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United Arab Emirates

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

See our information on Victims of Crime.

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our Customs Information.

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

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

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

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

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

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

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our information on Criminal Penalties.

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Niue

No Profile is available at present

Travel News Headlines WORLD NEWS

20th July 2012

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

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

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

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

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

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

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

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

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

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

Sao Toma and Principe

Sao Tome and Principe US Consular Information Sheet
August 15, 2008
COUNTRY DESCRIPTION:
São Tomé and Príncipe is a developing nation, comprising the islands of São Tomé and Príncipe, located off the western coast of central Africa.<
R />Facilities for tourism are limited, but adequate.
Read the Department of State Background São Tomé and Príncipe for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport, visa, and evidence of yellow fever vaccination are required for entry.
Visas must be obtained in advance.
Travelers can obtain visas and the latest information on entry requirements from the Permanent Mission of São Tomé and Príncipe to the UN, 400 Park Ave., 7th Floor, New York, NY
10022, telephone (212) 317-0533, fax (212) 317-0580.
Travelers transiting through Gabon can also obtain visas and the latest information on entry requirements from the São Tomé and Príncipe Embassy to Gabon, B.P. 49, Libreville, Gabon, telephone (241) 72-15-27, fax (241) 72-15-28.
Overseas, inquiries should be made at the nearest São Toméan and Príncipian embassy or consulate.

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

SAFETY AND SECURITY:
Americans should maintain security awareness at all times.
There have been recent, isolated incidents of civil unrest in the capital city.
Large gatherings or any other events where crowds have congregated to demonstrate or protest should be avoided.

Americans may contact the U.S. Embassy in Gabon for the most up-to-date information on safety and security.
The Embassy informs the registered resident U.S citizen community of security matters through a warden system (please see the Registration/Embassy Location section below for more information).

In the event of a fire, dial 112 on the telephone.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

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

CRIME:
Crimes such as burglary, pick-pocketing and armed robberies in homes do occur on the islands, particularly around the winter holidays.
Such crimes can occur anywhere, but are more prevalent in public places, such as in markets, on the streets, or near hotels.
Do not display large amounts of cash in public.
If possible, leave valuables and extra cash at your hotel while sightseeing or visiting the beach.
When dining in restaurants or visiting markets, it is recommended that one carry only minimal amounts of cash and avoid wearing excessive amounts of jewelry.
If involved in an attempted robbery or carjacking, Americans are encouraged to comply with the attacker to avoid injury and to report all incidents to the police and the U.S. Embassy in Libreville.
Police response time to reports of crime can be slow.

While scams and confidence schemes are not common, travelers should exercise caution.
The prevalence of sexual assault is low, and no specific groups seem to be targets for victimization.

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

The local equivalent to the “911” emergency line in São Tomé and Príncipe to reach the police is 22-22-22.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in São Tomé and Príncipe are extremely limited.
There is one hospital in the country, on the island of São Tomé, and several foreign-run clinics.
However, the level of care is low.
For all but minor medical needs, it is necessary to travel to Libreville (Gabon), Lisbon (Portugal), or elsewhere.
Additionally, some medicines are not available; travelers should carry properly labeled required medicines and medications with them.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of São Tomé and Príncipe.

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

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

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

Streets in the city of São Tomé are paved, but large potholes are common.
Major roads outside of town are also paved.
Pedestrians, bicyclists, motorcyclists, and animals on the roads can be a major hazard.
Outside of the city of São Tomé, there are no sidewalks or shoulders along the side of roads.
In rural areas outside of the capital city, drivers are expected to honk the car’s horn periodically as a warning signal of their approach.
There is no street lighting outside of the capital.
Some roads may be impassable without a four-wheel-drive vehicle.

Only a few miles of improved roads exist on the island of Príncipe; the conditions are similar to those found on São Tomé.
Although taking taxis is fairly safe, it is advisable to rent a car instead.
If you must take a taxi, exercise caution, and negotiate the rate before entering the taxi.

Please refer to our Road Safety page for more information.

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

SPECIAL CIRCUMSTANCES:
São Tomé and Príncipe is a lusophone country; travelers who do not speak Portuguese may face difficulties associated with the language barrier.

Americans should always carry identification with them in the event they are stopped by police.

Taking photographs of military or government buildings is strictly forbidden.
São Tomé and Príncipe is largely a cash economy.
Credit cards are accepted at only a few major hotels.
Travelers’ checks can be cashed or dollars exchanged for dobra at hotels and at one private bank in São Tomé city, but transaction fees can be high.
U.S. dollars are widely accepted at tourist establishments.

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 São Toméan and Príncipian laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in São Tomé and Príncipe 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:
Although there is no U.S. Embassy in São Tomé and Príncipe, the U.S. Embassy in Libreville, Gabon is also accredited to São Tomé and Príncipe and can provide assistance to Americans there.
All Americans in São Tomé and Príncipe are encouraged to register with the U.S. Embassy in Gabon through the State Department’s travel registration web site so that they can obtain updated information on travel and security within São Tomé and Príncipe.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, Americans make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy is located in downtown Libreville on the Boulevard du Bord de Mer.
The mailing address is Centre Ville, B.P. 4000, Libreville, Gabon.
The telephone numbers are (241) 76-20-03 or (241) 76-20-04.
The fax numbers are (241) 74-55-07 or (241) 76-88-49 and the web site is http://libreville.usembassy.gov/.
*

*

*
This replaces the Country Specific Information dated November 8, 2007 to update sections on Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, Traffic Safety and Road Conditions, Special Circumstances, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Tue, 12 Dec 2017 02:47:28 +0100
By Caroline CHAUVET

Sao Tome, Sao Tome and Principe, Dec 12, 2017 (AFP) - A big roadside poster announces a "Pest Control Campaign" in Sao Tome and Principe, with a man in a white face mask wielding an insecticide spray fuelled by a tank on his back.   The island nation in the Gulf of Guinea is at war against malaria, as it has been twice a year since 2003, with such success that the disease no longer routinely claims lives.   In mainland central Africa, the incidence of malaria spread by infected female mosquitos is among the highest rates in the world.

Malaria killed some 445,000 people around the planet in 2016, according to the World Health Organisation (WHO), out of 216 million estimated cases that year.   "Our last death was in 2016. It was a Portuguese man who failed to take measures for prevention and treatment," said Hamilton Nascimento, coordinator of the National Programme to Fight Paludism (PNLP) in Sao Tome.   In 2005, malaria claimed more than 5,000 lives out of about 50,000 infected people in Sao Tome and Principe, according to the WHO.   The humid tropical climate of the islands provides an ideal breeding ground for the female mosquitos that carry the parasitic infection from one person to another with their bloodsucking bites.

- National priority -
Yet since 2014, the number of deaths has fallen to none on Sao Tome, apart from the Portuguese victim. On Principe, lying to the north, malaria has been eradicated, in official terms.   The government wants to wipe it out everywhere by 2025, but the WHO has warned that a sizeable part of future funding is at risk.   The battle against a once endemic disease began as a national priority in the 1980s, in the wake of independence from Portugal in 1975, Nascimento told AFP.

The islands of Sao Tome and Principe, which have a combined land surface of 1,000 square kilometres (386 square miles), benefit from their offshore location west of Gabon and from a small population of less than 200,000 inhabitants.   "We have three strategies: spraying inside houses, distributing mosquito nets impregnated (with insecticide) and the fight against larvae using a biological insecticide that we spread in stagnant waters," Nascimento said.   The population of Sao Tome also has access to free medication to treat malaria and to testing campaigns nationwide. If a case of malaria is detected, "the hospital follows up the patient for 28 days," he added.   "Sick people are given free care by the health centres and medicine is
accessible everywhere in the country."

For all the successes in tackling a disease that has no available vaccine and is prone to mutate, residents of the islands have begun to grow weary of the repeated campaigns.   "The number of people who open their doors to the mosquito sprayers has gone down," Health Minister Maria Jesus Trovoada said, concerned that this refusal to take part "puts all the efforts of the government in peril".   Authorities in Sao Tome and Principe have been clear about their desire to reduce dependence on foreign aid, which accounts for about 90 percent of the nation's resources, and the battle with malaria is part of that goal.   At the end of the 1980s and again in 2012-2013, the disease ravaged the country because of a shortfall in funding and spreading resistance to insecticides, Hamilton said.   "We must often -- about every 10 years -- change the insecticide, because the mosquitos develop resistance," he explained.

- Funding cuts? -
While the government recently stepped up its contribution, the Global Fund to Fight AIDS, Tuberculosis and Malaria, a foundation partnered with the WHO, finances most measures to beat the disease on the islands.   The grant from the Global Fund may be slashed by more than 50 percent, the WHO warned in a recent report. Sao Tome and Principe would then "need more or less $5 million (4.2 million euros) between 2018 and 2021 to go on getting good results".   "The impact of lack of funding is unknown. However, if current efforts to control malaria have to be reduced due to lack of funds a high risk of a relapse exists," Rebekka Ott, the Global Fund representative on Sao Tome, told AFP.

