07 +0200 (METDST)

Seoul, Sept 8, 2019 (AFP) - North Korean state media said Sunday five people had been killed in a powerful typhoon that destroyed farmland and damaged hundreds of buildings.   Typhoon Lingling, called Typhoon-13 in North Korea, hit the reclusive nuclear-armed state on Saturday afternoon, reported the official KCNA news service.

The impoverished and isolated country is vulnerable to natural disasters, especially floods, due in part to deforestation and poor infrastructure.   "According to data available from the State Emergency Disaster Committee, five persons were dead and three persons injured. The injured persons are now under treatment at hospitals," KCNA said.   More than 460 houses and at least a dozen public buildings were "completely or partly destroyed or inundated" by the typhoon, it said.

Crops were wiped out or damaged in 46,000 hectares (110,000 acres) of farmland -- roughly the area of the small European country of Andorra -- the report said, adding that recovery efforts were underway.   It came after South Korea's disaster agency reported three deaths caused by the same typhoon, according to Yonhap news agency.   On Saturday, KCNA reported that North Korean leader Kim Jong Un had berated officials for their "easygoing" attitude to the approaching storm.   According to that dispatch, Kim had convened an emergency meeting on Friday and said "dangerous circumstances" caused by the typhoon were "imminent", but that many in positions of authority were ill-prepared.
Date: Tue, 18 Jun 2019 06:40:09 +0200
By Sebastien BERGER

Pyongyang, June 18, 2019 (AFP) - On a grey stone column in Pyongyang, a mural shows Chinese and North Korean soldiers rushing into battle against US-led forces in the Korean War. Decades later, the monument is a regular stop for new waves of Chinese going to the North, this time as tourists.   Hundreds of soldiers and workers have been sprucing up the obelisk and its grounds in recent days ahead of a state visit to Pyongyang by Chinese President Xi Jinping this week.   An inscription on it lauds "the Chinese People's Volunteer Army, who fought with us on this land and smashed down the common enemy".   Their "immortal exploits" will "last forever", it proclaims, as will "the friendship forged in blood between the peoples of the People's Republic of China and the Democratic People's Republic of Korea".   Nearly 70 years after Mao Zedong sent millions of soldiers to save Kim Il Sung's troops from defeat as General Douglas MacArthur's men marched up the peninsula, China remains the isolated, nuclear-armed North's key diplomatic backer and main provider of trade and aid.

Now the Friendship Tower, as the monument is known, attracts growing hordes of Chinese tourists -- and the renovations suggest it may also be on Xi's itinerary.   Ordinary Chinese pay travel companies around 2,500 yuan ($360) for a standard three-day trip, arriving overland by train in Pyongyang to tour the capital's highlights, from the Arch of Triumph to Kim Il Sung Square.   The following day they head south to the Demilitarized Zone that has divided the peninsula since the two sides fought each other to a stalemate in 1953, before returning home.   "I'm very interested in North Korea and wanted to come to see what North Korea looks like," said Yu Zhi, a retiree from Anhui province visiting Pyongyang, telling AFP that she had a "special feeling" for the country.   "China is very friendly with North Korea," added her fellow traveller, a woman surnamed Jin. "We have been friends for generations."

- Lips and teeth -
It was not always so. Mao -- whose eldest son Mao Anying was among those killed in what China still calls the "War to Resist US Aggression and Aid the DPRK" -- described the neighbours as "as close as lips and teeth".   Ties then waxed and waned during the Cold War, when founder Kim Il Sung was adept at playing his Soviet and Chinese allies off against each other, and his grandson, the current leader Kim Jong Un, did not visit Beijing to pay his respects for more than six years after inheriting power.   But as he embarked on a flurry of diplomacy last year he made sure that Chinese President Xi Jinping was the first foreign head of state he met, and he has since done so three more times -- more often than Kim has seen any other leader.    Now Xi is going to reciprocate.

At the same time Chinese tourism to the North has reached record highs, according to travel industry sources -- so much so that Pyongyang has imposed a limit on arrivals.   No official figures are available from authorities on either side, but Simon Cockerell, general manager of Koryo Tours, the market leader for Western visitors, said there had been "a huge increase in Chinese tourists".   At peak times 2,000 people a day had been arriving in Pyongyang, he said. "That's far too many because there is no infrastructure to accommodate that many tourists, so problems with train tickets, with plane tickets, hotel space."   As a result North Korean authorities had themselves set a 1,000-a-day cap, he added, although it was unclear whether this applied across the industry or solely to Chinese, who make up the vast majority of arrivals.   "There are issues with just hundreds of people showing up at the same time."

