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United Arab Emirates

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our Customs Information.

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

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

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

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

He said that some of the passengers had originally come from the Saudi Arabian city of Mecca, which was currently experiencing a flu outbreak, and that the passengers' symptoms were "pointing to the flu".
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Paraguay

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our information on Criminal Penalties.

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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Honduras

Honduras - US Consular Information Sheet
May 19, 2008

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

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

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

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

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

SAFETY AND SECURITY:
Political demonstrations sometimes disrupt traffic, but they are generally announced in advance and are usually peaceful. Travelers should avoid areas where demonstrations are taking place, and they should stay informed by following the local news and consulting hotel personnel and tour guides. Demonstrators frequently block public roads to press for concessions from the government of Honduras. These demonstrations may last several hours and the government rarely seeks to disperse the demonstrators. U.S. citizens should never try to pass such roadblocks. While the Honduran side of the Honduras-Nicaragua border has been largely cleared of land mines, travelers should exercise caution there. For more information, we strongly encourage travelers to visit the U.S. Embassy's web site at http://honduras.usembassy.gov/ and click on Crime and Security Matters. For the latest security information, American citizens traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SPECIAL CIRCUMSTANCES:

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

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

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

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

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

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

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

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

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Honduran laws, even unknowingly, may be fined, expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Honduras are severe, and convicted offenders can expect long jail sentences and heavy fines. Assisting or participating in the distribution of illegal drugs is also a crime prosecutable in the United States, and may lead to fines, property seizure, or imprisonment. Anyone offering you illegal drugs should be considered extremely dangerous – there is no “safe” source of illegal drugs.

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

Date: Fri, 26 Jul 2019 03:36:47 +0200
By Noe LEIVA

La Paz, Honduras, July 26, 2019 (AFP) - Of Honduras' 32 public hospitals, 26 are overflowing with patients due to what health authorities are calling the worst dengue fever epidemic in the past half century.   The disease has struck 28,000 people this year, of which 54, mostly children, have died.   The enormous case flow is evident in the western city of La Paz. Inside the local hospital's chapel, two tables are piled high with patient folders, which sit in front of a wooden depiction of Christ.   Even more telling are the beds lining the room, protected by red and blue mosquito nets, from which 10 women are being treated for some of dengue's typical symptoms: bone and joint pain, high fever, vomiting and dehydration.#

Officials have called a national emergency to fight the dengue-causing aedes aegypti mosquito and a fumigation program has been launched in homes and public buildings.   And yet the hospital bursts at the seams. On top of those housed in the chapel, six of the facility's eight rooms are taken up by those stricken by dengue, with some beds even in the corridors.   Three of the rooms house a total of 26 children, age two to 14 -- the most vulnerable group to dengue -- who are connected to IV bags and monitored by concerned parents.   "They're not all out of danger," said a nurse as she looked over the patients.

- 'We're overrun' -
Crista Alexandra Pineda, age seven, is one of the children whose health is worrying hospital staff the most.   She was admitted on Sunday suffering from bleeding, accompanied by her 59-year-old grandmother, Josefina Velasquez.   "We're overrun," hospital spokesman Marco Antonio Rodas told AFP.   "We had to postpone planned operations" to concentrate on the emergencies.   "In 20 years working here, I've never seen this," he added.

Over the last week, the number of patients rose from 53 to 78. The most serious cases were transferred by ambulance to the University Hospital in the capital Tegucigalpa, where already two have died, Rodas said.   He hasn't ruled out the possibility of taking over schools to accommodate patients who are "arriving in ever greater numbers."   Marta Zoila Lopez, 58, told AFP she was at home in Guajiquiro, close to a La Paz, on Sunday when she started feeling symptoms.   "At first I had pain in my stomach, head and bones, vomiting and bleeding" from her nose and gums. She was immediately taken to the hospital where nurses say she's still in a delicate condition.   President Juan Orlando Hernandez summoned all 298 municipal mayors to the capital on Monday and announced a special fund to combat the outbreak.