The foundation is also concerned about Sao Tome's cutting of diplomatic ties with Taiwan at the end of 2016 in order to develop relations with China. Taiwan previously paid more than 30 percent of the cost of fighting malaria.   China, whose flag has already been mounted at the National Centre for Endemics, is expected to take up the baton, but by providing "technical assistance" rather than financial aid.   Whatever the obstacles, the WHO announced in April 2016 that 21 countries in the world may eliminate malaria by 2020. Six of those nations are in Africa: Algeria, Botswana, Cape Verde, Comoros, Swaziland and South Africa.
Date: Wed 8 Feb 2017
From: Raquel Tavares <raquelmrtavares@gmail.com> [edited]
[Re: ProMED-mail posts Buruli ulcer - Sao Tome and Principe
http://promedmail.org/post/20170208.4824961 and http://promedmail.org/post/20170210.4830051]
----------------------------------------------------------------------
In March 2016 we started following a patient from Sao Tome with severe leg ulcer, complicated with bacterial infection and extension to bone. In December 2016, an _Aspergillus fumigatus_ DNA was found in a bone biopsy. The patient has improved since, with anti-fungal therapy (first with itraconazole and in the last 2 months changed to voriconazole). I think this is a possible aetiology. It was a very difficult diagnosis, because normal fungal cultures were negative. We also did DNA and culture for _Mycobacterium ulcerans_ and it was negative.
------------------
Raquel Tavares,
MD Infectious Diseases Specialist
Hospital Beatriz Angelo
Loures Portugal
raquelmrtavares@gmail.com
Date: Fri 3 Feb 2017 13:46 CET
Source: L'Express, Agence France-Presse (AFP) [in French, machine trans., edited]
<http://goo.gl/DUrF3d>

A disease of unknown origin, manifested by a violent cutaneous ulcer, torments the inhabitants of Sao Tome. 1094 cases have been registered since October [2016] among a population of less than 200,000 inhabitants, the health authorities of the small African archipelago announced this [Fri 3 Feb 2017]. The authorities have requested support from the World Health Organization (WHO), which has sent a Benin specialist in Buruli ulcer.
=======================
Dr Irene Lai International SOS
irene.lai@internationalsos.com
=======================
[ProMED-mail thanks Irene Lai for submitting the news report above. Sao Tome, with a population of 56,945 residents, is the capital city of the island nation of Sao Tome and Pri­ncipe, in the Gulf of Guinea, off the western equatorial coast of Central Africa. (<https://en.wikipedia.org/wiki/Sao_Tome>). Buruli ulcer (also known as the Bairnsdale ulcer in Australia) is a chronic skin and soft tissue infection due to _Mycobacterium ulcerans_ with large ulcers usually on the legs or arms that can lead to adjacent bone infection and permanent disfigurement and disability.

Buruli ulcer is named after a county in Uganda. _M. ulcerans_ needs a temperature between 29-33 deg C (84.2-91.4) to grow in vitro (<http://jcm.asm.org/content/36/11/3420.full>). The organism produces a unique toxin -- mycolactone, which causes tissue damage and inhibits the immune response. Local immunosuppressive properties of the mycolactone toxin enable the disease to progress with no pain and fever.

The diagnosis can be confirmed by polymerase chain reaction (PCR), direct microscopy, histopathology, and culture. Buruli ulcer has been reported in over 30 countries usually with tropical climates in Africa, South America, Asia, and Western Pacific regions, as well as Australia. Countries in West and Central Africa -- Benin, Cameroon, Cote d'Ivoire, Democratic Republic of the Congo and Ghana -- report the majority of cases. In Africa, most cases occur in children under 15 years, whereas in Australia, only 10 per cent are children under 15 years; and in Japan, 19 per cent are children under 15 years.

_M. ulcerans_ has been identified in fresh and brackish water and soil in swampy areas. Abrasions of the skin after contact with contaminated water, soil, or vegetation are likely routes of entry. _M. ulcerans_ is not believed to be transmitted from person to person; but the exact mode of transmission is unknown and may vary by geographic region. Vectors, in particular aquatic insects and mosquitoes, may also play a role in some locations.

In south-eastern coastal Australia, possums, which have laboratory-confirmed _M. ulcerans_ skin lesions and/or _M. ulcerans_ PCR-positive faeces, may be a reservoir (ProMED-mail post Buruli ulcer - Australia: (VI) M. ulcerans, possum faeces http://promedmail.org/post/20140913.2771412).

Buruli ulcer has been reported to develop in travellers at the site of a trauma after having left a disease-endemic area. 80 per cent of cases detected early can be cured with a combination of antibiotics; however, late diagnosis can result in long and costly hospitalizations with significant morbidity and disability.

Medical treatment is rifampin, combined with either streptomycin, clarithromycin, or moxifloxacin for 8 weeks, in addition to surgical wound management.

Pictures of Buruli ulcers can be seen at (<https://www.youtube.com/watch?v=XCQ67NGmytI>). - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/63>.]
Date: Thu, 5 Jan 2006 From: ProMED-mail Source: Adventist Development and Relief Agency (ADRA) [edited] In response to a cholera outbreak that struck Sao Tome and Principe in Oct 2005, the Adventist Development and Relief Agency (ADRA) is helping to control the outbreak by distributing disinfectants among the community, as well as promoting improved health and sanitation practices through campaigns that teach villagers how to prevent the transmission of this contagious disease. ADRA has organized an awareness campaign among 50 rural community groups targeting 1000 women, focusing primarily on the districts of MeZochi and Caue. With this training, the women become health promoters in their communities, teaching other people the same health and hygiene practices they have been taught. Each woman will receive training on how cholera is transmitted, how it can be treated, and how to prevent it. They will also receive bottles of lye, which they will use to safely disinfect water, food, and any other potential contaminant. In addition, ADRA will distribute 10 health education leaflets to each woman; one for her personal use, and 9 additional leaflets to share among her community. ADRA will also perform a theatre play that will be performed in 24 communities to educate the community on the cholera outbreak. As of 1 Jan 2006, nearly 30 people have succumbed to the disease, since the outbreak began 3 months ago, out of an estimated 1849 severe cases that have been reported since its inception.
Date: Tue, 20 Dec 2005 From: ProMED-mail Source: XinHuaNet.com [edited] The 2-month-old cholera epidemic sweeping Sao Tome and Principe shows no sign of letup, having claimed 5 more lives and doubling the number of reported cases. According to reports reaching here on Mon, 19 Dec 2005, the spokesman for the national committee overseeing the anti-cholera campaign, Jose Manuel de Carvalho, said that 5 more people had died from the disease in the preceding 2 weeks for a total of 25 fatalities. In the same period, de Carvalho added, the number of cases more than doubled to 1374 from 650. The outer island of Principe has so far been spared. He repeated government appeals for increased attention to personal and public hygiene to help staunch the highly infectious disease. Last week, a riot erupted in the archipelago's capital when a police officer tried to enforce a ban on the sale of street food at a Sao Tome market.
More ...

Nigeria

Nigeria US Consular Information Sheet
June 02, 2008
COUNTRY DESCRIPTION:
Nigeria is a developing country in western Africa that has experienced periods of political instability. It has the largest population on the continent, estimated at
44 million people, and its infrastructure is not fully functional or well maintained. Read the Department of State’s Background Notes on Nigeria for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. The visa must be obtained in advance from a Nigerian Embassy or Consulate. Visas cannot be obtained on arrival at the airport. Promises of entry into Nigeria without a visa are credible indicators of fraudulent commercial schemes in which the perpetrators seek to exploit the foreign traveler's illegal presence in Nigeria through threats of extortion or bodily harm. U.S. citizens cannot legally depart Nigeria unless they can prove, by presenting their entry visas, that they entered Nigeria legally. Entry information may be obtained at the Embassy of the Federal Republic of Nigeria, 3519 International Court NW, Washington, DC 20008, telephone (202) 822-1500, or at the Nigerian Consulate General in New York, telephone (212) 808-0301. Overseas, inquiries may be made at the nearest Nigerian embassy or consulate.

Visit the Embassy of Nigeria web site at http://www.nigeriaembassyusa.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:
The Department of State continues to caution U.S. citizens about the possible dangers of travel to some parts of Nigeria. [Please also see the Crime Section below.] In light of the risk of kidnapping, crime, militant activity, or armed attacks, the U.S. Mission restricts the travel of U.S. government personnel to the following states to official travel only: Delta, Bayelsa, Rivers and Akwa Ibom in the Niger Delta, and Edo and Imo in the south. Only essential travel by non-official Americans is recommended to these areas. In addition, the military's Joint Task Force patrols the creeks in the Niger Delta because of ongoing militant and piracy incidents, especially against oil-related facilities or infrastructure, so individuals may be questioned, detained or arrested when traveling in these sensitive areas without evidence of permission from the Nigerian government or for carrying electronic equipment such as cameras, recorders, etc. Periodically, travel by U.S. mission personnel is restricted in certain parts of Nigeria based on changing security conditions, often due to crime, general strikes, or student/political demonstrations or disturbances. See the Department of State’s Travel Warning for Nigeria for more information.

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 current Travel Warnings, Travel Alerts, and the Worldwide Caution can be found.

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

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

CRIME: Violent crime committed by individual criminals and gangs, as well as by some persons wearing police and military uniforms, is a problem, especially in Lagos, Abuja and other large cities, although it can occur anywhere. Some visitors and resident Americans have experienced armed muggings, assaults, burglary, carjacking, kidnappings and extortion, often involving violence. Home invasions are on the rise in Lagos, with armed robbers accessing even guarded compounds by following, or tailgating, residents or visitors arriving by car into the compound, subduing guards and gaining entry into homes or apartments. Armed robbers in Lagos also access waterfront compounds by boat. U.S. citizens, as well as Nigerians and other expatriates, have been victims of armed robbery on roads to airports during both daylight and evening hours. Law enforcement authorities usually respond to crimes slowly or not at all, and provide little or no investigative support to victims. U.S. citizens and other expatriates have experienced harassment and shakedowns at checkpoints and during encounters with Nigerian officials.