- 'Choices being made' -
China has a proven willingness to use tourism as a geopolitical negotiating weapon -- it banned group tours to South Korea after it deployed a US anti-missile system, THAAD.   With nuclear negotiations at a stalemate the North remains subject to multiple UN Security Council sanctions, and the US imposed a travel ban on its own citizens visiting following the death of student Otto Warmbier, who had been jailed after trying to steal a propaganda poster.   But tourism is not among the sectors targeted by the UN, potentially enabling Beijing to use it as an incentive for its sometimes wayward ally.

The Chinese travel phenomenon is market-driven, rather than prompted by state order -- as well as the market offered by China's huge population, the two countries' border enables cheap overland journeys.   But simply enabling it to take place, said John Delury of Yonsei University in Seoul, meant "We can infer some choices are being made" by Beijing.   "We know it's a lever they can turn on and off," he said.   Even with the diplomatic process at a standstill, he added, "The Chinese think you have to use this window of opportunity to move things forward. There has to be a path on both sides and so something like opening up tourism is a good way to enable that."   At the Monument to the Three Charters for Reunification on the edge of Pyongyang, where two giant stone women form an arch over a road, a secondary school teacher from Shanghai called Peng said: "We are both socialist countries. I feel there are more Chinese coming to visit."
Date: Sun, 7 Apr 2019 11:11:12 +0200

Pyongyang, April 7, 2019 (AFP) - Twice as many foreigners as last year gathered in Pyongyang Sunday for the city's annual marathon, tour firms said, as reduced tensions see visitor numbers rise in isolated North Korea.    The event -- part of the celebrations for the anniversary of founder Kim Il Sung's birth in 1912 -- is the highlight of the North's tourism calendar and offers the chance to run or jog through the streets of the tightly controlled city.

Around 950 Westerners entered the event, according to market leader Koryo Tours, compared to some 450 last year when numbers slumped.   That brought participation almost back to the levels of 2017, before tensions soared as the North carried out a series of missile launches and leader Kim Jong Un traded threats and personal insults with US President Donald Trump.   The same year, Washington also banned its citizens from visiting the North following the death of Otto Warmbier, a US student jailed for trying to steal a propaganda poster who died in a mysterious coma days after his release.

Several other countries subsequently raised their travel warnings, a combination of events that dealt a significant blow to the North's tourism industry.   The US ban remains in place but more Western tourists signed up for the marathon this time, tour operators said, following a year of high-level diplomacy between Trump and Kim.   "As political tensions have subsided, tourism demand has increased," said Elliott Davies, director at Uri Tours, another operator, adding: "You could plot a graph in this direct relationship."

- 'Marathon chasers' -
The vast majority of tourists to the North are Chinese and some 5,000 Westerners a year used to visit the North -- with about 20 percent of those from the US -- seeking unique adventures in one of the most closed countries in the world.   The annual race also attracts so-called "Marathon Chasers" who tick off runs around the world, said Matt Kulesza, a senior tour guide at Young Pioneer Tours.   Angel Arnaudov, a 34-year-old engineer from Macedonia, said Pyongyang came onto his "radar" after finishing more than 30 marathons in cities ranging from Tokyo, New York and Copenhagen.   "I want to experience the life in North Korea myself and see if it is like they say on TV or different," he said, adding he would be posting videos on his YouTube channel.

For third-time participant Jasmine Barrett, the Pyongyang Marathon was an opportunity to interact with ordinary North Koreans who line the streets to cheer on the runners, offering high-fives and posing for selfies.   "I keep coming back because I love to see the smiles on the children's faces," the Australian entrepreneur told AFP.   "I'd definitely recommend it to others because it's a great way to see the city and the people who live there," she added.   Tour operators advise visitors to take extra precautions about "what to do and what not to do" when travelling in the North.   Simon Cockerell, Koryo Tours' general manager, said: "This is vital when visiting North Korea and anyone wanting to travel shouldn't go without a briefing."
Date: Thu, 17 Jan 2019 07:33:49 +0100

Seoul, Jan 17, 2019 (AFP) - A giant beach resort in North Korea is nearing completion, a US monitor said Thursday, with satellite pictures showing rapid progress on the sprawling development, now equipped with a water slide and cinema.   The seaside strip known as the Wonsan-Kalma Coastal Tourist Area is squeezed between a new airport and the country's east coast, in an area that has previously been used for artillery drills and ballistic missile launches.