The only effective measure to halt the epidemic "is to destroy the mosquito's breeding grounds and this is something that every one of us has to do in our homes, where we work and also in every public area," said Hernandez.   He also announced a "massive mobilization" to fumigate and destroy those breeding grounds. Churches, press organizations and business leaders have committed to assisting the effort.   It's a critical situation with the three-month long rainy season about to begin, meaning that breeding grounds will soon proliferate and the mosquito's numbers could soar.
Date: Thu, 20 Jun 2019 09:02:06 +0200

Tegucigalpa, June 20, 2019 (AFP) - Thousands of Hondurans blocked streets across the country Wednesday night demanding the resignation of President Juan Orlando Hernandez as tensions mount over strikes by police and truckers.   Police spokesman Jair Meza told AFP that street occupations were reported in several areas of the country, but the force was working to restore order despite a sit-down strike by special operations units.

Meza said looters had raided and torched businesses in the capital, Tegucigalpa, while others blocked streets with bonfires made from tires and rocks.   He added that the police were receiving reinforcements from the armed forces to control the groups that, in their opinion, are made up of gangs and opponents demanding the resignation of President Hernandez.   Mezo said the striking officers -- mostly riot police -- claim "harassment in the workplace and abuse of authority by many chiefs," according to a statement.   The special forces police officers say they are given "terrible food," that they are sent on missions without their expenses being covered and that they are denied labour rights and salary increases.

The Ministry of Security responded in a statement that police bosses "ordered the review of work days," while recognizing that there had been extra shifts to address the demonstrations.   The conflict deepened when police chief Jose Aguilar visited the area where the strikers were holed up but had to flee after a tear gas canister was thrown at him, another police spokesman Orlin Cerrato told a press conference.

Meza said that there was also a strike by truck drivers, who since Monday have parked their rigs on roads near the capital, demanding a pay rise.    The blockage caused a shortage of fuel in some areas of the country, which in turn led to long lines of vehicles at gas stations, the spokesperson said.
Date: Sun, 19 May 2019 05:17:37 +0200

Tegucigalpa, May 19, 2019 (AFP) - Four Canadians and an American pilot died Saturday when their small plane plunged into the sea off the Honduran island of Roatan where they were vacationing, firefighters said.   The plane crashed near the town of Dixon Cove, a few minutes after taking off from the island's airport, rescuers said.   The dead were identified as Bradley Post, Bailey Sony, Tomy Dubler and pilot Patrick Forseth.

The other Canadian pilot, Anthony Dubler, briefly survived the crash but died at the Roatan hospital of his injuries.   The causes of the crash and the registration information for the aircraft were not immediately available.   It occurred as the tourists were headed toward the city of Trujillo, about 77 kilometres (48 miles) from Roatan.
Honduras. 21 Mar 2019. (Reported)

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

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

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

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

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

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

[HealthMap/ProMED-mail map Honduras:
<http://healthmap.org/promed/p/22>]
More ...

World Travel News Headlines

Date: Tue, 10 Dec 2019 10:50:09 +0100 (MET)

Sydney, Dec 10, 2019 (AFP) - The death toll from New Zealand's White Island volcano eruption rose to six late Tuesday, after an injured person died in an Auckland hospital, police said.   "Police can confirm a further person has died following the eruption on Whakaari/White Island, bringing the official toll to six," a police statement said.   Eight more people who remain missing are presumed dead after the volcano erupted Monday.
Date: Tue, 10 Dec 2019 09:27:57 +0100 (MET)
By Andrew BEATTY, with Daniel de Carteret in Gosford

Sydney, Dec 10, 2019 (AFP) - Toxic haze blanketed Sydney Tuesday triggering a chorus of smoke alarms to ring across the city and forcing school children inside, as "severe" weather conditions fuelled deadly bush blazes along Australia's east coast.   Fire engines raced office-to-office in the city centre with sirens blaring, as inland bushfires poured smoke laden with toxic particles into commercial buildings.   Emergency services responded to an "unprecedented" 500 automatic call-outs inside a few hours according to New South Wales Fire and Rescue's Roger Mentha.

A regional fire headquarters miles from the nearest blazes was itself evacuated while throngs of mask-wearing commuters choked their way through thick acrid air and the organisers of a harbour yacht race declared it was unsafe to proceed.   "The smoke from all the fires is just so severe here on the harbour that you just can't see anything, so it's just too dangerous," said spokeswoman Di Pearson of an event that normally foreshadows the famed Sydney-Hobart yacht race. "The vision is just so poor."   Some of the city's commuter ferries were also cancelled "due to thick smoke" and school kids were kept inside at breaktime and sent home early as pollution levels soared far above "hazardous" levels.