Nigerian-operated fraud scams, known as 419s, are noted for their cleverness and ingenuity. These scams target foreigners worldwide, posing risks of both financial loss and personal danger to their victims. Scams are often initiated through internet postings or from internet cafes, by unsolicited emails, faxes, and letters, or can involve credit card use. As anywhere else, no one should provide personal or financial information to unknown parties or via Nigerian telephone lines. The expansion of bilateral law enforcement cooperation, which has resulted in numerous raids on commercial fraud premises, has reduced the overall level of overt fraud activity, but new types of sophisticated scams are introduced daily.

American citizens are very frequently the victims of Nigerian confidence artists offering companionship through internet dating websites. These confidence artists almost always pose as American citizens visiting or living in Nigeria who unexpectedly experience a medical, legal, financial or other type of “emergency” that requires the immediate financial assistance of the American citizen in the United States. In these cases, we strongly urge the American citizen in the United States to be very cautious about sending money to any unknown person purportedly acting on their behalf, or traveling to Nigeria to meet someone with whom their sole communications have been via the internet. Other common scams involve a promise of an inheritance windfall, work contracts in Nigeria, or an overpayment for goods purchased on-line. For additional information on these types of scams, see the Department of State's publication, International Financial Scams.

Commercial scams or stings that targets foreigners, including many U.S. citizens, continue to be a problem. One needs to be alert to scams that may involve U.S. citizens in illegal activity, resulting in arrest, extortion or bodily harm. These scams generally involve phony offers of either outright money transfers or lucrative sales or contracts with promises of large commissions or up-front payments, or improperly invoke the authority of one or more ministries or offices of the Nigerian government and may cite, by name, the involvement of a Nigerian government official. In some scams, government stationery and seals are also improperly used to advance the scam. The ability of U.S. consular officers to extricate U.S. citizens from unlawful business deals or scams and their subsequent consequences is extremely limited. U.S. citizens have been arrested by police officials and held for varying periods on charges of involvement in illegal business activity or scams. Nigerian police or other law enforcement officials do not always inform the U.S. Embassy or Consulate immediately of the arrest or detention of a U.S. citizen. The U.S. Department of Commerce has advisories to the U.S. business community on a variety of issues that should be seriously reviewed with respect to doing business in Nigeria. To check on a business’s legitimacy while in the United States, contact the Nigeria Desk Officer at the International Trade Administration, Room 3317, Dept. of Commerce, Washington, D.C. 20230, telephone 1-800-USA-TRADE or (202) 482-5149, fax (202) 482-5198. If you are abroad, contact the nearest U.S. Embassy or Consulate.

The Department of State encourages all travelers abroad to register their travel. The most convenient way to do so would be through the online travel registration page. Travelers may also register in person at the U.S. Embassy in Abuja or the U.S. Consulate General in Lagos. See the section on Registration / Embassy Location below.

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, for example, can provide you with a list for appropriate medical care, or contact family members or friends and explain how funds could be transferred to you to cover unexpected costs. 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 the Department of State’s information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: While Nigeria has many well-trained doctors, medical facilities in Nigeria are in poor condition, with inadequately trained nursing staff. Diagnostic and treatment equipment is most often poorly maintained, and many medicines are unavailable. Caution should be taken as counterfeit pharmaceuticals are a common problem and may be difficult to distinguish from genuine medications. This is particularly true of generics purchased at local pharmacies or street markets. Hospitals often expect immediate cash payment for health services.

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

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their health insurance policy applies overseas and whether it will cover emergency expenses such as a medical evacuation from a foreign country to the United States or another location. Please see the our brochure 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 Nigeria is provided for general reference only and may not be totally accurate in a particular location or circumstance.

Roads in many areas are generally in poor condition, causing damage to vehicles and contributing to hazardous traffic conditions. There are few working traffic lights or stop signs. The rainy season from May to October is especially dangerous because of flooded roads and water-concealed potholes.

Excessive speed, unpredictable driving habits, and the lack of basic maintenance and safety equipment on many vehicles are additional hazards. Motorists seldom yield the right-of-way and give little consideration to pedestrians and cyclists. Gridlock is common in urban areas. Chronic fuel shortages have led to long lines at service stations, which disrupt or block traffic for extended periods.

Public transportation vehicles are unsafe due to poor maintenance, high speeds and overcrowding. Motorbikes, known in Nigeria as "okadas," are a common form of public transportation in many cities and pose particular danger to motorists, their own passengers and pedestrians. Motorbike drivers frequently weave in and out of traffic at high speeds and observe no traffic rules. Motorbikes are banned within Abuja's city limits. Passengers in local taxis have been driven to secluded locations where they were attacked and robbed. Several of the victims required hospitalization. The U.S. Mission advises that public transportation throughout Nigeria be avoided.

It is recommended that short-term visitors not drive in Nigeria. A Nigerian driver's license can take months to obtain, and to date an international driving permit is not recognized. Major hotels offer reliable car-hire services complete with drivers. Reliable car-hire services can also be obtained at the customer service centers at the airports in Lagos, Abuja, and Kano. Inter-city travelers must also consider that roadside assistance is extremely scarce, and as noted above medical facilities and emergency care are poor, meaning that being involved in a traffic incident might result in a lack of available medical facilities to treat either minor or life-threatening injuries.

All drivers and passengers are reminded to wear seat belts, lock doors, and raise windows. It is important to secure appropriate automobile insurance. It is also important to be aware that drivers and passengers of vehicles involved in accidents resulting in injury or death have experienced extra-judicial actions, i.e., mob attacks, official consequences such as fines and incarceration or involvement with the victim's family. Night driving should be done with extreme caution, but it is recommended to avoid driving between 6:00 p.m. and 6:00 a.m. as bandits and police roadblocks are more numerous at night. Streets are very poorly lit, and many vehicles are missing one or both headlights, tail lights, and reflectors.

The Government of Nigeria charges the Federal Road Safety Commission with providing maps and public information on specific road conditions. The Federal Road Safety Commission may be contacted by mail at: Ojodu-Isherri Road, PMB 21510, Ikeja, Lagos; telephone [243] (1) 802-850-5961 or [234] (1) 805-684-6911.
Please refer to our Road Safety page for more information.

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

The Port Harcourt International Airport, which was closed in mid-2006 for rehabilitation, resumed operations in December 2007 for domestic daylight flights. Installations and improvements needed for international flights and night operations are expected to be completed in 2008.

For additional information on aviation safety concerns, see the Department of State’s Travel Warning for Nigeria.
SPECIAL CIRCUMSTANCES:
Permission is required to take photographs or videotape any government buildings, airports, bridges, and in areas where the military is operating throughout the country. These sites include, but are not limited to, Federal buildings in the Three Arms Zone (Presidential palace area, National Assembly, Supreme Court/Judiciary) of the capital of Abuja, other government buildings around the country and foreign Embassies and Consulates. Many restricted sites are not clearly marked, and application of these restrictions is subject to interpretation by the Nigerian security services and can result in detention. Permission may be obtained from Nigeria's State Security Services, but even permission may not prevent the imposition of penalties or detention. Penalties for unauthorized photography or videography may include confiscation of the still or video camera, exposure of the film or deletion of film footage, a demand for payment of a fine or bribe, and/or detention, arrest, or physical assault. For these reasons, visitors to Nigeria should avoid taking still photos or videotaping in and around areas that are potentially restricted sites, including any government sites.

The Nigerian currency, the naira, is non-convertible. U.S. dollars are widely accepted. Nigeria is a cash economy, and it is usually necessary to carry sufficient currency to cover the expenses of a planned visit, which makes travelers an attractive target for criminals. Credit cards are rarely accepted beyond a few upscale hotels. Due to credit card fraud in Nigeria and by cohorts in the United States, credit card use should be considered carefully. While Citibank cashes some traveler’s checks, most other banks do not. American Express does not have offices in Nigeria; however, Thomas Cook does. Inter-bank transfers are often difficult to accomplish, though money transfer services such as Western Union are available. For further information, visitors may contact the U.S. Embassy or Consulate.

Please see the Department of State’s information on 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 Nigerian laws, even unknowingly, may be expelled, detained, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Nigeria 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 the Department of State’s information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Nigeria are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Nigeria and other general information.Americans withoutInternet 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 1075 Diplomatic Drive, Central Area, Abuja. American citizens can call [234] (9) 461-4176 during office hours (Monday through Thursday, 7:30 a.m. to 4:30 p.m.; Friday, 7:30 a.m. to 1:30 p.m.). For after-hours emergencies, call [234] (9) 461-4000. The email address for the Consular Section in Abuja is ConsularAbuja@state.gov.

The U.S. Consulate General is located at 2 Walter Carrington Crescent, Victoria Island, Lagos. American citizens can call [234] (1) 261-1215 during office hours (7:30 a.m. to 4:00 p.m.). For after-hours emergencies, call [234] (1) 261-1414, 261-0050, 261-0078, 261-0139, or 261-6477. The e-mail address for the Consular Section in Lagos is Lagoscons2@state.gov.