It is intended as a centrepiece of the isolated country's nascent tourism industry as Pyongyang seeks to develop its economy despite international sanctions imposed over its nuclear weapons programmes.   North Korea receives an estimated 100,000 foreign tourists a year, the vast majority of them Chinese, according to industry sources, but Pyongyang issues no official figures itself.   The site's construction has been closely overseen by leader Kim Jong Un and plans have been announced for a grand opening in October, when the country marks the 74th anniversary of the founding of the ruling Workers' Party of Korea.

The respected 38 North website released satellite images taken as recently as December showing that most buildings previously under construction were "nearing external completion and several new or redesigned buildings were in advanced stages".   Kim, who reportedly spent his childhood summers in the area, visited the site at least three times last year according to state media, sometimes berating officials in charge of the works and issuing detailed orders.

Kim "found that the whole street was not perfect in the artistic aspect", the official KCNA news agency reported after his October inspection.   "He instructed officials to envisage the construction of more hotels and inns with over 30 floors," it added, along with more games arcades, movie theatres and an "all-event stadium", plus a "large water park and funfair".   Satellite photos from December 28 indicated the resort was growing into a "vast beach complex", 38 North said.

- 'Great beaches' -
US President Donald Trump, a former real estate developer turned billionaire, applauded North Korea's tourism potential last year following his landmark summit with Kim in Singapore.   After a four-minute screening of a bizarre Hollywood-style trailer -- apparently part of an overall pitch that the US could help the North advance technologically and economically -- Trump pointed to potential property projects in the cash-strapped nation.   "As an example, they have great beaches," he told reporters.    "You see that whenever they are exploding their cannons into the ocean. I said, 'Boy, look at that view. Wouldn't that make a great condo?'"

Kim mentioned the Wonsan-Kalma project in his key New Year speech and 38 North said the push on the development showed "a desire to demonstrate that North Korea, despite the economic sanctions in place, has an economy that is moving forward and showing signs of prosperity.   "It may also reflect an expectation that as the country improves its external political relations, tourism will follow," it added.

At present the US bans its own citizens from tourism in the North.   Hundreds of thousands of South Koreans used to visit Mount Kumgang near the inter-Korean border every year, travelling to a Seoul-funded tourist resort that was the first major cooperation project between the neighbours.   The trips came to an abrupt end in 2008 when a North Korean soldier shot dead a South Korean tourist who strayed off the approved path and Seoul suspended travel.
More ...

World Travel News Headlines

Date: Mon, 17 Feb 2020 11:56:28 +0100 (MET)

Tokyo, Feb 17, 2020 (AFP) - Organisers said Monday they are cancelling the amateur portion of the Tokyo marathon, affecting around 38,000 runners, on fears about the spread of the new coronavirus in Japan.   "We reached the conclusion that unfortunately it is difficult to organise the event... after several cases (of the virus) were confirmed in Tokyo," the Tokyo Marathon Foundation said in a statement.
Date: Mon, 17 Feb 2020 10:59:27 +0100 (MET)

Cairo, Feb 17, 2020 (AFP) - Egypt's Sharm el-Sheikh has welcomed the first British charter flights since 2015, when the Islamic State group's bombing of a Russian airliner dealt a devastating blow to the Red Sea resort.   Britain halted flights to Sharm el-Sheikh following the attack, which killed all 224 people on board the plane that took off from the resort, long popular with British tourists.

After multiple airport inspections and visits by aviation security experts, Britain announced in October that it was lifting the flight restrictions.   "Sharm el-Sheikh airport received the first two direct charter flights... from London's Gatwick airport carrying 184 passengers and Manchester airport carrying 190 passengers," Egypt's civil aviation ministry said in a statement late Sunday.    The flights were operated by Britain's biggest travel agency, TUI.

The company has scheduled three flights a week between London's Gatwick Airport and Sharm el-Sheikh until late March, the statement said.   British budget airline easyJet said in January it would restart flights to the resort town in June.   On Sunday, flag carrier EgyptAir said it would start operating a weekly flight between London and Sharm el-Sheikh later this month.   British tourists have long been vital to the tourism industry in Sharm el-Sheikh, which was left reeling after the airliner bombing.