For weeks the east of the country has been smothered in smoke as drought and climate-fuelled bushfires have burned. But the scale of the problem on Tuesday shocked even hardened residents.   Bruce Baker -- an 82-year-old who lives in Gosford, north of Sydney -- said he was skipping his daily morning walk because of the smoke.   "This is the worst it's been, for sure," he told AFP. "It dries your throat. Even if you're not asthmatic, you feel it."   Authorities recommended that the vulnerable cease outdoor activity altogether and that everyone stay inside as much as possible, although one couple braved the toxic air to get married on the waterfront in front of Sydney Harbour Bridge shrouded in smog.

A cricket match between New South Wales and Queensland also went ahead, despite a barely visible ball.   Tuesday had been expected to bring strong winds and high temperatures that made for "severe conditions where embers can be blown ahead of the fire into suburbs and threaten properties."   But New South Wales Rural Fire Service said "deteriorating fire conditions have been delayed by a thick blanket of smoke" over the east of the state.   As the day developed there were nearly 100 bushfire incidents in the state of New South Wales alone and dozens more in Queensland.   Total fire bans were put in place across much of the east of the country and in large parts of western Australia.   Temperatures in some inland areas eased past 44 degrees Celsius (111 Fahrenheit).

- The 'big dry' -
To the northwest of Sydney, several fires already burning for weeks have combined to create a "megafire" that has already destroyed 319,000 hectares (788,000 acres) of land, mostly inside national parks.   Prime Minister Scott Morrison  -- who for weeks has not commented on the smoke haze -- defended his government's handling of the fires and said there were no plans to professionalise the countryside's largely volunteer force.    "Our policy is sensible when it comes to addressing and taking action on climate change. Our actions on climate change are getting the results they're intended to get," he said.   Morrison's conservative coalition has been criticised by former fire chiefs for failing to heed warnings about climate change.   The crisis has been propelled by a prolonged drought that has made vegetation tinder dry.

The Bureau of Meteorology has reported that Australia experienced its driest November on record this year.   The "big dry" has left farmers desperate and small towns facing the prospect of running out of water completely.   A swathe of the east of the country has seen "rainfall deficiencies" since early 2017 -- almost three years.   Many dams in New South Wales are empty and almost all are well below capacity.   Firefighters south of Brisbane recently reported 1,000 litres of water were stolen from tanks at their station.   Amid the shortage, Tuesday also saw the toughest water restrictions in a decade being introduced for Sydney -- with curbs on everything from hosepipe use to washing cars.
Date: Tue, 10 Dec 2019 03:09:17 +0100 (MET)
By Allison JACKSON

Sao Paulo, Dec 10, 2019 (AFP) - Gripping the deadly snake behind its jaws, Fabiola de Souza massages its venom glands to squeeze out drops that will save lives around Brazil where thousands of people are bitten every year.   De Souza and her colleagues at the Butantan Institute in Sao Paulo harvest the toxin from hundreds of snakes kept in captivity to produce antivenom.    It is distributed by the health ministry to medical facilities across the country.

Dozens of poisonous snake species, including the jararaca, thrive in Brazil's hot and humid climate.    Nearly 29,000 people were bitten in 2018 and more than 100 died, official figures show.   States with the highest rates of snakebite were in the vast and remote Amazon basin where it can take hours to reach a hospital stocked with antivenom.   Venom is extracted from each snake once a month in a delicate and potentially dangerous process.

Using a hooked stick, de Souza carefully lifts one of the slithering creatures out of its plastic box and maneuvers it into a drum of carbon dioxide.    Within minutes the reptile is asleep.    "It's less stress for the animal," de Souza explains.    The snake is then placed on a stainless steel bench in the room where the temperature hovers around 27 degrees Celsius (80 degrees Fahrenheit).    De Souza has a few minutes to safely extract venom before the snake begins to stir.      "It's important to have fear because when people have fear they are careful," she says.

- Antivenom 'crisis' -
The snakes are fed a diet of rats and mice that are raised at the leafy institute and killed before being served up once a month.   After milking the snake, de Souza records its weight and length before placing it back in its container.    The antivenom is made by injecting small amounts of the poison into horses -- kept by Butantan on a farm -- to trigger an immune response that produces toxin-attacking antibodies.