The Embassy and Consulate website is http://nigeria.usembassy.gov/.
* * *
This replaces the Consular Information Sheet dated April 16, 2007, to update sections on Country Description, Safety and Security, Crime, Traffic Safety and Road Conditions, Aviation Safety Oversight, Special Circumstances and Registration / Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu, 20 Feb 2020 10:28:16 +0100 (MET)

Lagos, Feb 20, 2020 (AFP) - An outbreak of Lassa in Nigeria has killed 103 people this year, health authorities said, as the first confirmed case was reported in the economic hub Lagos.    "Cumulatively from week 1 to week 07, 2020, 103 deaths have been reported with a case fatality rate of 17.6%," said the Nigeria Centre for Disease Control (NCDC) in its latest statistics on the virus released on Wednesday.    The overall number of confirmed cases rose by 115 last week to a total of 586 across the country.

Separately, health authorities in Lagos, Nigeria's most populous city with 20 million inhabitants, said an infected person was diagnosed there on February 17 and being treated in isolation in hospital.    "Sixty-three people that may have been in contact with the patient and who may have been infected in the process have been identified and are being monitored," the state government wrote on Twitter on Thursday.

Endemic to Nigeria, Lassa fever belongs to the same family as the Ebola and Marburg viruses, but is much less deadly.   The disease is spread by contact with rat faeces or urine or the bodily fluids of an infected person.    The majority of those infected do not show symptoms but the disease can go on to cause severe bleeding and organ failure in about 20 percent of cases.

An outbreak of Lassa fever killed some 170 people around Nigeria last year.     The number of cases usually climbs around the start of the year linked to the dry season.   While the overall number of confirmed cases and deaths is up this year on the same period in 2019, the mortality rate is lower.    Twenty health workers across the country have been confirmed as contracting the disease so far in 2020.    The virus takes its name from the town of Lassa in northern Nigeria, where it was first identified in 1969.
Date: Fri 31 Jan 2020
Source: Nigeria CDC Situation report, yellow fever [edited]

Highlights
----------
In this reporting period:
- A total of 139 suspected cases were reported in 90 LGAs across 27 states
- All 139 suspected cases had blood samples collected
- 2 presumptive positive and 1 inconclusive case were reported; the inconclusive case was reported from Katsina State
- No confirmed case was recorded from Institute Pasteur Dakar
- No death was recorded from all the cases reported

Yellow fever response activities are being coordinated by the multi-agency yellow fever Technical Working Group (YF TWG).

Off-site support is being provided to all states.

Yellow fever preventive mass vaccination (PMVC) campaigns are planned for implementation in Oyo, Delta, Benue, Osun, Bauchi and Borno in the 3rd and 4th quarters.

Graphs and a map accessible at the above URL;
Figure 1 [graph]: Epidemic Curve of All Cases of Yellow Fever in Nigeria from Week 1 - Week 5, 31 Jan 2020
Figure 2 [graph]: Trends of Confirmed Cases in Nigeria - 2018, 2019 and January 2020
Figure 3 [graph]: Yellow fever Attack rate by State in Nigeria from Week 1 - Week 5, 31 Jan 2020
Figure 4: Map of Nigeria Showing States with Suspected and Presumptive confirmed Cases from Week 1 - Week 5, 31 Jan 2020
====================
[This report is not clear about the number of confirmed yellow fever (YF) cases that there have been in Nigeria this year (2020). The above report indicates that there are 139 suspected cases and all have had blood samples taken but does not state if all samples have been tested for YF by the Institute Pasteur in Dakar. The report does state that no confirmed case was recorded by the Institute Pasteur Dakar. The report states that 2 cases are presumptive and 1 is inconclusive. The graph in Figure 2 shows no confirmed cases in 2020.

It is curious that a 19 Jan 2020 report indicated that there were 141 suspected yellow fever cases in Jos North, Wase, Bassa, Kanam and Riyom Local Governments of Plateau State, of which 25 cases had been confirmed (see Yellow fever - Africa (02): Nigeria (PL) http://promedmail.org/post/20200121.6903167). A 29 Dec 2019 The World Health Organization (WHO) report confirmed 13 cases of yellow fever (YF), with 3 deaths in 4 local government areas of Plateau State (see Yellow fever - Africa (01): Nigeria (PL) http://promedmail.org/post/20200101.6862783). It is possible that all of these Plateau state cases occurred in 2019 and, hence, are not included in the above 2020 report which does not mention any cases in Plateau state. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Wed 29 Jan 2020
Source: Daily Trust [edited]

An unknown illness has reportedly claimed the lives of 4 persons in the rural community of Oye-Obi in Obi local government area of Benue state. The president-elect, Igede National Youths Council, Andyson Iji Egbodo, who raised the alarm on Wednesday night [29 Jan 2020] on behalf of the villagers, told our correspondent by telephone that 15 more people with the same symptoms are already hospitalised in the affected community.

"The sickness has so far killed 4 persons in 2 weeks. The 4 victims developed the same symptoms -- headache, fever, diarrhoea, vomiting, stomach-ache, weakness of the body, and swollen stomach -- and died alike," he said. Egbodo added that about 6 more persons who as at Wednesday [29 Jan 2020] were developing the same symptoms have been moved to the General Hospital in Oju, while the remaining 9 that made up the total of 15 on admission are kept at a private dispensary.

The youth leader who suspected the illness to be Lassa fever has appealed as a matter of urgency to the state government as well as relevant health authorities to come to the aid of the boundary settlement people before the illness causes further harm.

When contacted, the state's epidemiologist, Dr. Sam Ngishe, confirmed the death of the 4 people, adding that the health authorities were alerted to the situation a few hours ago.

Ngishe said an emergency response team from the state's Ministry of Health had been immediately sent to the area to contain the situation, while 3 of the patients are expected to be moved to Makurdi on Thursday [30 Jan 2020] for further investigation. The epidemiologist added that until investigation on the matter is completed, he cannot immediately confirm the nature of the illness, as there were already 2 sides to the rumour of possible causes of the deaths. He explained that there were reports that the community's source of drinking water was poisoned with Gamalin, and those affected may have consumed fish taken from the pond, while another side of the story suggested that the people who died presented symptoms of fever. "We can't base our findings yet on these rumours. We'll have to investigate it, and by tomorrow [Thu 30 Jan 2020], we will able to tell the press what exactly the challenge might be," Ngishe said.  [Byline: Hope Abah Emmanuel, Makurdi]
=======================
[It is difficult to speculate on the etiology of the illnesses that these individuals were suffering. Although no hemorrhaging was reported, the other reported symptoms are compatible with Lassa fever, and this is the season when Lassa fever virus transmission is highest (see <Lassa fever - West Africa (07): Nigeria http://promedmail.org/post/20200129.6930926>). The epidemiological investigations may provide additional information. Laboratory testing of samples from the affected individuals should provide information that may indicate the etiology involved. - ProMED Mod.TY]

[This article mentions "..community's source of drinking water was poisoned with Gamalin and those affected may have consumed fish taken from the pond.."

Gamalin, more often spelled Gammallin is also known as Lindane, which is a gamma-hexachlorocyclohexane, also called gammaxene. It is an organochlorine chemical and has been used as an insecticide and as a treatment for lice and scabies.

Lindane, a neurotoxin, interfering with nervous system, and can also affect the function of the liver and/or kidneys. It may be a carcinogen but has not specifically been designated as such. It has been classified as moderately hazardous by the World health Organization.

Being exposed to large amounts of lindane may be harmful to the neurological system. Clinical signs may include headache, dizziness, and seizures/convulsions, but rarely does it cause death.

Many of the organochlorines are banned in many areas because of the neurological effects, with the exception of the specific use of treating scabies.

Although the article specifically mentions lindane (organochlorine) the clinical signs mentioned in the article (headache, fever, diarrhoea, vomiting, stomach ache, weakness of the body and swollen stomach and death) do not mention the overwhelming clinical sign of most organochlorines, which is over-stimulation of the CNS, with seizures beginning approximately 1 hour post ingestion.

We look with interest to the outcome of the investigation and learning what affected these individuals. - ProMED Mod.TG]

[Maps of Nigeria:
Date: Thu 30 Jan 2020
Source: All Africa [edited]

An epidemiologist in Ondo state, Dr. Stephen Fagbemi, on Wednesday [29 Jan 2020] said the death toll from Lassa fever has risen to 20. The casualty figure was also corroborated by the state commissioner for health, Dr. Wahab Adegbenro.

A total of 112 confirmed cases were said to have been recorded in the state so far just as 5 local government areas [LGAs] of the state were said to have been hit by the disease.

The affected council areas include Akoko South West, Ose, Owo, Akure South, and Ondo West LGAs, while the victims were transferred to the Federal Medical Centre, Owo, and a treatment centre in Akure.

The state government last week revealed that 16 deaths had been recorded from the disease out of the 100 cases that were confirmed.

Adegbenro said the figure of the victims rose as a result of the influx of some victims from the neighbouring states to Ondo due to free treatment in the state.

"We are having the high figure because Ondo state is the only state that the treatment of Lassa fever is free of charge. I think we are having people coming from other areas to access the free treatment," he said.