Egypt has since sought to lure tourists back, boosting airport security and allowing international inspections of security procedures there.   Russia, another major source of tourists to Egypt, initially suspended all direct flights to the North African country following the attack.   It resumed direct flights to Cairo in 2018 but has yet to restart them to popular Red Sea resorts.   Egypt's tourism industry has shown signs of recovery in recent years with arrivals reaching 11.3 million in 2018, compared with 5.3 million in 2016.
Date: Mon, 17 Feb 2020 10:43:58 +0100 (MET)

Hong Kong, Feb 17, 2020 (AFP) - A gang of knife-wielding men jumped a delivery driver in Hong Kong and stole hundreds of toilet rolls, police said Monday, in a city wracked by shortages caused by coronavirus panic-buying.   Toilet rolls have become hot property in the densely packed business hub, despite government assurances that supplies remain unaffected by the virus outbreak.   Supermarkets have found themselves unable to restock quickly enough, leading to sometimes lengthy queues and shelves wiped clean within moments of opening.

There has also been a run on staples such as rice and pasta, as well as hand sanitiser and other cleaning items.     Police said a truck driver was held up early Monday by three men outside a supermarket in Mong Kok, a working-class district with a history of "triad" organised crime gangs.   "A delivery man was threatened by three knife-wielding men who took toilet paper worth more than HK$1,000 ($130)," a police spokesman told AFP.   A police source told AFP the missing rolls were later recovered and two suspects were arrested on scene although it was not clear if they were directly involved in the armed robbery.

Footage from Now TV showed police investigators standing around multiple crates of toilet roll outside a Wellcome supermarket. One of the crates was only half stacked.   Hong Kongers reacted with a mixture of bafflement and merriment to the heist.   One woman passing by the scene of the crime who was interviewed by local TV station iCable quipped: "I'd steal face masks, but not toilet roll."   The city, which has 58 confirmed coronavirus cases, is currently experiencing a genuine shortage of face masks.    The hysteria that has swept through Hong Kong since the coronavirus outbreak exploded on mainland China is partly fuelled by the city's tragic recent history of confronting a deadly disease.

In 2003, some 299 Hong Kongers died of Severe Acute Respiratory Syndrome (SARS), an outbreak that began on the mainland but was initially covered up by Beijing -- action that left a lasting legacy of distrust towards the authorities on public health issues.   The new coronavirus outbreak also comes at a time when the city's pro-Beijing leadership has historic low approval ratings after refusing to bow to months of angry pro-democracy protests last year.   Authorities have blamed online rumours for the panic-buying and say supplies of food and household goods remain stable.   But the panic-buying has itself created shortages in one of the world's most densely populated cities where supermarkets and pharmacies have limited
floor space.

Photos posted online have shown some people proudly stuffing their cramped city apartments with packets of hoarded toilet rolls.    On Sunday, the head of the city's Consumer Council warned people not to stockpile toilet rolls in their flats as they were prone to mould in the notoriously humid climate.   She also reiterated that there were ample stocks of paper.    Supermarket chain Wellcome called Monday's robbery a "senseless act", and called on people not to bulk buy or hoard toilet roll.    "We want to emphasize that we have sufficient toilet roll supply to meet demand," it said in a statement. "The temporary shortage was caused by the sudden and unusual surge in demand."
Date: Mon, 17 Feb 2020 10:11:30 +0100 (MET)

Tokyo, Feb 17, 2020 (AFP) - An additional 99 people have tested positive for coronavirus on a cruise ship off the Japan coast, Japanese media said Monday, citing new figures from the health ministry.   That would take the total number of positive cases on the Diamond Princess to 454. The health ministry declined to confirm the reports immediately.   It was also not clear whether the figures included 14 US citizens who tested positive for the virus but were allowed to board evacuation flights home.

The Diamond Princess vessel moored in Yokohama near Tokyo has become the second-largest cluster of coronavirus cases outside the epicentre in China.    Passengers have been largely confined to quarters since February 5 with only brief and occasional breaks to take air on deck -- with face masks.   The quarantine period is over on Wednesday but many countries have decided to repatriate their citizens after an alarming climb in cases on board.