Blood is later extracted from the hoofed animals and the antibodies harvested to create a serum that will be administered to snakebite victims who might otherwise die.   Butantan project manager Fan Hui Wen, a Brazilian, says the institute currently makes all of the country's antivenom -- around 250,000 10-15 millilitre vials per year.

Brazil also donates small quantities of antivenom to several countries in Latin America.    There are now plans to sell the life-saving serum abroad to help relieve a global shortage, particularly in Africa.    About 5.4 million people are estimated to be bitten by snakes every year, according to the World Health Organization (WHO). 

Between 81,000 and 138,000 die, while many more suffer amputations and other permanent disabilities as a result of the toxin.   To cut the number of deaths and injuries, WHO unveiled a plan earlier this year that includes boosting production of quality antivenoms.   Brazil is part of the strategy. It could begin to export antivenom as early as next year, Wen says.   "There is interest for Butantan to also supply other countries due to the global crisis of antivenom production," she says.
Date: Mon, 9 Dec 2019 14:14:15 +0100 (MET)

Dec 9, 2019 (AFP) - New Zealand, struck by a deadly volcanic eruption Monday, lies in a zone where Earth's tectonic plates collide, making it a hotspot for earthquakes and volcanic activity.   In one of its worst natural disasters, a huge mass of volcanic debris from the eruption of Mount Ruapehu triggered a mudslide in 1953 that washed away a bridge and caused a passenger train to plunge into a river with the loss of 151 lives.  After Monday's eruption on New Zealand's White Island, here is a recap of some of the deadliest volcanic eruptions around the world in the past 25 years.

- 2018: Indonesia -
In December the Anak Krakatoa volcano, a small island in the Sunda Strait between Java and Sumatra, erupts and a section of its crater collapses, sliding into the ocean and generating a tsunami. More than 420 people are killed and 7,200 wounded.

- 2018: Guatemala -
The June eruption of the Fuego volcano, about 35 kilometres (22 miles) from the capital, unleashes a torrent of mud and ash that wipes the village of San Miguel Los Lotes from the map. More than 200 people are killed.

- 2014: Japan -
The sudden eruption in September of Mount Ontake, in the central Nagano region, kills more than 60 people in Japan's worst volcanic disaster in nearly 90 years. The mountain is packed with hikers at the time. In 1991 an eruption of the southwestern Unzen volcano kills 43.

- 2014: Indonesia -
At least 16 people are killed on the island of Sumatra in February by a spectacular eruption of Mount Sinabung, which had lain dormant for 400 years before roaring back to life five months earlier. In 2016 villages are scorched and farmland devastated after another eruption kills seven.

- 2010: Indonesia -
Indonesia's most active volcano, Mount Merapi on Java island, starts a series of explosions in October, eventually killing more than 320 people. An 1930 eruption of the volcano killed 1,300 people and one in 1994 claimed more than 60 lives.

- 2002: DR Congo -
The eruption in July of Mount Nyiragongo in the eastern Democratic Republic of Congo destroys the centre of Goma town, along with several residential areas, and kills more than 100 people.

- 1997: Montserrat -
The capital of the small British colony, Plymouth, is wiped off the map and 20 are killed or left missing in avalanches of hot rock and ash clouds when its volcano erupts in June.

- 1995: The Philippines -
At least 70 are killed and another 30 missing after the crater of the Parker volcano in the south of the island of Mindanao collapses. Five years earlier the eruption of Mount Pinatubo, 80 kilometres north of the capital Manila, kills more than 800 people.

- Worst ever -
The explosion of Indonesia's Krakatoa volcano in 1883 is considered the worst ever seen. The eruption sent a jet of ash, stones and smoke shooting more than 20 kilometres (12 miles) into the sky, plunging the region into darkness, and sparking a huge tsunami that was felt around the world. The disaster killed more than 36,000 people.