The commissioner, who addressed journalists on World Neglected Tropical Diseases [NTD] Day, held on 20 Jan [2020], said the state has been mapped for the various neglected tropical diseases [NTDs]. Some of these, he said, include onchocerciasis, lymphatic filariasis, leishmaniasis, soil-transmitted helminths, schistosomiasis, and human African trypanosomiasis.

He explained that the "mapping result indicates that the state has overlapping endemicity for 4 preventive chemotherapy NTDs: the onchocerciasis, lymphatic filariasis, schistosomiasis, and schistosomiasis."

He said the government was being proactive in tacking the diseases as the government had begun the distribution of the preventive chemotherapy for the NTD, adding that the distribution varies across the communities and LGAs in the state.

"The scourge of NTDs were also being addressed through mass awareness created through different print and electronic media along with specific mass administration of medicines in the endemic areas," he stated.

The commissioner also noted that the World Health Organisation had targeted most of the preventive chemotherapy of the NTDs for elimination by 2030 "in line with the Millennium Development Goal 3."  [Byline: James Sowole]
===========================
[The number of Lassa fever cases in Ondo state is increasing, although not all may have originated in that state, as mentioned above. The most recent Nigeria CDC Lassa fever update indicates that Ondo and Edo states have the majority of cases (see Lassa fever - West Africa (07): Nigeria http://promedmail.org/post/20200129.6930926). Nigeria is now well into the period of the year when more cases usually occur, as illustrated in the graph in Figure 6 (at the source URL in above-mentioned post). There has been a peak in case numbers between weeks 1 and 11 (January-March) over the past 3 years, and it appears that this will be the case again this year (2020).
Transmission of LF virus occurs when individuals are in contact with rodent reservoir host excreta or are within healthcare facilities. The above report does not mention the circumstances under which the individuals acquired their infections. Presumably, it was from contact with the rodent reservoir or their excreta. Public education at the village level about the risks these rodents present and ways to avoid exposure is the best way to prevent most cases.

Images of the rodent reservoirs of Lassa fever virus:
_Mastomys natalensis_:
_Mastomys erythroleucus_ and _Hylomyscus pamfi_:

Maps of Nigeria:
Date: Wed, 29 Jan 2020 09:43:38 +0100 (MET)

Lagos, Jan 29, 2020 (AFP) - The death toll from Lassa fever in Nigeria since the beginning of January has risen to 41 as cases were confirmed in more regions, Nigeria's disease control agency said.  The Nigeria Centre for Disease Control (NCDC) said Tuesday that from January 1 to January 26 a total of 258 confirmed cases, including five health workers, were reported across 19 states.   The latest figures marked an increase from 29 deaths and 195 confirmed cases given by the authorities for the period up to January 24.

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

The NCDC said that the fatality rate was down to 15.9 percent from 19.7 percent during the same period last year.    The agency said although there has been a spike in the number of deaths reported for the week, the figure is still lower than the 42 deaths reported in January 2019.    The NCDC said at the weekend that it had activated a national emergency operations centre to coordinate the response "to the increasing number of Lassa fever cases" across the country.  The name of the virus comes from the town of Lassa in northern Nigeria where it was first identified in 1969.
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Albania

Albania US Consular Information Sheet November 04, 2008

 COUNTRY DESCRIPTION

Albania is a parliamentary democracy that is transforming its economy into a market-oriented system. Albania's per capita income is among the lowest in Eu

ope, but economic conditions in the country are steadily improving. Tourist facilities are not highly developed in much of the country, and though Albania's economic integration into European Union markets is slowly underway, many of the goods and services taken for granted in other European countries are not yet available. Hotel accommodations are limited outside of major cities. Read the Department of State Background Notes on Albania for additional information.

ENTRY/EXIT REQUIREMENTS

 A passport is required. All travelers entering or exiting Albania must have six months or more validity on their passport. Customs officers strictly enforce this law. U.S. citizens do not require a visa prior to entering Albania, but those traveling without a visa will be charged a fee for an entry stamp at the point of entry, which is valid for a stay of up to 90 days. This fee is currently 10 Euros, or the equivalent in any easily convertible currency, including U.S. dollars. Travelers without a visa who intend to stay in Albania for more than 90 days should be aware that Albanian law allows a traveler without a visa to remain in Albania for 90 days only within a specific 180-day period. That 180-day period is defined from the first day of entry. For example, a traveler entering without a visa on January 1 may remain in Albania for 90 days total during the period of time between January 1 and June 28. Departing Albania during this time period does not "restart the clock." Travelers attempting to reenter Albania without a visa and within 180 days of a previous entry and after an aggregate stay of 90 days may be denied entry. For stays exceeding 90 days within a 180-day period, those interested must apply for a Residency Permit at the police station with jurisdiction over the city of residence. Information on how to apply for a residency permit is available on the Embassy of Albania web site at http://www.embassyofalbania.org/. There is also a departure fee of ten Euros, or the equivalent in any easily convertible currency, including U.S. dollars. Visit the Embassy of Albania web site at http://www.embassyofalbania.org/consular.html#visa for the most current visa information. Dual Nationality: The Albanian government considers any person in Albania of Albanian parents to be an Albanian citizen. In addition to being subject to all Albanian laws affecting U.S. citizens, dual nationals may be subject to Albanian laws that impose special obligations. Male Albanian citizens are subject to compulsory military service regulations. If such persons are found guilty of draft evasion in Albania, they are subject to prosecution by the Albanian court. Those who might be affected should inquire at an Albanian Embassy or Consulate outside Albania regarding their status before traveling. In some instances, dual nationality may hamper U.S. Government efforts to provide protection abroad. 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

Although the overall security situation in Albania has improved in recent years, organized criminal activity continues to operate in all regions, and corruption is pervasive. US Government employees need permission to travel to the northern administrative districts of Shkoder, Malesi E Madhe and Tropoje (with the exception of the route along the national road to Montenegro and the city of Shkoder) and to the southern town of Lazarat, with such travel restricted to secure vehicles with escort. Travel restrictions for U.S. Government employees have been lifted for overnight stays in the city of Shkoder. In most cases, police assistance and protection is limited. A high level of security awareness should be maintained at all times. Photographing anything that authorities regard as being of military or security interest may cause travelers problems. All gatherings of large crowds should be avoided, particularly those involving political causes or striking workers. For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found. Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.

CRIME

In the latest State Department assessment, Albania’s crime rating is “medium.” Crime against foreigners is rare in Albania, as targeting foreigners is often viewed as too risky. Visitors should maintain the same personal security awareness that they would in any metropolitan U.S. city. Caution should be exercised in bars in Tirana where violent incidents, some involving the use of firearms, have occurred in the past, particularly in the early morning hours. Within the last years there have been fewer cases of carjacking compared with previous years. Anyone who is carjacked should surrender the vehicle without resistance. Armed crime continues to be more common in northern and northwestern Albania than in the rest of the country. Street crime is fairly common in Albania, particularly at night. Criminals do not seem to deliberately target U.S. citizens or other foreigners, but do seek targets of opportunity, and select those who appear to have anything of value. Vehicle theft is still one of the biggest problems in Albania. Pick-pocketing is widespread; U.S. citizens have reported the theft of their passports by pick-pockets. INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. The local equivalent to the “911” emergency line is 129, though coverage is inconsistent at best. See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION

Medical facilities and capabilities in Albania are limited beyond rudimentary first aid treatment. Emergency and major medical care requiring surgery and hospital care is inadequate due to lack of specialists, diagnostic aids, medical supplies, and prescription drugs. Travelers with previously diagnosed medical conditions may wish to consult their physicians before travel. As prescription drugs may be unavailable locally, travelers may also wish to bring extra supplies of required medications. Recent electricity shortages have resulted in sporadic blackouts throughout the country, which can affect food storage capabilities of restaurants and shops. While some restaurants and food stores have generators to properly store food, travelers should take care that food is cooked thoroughly to reduce the risk of food-borne illness. Water in Albania is not potable. Visitors should plan to purchase bottled water or drinks while in country. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Albania. 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 (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en

MEDICAL INSURANCE

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

TRAFFIC SAFETY AND ROAD CONDITIONS

While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Albania is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Major roads in Albania are often in very poor condition. Traveling by road throughout Albania is the most dangerous activity for locals and tourists. Vehicle accidents are the major cause of death, according to police statistics. Electricity shortages have resulted in sporadic blackouts throughout the country that can happen any hour of the day or night. Such outages affect traffic signals and street lights, making driving increasingly treacherous at any time of day. Travel at night outside the main urban areas is dangerous and should be avoided due to deplorable road conditions. During the winter months, travelers may encounter dangerous snow and icy conditions on the roads throughout mountainous regions in northern Albania. Buses travel between most major cities almost exclusively during the day, but they are often unreliable and uncomfortable. Many travelers looking for public transport prefer to use privately owned vans, which function as an alternate system of bus routes and operate almost entirely without schedules or set fares. Please note that many of these privately owned vans may not have official permission to operate a bus service and may not adhere to accepted safety and maintenance standards. Persons wishing to use privately owned vans should exercise caution. There are no commercial domestic flights and few rail connections. Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office at www.albaniantourism.com.