The US was the first country to evacuate its citizens from the ship but Australia, Canada, Italy and Hong Kong have indicated they will follow suit.   On land, cases in Japan have risen to 65, with authorities warning that the outbreak is entering a "new phase" and advising people to avoid large gatherings.    A public celebration of the new emperor's birthday on Sunday has been scrapped and organisers of the Tokyo Marathon scheduled on March 1 are reportedly considering cancelling the amateur part of the race.
Date: Sat, 15 Feb 2020 15:25:00 +0100 (MET)
By Benoît Pavan à Moûtiers avec Thomas Rossi dans les Pyrénées

Moûtiers, France, Feb 15, 2020 (AFP) - French protests at planned labour reforms hit ski resorts on Saturday, with chairlift operators and other seasonal staff downing tools over fears their livelihoods could be on a slippery slope.   Hundreds of staff at a clutch of resorts in the Alps and Pyrenees walked out in response to calls for action by the CGT and FO unions, forcing some runs to be closed or partially closed.   They are concerned that reforms extending the required period of employment before people are eligible for benefits, set to take effect from April 1, could stop thousands of seasonal workers from claiming.

Some voiced their protest in song at the bottom of pistes at Serre-Chevalier close to the Italian border, chanting: "We're going down the mountain to get rid of Macron," referring to French President Emmanuel Macron.   The French leader's attempts to overhaul pensions and welfare have led to months of bitter protests and strikes.    "Our situation will become even more precarious with these reforms," explained Christophe Dupuis, who works as a ski patroller at La Plagne, one of the world's most popular ski areas.   "We will need six months instead of four before we can apply for unemployment benefit," added Dupuis, who works as a lifeguard during the summer.   "We don't have six-month seasons, not least as the winter seasons are tending to get shorter rather than longer," said Maud Goret, a seasonal worker and CGT member at Font-Romeu in the Pyrenees -- where half the workforce had downed tools.

Many relatively low altitude resorts are suffering from a lack of snow owing to climate change, compounding fears over what the future holds.   As the workers voiced their grievances, further signs of the shortage of snow increasingly hitting resorts came as local authorities at Luchon-Superbagneres in the French southwest told AFP they had decided to have extra snow helicoptered in to three areas running short.

A union official said some 50 tons were being brought in for between 5,000 and 6,000 euros ($5,500-6,500) "in the knowledge that in terms of return on the investment you need to multiply that at least by ten," for an operation lasting around two-and-a-half hours.   He added that it might not be a "particularly ecological" solution but "we had no choice" at the height of the season when many children in French are on half-term holiday.
Date: Wed 12 Feb 2020
Source: Teresina Municipal Health Foundation [in Portuguese, machine trans., edited]

Health Surveillance Directorate - Epidemiology Management
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Given the laboratory confirmation of 5 human cases of melioidosis (ICD-10 A24.4) that occurred in the state of Piaui in 2019 (including one death), the FMS Health Surveillance Directorate recommends Hospital Infection Control Commissions, to the Hospital Surveillance Centers, public and private microbiology laboratories, infectious disease specialists, pulmonologists, microbiologists, biochemists and physicians in general who are attentive, immediately report any case with a result of a culture of biological material (blood culture, urine culture, wound culture, tracheal secretion, cerebrospinal fluid, bronchial lavage, ascitic fluid, abscess, tissues, etc.) positive for the bacterium _Burkholderia pseudomallei_ (or _Burkholderia_ sp.). The notification must be made through the individual notification form of SINAN (available at <http://portalsinan.saude.gov.br/images/documentos/Agravos/NINDIV/Notificacao_Individual_v5.pdf>) and sent to the FMS, with the code appended ICD10: A24.4.