The most famous eruption in history is that of Mount Vesuvius in modern-day Italy in 79 AD, which destroyed the towns of Herculaneum, Stabiae and Pompeii, wiping out an estimated 10 percent of the population of the three cities.
Date: Mon 9 Dec 2019
Source: Fox 29 Philadelphia [edited]

A total of 31 people have been sickened by salmonellosis at 4 health care facilities in south-eastern Pennsylvania. A majority of those cases occurred after individuals ate pre-cut fruit from New Jersey-based Tailor Cut Produce. The Food and Drug Administration (FDA) announced the salmonellosis outbreak in conjunction with the Pennsylvania Department of Health (DOH) on [Fri 6 Dec 2019]. The North Brunswick distributor has recalled its fruit mix with cantaloupe, honeydew, pineapple and grapes as a result.

Tailor Cut Produce reports that its products may be found in restaurants, banquet facilities, hotels, schools and institutional food service establishments in Pennsylvania, New Jersey and New York. "We recommend that any facility who use Tailor Cut Produce pre-cut fruit to immediately stop and throw it away," Pennsylvania Secretary of Health Dr. Rachel Levine said.

Salmonellosis is an infection caused by _Salmonella_ bacteria that generally affects the intestinal tract. People usually become infected by either eating or drinking contaminated food or water, by contact with infected people or animals, or through contact with contaminated environmental sources.
Date: Mon 9 Dec 2019
Source: Sixth Tone [edited]

Dozens of researchers in northwestern China's Gansu province have been infected with brucellosis, an animal-borne disease that causes flu-like symptoms and, potentially, lingering problems. In a statement [Fri 6 Dec 2019], the Lanzhou Veterinary Research Institute, an affiliated institute of the Chinese Academy of Agricultural Sciences, said that the 1st few grad students from the institute's foot-and-mouth disease prevention team tested positive for brucellosis antibodies on [28 Nov 2019]. The labs affected have been closed, the institute said, and national and local health authorities have assembled a team to investigate the outbreak.

Li Hui, an official at the health commission in Lanzhou, the provincial capital, told Sixth Tone on [Mon 9 Dec 2019] that the total number of brucellosis cases at the institute had climbed to 96. None have shown clinical symptoms, according to domestic media, and it remains unclear how they were exposed to the bacteria.

Brucellosis -- also known as Malta, Mediterranean, or undulant fever -- is a zoonotic disease that mainly affects animals, including livestock and dogs, which can in turn transmit the bacteria to humans through direct contact. Symptoms include fever, chills, sweating, lethargy, and aches and pains, according to the WHO. In the absence of early diagnosis and treatment, brucellosis can become a chronic condition that is difficult to cure.

In China, brucellosis is a Class B disease, ranking below a more serious category that includes cholera and plague. Human-to-human transmission has only been known to occur between lactating mothers and their babies. According to state broadcaster China National Radio, the brucellosis outbreak at the Gansu veterinary institute has prompted health checks among local students and staff who fear that they may have come into contact with infected animals.

One of the last brucellosis outbreaks in China occurred in 2011, when an agricultural university in the northeastern Heilongjiang province reported 28 cases stemming from infected goats being used in lab research. The school publicly apologized, fired 2 administrators, and offered each of the students' affected monetary compensation.

Scientific labs are subject to different experimental standards depending on their biosafety level, according to a researcher surnamed Yang at the Shanghai Institutes for Biological Sciences, an affiliate of the Chinese Academy of Sciences.

"If the protection levels don't keep pace (with biosafety levels), there will be a risk of infection," Yang, who studies viruses and works in a Biosafety Level 2+ lab, told Sixth Tone. As a result, labs generally require researchers to undergo safety training or even pass an exam to earn a certification, said Yang, who only used her surname because she was not authorized by her employer to speak to media.

The Lanzhou Veterinary Research Institute describes itself as "China's only authorized research center for working with the live virus that causes foot-and-mouth disease," a highly contagious disease affecting livestock. The institute is reportedly also one of the few in China with Biosafety Level 3 labs, which are required for _brucella_ pathogen studies, according to the National Health Commission.

As the local agriculture department tries to ascertain the source of the recent infections, Lanzhou's health commission said [Fri 6 Dec 2019], it is implementing precautionary measures so that brucellosis does not pose a threat to neighbouring communities. [Byline: Yuan Ye]
=================
[An earlier report suggested that 4 persons were clinically ill but this is not confirmed here.  Brucellosis (<http://www.medicinenet.com/brucellosis/article.htm>) is a disease that is thought to have existed since ancient times, as it was 1st described more than 2000 years ago by the Romans and Hippocrates. It was not until 1887 that a British physician, Dr. David Bruce, isolated the organism that causes brucellosis from several deceased patients from the island of Malta. This disease has had several names throughout its history, including Mediterranean fever, Malta fever, Crimean fever, Bang's disease, and undulant fever (because of the relapsing nature of the fever associated with the disease).