AVIATION SAFETY OVERSIGHT

As there is no direct commercial air service to the United States by carriers registered in Albania, the U.S. Federal Aviation Administration (FAA) has not assessed Albania's Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For further information, travelers may visit the FAA's web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa SPECIAL CIRCUMSTANCES: Albania's customs authorities may enforce strict regulations concerning temporary importation into or export from Albania of some items. It is advisable to contact the Embassy of Albania in Washington, D.C. or one of Albania's Consulates in the United States for specific information regarding customs requirements. As noted previously, the Albanian government considers any person in Albania of Albanian parents to be an Albanian citizen. In addition to being subject to all Albanian laws affecting U.S. citizens, dual nationals may be subject to Albanian laws that impose special obligations. Male Albanian citizens are subject to compulsory military service regulations. See our information pertaining to dual nationality. Albania is a cash economy. Credit cards and travelers checks are not generally accepted, except at the major new hotels in Tirana and some international airline offices. Travelers' checks can be changed at banks in larger towns. Automated Teller Machines (ATMs) are available in most cities. 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 Albania’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Albania 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. Under Albanian law, police can detain any individual for up to 10 hours without filing formal charges. U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times to show proof of identity and U.S. citizenship if questioned by local officials.

CHILDREN'S ISSUES

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

REGISTRATION / EMBASSY LOCATION

 Americans living or traveling in Albania 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 Albania. 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 Rruga Elbasanit 103, tel. (355)(4) 2247285; fax (355)(4) 2232222. The U.S. Embassy web site is http://tirana.usembassy.gov/ * * * This replaces the Consular Information Sheet dated June 10, 2008, to update sections on Entry and Exit Requirements, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Tue, 26 Nov 2019 09:28:12 +0100 (MET)
By Briseida MEMA

Tirana, Nov 26, 2019 (AFP) - Six people died and some 150 were injured in Albania after the strongest earthquake in decades rocked the Balkan country early Tuesday, destroying buildings and burying victims in rubble.

The epicentre of the 6.4 magnitude quake was about 34 kilometres (about 20 miles) northwest of the capital Tirana, at a depth of 10 km, according to the European-Mediterranean Seismological Centre.   "We have victims," Prime Minister Edi Rama wrote on Twitter. "We are working to do everything possible in the affected areas."   The quake struck at 3:54 am local time (0254 GMT) and sent panicked residents running out onto the streets of Tirana, with people huddling in the open, an AFP correspondent said.

The worst damage appeared to be around the coastal town of Durres. The quake was the strongest to hit this region since 1926, Albanian seismologist Rrapo Ormeni told local television.   Three bodies were pulled from the ruins of damaged buildings in the port town, where a three-story hotel collapsed and other buildings were damaged, according to the defence ministry.   The bodies of a man and a woman were uncovered in rubble in the nearby town of Thumane, the ministry said.

A man in his fifties died after he jumped out of his building in panic in the town of Kurbin, the defence ministry said.   Some 300 armed forces personnel have rushed to Durres and Thumane for rescue operations, where "there are people trapped under the ruins", defence ministry spokeswoman Albana Qahajaj said.

In Thumane, around a dozen rescuers used an excavator to dig through a mountain of debris in search of possible victims.   At least 150 people with injuries have sought first aid in Tirana and Durres, Health Minister Ogerta Manasterliu said.

- Trapped under rubble -
In Thumane, soldiers, rescuers and families were sifting through the rubble of a collapsed five-storey building as cries of people trapped under debris were heard, an AFP reporter said.   Thoma Nika, a 58-year-old who lived in the building, said there were at least six people under rubble.    Another man, Arben Allushi said with tears in his eyes, that his wife and niece missing after the building collapsed.

A man in Durres told local television that his daughter and niece were trapped in the rubble of a collapsed apartment building.    "I talked with my daughter and niece on the phone. They said they are well and are waiting for the rescue. I could not talk to my wife. There are other families, but I could not talk to them," the man said.

The tremors were felt across the Balkan region, from Sarajevo to Bosnia and even in the Serbian city of Novi Sad almost 700 kilometres away, according to reports in local media and on social networks.   It was followed by several aftershocks, including one of 5.3 magnitude, the European-Mediterranean Seismological Centre said. It was described by authorities as the strongest earthquake in the last 20-30 years.   The Balkans is an area prone to seismic activity and earthquakes are frequent.
Date: Sat, 21 Sep 2019 20:39:17 +0200 (METDST)

Tirana, Sept 21, 2019 (AFP) - Albania was rattled by its strongest earthquake in decades Saturday, officials said, sending people fleeing into the streets in several cities, damaging buildings and triggering power cuts in the capital.   The epicentre of the shallow 5.6-magnitude quake, was near Durres, less than 40 kilometres (25 miles) west of the capital Tirana, according to the US Geological Survey.

Albania's defence ministry said it was the "strongest earthquake in the country in the last 20 to 30 years".   "There are no deaths," defence ministry spokeswoman Albana Qajaj said.   Some 80 people sought medical help in both Tirana and Durres, 21 of whom were hospitalised due to injuries caused by falling objects or parts of walls as well as for panic attacks, Health Minister Ogerta Manasterilu said.   Qajaj told AFP that houses and buildings in Tirana had been damaged but were still standing and that the ministry was accessing damage in other towns and villages.   Prime Minister Edi Rama cancelled his scheduled trip to the United States following the quake, which cut electricity and telephone lines in Tirana and a number of other towns and villages.

Many people remained outside their homes for several hours in the capital, fearful of aftershocks.   "I fear to return because such a strong earthquake could be followed with others," Drita Lohja, a resident in her fifties, told AFP.    Falling debris pulverised parked cars in parts of the city.   AFP reporters and witnesses saw windows broken and deep fissures in the facades of buildings in Durres, as well as in the capital.   Media reported that a large building in Tirana was seriously damaged and that residents were being evacuated.   A University of Tirana building was also damaged, witnesses said.

According to local media reports, at least two people were lightly injured and a dozen houses collapsed in the village of Helmes, 10 kilometres from Tirana.   Two other earthquakes followed the strong one that occurred at around 4:00 pm (1400 GMT) and was felt in neighbouring Montenegro and Italy, but also on the Greek island of Corfu according to some Twitter users.
Date: Fri, 9 Mar 2018 16:28:50 +0100

Tirana, March 9, 2018 (AFP) - The military has been deployed in northern Albania to help hundreds of people trapped by floods following heavy rainfall, authorities said on Friday.   More than 9,230 hectares (22,800 acres) of agricultural land is underwater in the Shkodra region, including villages where the only means of transport is by boat, the defence ministry said.

Army personnel are evacuating residents and securing food supplies in the affected areas, 100 kilometres (60 miles) north of the capital, Tirana.   The torrential rain in recent days has caused landslides damaging dozens of homes and flooding roads, said the transport ministry.   The rain has also forced the Albanian authorities to release excess water from a hydroelectric plant, which has added to the flooding in northern areas of the country.   Weather forecasters say the rain is likely to ease from Saturday.
Date: Sun, 3 Dec 2017 12:29:40 +0100

Tirana, Dec 3, 2017 (AFP) - Thousands of police and soldiers have been deployed in Albania to rescue stranded residents after heavy rainfall triggered major flooding, and caused the death of a utility worker, officials and the power company said Sunday.   The victim, Sabri Vlinga, died while he was working on a electricity pole at Roskovec in the flooded south of the country, the power company said in statement.   Two other people were injured in similar accidents. it added.   Some 6,400 police and soldiers have been sent to help rescue people stranded by the floods, Prime MInister Edi Rama said Saturday, calling the situation "very critical".

Around 1,500 people in the affected areas have been rescued, while several thousand homes were without electricity as many utility poles have been swept away by mudslides, said Shemsi Prenci, head of civil protection.   More than 7,874 hectares (19,450 acres) of farm land as well as 3,193 homes are under water and several roads in the south remained impassable.

Army forces have built a temporary bridge at Darezeze, about 70 kilometres (44 miles) from the capital Tirana, to come to the aid of 2,000 residents stranded by the floods, the defence ministry said.    In neighbouring Macedonia, the heavy rains have also caused flooding as several rivers include the main Vardar river have burst their banks, the MIA news agency reported.
Date: Sat 5 Aug 2017
From: Edmond Puca <edmond_puca@yahoo.com> [edited]

Here in Albania, we have 2 imported cases of haemorrhagic fever with renal syndrome (HFRS), one imported from the north of Greece and another from Macedonia in a village near the border with Albania.

The patient from Macedonia is 25 years old. He presented in the emergency room on 31 Jul [2017]. Right now, he is in good condition and will survive. He presented with fever, nausea and vomiting, abdominal pain, and lower back pain.

The other patient from Greece had been in our service for the previous 2 weeks and now is at home in good condition.

The disease is caused by Dobrava-Belgrade virus infection.
---------------------------------
Dr Edmond Puca
Infectologue
Department of Infectious Disease
UHC "Mother Teresa"
Tirana, Albania
===================
[ProMED-mail thanks Dr Edmond Puca for sending in this report.  This and the previous report are the 1st reports of hantavirus infections in Macedonia that ProMED-mail has posted. There is also evidence of HFRS in Greece, although ProMED-mail has not posted reports previously. Sero-epidemiological investigations conducted in several Balkan countries revealed an overall seroprevalence of 4 per cent in Greece (<http://www.sciencedirect.com/science/article/pii/S0168170213004887#>). There doubtless have been Dobrava-Belgrade virus infections in Greece and the Balkans over the years, given that this virus is known to circulate widely in the Balkans.

The yellow-necked field mouse (_Apodemus flavicollis_) is the principle vertebrate host for Dobrava-Belgrade virus. - ProMED Mod.TY]

[A HealthMap/ProMED-mail map can be accessed at:
More ...

World Travel News Headlines

Date: Sun 23 Feb 2020
Source: Q Costa Rica News [edited]
<https://qcostarica.com/costa-rica-is-the-first-country-in-america-where-very-resistant-antibiotic-bacteria-for-meningitis-is-isolated/>

A 50-year-old man and a senior became the 1st 2 people in Costa Rica -- and in the Americas -- found to be infected with the bacteria most resistant to antibiotics used in the treatment of meningitis and meningococcal septicaemia that cause serious brain damage and even death. The Centro Nacional de Referencia en Bacteriolog­a (CNRB) -- National Center of Reference in Bacteriology, of the Instituto Costarricense de Investigacian y Enseaanza en Nutricin y Salud (Inciensa) -- Costa Rican Institute for Research and Education in Nutrition and Health (Incense), issued an alert, in early February [2020], after documenting the circulation of _Neisseria meningitidis_ (_N. meningitidis_) serogroup Y, resistant to penicillin and not sensitive to cefotaxime [and ceftriaxone?], two 3rd generation antibiotics, reports La Nation.
====================
[Invasive meningococcal disease (meningococcaemia and meningitis) is a life-threatening infection caused by _Neisseria meningitidis_ that evolves rapidly, often even when appropriate treatment has been started promptly. Because antimicrobial treatment for invasive meningococcal disease with a 3rd-generation cephalosporin (cefotaxime and ceftriaxone) is the widely accepted standard recommendation (<https://academic.oup.com/cid/article/39/9/1267/402080>), resistance of _N. meningitidis_ to cefotaxime and ceftriaxone is very worrisome.

The news report above says that 2 patients in Costa Rica were infected with _N. meningitidis_ serogroup Y resistant to penicillin and 2 3rd generation cephalosporins, one of which was cefotaxime. The other 3rd generation cephalosporin is not specified, but is perhaps ceftriaxone, the other 3rd generation cephalosporin usually used to treat this disease. We are also not told in the news report above if the 2 patients were epidemiologically linked, nor are we told the extent (that is, MICs [minimum inhibitory concentration] of penicillin or cefotaxime), the mechanisms of resistance, or resistance to any of the other antimicrobial drugs used to prevent or treat this disease.

More information would be appreciated from knowledgeable sources. Reduced susceptibility of _N. meningitidis_ to penicillin has been reported in the past in many countries, including the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>), usually due to decreased affinity of target penicillin-binding proteins for penicillin and less commonly to beta-lactamase production (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC89938/>, <https://pubmed.ncbi.nlm.nih.gov/3134848-relative-penicillin-g-resistance-in-neisseria-meningitidis-and-reduced-affinity-of-penicillin-binding-protein-3/>, and <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC162989/pdf/392577.pdf>).

Meningococcal isolates with reduced susceptibility to penicillin G usually were reported susceptible to 3rd-generation cephalosporins (cefotaxime and ceftriaxone). For example, despite the decrease in susceptibility to penicillin G in 33% of 2888 isolates of _N. meningitidis_, all isolates were susceptible to ceftriaxone in Brazil from 2009 to 2016 (<https://pubmed.ncbi.nlm.nih.gov/29717974-surveillance-of-antimicrobial-resistance-in-neisseria-meningitidis-strains-isolated-from-invasive-cases-in-brazil-from-2009-to-2016/>). Similar data have been reported for the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>).

However, one previous study reported 8 clinical isolates _N. meningitidis_ in Delhi, India in 2006 that were resistant to ceftriaxone and cefotaxime, with most also resistant to penicillin, ciprofloxacin, and chloramphenicol (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698303/>). All of the isolates were identified as serogroup A _N. meningitidis_, but no further details concerning these isolates were given in this report (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1865813/>).

Resistance to other antimicrobial agents that may be used for therapy of meningococcal infections or for prophylaxis of case contacts has been reported in several countries. This includes resistance to chloramphenicol, fluoroquinolones, and rifampin. Horizontal exchange of genes that encode resistance for penicillin, rifampin, and the fluoroquinolones from other _Neisseria_ species that share a common ecological niche with _N. meningitidis_ in the nasopharynx has been proposed as one possible mechanism of acquisition of meningococcal antibiotic resistance (<http://jac.oxfordjournals.org/cgi/content/full/49/3/545>). - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Costa Rica: <http://healthmap.org/promed/p/17>]
Date: Tue 25 Feb 2020
From: Anne Laudisoit, PhD [edited]
<laudisoit@ecohealthalliance.org>

A suspect plague outbreak cluster has been noted in the the Godjoka health area as of 19 Feb 2020. The chief medical officer of the Rethy Health zone, the head nurse and the laboratory team from the Rethy General reference hospital investigated the outbreak site. The Godjoka village is located in the Linga health zone, Djugu territory, Ituri province, in the Congo DR (N 02.01'47.9'' and E030.44'56.6'', 1940m) in the plague endemic area.
 
There have been 6 suspected cases of plague, including 5 deaths and 1 recovering patient. The index case is a young boy who died on 19 Feb 2020. His mother, the neighbour and her child all died on 21 Feb 2020 and were buried the night of 24 Feb 2020, under pressure from the villagers. Finally the traditional healer ["tradipraticien"] who took care of the mother (who was the 2nd case) died in turn on 25 Feb 2020, and samples were taken that same day. The rapid diagnostic test was positive for plague.  Because of their rapidly fatal course, pneumonic plague is suspected for one or more of the 5 fatal cases. 

The only survivor has been under treatment at the Godjoka Health center since 22 Feb; he is the 20 year-old brother of the index case. The test on the sputum of this patient was negative.
-------------------------------------
Francoise Ngave Nyisi, Rethy General Reference Hospital, DR Congo
Mandro Michel, Provincial Division of Health, Bunia, DR Congo
Adroba Pascal, Provincial Division of Health, Bunia, DR Congo
Laudisoit Anne, Ecohealth Alliance, New York, USA
=====================
[ProMED thanks Dr Laudisoit and her hardworking Congolese colleagues for this important report.  Thus far the diagnosis of plague rests on the single positive diagnostic test obtained from the traditional healer, as it appears that the first 4 fatal cases were buried before diagnostic tests could be obtained. Following this logic, It is possible that the sole survivor thus far has the bubonic form of the disease, and thus a negative sputum result.  We seek and hope to obtain further information on all of these cases, including age, nature and duration of symptoms, presence or absence of buboes, etc.

This putative plague cluster is in a known historic plague-endemic region, where there were 31 cases and 8 deaths between Jan - Oct 2019, as previously reported by ProMED (Plague - Congo DR (02): (IT) fatal http://promedmail.org/post/20191016.6731137).  The Ituri district, of course, has also been affected by the still smouldering North Kivu-Ituri Ebola outbreak that began in July 2018.  This district has also been, and continues to be, a region of great civil unrest, with multiple armed insurgency groups operating near and across the Ugandan border.

The following background information on plague by Mod.LL is copied from our most recent ProMED post on plague [see below under See Also]:

"The bacterium that causes plague is _Yersinia pestis_. Most cases of plague are due to bubonic plague following the bite of an infected rodent flea causing a swollen and very tender lymph gland. The swollen gland is called a "bubo." Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2-6 days after being bitten. At this point in the illness, there is no risk of person-to-person spread, so if this was indeed a case of bubonic plague, no isolation or quarantine is necessary.

When bubonic plague is left untreated, plague bacteria invade the bloodstream. As the plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may expel bloody sputum. If plague patients are not given specific antimicrobial therapy, the disease can progress rapidly to death. At this stage, as appears to have happened in this case, person-to-person spread can occur, causing other cases of "primary" plague pneumonia. - ProMED Mod.LL]

[A ProMED/HealthMap of DR Congo is available at: DR Congo:
Date: Thu, 27 Feb 2020 09:14:05 +0100 (MET)
By Anuj Chopra and Haitham El-Tabei

Riyadh, Feb 27, 2020 (AFP) - Saudi Arabia on Thursday suspended visas for visits to Islam's holiest sites for the "umrah" pilgrimage, an unprecedented move triggered by coronavirus fears that raises questions over the annual hajj.   The kingdom, which hosts millions of pilgrims every year in the cities of Mecca and Medina, also suspended visas for tourists from countries with reported infections as fears of a pandemic deepen.

Saudi Arabia, which so far has reported no cases of the virus but has expressed alarm over its spread in neighbouring countries, said the suspensions were temporary. It provided no timeframe for when they will be lifted.   "The kingdom's government has decided to take the following precautions: suspending entry to the kingdom for the purpose of umrah and visit to the Prophet's mosque temporarily," the foreign ministry said in a statement.   "Suspending entry into the kingdom with tourist visas for those coming from countries, in which the spread of the new coronavirus (COVID-19) is a danger."

The move comes as Gulf countries implement a raft of measures, including flight suspensions and school closures, to curb the spread of the disease from people returning from pilgrimages to Iran.  Even as the number of fresh coronavirus cases declines at the epicentre of the disease in China, there has been a sudden increase across the Middle East.

Since its outbreak, the United Arab Emirates has reported 13 coronavirus cases, Kuwait has recorded 43, Bahrain has 33 and Oman is at four cases.   Iran has emerged as a major hotspot in the region, with 19 fatalities from 139 infections -- the highest death toll outside China, where COVID-19 originated.   While no cases have been reported in Saudi Arabia, one citizen is reported to be infected in Kuwait along with four Saudi women in Bahrain -- all of whom had returned from Iran.

- 'Unprecedented' move -
The umrah, which refers to the Islamic pilgrimage to Mecca that can be undertaken at any time of year, attracts millions of devout Muslims from all over the globe each year.    There was no clarity over how the move would affect the annual hajj pilgrimage due to start in late July.   Some 2.5 million faithful travelled to Saudi Arabia from across the world to take part in last year's hajj -- one of the five pillars of Islam.

The event is a key rite of passage for Muslims and a massive logistical challenge for Saudi authorities, with colossal crowds cramming into relatively small holy sites.   "This move by Saudi Arabia is unprecedented," Ghanem Nuseibeh, founder of London-based risk consultancy Cornerstone Global Associates, told AFP.   "The concern for Saudi authorities would be Ramadan, which starts at the end of April, and hajj afterwards, should the coronavirus become a pandemic."

The holy fasting month of Ramadan is considered a favourable period by Muslim pilgrims to perform the Umrah.   Saudi Arabia's custodianship of Mecca and Medina -- Islam's two holiest sites -- is seen as the kingdom's most powerful source of political legitimacy.     But a series of deadly disasters over the years has prompted criticism of the Sunni kingdom's management of the pilgrimage.

In September 2015, a stampede killed up to 2,300 worshippers -- including hundreds of Iranians -- in the worst disaster ever to strike the pilgrimage.   The pilgrimage forms a crucial source of revenue for the government, which hopes to welcome 30 million pilgrims annually to the kingdom by 2030.   De facto ruler Crown Prince Mohammed bin Salman's Vision 2030 reform plan seeks to shift the economy of Saudi Arabia -- the world's top crude exporter -- away from oil dependency towards other sources of revenue, including religious tourism.
Date: Thu, 27 Feb 2020 05:04:04 +0100 (MET)

Kuala Lumpur, Feb 27, 2020 (AFP) - Badminton's German Open will not go ahead next week and the Polish Open has been postponed, officials said as two more Olympic qualifying events fell victim to the coronavirus.   It hasn't yet been decided whether the German Open, originally scheduled for March 3-8, will be postponed or cancelled entirely, the Badminton World Federation said late Wednesday.   New dates are being sought for the Polish Open, which was meant to take place on March 26-29, but it will not now fall in the qualifying period for the Tokyo Olympics.

Both events were in the same month as the All England Open, one of the biggest events in the badminton calendar, although that tournament is currently still set to go ahead.   "The BWF is continuing to monitor all official updates on COVID-19 with no change to the intention to stage other HSBC BWF World Tour or BWF-sanctioned tournaments," said a statement.   This week the Vietnam International Challenge, which also carried rankings points for the Olympics, was shifted from late March to early June.

The loss of qualifying tournaments will pose a problem for many players including two-time Olympic champion Lin Dan, who needs a rapid rise up the rankings to win a place on the Chinese team.   Many of China's players are currently in Britain and have been cleared to play during what is a "critical period" of Olympic qualifying, the Chinese Badminton Association said last weekend.   China have been the dominant force in badminton at recent Olympics, sweeping all five titles at London 2012 and winning the men's singles and doubles gold medals four years ago in Rio.
Date: Thu, 27 Feb 2020 09:58:42 +0100 (MET)

Tallinn, Feb 27, 2020 (AFP) - Estonia reported its first coronavirus case on Thursday, a day after the man returned to the Baltic nation of just 1.3 million people from his homeland Iran.    "The person, a permanent resident of Estonia who is not a citizen, arrived in Estonia on Wednesday evening," Social Affairs Minister Tanel Kiik told public broadcaster ERR.   He said the Iranian citizen is currently hospitalised.

Local media said the man arrived in Tallinn by bus from the Latvian capital Riga.   "For now, there are no plans of putting cities in quarantine following this one case," Kiik said.    "The patient is isolated, there is no risk of the disease spreading, now we have to identify all the people the patient was in contact with."   Iran has announced a total of 19 deaths and more than 130 infections, including the country's deputy health minister.   Iran's coronavirus death toll is the highest after that of China, where more than 2,700 people have died from the disease.
Date: Wed, 26 Feb 2020 19:27:33 +0100 (MET)

Vynnyky, Ukraine, Feb 26, 2020 (AFP) - Ukrainian authorities began the task of destroying 37,000 bottles of illicit adulterated vodka on Wednesday, a national "record" in a country where consumption of illegal alcohol regularly poisons and even kills.    Minister of Justice Denys Malyuska launched the operation in the city of Vynnyky in the central Lviv region where the bottles, holding 14 tonnes of alcohol, have been stored since their seizure in 2014.   "It is difficult to say what is in there but consumption is strictly not recommended," said the minister.    "This adulterated alcohol poses a huge threat to people's health and their lives."    In front of the media, the contents of several bottles were poured into plastic tanks or blue dye was added, to rule out any illegal re-sale of the beverage.

The procedure should last about a week, after which the liquid will be poured into the sewers at a secret location, according to the minister.   "This is the first time this procedure has been used so that everyone can see that the alcohol that has been seized is really destroyed," said Maliouska.   The minister said that in the past there had been "complaints" from the business community that because of corruption within the police, the illicit alcohol had often turned up in shops after being seized.   Cases of poisoning from adulterated drinks are a regular occurence in Ukraine, where the consumption of alcohol, especially spirits, remains high. And they are often fatal.

In 2016, 73 people died from a total of 150 people who were poisoned by adulterated alcohol.    The following year, six poisoning cases killed three people and, according to Ukrainian media, ten poisonings recorded by the authorities in 2018 led to nine deaths.   The tax department of the Lviv region told AFP on Wednesday that the most adulterated alcohol was vodka, which is then sold in shops in small towns or cafes located along the roads.
Date: Thu, 27 Feb 2020 07:21:09 +0100 (MET)

Copenhagen, Feb 27, 2020 (AFP) - Denmark reported its first coronavirus case Thursday, a man who had returned from a skiing holiday in northern Italy which has become a hotspot for the disease.   "The man who came back from a skiing trip with his wife and son on February 24 has been suffering since then from a cough and a temperature," Denmark's public health agency said in a statement.   "The man tested positive, but the results of his wife and son are negative," it said.   The man is relatively well and has returned to his home, where he remains in isolation with his family, it added.   According to public TV station TV2, the man is one of its employees.   Italy has reported 400 coronavirus cases, mostly in the north, and 12 deaths.
Date: Wed, 26 Feb 2020 23:18:10 +0100 (MET)

Bucharest, Feb 26, 2020 (AFP) - Romania reported its first confirmed case of the novel coronavirus on Wednesday -- a man who was in contact with an Italian who visited the country last week.    "The patient, who is in good health and is showing no symptoms, will be transferred to Bucharest's hospital of infectious diseases," Health Minister Victor Costache told a press conference.

Seven other people who live at the same address as the man in the south-eastern Gorj county have all tested negative but will be quarantined for 14 days as a precaution, emergency department official Raed Arafat said.   The Italian believed to be the source of Romania's first diagnosis tested positive for the deadly virus upon returning to Italy after a four-day visit to Gorj.

New cases have been emerging across Europe, many linked to the continent's coronavirus hotspot in northern Italy.    Several governments have advised against travel to Italy, which has now recorded 400 cases and 12 deaths.   The COVID-19 outbreak has killed over 2,700 people and infected more than 80,000 in 34 countries, although the vast majority of cases remain in China, according to the World Health Organization.
Date: Wed, 26 Feb 2020 21:33:56 +0100 (MET)

Oslo, Feb 26, 2020 (AFP) - Norwegian health authorities on Wednesday announced the first case of coronavirus in the Nordic nation in someone who returned from China last week, but said the patient was not "in danger".   "The person is not ill, they are in good health and do not present any symptoms," Line Vold, an official at the Norwegian Institute of Public Health, told reporters. "We think it is very unlikely that they have infected" others.   Routine tests had given a "weekly positive result" and detected traces of the new coronavirus, the institute said.
Date: Wed, 26 Feb 2020 20:03:47 +0100 (MET)

Tbilisi, Feb 26, 2020 (AFP) - Georgia on Wednesday announced its first confirmed case of the novel coronavirus in the South Caucasus region.   "A Georgian national has tested positive for the novel coronavirus," Health Minister Ekaterine Tikaradze told a news conference, adding that the infected man has been placed in isolation in a Tbilisi hospital.   "Three different tests of the 50-year-old man's nasopharyngeal smear gave positive results, but he is doing well, he is clinically healthy," head of Georgia's national centre for disease control, Amiran Gamkrelidze told journalists.

The man had arrived in Georgia from Iran via Azerbaijan, Gamkrelidze said.   Tikaradze said Georgia would introduce a two-week ban on Iranian nationals entering Georgia, but flatly dismissed fears of a coronavirus epidemic in the ex-Soviet country "at this point".   On Sunday, Georgia's neighbour Armenia closed its border with Iran and suspended flights as fears over an outbreak of coronavirus in Iran sent neighbouring countries scrambling to contain the outbreak.