The positive bacterial isolate should be sent to the Central Public Health Laboratory, Dr. Costa Alvarenga (LACEN - PI) for confirmatory examination (Nested - PCR), upon registration in the GAL system (research: _Burkholderia pseudomallei_ sample: swab), in swab with Stuart's medium, at room temperature, along with a copy of the notification form.
======================
[This 2016 article (Limmathurotsakul D, Golding N, Dance DA, et al., Predicted global distribution of _Burkholderia pseudomallei_ and burden of melioidosis. Nat Microbiol. 2016;1:15008. <https://doi.org/10.1038/nmicrobiol.2015.8>; article available at <http://www.nature.com/articles/nmicrobiol20158.pdf>) for 2015 estimates the burden of melioidosis for the areas of major and some risk as follows:

Area / Population at risk in millions / Melioidosis cases in thousands / Melioidosis deaths in thousands
South Asia / 1525 / 73 / 42
East Asia and Pacific / 858 / 65 / 31
Sub-Saharan Africa / 602 / 24 / 15
Latin America and Caribbean / 246 / 2 / 1
Middle East and North Africa / 49 / less than 1 / less than 1

Although a classical infection in eastern Asia and northern Australia, cases have been acquired in Africa, the Caribbean basin, Central America, and, as in this case, South America. - ProMED Mod.LL]

Date: Tue 11 Feb 2020
Source: SABC News [edited]

A 56-year-old was admitted at the Klerksdorp Tshepong Hospital on Saturday [8 Feb 2020] with a history of tick bite followed by flulike symptoms including headaches and fatigue.

The North West Health Department says while no active bleeding was noted, treatment was started immediately.

Crimean-Congo fever, also known as Congo fever/haemorrhagic fever, is a disease caused by a tick-borne virus with a case fatality rate of 10% to 40%.

Transmission to humans occurs through contact with infected animal blood or ticks. It can be transmitted from one infected human to another by contact with infectious blood or body fluids.

Symptoms include high fever, vomiting and abdominal pain, but as the illness progresses, large areas of severe bruising and severe nosebleeds are also common.

Clinical Manager at the Klerksdorp Hospital Dr. David Leburu says: "Crimean-Congo fever can make a person bleed. It can make people bleed just like Ebola but not as aggressive as Ebola."
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[Occupational groups such as herders, farmers, abattoir workers, veterinarians/animal health workers, hunters and persons informally slaughtering domestic/wild animals are at higher risk of infection. These persons often have exposure to ticks on the animals and in the animal environment, and also often have exposure to animal blood/tissues (e.g., during castration of calves, vaccination, notching/tagging of ears, slaughtering).

Humans can become infected in the following ways:
- Being bitten by infected ticks;
- Squashing infected ticks (if fluid from the ticks enters into cuts/grazes on the skin, or splashes onto mucous membranes, including the eyes, nose and mouth);
- If blood/tissue from infected animals (during the short period that the animals have virus in circulation) comes into contact with cuts/grazes on the skin, or splashes onto mucous membranes, including the eyes, nose and mouth;
- Needle-stick/sharps injuries in healthcare workers from infected patients.

The patient in the above report had a history of tick bite, but no other epidemiological information is available.

Human CCHF cases have been reported annually from South Africa since 1981, when it was first recognized in the country; between 0 and 20 cases of CCHF are reported each year. Through nearly 30 years of passive surveillance, more than 180 cases have been laboratory-confirmed. Although cases have been reported from all 9 provinces in the past 30 years, more than half of the cases originate from the semi-arid areas of Northern Cape Province (31.5% of cases) and Free State Province (23% of cases) (<http://www.nicd.ac.za/assets/files/CCHF_FAQ-General_Public.pdf>). - ProMED Mod.UBA]

[HealthMap/ProMED-mail maps:
North West Province, South Africa:
Date: Wed 12 Feb 2020 05:23 PM EST
Source: ABC27/WHTM [edited]

Two Newberry Township [York County] men are getting treatments for rabies after a coyote that attacked them tested positive for the deadly virus.

One man was with his dog when the coyote attacked [Mon 10 Feb 2020] on Red Bank Road. The 2nd man was working nearby in his garage when the coyote entered and bit him.

A neighbour shot and killed the coyote the following day and gave the carcass to the Pennsylvania Game Commission. A test confirmed the animal was rabid.
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[[HealthMap/ProMED-mail map of Pennsylvania, United States:
Pennsylvania county map:

Rabies is a serious disease, and is always fatal in animals. In humans there is post exposure prophylaxis (PEP), which must be given within a prescribed amount of time. Individuals bitten by a rabid animal who do not seek treatment within the narrow window for PEP in all likelihood will die if they develop rabies. Heroic measures have succeeded in preserving the lives of only a handful of individual, and yet their live is never a complete return to normal.

Rabies is a serious disease and should be taken seriously by all individuals, whether you are a pet owner or not. Animal owners, regardless of whether your animal is a horse, or dog, or cow, or cat, or goat, or other animal, vaccinate the animal against this fatal disease. Protect your investment in your farm animals, and protect yourself by vaccinating farm animals and pets.