The symptoms and signs of brucellosis may develop from days to months after the initial exposure to the organism. While some individuals may develop mild symptoms, others may go on to develop long-term chronic symptoms. The signs and symptoms of brucellosis are extensive, and they can be similar to many other febrile illnesses, so recognition of potential exposure -- from ingestion of unpasteurized milk or cheese, employment as a veterinarian or veterinary student, in a slaughter house or meat processing plant, or working in a microbiology lab -- is vital. In this outbreak, it is not clear what symptoms the students had or whether they were just seropositive. ProMED would like more information about this episode. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Gansu Province, China: <http://healthmap.org/promed/p/333>]
Date: Tue 3 Dec 2019
Source: Outbreak News Today [edited]

In late November [2019], Uganda health authorities notified the World Health Organization of a fatal Rift Valley fever (RVF) case from Obongi district.  The case was a 35-year-old man from South Sudan who was living in the Palorinya Refugee camp in Obongi district, Uganda. The case had travel history to South Sudan between 12 and 19 Nov 2019 to harvest cassava. While in his home country, he developed fever and other symptoms and was treated for malaria; however, his condition got worse.  He later returned to the refugee camp in Uganda and his symptoms progressed and he was hospitalized. Viral hemorrhagic fever was suspected. Samples were collected and sent to the Uganda Virus Research Institute; however, the patient died. A safe and dignified burial was performed on 22 Nov 2019. As of 24 Nov 2019, a total of 19 contacts were recorded during the active case search including 10 healthcare workers.
===================
[The circumstances and specific location under which the man became infected with Rift Valley fever (RVF) virus in South Sudan is not mentioned. It is worth noting that there was an RVF outbreak in the Eastern Lakes region of South Sudan during the 1st 3 months of last year (2018). At the end of that outbreak, the OIE's follow-up report no. 3 reported: "The event cannot be considered resolved, but the situation is sufficiently stable. No more follow-up reports will be sent. Information about this disease will be included in the next 6-monthly reports."

There were more human cases than animal ones in that outbreak, prompting Mod.AS to comment: "Unfortunately, during the recent South Sudan RVF event, as in most -- if not all -- previous RVF events in other African countries, humans served as sentinels. Improved surveillance in animals is desperately needed in Africa, to allow timely measures applied, predominantly preventive vaccination, before the development of a full-blown epizootic involving secondary infection in humans." Intensified surveillance is needed in South Sudan in those localities where the affected man had been prior to his return to Uganda.

It is likely that RVF virus has persisted in this area in transovarially infected eggs of _Aedes_ mosquito vectors. These eggs can remain viable for long periods of time and hatch when flooded during future rain events, with the subsequent emergence of infected females ready to transmit the virus. This risk provides justification for maintaining livestock of the area well vaccinated into the future. This may have accounted for the reappearance of RVF in South Sudan in 2018, after nearly 2 years without additional reported cases in humans or livestock and again with this human case in 2019. - ProMED Mod.TY]

Obongi district, Uganda is located approximately 50 km (30 mi) from the South Sudan border.
HealthMap/ProMED-mail maps:

According to OIE's data, a total of 2 outbreaks of RVF affecting animals have been reported from Sudan during the event. The 1st outbreak started in the Arabaata dam area, Red Sea state, on 25 Sep 2019, affecting goats. The 2nd (and, so far, last) outbreak started 10 Oct 2019 in the River Nile state, affecting sheep and goats. Both outbreaks have been declared as 'resolved' on 14 Nov 2019.

Outbreak summary:
Total outbreaks = 2 (Submitted)
Species / Susceptible / Cases / Deaths / Killed and disposed of / Slaughtered
Goats / 1700 / 37 / 7 / 0 / 0
Sheep / 1550 / 37 / 5 / 0 / 0

According to the recent (5 Dec 2019) OCHA (UN Office for the Coordination of Humanitarian Affairs) update, the (human) RVF situation in Sudan, as of 26 Oct 2019, was the following: "a total of 345 suspected RVF cases -- including 11 related deaths -- reported in the states of Red Sea (128), River Nile (212), Khartoum (1), White Nile (1), Kassala (2), and Gedaref (1). The most affected age group is 15 to 45 years, which accounts for 83% of the total suspected cases. The male to female ratio is 2.6, with a high proportion of the cases being farmers (37.5 per cent). RVF is endemic in Sudan and 3 outbreaks affecting people have been documented in 1973, 1976, and 2008. During the outbreak in 2008, a total of 747 laboratory-confirmed cases were reported, including 230 deaths."

Egypt suffered its 1st RVF outbreak in 1977/78 with serious human disease and death as well as severe losses in livestock; several additional events have been recorded since. A recent historical review paper [1] concluded: "due to the availability and abundance of the potential vectors, the suitability of environmental conditions, continuous importation of livestock's from Sudan, and the close association of susceptible domestic animals with humans, the RVF virus could possibly occur and circulate in Egypt."   (https://tinyurl.com/whz3pz5)

Reference
---------
1. Kenawy MA, Abdel-Hamid YM, Beier JC. Rift Valley fever in Egypt and other African countries: Historical review, recent outbreaks, and possibility of disease occurrence in Egypt. Acta Trop. 2018; 181: 40-49; <https://doi.org/10.1016/j.actatropica.2018.01.015>  - ProMED Mods.AS/TY]
Date: Fri 6 Dec 2019 5:53 PM MST
Source: CTV News [edited]

A syphilis outbreak is worsening in Alberta [Canada], and the majority of new cases are in the Edmonton zone. Edmonton saw 1186 of the 1753 infectious syphilis [primary, secondary and early latent syphilis] cases reported in Alberta in 2019, a total of 68 per cent.

Alberta Health Services [AHS] declared an outbreak in July 2019, saying cases had 'increased dramatically' in the province since 2014. The number increased again in July [2019]  [<https://edmonton.ctvnews.ca/alberta-declares-province-wide-syphilis-outbreak-1.4510737>].

AHS sent a new public health alert to doctors on [27 Nov 2019], asking for their help to control the outbreak [<https://www.albertahealthservices.ca/assets/info/hp/phys/if-hp-phys-moh-ez-syphilis-outbreak.pdf>]. "It's very significant," said Dr Ameeta Singh, a clinical professor in infectious diseases. "That's an alarming rise in new syphilis cases in Alberta." She said it's the highest number of cases the province has seen since the 1940s.

According to Dr Singh, the increase in cases being reported is partially due to a greater number of people getting tested. "We know more people are coming in to get tested, but if we look a bit closer at the data we have, we do see there's, in fact, a [bigger] rise in the number of cases than we would expect to see," said Singh.

Another factor could be the rise in methamphetamine use in Edmonton. "I believe this is a major factor. Meth also stimulates risky sexual behaviour and increases the chance people will engage in multiple, usually casual or anonymous partners as well and not use precautions such as condoms to protect themselves during sex," she said.

What's also alarming, Singh said, is the spike in cases of congenital syphilis, where the disease is passed on to newborns. According to AHS, there have been 38 cases of congenital syphilis in 2019, 31 of which were in the Edmonton area. That accounts for more than half of the 61 cases of congenital syphilis reported since 2014.

"Those are not numbers we should be talking about in Canada ever...in a country that has universal access to health care, in a major city in Canada where syphilis testing is offered to all pregnant women who access prenatal care," she said. "What we're seeing with the congenital syphilis cases is many of the women are not accessing prenatal care until they come into the hospital to deliver and then the tests are being done."
===================
[A recent ProMED-mail post (Syphilis - Canada (04): (AB) RFI http://promedmail.org/post/20190718.6574300) reported a rise in "infectious syphilis" cases over a 4-year period: from 2014 to 2018 but made no mentioned of contributing factors. As illicit drug use has been cited as a contributing factor to recent increases in syphilis cases in the Canadian provinces of Ontario and Manitoba, I questioned in this prior ProMED-mail post if use of illicit drugs, in particular, methamphetamine, could similarly be contributing to the rise of syphilis cases in Alberta. The news article above reports that the rise in methamphetamine use in Edmonton, as well as increased testing for syphilis, are thought to be contributing factors in Alberta.

Methamphetamine can be swallowed, snorted, smoked or injected by needle and syringe

When methamphetamine is injected, transmission of syphilis may occur as a consequence of sharing a needle/syringe contaminated with infected blood from somebody who has primary or secondary syphilis (<https://ucsdnews.ucsd.edu/archive/newsrel/health/04-28TransmissionSyphilis.asp>); but syphilis can also be acquired by direct contact with an infected lesion during oral, vaginal, or anal sex when the drug is taken by any route of administration. Methamphetamine use is associated with sexual behaviors that increase the risk for acquiring syphilis and other sexually transmitted diseases, including having multiple sex partners, inconsistent condom use, and exchange of sex for drugs or money (<https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a4.htm>).

The linkage of methamphetamine use and syphilis transmission is reminiscent of the increase in syphilis among heterosexuals during the crack cocaine epidemic of the 1980s and 1990s, when the practice of trading sex with multiple partners for drugs, especially crack cocaine, played a major role in the transmission of syphilis. Under these circumstances, the identities of sex partners are often unknown, which weakens the traditional syphilis-control strategy of partner notification.

Bacteremia due to _Treponema pallidum_, the cause of syphilis, which occurs during primary, secondary, and latent syphilis, can result in transplacental transmission of this organism to the fetus during pregnancy and cause congenital syphilis. An increase in the incidence of syphilis in women in the population is commonly accompanied by increasing rates of congenital syphilis.

Edmonton, with a population of 932 546 residents in 2016, is the capital of the Canadian province of Alberta
(<https://en.wikipedia.org/wiki/Edmonton>).

A map showing the location of Edmonton can be found at
<https://goo.gl/maps/Rfq6XC2vvwi19ypb6>. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Alberta, Canada:
9 December 2019
https://www.who.int/bangladesh/news/detail/09-12-2019-cholera-vaccination-campaign-launched-to-protect-635-000-people-in-cox-s-bazar

Cox’s Bazar, Bangladesh

Over 635,000 Rohingya refugees and Bangladeshi host community will be vaccinated against cholera in a 3-week-long campaign beginning today at the refugee camps in Cox’s Bazar and nearby areas, to protect vulnerable population against the deadly disease amidst increasing number of cases of acute watery diarrhoea (AWD).


The Oral Cholera Vaccination (OCV) campaign will be implemented in the refugee camps from 8-14 December to reach 139,888 Rohingya aged 1 year and less than 5 years. In the host community, the campaign will take place from 8-31 December and aims to reach any person older than 1 year (495,197). In total, 635,085 people are expected to be reached.

Led by the Ministry of Health and Family Welfare, with support of the World Health Organization (WHO), UNICEF and other partners, the campaign aims to reach people who missed some or all previous cholera vaccination opportunities. The campaign, including operational costs, is funded by Gavi, the Vaccine Alliance.

“We want to equip these populations with more protection against diarrheal diseases. Despite the progresses made to ensure access to quality water and sanitation, such diseases remain an issue of concern: approximately 80% of host community living near the camps have not been targeted in previous OCV campaigns and are still vulnerable”, says Dr Bardan Jung Rana, WHO Representative in Bangladesh.

Earlier rounds of cholera vaccination, which have taken place since the beginning of the emergency response in 2017, have helped prevent outbreaks of the disease. To this date, over 1 million people were vaccinated against cholera.
6th December 2019
https://www.theguardian.com/world/2019/dec/06/flooding-hits-new-zealand-tourist-hubs-of-wanaka-and-queenstown

Heavy rain has led to rivers bursting their banks, forcing the closure of shops and restaurants

Streets in the South Island tourist towns of Wanaka and Queenstown were slowly going under water on Friday, after Lake Wanaka and Lake Wakatipu burst their banks earlier in the week, flooding businesses and sewerage systems.

Water and large debris closed the main street of Wanaka, a popular spot with Instagrammers thanks to its famous tree that appears to have grown out of the lake. On Friday businesses were sandbagging as heavy rain continued to fall.

Sewerage systems in the town were also at risk of contaminating the lake, with the Queenstown Lakes District council taking the precautionary measure of shutting down the sewer connection to a handful of premises.

Wanaka residents were told to be on “high alert” with heavy rain predicted all weekend.

The streets of the usually bustling tourist town were largely empty, and the popular cafes and restaurants on the lake shore were closed.