Rabies can be in wildlife, as these stories note. However, we seldom get one involving an otter. While otters are cute and playful on the nature programs, they are susceptible to rabies, as is any mammal, so it is imperative we be alert to the animals around us, no matter where we are or what animal is involved. - ProMED Mod.TG]
Date: Sat 8 Feb 2020 05:16 PM EST
Source: Fox 8 [edited]

A Florida mom says she had to tackle an otter to protect her daughter and dog, WFLA reports. We don't often hear about aggressive river otters. But by fighting its way inside a home in Florida, experts say the otter was definitely not acting normal.  "My husband's like 'you just alligator wrangled an otter in the living room!'" [CE] said. The otter learned to not mess with a mother's instincts. "I think life is full of surprises, and you should just be ready for whatever," [she] said.

The story starts after 17-year old [GE] let their dog Scooter out before dawn Tuesday morning [4 Feb 2020]. Scooter had found an enemy.  "I sprinted to the backdoor, and I was like 'Scooter!' All I saw was like a big black ball just all over the place. So he stumbled in the door, and I tried to shut it as fast as possible, but then the otter got stuck," [GE] said.

By this time, the whole house is awake and her mother bursts in.  "I snatched it by the tail," [CE] said. "And then I held it up like a prize. And the otter's going crazy. It was like clawing at me and grabbing on to the backs of the furniture in my house." [CE] tossed the otter outside and discovered it had bit her daughter in the leg.

Several rabies shots later, [GE] and Scooter are on the mend. Now Florida Fish and Wildlife is trying to find the otter. It is unknown whether the otter has rabies because it has not been caught. His behaviour was definitely abnormal.  "Any time an otter's onshore going for a human, there's something not right. Usually, they see you, they're gone," said Dustin Hooper, an animal trapper, and owner of All Creatures Wildlife Control.
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[HealthMap/ProMED-mail map of Florida, United States:
Florida county map:
Date: Tue 4 Feb 2020
Source: Robesonian [edited]

A 9-year-old boy is undergoing treatment after being bitten by a rabid fox, according to the [Robeson] County Department of Public Health.

The boy was riding his bicycle Sunday evening [2 Feb 2020] on Barnhill Road in Lumberton when he was attacked by a fox, according to the Health Department. The fox was killed at the scene and its head was submitted for testing on [Mon 3 Feb 2020]. The results came back positive for rabies on [Tue 4 Feb 2020].

The boy will undergo a series of shots to prevent the onset of rabies, according to the Health Department. Area residents have been alerted and advised to monitor their children's and pets' activities.

According to the Health Department release, Sunday's bite case was properly reported "and as such, the system responded correctly. After-hour calls go to communications who contact the Animal Control officer on call."

Sunday's attack by a rabid wild animal is the 1st confirmed case of rabies in Robeson County this year [2020], said Bill Smith, Health Department director.

"I believe we had 3 this past year," he said. Those cases were animal-on-animal attacks, Smith said. "I think they were all pets last year," he said.

County residents need to be aware there are many more rabid animals in the area, he said. But the rate of confirmed contact between rabid animals and humans or pets is low because Robeson County is a rural county with large tracts of forests.

In rural areas the most likely scenario is an animal attacking a pet or human and then running into the woods, where it will die without anyone knowing if it had rabies or not, Smith said. In urban areas, there is more contact between humans and pets and animals known to be rabid because the attacking animal has no woods into which to run and hide. Therefore, the animal is easier to catch and test.

If someone is bitten by an animal that runs into the woods and is not caught and tested then precautions have to be taken, he said.

"We would treat that as a rabid animal," Smith said.

Sunday's incident prompted the county Health Department to issue the following advisories:
- all dogs, cats, and ferrets 4 months and older are required to be vaccinated against rabies and wear a current rabies vaccination tag per North Carolina law;
- if an animal is destroyed, try not to damage the head because it jeopardizes the testing of the brain;
- avoid feeding wild animals. Foxes and raccoons are the main sources of rabies in the Robeson County area and feeding them increases the likelihood of interaction between the wildlife and dogs, cats and humans.
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[HealthMap/ProMED-mail map of North Carolina, United States:
North Carolina county map: