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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: Sat 24 Aug 2019 3:39:38 PM PKT
Source: Mena FN[edited]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More information from knowledgeable sources would be greatly appreciated.

The HealthMap/ProMED map of the UAE can be found at:
More ...

Paraguay

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Please see our information on Criminal Penalties.

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

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

Travel News Headlines WORLD NEWS

Date: 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: Sat 7 Sep 2019
Source: WHO Africa [edited]

The federal government, in collaboration with the World Health Organization (WHO), Gavi, the Vaccine Alliance, and partners, is launching a yellow fever (YF) reactive vaccination campaign in 3 states to help control an expanding YF outbreak in Nigeria identified in Ebonyi.

The 10-day campaign (7-16 Sep 2019), to be implemented in parts of Ebonyi (3 LGAs), Benue (2 LGAs) and Cross River (1 LGA) States, targets vaccination of 1.6 million people (aged 9 months to 44 years old) to contain the outbreak in affected areas. The campaign, supported by Gavi, will use 1 802 044 vaccine doses provided by the International Coordination Group (ICG) on Vaccine Provision, funded by Gavi, the Vaccine Alliance.

"This vaccination campaign will be a crucial activity to stop the spread of the outbreak and ensure that all people at highest risk are safe," says Dr Clement Peter, Officer in Charge, WHO Nigeria. "We encourage all eligible persons in the target LGAs to come forward and get vaccinated,"

Since May 2019, more than 55 suspected cases have been reported across 8 LGAs in Ebonyi State, most of which have been reported in recent weeks from Izzi LGA. Already, 9 of the suspected cases had samples that tested positive for yellow fever, and further tests are pending. The outbreak has resulted in a high number of deaths, as 20 of the suspect cases have died (case fatality ratio (CFR) 40%). The scope of the response is, therefore, in Izzi LGA and surrounding LGAs with contiguous borders (such as, Abakaliki in Ebonyi State, Yala LGA in Cross River state, and Ada and Oju LGAs in Benue State).

A rapid response team (RRT) under the leadership of the National Primary Health Care Development Agency (NPHCDA) and Nigeria Centre for Disease Control (NCDC), composed of Ebonyi State health authorities, WHO and other partners, was deployed to investigate the cases, strengthen efforts to control virus circulation and sensitize health workers and communities on prevention methods against yellow fever.

While vaccination is the best-known measure for keeping people protected for life, Dr Joseph Oteri, NPHCDA Director Disease Control and Immunization, implores people to protect themselves and their families. According to him, "Reducing exposure to mosquitoes, including the use of insect repellent to avoid bites both during the day and at night and removing potential breeding sites such as standing water containers are also effective."

The response of the outbreak in Ebonyi State is part of the global strategy to Eliminate Yellow Fever Epidemics (EYE) by 2026. With the support from WHO, UNICEF, Gavi, the Vaccine Alliance and more than 50 partners, Nigeria has developed a 10-year strategic elimination plan to improve yellow fever diagnosis capacity, childhood immunization and overall population immunity in all states.

Nigeria is a priority country for the EYE Strategy, and it is expected that more than 75 million people will be protected against yellow fever in the country by the end of 2021.

The impact of the EYE strategy is already tangible, with more than 35 million people vaccinated during outbreak response and preventive mass campaigns aimed at establishing high population immunity. Efforts will continue towards full implementation of the EYE 10-year plan to eliminate yellow fever outbreaks.

"Thanks to the leadership of the Nigeria Center for Disease Control, yellow fever surveillance has strengthened and improved, enabling quick outbreak detection and rapid response," said Thabani Maphosa, Gavi Country Programmes Managing Director. "However, the global vaccine stockpile is our last line of defense against the growing threat of yellow fever outbreaks. The most important long-term strategy is high coverage of yellow fever vaccination during preventive campaign and in routine immunisation so every child is protected, preventing outbreaks from happening in the 1st place."

For the record, from the onset of the outbreak in September 2017 to December 2018, 3902 suspected cases were reported from all 36 states and the FCT in Nigeria. Out of the 3295 samples collected and tested, 185 were presumptive positive in country and were sent for confirmation to the Institute Pasteur (IP) Dakar for further testing. From the results, 78 positive cases from 14 states (Kwara, Kogi, Kano, Zamfara, Kebbi, Nasarawa, Niger, Katsina, Edo, Ekiti, Rivers, Anambra, FCT, and Benue States) were confirmed at IP Dakar (Source: NCDC).

Furthermore, Gavi-supported YF preventive mass vaccination campaigns were conducted in 6 other states (Borno, Kebbi, Niger, Plateau, Sokoto and the FCT) between 22 Nov - 2 Dec 2018, bringing the total states covered by preventive mass vaccination campaigns in Nigeria to 12.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The "yellow" in the name refers to the jaundice that affects some patients. Symptoms of yellow fever include fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue. Vaccination is the most important means of preventing yellow fever. To prevent further spread, pre-emptive vaccination campaigns are required in neighboring areas not directly affected by the ongoing yellow fever outbreak and reactive campaigns but which face heightened risk and vulnerability.
=========================
[This report provides a broader overview of the recent yellow fever (YF) situation in Nigeria. Although the current cases occurred in Ebonyi state, local government areas in adjacent Benue and Cross River states are considered at risk and are prudently included in the vaccination campaign. The previous report indicated that as of Wed 31 Jul 2019, 78 cases have been laboratory confirmed in Nigeria in 2019 (see Yellow fever - Africa (11): Nigeria (EB) http://promedmail.org/post/20190814.6622764). There is still no confirmation of the cause of 8 illnesses and 6 deaths of schoolgirls who had visited a national park where there was one confirmed and one probable YF case (see Undiagnosed illness - Nigeria (02): (BO) fatal, poss. link to game reserve, RFI  http://promedmail.org/post/20190906.6660123).

Map of Nigeria:

[HealthMap/ProMED map available at:
Date: Thu 5 Sep 2019
From: Marycelin Baba [edited]

The number of deaths is still uncertain. It has been presumptively diagnosed as yellow fever. Knowing the mode of transmission of yellow fever and the low population immunity especially in Borno State, more transmission is ongoing. I think ELISA was used for the presumptive diagnosis. Plans are being made to ship the IgM positive samples to Dakar for confirmation. I have also requested that part of the samples should be sent to the Arbovirus Laboratory at University of Maiduguri Teaching Hospital (UMTH) for confirmation. At UMTH, plaque assay would be used for confirmation within 4 days.
---------------------------------------------
EpiCore Surveillance Project member
Professor Marycelin Baba
University of Maiduguri
Nigeria
**************************************
Bauchi: Yankari Game Reserve
Date: Fri 6 Sep 2019
Source: EpiCore Global Surveillance Project [edited]

[The following information was submitted by an EpiCore Surveillance Project member who wishes to remain anonymous.]

The Nigeria Centre for Disease Control [NCDC] has confirmed 4 cases of yellow fever in Bauchi State. 3 of the confirmed cases are residents of Alkaleri Local Government Area (LGA) and the 4th case is a tourist who was visiting Kano State and also visited the Yankari Games Reserve in the same LGA in Bauchi State.

NCDC was first notified on [29 Aug 2019], when it received the report of a confirmed case of yellow fever in Kano State from a laboratory in its yellow fever laboratory network. Subsequent investigations led by the Kano State Epidemiology Team established that this confirmed case of yellow fever was from a patient who visited the Yankari Game Reserve in Bauchi, in August 2019 with his father. Unfortunately, the father died with similar symptoms before a sample could be collected and tested.

Subsequently, on [3 Sep 2019], the Borno State Epidemiology Team reported deaths among students of Waka College of Education in Biu LGA Borno State. These students visited the Yankari Game Resort in August 2019. Of the 95 students who visited the resort, 8 developed symptoms and 6 had died as at the time of the report. The others are in a stable condition. Samples from these cases are being tested.

Intensification of surveillance activities has led to the identification of 3 more confirmed cases who are all resident in Alkaleri Local Government Area (LGA), of Bauchi state.

Altogether, 4 cases of yellow fever were confirmed in people that either live or have visited Bauchi in the last one month.

Since it was notified, the NCDC has collaborated with the State epidemiologists of the affected States and the World Health Organization country office to investigate these events. The agency has also deployed a rapid response team to support Bauchi State to carry out further in-depth investigations, including case finding, risk communications, and support the management of cases. Samples of the other suspected cases from Bauchi and Borno states are currently being transported to the NCDC National Reference Laboratory in Abuja for further testing.
******************************************
Osun: ACEGID offer of assistance
Date: Thu 6 Sep 2019
From: Philomena Eromon <Eromonp@run.edu.ng> [edited]

With the recent development in Biu [Local Government Area in southern Borno State], I am very much concerned as a citizen of Nigeria, who also has a connection with Biu. I am a research scientist with the African Center of Excellence for the Genomics of Infectious Disease [ACEGID]. We are located in Redeemers University Ede Osun State and we're concerned with outbreaks as this. My advice will be to send plasma samples of those who are sick and their possible contact for a whole genome sequencing which will unravel these mysterious illness. We have the platform and have used it in such capacity. Contact me at <Eromonp@run.edu.ng> should you want more information. You can also check our site <http://www.acegid.org>
-----------------------------------------------
Philomena Eromon
African Center of Excellence for Genomics of Infectious Diseases,
Redeemer's University
Ede
Nigeria
===========================
[ProMED thanks Philomena Eromon, Prof Baba, and anonymous EpiCore members who have submitted rapid responses to this request for further information. The possibility of toxic ingestion as well as yellow fever are discussed by other ProMED moderators as follows. - ProMED Mod.LXL]

[These cases, if limited to the Waka Biu College group, would be unusual for yellow fever on epidemiological grounds. However, the occurrence of a yellow fever case in the Yankari Game Reserve that the students also visited indicates that YF virus was circulating there and there were additional YF cases in the state. Nonetheless, the occurrence of a cluster of 16 simultaneous cases with just one report of other cases in the area where the students and photographers had been argues against yellow fever virus transmission. One would expect to see a chain of cases, not an abrupt outbreak with all coming down with illness at the same time. Sylvan spill-over of YF virus is also unlikely for the same reason. However the case fatality rate (4 dead of 16 cases) is about right for YF. It would be important to know if any of the ill individuals had been vaccinated against YF. Laboratory confirmation of the etiology of these 16 student cases is essential to know the cause of their illness. - ProMED Mod.TY]

[There are very few clinical signs to attempt to make a diagnosis. However, if the individuals did not purchase water or food, then one wonders whether the food they may have taken with them was spoiled in some way. These individuals swam in the water. A number of things come to mind, such as blue-green algae or cyanobacteria, that could be the cause. One also wonders whether the water had coliform or other bacteria or toxins which could have affected these individuals in the manner described. If others have additional information, we would appreciate knowing. Please send to <promed@promedmail.org>. - ProMED Mod.TG]

[Maps of Nigeria:
Date: Wed 4 Sep 2019
Source: Premium Times [edited]

At least 4 people have been confirmed dead and 12 hospitalized after students of the College of Education, Waka-Biu in Biu Local Government Area of Borno State returned from a Yankari Games Reserve field trip. According to witnesses who spoke to Premium Times on [the] phone from Biu, those that lost their lives complained of abdominal pains after which they vomited blood. Initially, the death toll was put at 9, a figure which the Provost of the school, Mohammed Audu, said was incorrect.

Biu has been thrown into confusion in the last few days as the strange illness continues to affect mainly students of the institution. One of the dead students is the daughter of the caretaker chairman of Biu Local Government Area. The Borno State Deputy Governor, Umar Kadafur, who hails from Biu, has also confirmed the development.

Speaking through his Press Secretary, Bulama Alkali, the deputy governor, said the Borno State health ministry and the federal ministry of health have been directed to investigate the matter. "For now the deputy governor may not have ample information that will enable him [to] make [an] informed comment on the matter," said Mr. Alkali. "However the deputy governor, just like any other parent, is very much saddened and concerned about the development," he added.

The College Provost, Mr. Audu, said the students were on holiday at the time they embarked on the field trip to Yankari. He said the "school was closed for the season on 10 Aug 2019. But the students had to return to the campus to embark on the excursion because it was already planned, and they had to go for the trip as part of their course work."

He said the field trip was done in 3 batches, and the last batch that encountered the problem was "batch C" who travelled on 21 Aug 2019 and returned a day later. The excursion has been an annual event for students, he said. "When they returned, they left for their homes and there was no issue until Saturday, 31 Aug 2019, when the daughter of [the] Biu local government chairman died," he said. The provost said even when the female student died, her death was not immediately linked with the Yankari trip.

"People began to raise eyebrows some days after when 3 other students who were in the same trip batch died after exhibiting similar health conditions," he said. Mr. Audu said tension began to mount when more of the students fell ill. "Of the 4 that died, 2 were not our students but the commercial photographers that usually accompany the students on such trips," he said. One of the photographers was said to be asthmatic.

The provost explained that he wrote to the General Hospital in Biu alerting the Principal Medical Officer (PMO) of the situation in the college following the death of one of the students. He said he also alerted the state government, which deployed an emergency medical response team to Biu from Maiduguri. "Meanwhile, the PMO in Biu had mobilized his team to the school after all the students on the last batch that contracted the unknown disease were summoned back to the campus," Mr. Audu said.

Mr. Audu said the students were questioned on the kind of food they ate and the water they drank. "Most of them said they couldn't eat the food sold in Yankari because [it was] very expensive, but they all said they swam in the stream there. The PMO assured them that though the strange ailment has no signs of being communicable, it's root cause has to be verified in a laboratory test."

The provost informed Premium Times that some of the students that were examined exhibited symptoms of being ill. A total of 12 of them were not feeling very well, and the medics gave them some medication and asked them to return for further medical examination by the medical team from Maiduguri. "However, the PMO had to refer 3 of the ill with more severe case[s] of ailment to be admitted at the hospital," he said.

Efforts to contact the Borno State health commissioner and his counterpart in the ministry of higher education were not successful, as they could not be reached on their known mobile lines.

Premium Times gathered that the Waka Biu students' travail may not have been isolated. One of the medical personnel was quoted to have said that a similar case was reported in Kano after a set of students from the Northwest state visited Yankari reserve on the same day, 21 Aug 2019.

Although Premium Times has not independently verified that piece of information, the medical personnel feel strongly that the strange illness has a lot to do with the popular games reserve. The medical team from Maiduguri is expected to reexamine the students.  [Byline: Abdulkareem Haruna]
====================
[The etiology of these illnesses is unclear. With the bleeding, a viral hemorrhagic fever such as Lassa or yellow fever could be considered. ProMED would appreciate any information regarding this outbreak.

Yankari National Park (<https://en.wikipedia.org/wiki/Yankari_National_Park>) is a large wildlife park located in the south-central part of Bauchi State, in northeastern Nigeria. It covers an area of about 2244 square km (866 sq mi) and is home to several natural warm water springs, as well as a wide variety of flora and fauna. Its location in the heartland of the West African savanna makes it a unique way for tourists and holidaymakers to watch wildlife in its natural habitat. Yankari was originally created as a game reserve in 1956 but later designated Nigeria's biggest national park in 1991. It is the most popular destination for tourists in Nigeria and, as such, plays a crucial role in the development and promotion of tourism and ecotourism in Nigeria. It is also one of the most popular eco-destinations in West Africa. - ProMED Mod.LL

[HealthMap/ProMED-mail map:
Borno State, Nigeria: <http://healthmap.org/promed/p/621>]
Date: Fri 23 Aug 2019
Source: Pulse [abridged, edited]

The director-general of the Nigeria Centre for Disease Control (NCDC), Dr Chikwe Ihekweazu said, "DSNOs (disease surveillance notification officers) and health facilities in high-risk areas and the technical working group (TWG) members, with a team from John[s] Hopkins University, visited 4 states to conduct training on use of measles RDTs (rapid diagnostic test kits). "They planned to follow up with states to ensure continued vigilance and early reporting" and "to also conduct state-level training on sample management and RDT testing for other high-priority states and to conduct community sensitisation across all LGAs (local government areas) of Adamawa State," he said.

Speaking on measles, he disclosed that there were 470 suspected cases reported from 136 LGAs in 28 converted states and the FCT. He added that none were laboratory confirmed, and no deaths were recorded.

Ihekweazu said that the multi-agency National Measles TWG was monitoring and coordinating response activities across the states. "TWG is working closely with [the] National Measles Technical Coordination Committee  (NPHCD) towards the upcoming measles supplementary immunisation activity (SIA), and introduction of [the] 2nd dose of measles vaccination.

"They conducted a planning meeting for AAR [after action report? - ProMED Mod.SH] and [a] measles guideline review meeting, also [devised] a travel advisory [notice] on [the] measles outbreak, shared across different media platforms," he said. The NCDC boss said that the centre would continue the review of measles surveillance data, across the nation, and also [would] continue planning for [the] AAR and measles guideline review meeting.
Date: Wed, 21 Aug 2019 18:28:15 +0200 (METDST)

Abuja, Aug 21, 2019 (AFP) - Nigeria on Wednesday announced that three years had elapsed since it last recorded a case of polio, a key step towards eradicating the notorious disease in Africa.    "Three years without a case of wild polio virus is a historic milestone for Nigeria and the global community," said Faisal Shuaib, director of the National Primary Health Care Development Agency.   Nigeria, Africa's most populous nation, was the last country on the continent to suffer from outbreaks of the wild polio virus, but has recorded none since August 2016. 

The West African giant will submit data on its polio cases to the World Health Organization (WHO) in March 2020, a move that could pave the way for the whole of the continent to be declared free of the virus.   "If the data confirms zero cases, the entire African region could be polio-free by middle of next year," the WHO representative in Nigeria, Clement Peter, said.    The poliovirus infects the brain and spinal cord, potentially causing lasting muscle pain, weakness or paralysis.    The virus only infects humans, with young children highly vulnerable.   It is transmitted through contact with the faeces of infected individuals, such as through unsanitary water or food.   It has no cure but can be prevented through immunisation.

Only Pakistan and Afghanistan are still battling incidents of the disease around the world.   The fight against the virus in Nigeria was slowed by the Boko Haram insurgency that has torn apart the northeast of the country over the past decade.    The insecurity, which has displaced more than two million people, hampered vaccinations in the region and prevented access to people in remote areas.    While fighting jihadists, Nigeria and neighbouring countries in the Lake Chad Basin have held polio vaccination campaigns to prevent the spread of the virus.

Once a worldwide scourge, the number of cases around the globe have fallen by more than 99 per cent since 1988, according to the WHO.   In 2012, Nigeria had 122 polio sufferers, more than half of the 223 victims worldwide.   Despite the progress, aid organisations warned there could be no letup.   "The battle is not over yet," Pernille Ironside, Unicef's deputy representative for Nigeria, said.    "We have to maintain our effort and intensify them to make sure the historic gains are sustained."
More ...

Ecuador

Ecuador US Consular Information Sheet
November 05, 2008
COUNTRY DESCRIPTION:
Ecuador is a Spanish-speaking country about the size of Colorado.
It has a developing economy and a democratically elected government.
Ecuador is geogra
hically and ethnically diverse.
In general, tourist facilities are adequate but vary in quality.
Ecuador adopted the U.S. dollar in 2000.
Both U.S. coins and Ecuadorian coins, which are equivalent to the value of the U.S. coins, are used.
Read the Department of State Background Notes on Ecuador for additional information.

ENTRY/EXIT REQUIREMENTS:
A U.S. passport with remaining validity of at least six months is required to enter Ecuador. A valid U.S. passport is required to depart Ecuador.
Tourists must also provide evidence of return or onward travel.
U.S. citizens traveling on regular passports for tourism or business do not need a visa for a stay of 90 days or less.
Those planning a longer visit must obtain a visa in advance of arrival.
Travelers who stay in Ecuador beyond the allowed entry time are charged a substantial fee and are barred from re-entering Ecuador for six months from the date of departure.
An airport exit tax is required when departing Ecuador.

U.S. citizens whose passports are lost or stolen in Ecuador must obtain a new passport at the U.S. Embassy in Quito or the U.S. Consulate General in Guayaquil and present it, together with a police report of the loss or theft, to the main immigration offices in those cities prior to arriving at the airport in order to obtain permission to depart.

Ecuador’s exit procedures mandate that minors (under the age of 18) who are citizens or residents of Ecuador and who are traveling alone, with one parent, or with a third party, must present a copy of their birth certificate and written authorization from the absent parent(s) or legal guardian.
When a parent is deceased, a notarized copy of the death certificate is required in lieu of the written authorization.
If documents are prepared in the United States, the authorization and the birth certificate must be translated into Spanish, notarized and authenticated by the Ecuadorian Embassy or an Ecuadorian consulate within the United States.
It is not uncommon for some local authorities to insist these documents be apostilled (authenticated).
Documents must be apostilled by the same State that issued the document.
For a list of State Authentication Authorities go to http://travel.state.gov/about/info/customer/customer_312.html; if documents are prepared in Ecuador, only notarization by an Ecuadorian notary is required.
This paragraph does not apply to children who enter Ecuador with U.S. passports as tourists, unless they hold dual U.S./Ecuadorian citizenship.

For further information regarding entry, exit, and customs requirements, travelers should contact the Ecuadorian Embassy at 2535 15th Street NW, Washington, DC 20009; telephone (202) 234-7166; web page http://www.ecuador.org/; or the Ecuadorian Consulate in Chicago (312) 338-1002/03; fax (312) 338-1004, Houston (713) 572-8731, Jersey City (201) 985-1700, Los Angeles (323) 658-5146; (323) 658-1068; fax (323) 658-1198, Miami (305) 539-8214, New Orleans (504) 523-3229, New York (212) 808-0211, or San Francisco (415) 982-1819.
Visit the Embassy of Ecuador’s web site at http://www.ecuador.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 U.S. Embassy in Quito advises caution when traveling to the northern border region of Ecuador, to include areas in the provinces of Sucumbios, Orellana and Carchi, northern Esmeraldas, and southern Esmeraldas, south of Atacames.
U.S. government personnel are under limitations with respect to traveling alone and over-nighting in these areas due to the spread of organized crime, drug trafficking, small arms trafficking, and incursions by various Colombian terrorist organizations.
Since 1998, at least ten U.S. citizens have been kidnapped near Ecuador's border with Colombia.
One U.S. citizen was murdered in January 2001 by kidnappers holding him for ransom. Violent crime has significantly increased in 2007 and 2008 with American citizens being victims of crimes, to include but not limited to, homicides, armed assaults, robberies, sexual assaults, and home invasions.
American citizens have also been the victims of violent crime on beaches regardless of whether the beach is a popular tourist destination or remote.

Political demonstrations occur frequently throughout Ecuador for various reasons. Protesters often block city streets and rural highways, including major arteries such as the Pan American Highway. Public transportation is often disrupted during these events. Protesters may burn tires, throw rocks and Molotov cocktails, engage in destruction of property and detonate small improvised explosive devices during demonstrations. Police response may include water cannons and tear gas. U.S. citizens and U.S. affiliated interests are not usually targeted, but U.S. citizens are advised to avoid areas where demonstrations are in progress and to be prepared with backup transportation plans. Although political demonstrations have not been directed at foreigners in the past, visitors are reminded that peaceful demonstrations can turn violent with little or no warning.
Additionally, foreigners are prohibited from protesting in Ecuador and may be subject to arrest for participating in demonstrations of any kind.
Please see the following links for the local information in Quito and Guayaquil's Consular Districts, respectively at http://ecuador.usembassy.gov/security-and-safety/warden-messages.html and http://guayaquil.usconsulate.gov/warden_messages.html . U.S. citizens may also keep informed of daily happenings by following the local news and police reports.

Ecuadorian authorities may declare states of emergency in provinces and regions affected by civil unrest, natural disaster, or other disruptions. During states of emergency, authorities have expanded powers to restore order, including suspension of some constitutional rights, expanded detention powers, and imposition of curfews.

Radicals in various locations in Ecuador, including Quito, Guayaquil, and Cuenca, have occasionally placed small explosive devices that release political literature, known locally as pamphlet bombs. Targets have included local and international businesses and various Government of Ecuador buildings. Although no foreign tourists have been injured in these explosions, American citizens visiting or residing in Ecuador are urged to take common-sense precautions and avoid suspicious looking packages.

U.S. citizens should carry identification at all times, including proof of U.S. citizenship.
Travelers to Ecuador’s beach areas should be aware that strong currents, undertow, and underwater hazards may exist and are not always posted.
Most beaches lack staffed lifeguard stations.

For information on the Galapagos Islands, please see the “Special Circumstances” section of this Country Specific 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 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:
Crime is a serious problem in Ecuador, and visitors should be alert and cautious.
Non-violent crime is common: hundreds of Americans are robbed every year in Ecuador.
Violent crime has increased in recent years.
Thieves and small gangs armed with guns or knives are now sometimes active even in smaller cities such as Otavalo, Manta, and Cuenca.
Tourists have been robbed at gunpoint on beaches and along hiking trails, including on the well-populated trail to the summit of Pichincha Volcano in Quito.
Incidents of rape have increased, even in well-traveled tourists areas and when the victims traveled in groups for safety. Shootings, kidnappings, and carjackings are still relatively rare, but American citizens have been victimized by those crimes.
The Ecuadorian government has increased police patrols in tourist areas, but travelers should remain alert to their surroundings and maintain constant control of personal belongings.

Travelers should avoid wearing expensive-looking jewelry and watches.
Avoid deserted beaches, hiking trails, and infrequently traveled roads, as well as the interior regions of large city parks, particularly at night. Robberies on public buses are a continuing problem.
The Embassy recommends that visitors use legitimate taxicabs (yellow, with meters) to travel around the larger cities.
Public buses can be dangerous – from both a traffic safety and a personal security point of view.

Pickpockets and other petty thieves are particularly active in public markets, airports, bus terminals, restaurants, and crowded streets.
Backpackers are frequently targeted for robbery and “snatch and grabs”; business travelers carrying laptop computer bags are similarly targeted.
Many travelers who travel by bus store their luggage below the bus, where it is sometimes stolen.
Therefore, we recommend that you do not store your passport in your luggage. Always be aware of your surroundings, and try to not travel alone.
Thefts from vehicles are common.
Do not leave anything of value in plain view in a car, including sunglasses or sports equipment.
Carjackings have occurred in both rural and urban areas.
Visitors are advised to drive with doors locked and windows rolled up.

In Quito, travelers should be particularly alert on the crowded streets of south Quito, at the Panecillo, in Old Quito, and in the areas of El Tejar, Parroquia San Sebastian, Avenida Cristobal Colon, and Gonzalez Suarez.
The U.S. Embassy strongly discourages hiking to the summit of Pichincha as violent crime is sharply rising.
Groups as large as eight have been robbed at gunpoint by masked men; female hikers have been sexually assaulted.
The Mariscal Sucre District is a popular tourist area in Quito with numerous restaurants, bars, hotels, and shopping sites.
Since 1999, U.S. government employees and private U.S. citizens have been victimized there, prompting the U.S. Embassy to put certain bars off-limits and to declare a nighttime curfew in the area for its employees.
Increased police presence and better lighting in prime tourist squares of Old Quito have improved safety, but similar measures in the Mariscal district have not been as effective.

In Guayaquil, take extra caution in the downtown area at night, in the street market area of La Bahia, at the Christ Statue (Sagrado Corazon de Jesus) on Cerro del Carmen, in the airport area, and in the southern part of the city.
The riverfront park area called the Malecon 2000 and the passage up to the lighthouse in the Las Penas area are generally safe and well patrolled although at night caution should be observed.
There have been repeated instances of travelers followed from the airport and intercepted by robbers using two vehicles to cut off the traveler.
There is some evidence that those most at risk are people who appear to be returning from family visits laden with gifts and large amounts of cash.
There have been armed robberies of restaurants and their patrons, including in the fashionable areas of Guayaquil.
Guayaquil has also experienced an increase in kidnappings for ransom, often in connection with hijackings, although tourists have not been targeted.

Criminals sometimes use incapacitating drugs such as scopolamine on unsuspecting tourists in order to rob them.
These so-called date rape drugs are put into drinks in order to drug the unsuspecting victim.
This drug can render the victim disoriented and can cause prolonged unconsciousness and serious medical problems.
Never allow a stranger to “buy” you a drink and never leave your drink unattended.
Several American citizens have reported thefts of property following ingestion of such substances.

Every year, 15 to 20 American citizens are arrested for attempting to traffic drugs between Ecuador and the United States, or between mainland Ecuador and the Galapagos.
Suitcases with false bottoms and other packages are common methods of transporting illegal substances. Many of these citizens claim to have been unaware that they were transporting drugs.
As in any other country, do not accept gifts, packages, or suitcases from other persons; even trusted travel companions have been known to take advantage of their friends and family to traffic drugs through Ecuador’s airports. See the Criminal Penalties section below for more details about Ecuador strict laws and sentences regarding illegal drug trafficking.

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 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.
Female victims of crime may receive assistance from the Comisaria de la Mujer at Ave. 24 de Mayo y Calle Loja, telephone 593 2 228 4016 or the Oficina de Derechos de la Mujer, Guayanas E-331 y Inglaterra, Quito 593 2 252 9909.
The local equivalent to the emergency line in Ecuador is the same as the U.S., dial “911”. The operators typically speak Spanish only. Victims should also call the Embassy or Consulate to report the crime and for assistance.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Adequate medical and dental care can be readily obtained in the major cities of Ecuador.
In smaller communities and in the Galapagos Islands services are limited, and the quality is variable and generally below U.S. standards.
Ambulances, with or without trained emergency staff, are in critically short supply.
Acute surgical and cardiac services are not available on the Galapagos Islands.
Serious cases must be evacuated to the Ecuadorian mainland or the United States for treatment.
Pharmacies are readily available in any city.
However, the availability of some medications is sporadic, and formulations and brand names will differ from products available in the U.S.
Narcotics and tranquilizers are extremely limited in availability.
“Pharmacists” sometimes prescribe and dispense medications.
These individuals often have little training and prescribe broad-spectrum antibiotics and other inappropriate medications.
Travelers should not seek their advice.
Folk healers and traditional markets offer herbal and folk remedies which should be avoided as formulations are questionable and some components may interact with other prescription medications.

Travelers to Quito (close to 10,000 feet) and other highland areas may require some time to adjust to the altitude, which can adversely affect blood pressure, digestion, and energy level.
Travelers are encouraged to consult with their personal health care providers before undertaking high-altitude travel.
In particular, travelers with heart or lung problems and persons with sickle cell trait may develop serious health complications at high altitudes.

Scuba divers in the Galapagos Islands should be aware of limited facilities for decompression.
A privately owned decompression chamber is available on Santa Cruz Island in the Galapagos Islands.
The Ecuadorian Navy operates a second decompression chamber at the San Eduardo Naval Base in Guayaquil.
Due to the high costs for these services and associated emergency transportation, divers are advised to obtain adequate medical evacuation and divers insurance.

Travelers should be aware of the presence of malaria, dengue fever, and yellow fever in areas of Ecuador below 4,500’ elevation.
Historically there has not been dengue or malaria in the Galapagos archipelago, and yellow fever has only occurred in the Amazon Basin.
Travelers who are on an appropriate anti-malarial drug have a greatly reduced chance of contracting malaria, while vaccine can provide protection against yellow fever.
Avoiding mosquito bites is the only effective prevention for dengue and personal protective measures, such as the use of insect repellents, help to reduce the risk of contracting all of these illnesses.
Travelers who become ill with a fever or flu-like illness while traveling in a high-risk area, and for up to one year thereafter, should seek prompt medical attention.
For additional information on malaria or dengue, protection from insect bites, and anti-malarials, consult the Center for Disease Control and World Health Organization web sites listed below.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Ecuador.
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 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 Ecuador is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Road travel throughout Ecuador can be dangerous, especially at night.
Many roads are poorly maintained or unmarked.
Heavy rains and mudslides often close or wash out roads.
Heavy fog is common in mountainous areas.
Driving practices differ from U.S. standards.
Inter-urban and inter-provincial bus passengers are often targets of crime, including robbery and sexual assault.

Highways are often unmarked and do not have signs indicating destinations.
Road safety features such as crash barriers and guardrails along steep mountainsides are rare.
In the countryside livestock are often herded along roads or graze on roadsides.
Many roads are used for pedestrian and animal traffic as well as vehicular traffic.
Driving habits vary from region to region.
In general, drivers in Quito and the mountain areas and the Oriente (eastern jungle) drive more slowly, observe traffic signals, and slow down for speed bumps.
Vehicles are reasonably well maintained.
On the coast, drivers have a more liberal approach to vehicle maintenance and traffic regulations.
In all areas buses, both intra-city and intercity, will stop at any point on their route to pick up or drop off passengers.
Speed bumps abound, even on major highways such as the Pan American Highway, to slow traffic.
Drivers turn right and left from any lane and do not yield for pedestrians and cyclists.

Intoxicated drivers can be encountered at any time, but they are especially prevalent on weekends and holidays.
Ecuador’s frontier regions are largely rural, poor, and lack police presence.
Because drug traffickers, criminal organizations, and smugglers of all types use clandestine border crossings to move their goods, the U.S. Embassy advises against driving on all but the most traveled highways.

If you are the driver of a vehicle involved in an automobile accident, you will likely be taken into police custody, especially if injuries are involved.
You are almost certain to spend some time in jail until all parties are satisfied that responsibility has been assigned and adequate financial satisfaction received.
Drivers may face criminal charges if injuries or damages are serious.
When driving your own vehicle or a rented vehicle, be sure to have proper vehicle registration papers with you.
Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office at http://www.turismo.gov.ec/ and the Ministerio de Transporte y Obras Publicas, the national authority responsible for road safety, at http://www.mtop.gov.ec/ .

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ecuador's Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Ecuador's air carrier operations.
For more information, travelers may visit the FAA's web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa . SPECIAL CIRCUMSTANCES
GALAPAGOS ISLANDS: A significant number of Ecuadorian tour vessels operating in the Galapagos Islands are neither inspected nor operated in accordance with U.S. regulations, and do not meet U.S. safety standards.
The Government of Ecuador requires that vessels carrying more than sixteen passengers comply with the International Safety Management (ISM) code established by the International Maritime Organization.
However, the quality of inspections, oversight, crewmember proficiency evaluation, and other requisites for safe vessel operation may vary substantially.
Tour boat accidents are more frequent among small vessels (those carrying fewer than sixteen passengers), but travelers should inquire about safety features of any vessel, regardless of size. When boarding vessels be sure to look for the life boats, floatation devices and if possible take a moment to inspect the life vest you would be using if there were an accident.

There have been at least three cases in 2004-2006 in which small quantities of drugs have been placed by unknown persons in unsecured pockets of tourists' checked bags, including backpacks, en route to the Galapagos.
Upon arrival, these drugs have been detected by police canine units, and the owners of the bags have been arrested and detained for months while the cases are resolved.
Travelers are advised to secure all parts of their bags thoroughly before checking them on flights to the Galapagos.

Strikes and disturbances by local fisherman in the Galapagos Islands have become violent on occasion.
While tourists have not been targeted, the incidents affected their movement and access to some sites.
Such disturbances have been minimal since April 2004, but the issue remains unsettled and could resurface at any time.

The islands are over 600 miles from the mainland and help may be slow in arriving in case of emergency.
The Government of Ecuador has very limited search and rescue capabilities.
Travelers to the Galapagos are encouraged to contact tour operators and visit the Bureau of Consular Affairs' web site for the most recent information when planning their trips to the Galapagos.

OTHER LEGAL ISSUES: Under Ecuadorian law, business disputes that normally would be handled by civil litigation in the United States may be converted into criminal proceedings.
This provision of the law has been used to impose travel prohibitions against resident U.S. citizens, and it also has led to the arrest and incarceration of U.S. business people while they were awaiting a hearing on the civil matter.

When considering purchasing property in Ecuador, Americans should be aware that competing claims to property might only surface after an apparently legal sale has been made.
Deficiencies in the Ecuadorian system for surveying and registering property and weaknesses in the judicial system mean that these disputes can last years.
The Mission is aware of several cases of American citizen land owners in Ecuador being threatened with physical harm and/or confiscation of their property by individuals claiming rights to the land, and, in at least one case, buildings have been razed.
American citizens considering buying property in Ecuador should engage a competent attorney and carefully research land title issues before making a purchase.

DISASTER PREPAREDNESS: Ecuador has 19 potentially active volcanoes, including nine that have shown recent activity.
Earthquakes occur frequently.
Three active volcanoes within 50 kilometers of Quito pose a significant threat to the city: Guagua Pichincha, Cotopaxi, and Reventador.
The primary threat is from failures of transportation, water, communications, and power systems due to heavy ash fall and damage to infrastructure outside the city.
Air transportation is especially vulnerable.
Potentially serious respiratory problems are caused by inhalation of ash.

The town of Banos, a popular tourist destination approximately 120 kilometers south of Quito, is at the base of the Tungurahua Volcano.
Tungurahua has erupted explosively several times since 1999, most recently in February of 2008, causing deaths and forcing thousands to evacuate their homes.
Explosive eruptions can occur with little warning.
The resulting flows of mud and lava could pose a significant and immediate threat to Banos and other population centers in the vicinity.
Travelers should to be aware of these conditions when choosing to stay overnight in Banos, especially on the western side of the town, and should be ready to evacuate on short notice.

Other volcanoes active in Ecuador include Reventador, 100 kilometers east of Quito, and Cotopaxi, 50 kilometers south of Quito.
In 2002, lava and mudflows caused by Reventador volcano closed a major Quito/northern-border highway and volcanic ash blanketed Quito, shutting down the Quito airport for several days.

The Quito City Government and the Ecuadorian Geophysical Institute monitor these volcanoes and issue regular reports on their activity.
In the event of eruptions, travelers should pay close attention to the news media for updates on the situation.
Other volcanoes in Ecuador may also exhibit increased activity at any time.
Further information is available via the Internet from the Ecuadorian Geophysical Institute at http://www.igepn.edu.ec/ and the National Oceanic and Atmospheric Administration at http://www.ssd.noaa.gov/VAAC/guag.html .

CUSTOMS REGULATIONS:
Ecuadorian customs authorities may enforce strict regulations concerning temporary importation into or export from Ecuador of items such as firearms, religious materials, antiquities, medications, electronic equipment, and currency.
Contact the Embassy of Ecuador in Washington, D.C., or one of Ecuador’s consulates in the United States for specific information regarding customs requirements. 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 Ecuadorian laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Ecuador 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.

The Ecuadorian government is required by international law to notify the U.S. Embassy or the nearest U.S. Consulate promptly when an American citizen is arrested and requests such notification.
Delays in notification can limit the assistance the U.S. Government can provide an arrested American citizen.
Therefore, Americans should promptly identify themselves as such to arresting officers and request that the U.S. Embassy in Quito or the U.S. Consulate in Guayaquil be notified immediately.

Prison conditions in Ecuador are extremely poor.
In many facilities food is insufficient in both quantity and quality, and prisoners must pay for adequate nutrition from their own funds.
Most Ecuadorian prisons provide poor medical care, and urgent medical conditions may receive only minimal attention.
The Guayaquil penitentiary medical clinic does not have medicine but is staffed with medical personnel. Prisoners must personally pay to have someone outside of the prison obtain medicine and prescriptions. Those accused of crimes in Ecuador can expect lengthy delays before trial and sentencing.
The accused are usually incarcerated while awaiting trial and sentencing, and in the case of serious crimes, bail is generally not an option.

CHILDREN'S ISSUES:
For information on 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 Ecuador 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 Ecuador.
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 Quito is located at Avigiras E12-170 y Eloy Alfaro.
The telephone during business hours (8:00a.m. to 5:00 p.m.) is (011) 593 2 398 5000.
For after-hours emergencies use (011) 593 2 398 5000. Within the same city use the last seven digits.
Add the city code for intercity telephone calls.
The Embassy's web site is http://ecuador.usembassy.gov/
The U.S. Consulate General in Guayaquil is located at the corner of 9 de Octubre and Garcia Moreno (near the Hotel Oro Verde); telephone (011-593-4) 232-3570 during business hours (8:00 a.m. to 5:00 p.m.) or 232-1152 for after-hours emergencies; fax (011-593-4) 232-0904.
The Consulate General's web site is http://guayaquil.usconsulate.gov/.

Consular services for U.S. citizens in the Galapagos Islands are provided by the Consulate General in Guayaquil with assistance from a U.S. Consular Agent in Puerto Ayora, Galapagos, at (05) 2526-330 or (05) 2526-296.

The Consular Section in Quito is open for American Citizen Services, including registration, from 1:30 to 4:00 p.m., Monday through Thursday, excluding U.S. and Ecuadorian holidays.
In order to provide better customer service and reduce waiting times, the American Citizen Services section in Guayaquil uses an online appointment system. Appointments are available from 12:00 noon to 4:00 p.m., Monday through Thursday. Notary appointments are Friday, 8:00 a.m. to 12:00 p.m., excluding U.S. and Ecuadorian holidays. Walk-in service remains available, but customers with appointments take precedence.
To make an appointment, go to http://guayaquil.usconsulate.gov/online_appointments.html
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This replaces the Country Specific Information for Ecuador dated March 28, 2008, to update the sections on Entry/Exit Requirements, Information for Victims of Crime, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Sun, 31 Mar 2019 11:14:25 +0200

Washington, March 31, 2019 (AFP) - A strong 6.2 magnitude earthquake struck just off the coast of Ecuador early Sunday, the US Geological Survey said, but there were no immediate reports of damage and there was no tsunami warning.   The quake occurred at a shallow depth of 18.5 kilometres (11.5 miles), in the Pacific Ocean west of Guayaquil and 27 kilometres north of Santa Elena, the agency reported.
Date: Fri, 7 Sep 2018 12:17:58 +0200

Quito, Sept 7, 2018 (AFP) - A deep 6.2 magnitude earthquake struck Ecuador on Thursday night, causing damage to buildings and injuring two people.   The quake hit at 9:12 pm local time (0212 GMT on Friday) at a depth of 93.5 kilometres, near the center of the South American country.   It was felt across several provinces, according to Twitter users. Two people were injured in the town of Cumanda.

The walls of homes cracked and ceilings caved in, mayor Marco Marquiasca said.   Local authorities recorded its magnitude as 6.5.   Ecuador suffered a 7.8 magnitude earthquake on April 16, 2016, which devastated villages in the coastal provinces of Manabi and Esmeraldas and killed 673 people.   The losses amounted to more than $3 billion, according to authorities.    Located on the boundary of the Nazca and South America tectonic plates, Ecuador is very prone to seismic activity.
Date: Thu, 16 Aug 2018 03:58:11 +0200

Quito, Aug 16, 2018 (AFP) - Colombia's government said Wednesday that 19 of the victims of a deadly bus crush in Ecuador were its citizens, as Quito lowered the overall death toll from the accident.   Ecuador's foreign ministry said in a statement that 23 people were killed in the Tuesday crash, instead of 24 as previously announced.   Twelve Colombians, four Venezuelans and two Ecuadorans who died in the accident have been identified, the statement said.

The bus, which had foreign license plates, overturned and crashed into three houses after a collision with an all-terrain vehicle near Quito.   Ecuador transport colonel Julio Barba said the driver "probably overused the brakes... which produced an overheating of the brake system leading to a loss of control of the vehicle."   Colombia's Transport Ministry had said on Tuesday that the bus was not authorized to carry tourists.  One of the two drivers, who was injured in the crash, has been arrested.

Traffic accidents are among the leading causes of death in Ecuador. According to the watchdog group Justicia Vial, on average seven people are killed and some 80 people injured each day in traffic accidents.   And 96 percent of those accidents are due to human error, according to the group's figures.   On Sunday, 12 people were killed and 30 injured when a bus carrying fans of Barcelona SC, Ecuador's most popular football club based in Guayaquil, ran off the highway and flipped.
Date: Mon, 11 Jun 2018 22:10:52 +0200

Quito, June 11, 2018 (AFP) - A Lebanese man has been stuck in immigration purgatory at an airport in Ecuador for 42 days after losing his passport and being returned there from Spain.   Nizam Hussein Shalak, 56, who does not speak Spanish, has been residing in the international terminal of the Jose Joaquin de Olmedo airport in Guayaquil, El Universo newspaper reported.   "It is a case of inadmissibility because he has no documents," a foreign ministry source said.   "The only legal body to issue a travel document is the Lebanese consulate in Bogota," which has not responded to requests that it do so, the source said.   "We are closely following the case and are working with the interior (ministry) to get Lebanon to issue him a travel document so he can return to his country."   The situation resembles that of an Iranian refugee who lived in a Paris airport from 1988 to 2006 and was portrayed in the film "The Terminal" starring Tom Hanks.

Shalak visited Guayaquil two months ago and stopped on the way back to Lebanon in Lima, Peru, and Barcelona, Spain, where he was detained after losing his passport as well as his credit cards, El Universo newspaper reported.   He stayed in Barcelona for 10 days and Lima for another 11 before being returned to Guayaquil, where he had to make a makeshift a bed on the seats of the terminal.   "He eats with the coupons that the airline... gives him from time to time" and showers "every three or four days, when they take him to a bathroom in another part of the terminal," the newspaper said.   The foreign ministry source said that while Shalak left with a passport, he did not have one upon his return and could not pass immigration.   Therefore, "he is not legally in the country."
Date: Fri, 6 Apr 2018 03:41:33 +0200

Quito, April 6, 2018 (AFP) - An Ecuadoran soldier died Thursday from wounds sustained in a roadside bomb blast two weeks ago on the border with Colombia, Ecuadoran President Lenin Moreno said, calling the explosion a "terrorist act."   He said on Twitter that the corporal was being treated in a military hospital when he succumbed to his grievous injuries, which had resulted in both his legs being amputated.   "A hug of solidarity to his family," Moreno tweeted.   The death took to four the number of soldiers killed in the March 20 blast, which occurred near the border town of Mataje. A dozen others were wounded.

Ecuador has since January been confronted with an unusual wave of attacks directed at its security forces.    The government blames dissident rebels with Colombia's former FARC guerrilla group which has disbanded and become a political party following a landmark 2016 peace deal.   An Ecuadoran media team comprising a reporter, a photographer and a driver were abducted last week in Mataje.   Quito has stepped up the military presence in the region, and has reinforced cooperation with Colombia to try to quell the border violence. But the task is a difficult one, with dense jungle providing cover to insurgents.
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World Travel News Headlines

Date: Sun 15 Sep 2019
Source: Pakistan Today [edited]

A Crimean-Congo Haemorrhagic Fever (CCHF) patient died in a private hospital of Karachi. The death toll from the tick-born viral disease has climbed to 17 in the megacity this year (2019). Sindh Health Department confirmed the death of a 52-year old man, [HK], a resident of Lyari area of Karachi who died in private hospital of the city due to CCHF. The patient was brought to hospital a few days ago with fever where he was diagnosed.

The tick-born viral disease had infected 36 people this year (2019) so far out of which 17 died. Currently, a 62 year old man [MD] is under treatment in a private hospital. CCHF is a fatal viral disease that spreads through a tick bite, which is a [arthropod vector and transmits the CCHF virus into the blood of animals]. The CCHF is mainly contracted by people who deal with cattle and livestock. The symptoms include backache, joints pain, pain in the abdomen, high grade fever and bleeding from any part of the body.
Date: Thu 12 Sep 2019
Source: Hindustan Times [edited]

Japanese encephalitis (JE) has killed 154 people in Assam in 2019, the highest in 5 years officials said even as they claimed that the outbreak, which peaked in July and August, was subsiding and only a few fresh cases were reported in September.  A top state government official also said a state-wide adult vaccination campaign will begin in November [2019] covering all districts after the Centre agreed to provide around 57 lakh [5.7 million] vaccines.  "From [15 Nov 2019], we plan to start an intensive adult vaccination campaign covering the whole state. We plan to conclude it by [15 Mar 2020]. The Centre has agreed to provide around 57 lakh vaccines. We will procure the rest on our own if there is a shortfall," Samir Sinha, Principal Secretary, Health and Family Welfare Department said. The campaign is likely to be announced in a week.

On Thursday [12 Sep 2019], while no fresh JE cases were reported, one person from Kamrup (Rural) succumbed to the disease that is spread by _Culex_ mosquitoes, according to the daily bulletin from the office of JVN Subramanyam, Director, National Health Mission (NHM), Assam.  The state recorded 614 JE positive cases in 2015, 427 in 2016, 605 in 2017 and 509 in 2018. In 2015, the number of deaths due to JE stood at 135; in 2016 the number came down to 92 and further decreased to 87 in 2017. In 2018, the state saw 94 deaths due to the vector-borne disease. In 2014, the state recorded 165 deaths due to JE.

The bulletin from NHM said till 12 Sep [2019], the total number of persons who have been affected by JE stood at 630, out of which 154 people have died. While 13 persons who died belonged to Goalpara, 11 came from Kamrup (Rural), the 2 neighbouring districts in lower Assam where maximum fatalities have been recorded this year [2019]. Kokrajhar, in Bodo Territorial Administrative District, has not reported any JE positive case for the 1st time in the last 6 years, even as the rest of the state has been affected in [the] 2019 outbreak.  "Since the last 4, 5 years were relatively calm and quiet, this year [2019] the peripheral workers seemed to be reluctant to perform their field duties properly. During my visit to Goalpara, I found that peripheral workers did not attend to cases of fever initially," said CR Pathak, State Programme Officer of the National Vector Borne Disease Control Programme, explaining how the lax attitude of the ground staff may have added to the late detection and higher fatalities.

Pathak pointed out another reason and explained how a lot of ground staff, the multipurpose workers were involved in National Register of Citizens (NRC) duty. "I am sure the NRC authorities also did not know that the outbreak would be severe this year. We recalled the workers in July [2019]," he said.  Health officials also introduced urgent measures like fogging, blood sample collection of all cases of fever and sending all suspected JE cases for proper tests, treatment at civil hospitals and medical colleges, among others. "Post July [2019] the number of fresh cases have been on a decline," said Pathak.

Sinha said, "The last 10 deaths are all old cases." In September [2019], only 4 fresh cases have been recorded in the state. Unlike previous years when the disease was mostly confined to Upper Assam and North Assam, the whole state was affected this time, he said.  He said analysis also showed that the adults constituted almost 80% of the casualties. "The writing on the wall is clear. Vaccination of persons in the age group of 15-65 is the way forward to contain it," Sinha said.  While the entire state has been covered under the JE vaccination campaign for children, 14 have been covered under the adult vaccination campaign in a phased manner. Officials point out the coverage [of the] latter has not been satisfactory for a multitude of reasons, including rumours about the effects of the vaccine.

Records show even vaccination is not a foolproof way to stop the outbreak. "This year [2019], too, 15%-20% of the casualties would be from the section which had been given JE vaccination. We know that JE vaccine is effective in around 85% of the cases and depends on immunity of the persons among other factors," said Pathak.  [Byline: Sadiq Naqvi]
=====================
[All the above cases are attributed to Japanese encephalitis (JE), with no mention of non-JE acute encephalitis syndrome that was mentioned in the previous Assam report (see Japanese encephalitis & other - India (23): (AS) http://promedmail.org/post/20190728.6591689). It is not stated if the vaccine used is inactivated or a live modified one. The immunity of inactivated vaccine likely is of considerably shorter duration than a live vaccine would be. It is unfortunate to learn that the rumor that the vaccine is not safe reduces coverage of the population at risk of infection. The price paid for this rumor is a population of increased susceptibility with more cases and deaths. A public information campaign is necessary to counteract the rumors. - ProMED Mod.TY]

[Map of India:

HealthMap/ProMED-mail maps:
Assam State, India: <http://healthmap.org/promed/p/299>]
Date: Mon, 16 Sep 2019 08:19:07 +0200 (METDST)

Tokyo, Sept 16, 2019 (AFP) - Almost 80,000 homes are still without power a week after a powerful typhoon battered eastern Japan, authorities said Monday, with sustained heavy rain prompting evacuation orders and hampering recovery efforts.    Typhoon Faxai powered into the Tokyo region in the early hours of Monday last week, packing record winds that brought down power lines, disrupted Rugby World Cup preparations and prompted the government to order tens of thousands of people to leave their homes.

The storm killed two people, with at least three elderly later confirmed dead due to heatstroke as temperatures soared to above 35 degrees Celsius (95 degrees Fahrenheit) in areas affected by a post-typhoon blackout.   Some 78,700 households were still without power in Chiba, southeast of the capital, Tokyo Electric Co. (TEPCO) spokesman Naoya Kondo told AFP.   "A complete recovery is still unlikely until September 27 as we have difficulties in mountain areas," he added.   Some 16,700 households were also without water because several water purification plants had no power, a local official said.   With help from the military, officials were dispatching water tanker trucks to the affected areas.

The national weather agency Monday issued new warnings for heavy rain in Chiba, while local authorities issued non-compulsory evacuation orders to 46,300 people due to the risk of landslides.   "A delay in recovery work is expected due to heavy rain," said Kenta Hirano, a disaster management official in Futtsu in Chiba, where more than 1,000 houses were damaged by the typhoon.   Local media showed residents in Chiba hurriedly covering broken roofs with blue tarps.   "We are at a loss as we can't live there again," a 66-year-old man told public broadcaster NHK after the typhoon ripped off the roof of his house.
Date: Sun, 15 Sep 2019 15:38:29 +0200 (METDST)

Athens, Sept 15, 2019 (AFP) - More than 160 firefighters on Sunday battled to contain a large fire near Athens blazing for a second day amid gale force winds, officials said.   And in another emergency, authorities evacuated dozens of people from two villages and a hotel on the island of Zakynthos after a new fire broke out on Sunday.

The fire department said the blaze near Athens burned in the mountains above Loutraki, a coastal resort some 60 kilometres (35 miles) west of Athens.   "The fire is burning near the top of the mountain," Stefanos Kolokouris, the fire department's deputy chief of operations, told state TV ERT.   "We are trying to create a perimeter but the terrain is very difficult, with ravines," he said.   Four water bombers and six helicopters were participating in operations. Given a lack of roads in the area, two squads of firefighters had to be carried to the mountaintop by Super Puma helicopter, state agency ANA said.   Officials had already evacuated 50 people from a local monastery when the fire broke out on Saturday, but stressed that other inhabited areas were not in danger.

On Zakynthos, officials ordered the evacuation of the villages of Agalas and Keri in the south of the island. Some 120 tourists were also relocated to a safe area.   The Greek fire department on Sunday said it had been called to nearly 80 fires over the past 24 hours.   It has already faced more than 9,600 rural and urban fires this year.
Date: Sat, 14 Sep 2019 16:08:47 +0200 (METDST)

Singapore, Sept 14, 2019 (AFP) - Pollution from forest fires in Indonesia pushed Singapore's air quality to unhealthy levels for the first time in three years on Saturday, the government said, a week ahead of the Formula One night race in the city.   The toxic smoke caused by burning to clear land for plantations is an annual problem for Indonesia's neighbours, but has been worsened this year by particularly dry weather.   "There has been a deterioration in the haze conditions in Singapore this afternoon," the National Environment Agency (NEA) said in a statement.   "This was due to a confluence of winds over the nearby region that led to more smoke haze from Sumatra being blown toward Singapore," it said, referring to one of the Indonesian islands where fires are raging.

The NEA said the pollutant standards index (PSI) worsened to 112 in parts of the island Saturday night.   An index reading between 101-200 is considered unhealthy, with residents advised against doing prolonged strenuous exercises outdoors.   Singapore may continue to experience hazy conditions over the next few days, the agency warned.   The city-state of 5.6 million people was shrouded in a thin white haze, with a few residents seen wearing face masks, but there was no major disruption to daily activities.   The F1 race is scheduled from Friday to Sunday on a street circuit in the Marina Bay financial district.

Singapore GP, the Formula One organisers, said the possibility of haze is one of the potential issues covered in their contingency plan for this year's grand prix.   "The plan was formulated and refined with stake holders, government bodies and the Formula One community," Singapore GP said in an emailed statement.   "In the event that the haze causes visibility, public health or operational issues, Singapore GP would work closely with the relevant agencies before making any collective decisions regarding the event."

Neighbouring Malaysia has also been affected by the smoke, with air quality in parts of the country including the capital Kuala Lumpur reaching unhealthy levels over the past few days and triggering a diplomatic row with Jakarta.   In 2015, the index reached "hazardous" levels of more than 300 in Singapore, forcing the closure of schools. Indonesian forest fires were the worst in two decades that year, firing up smog that blanketed large parts of Southeast Asia for weeks.
Date: Sat, 14 Sep 2019 11:16:53 +0200 (METDST)

Bangkok, Sept 14, 2019 (AFP) - Floods in northeastern Thailand have submerged homes, roads and bridges, leaving more than 23,000 people in evacuation shelters as anger grows over the government's "slow" emergency response.   Torrential rain has lashed the country for the last two weeks, causing flash floods and mudslides in almost half its provinces, with families evacuated from their homes in boats or makeshift rafts.   Since August 29, 32 people have been killed in the deluge, said a statement from the disaster department on Saturday that also gave the number of people staying in emergency shelters.   Two weather events are behind the widespread floods, the department said -- Storm Podul and a tropical depression that formed over the South China Sea called Kajiki.

Local media reports from the worst-hit province of Ubon Ratchathani showed people wading through chest-deep water and rescuers in boats trying to steer buffalo to higher ground.   Flooding in the province, which borders Laos and Cambodia, has been exacerbated by rising water levels in the Moon and Chi rivers.   "It will take three weeks to drain the floodwater" from up to 90 percent of inundated households, said provincial governor Sarit Witoon.   "The water has slightly receded about four centimetres today and I think it will keep going down," he added.

But the situation is already "unlivable" for families in one-storey homes, said Pongsak Saiwan, local director of opposition party Future Forward.   Access to an entire district is currently cut off due to flood waters, which are about two metres (6.5 foot) deep in the main town, while three major bridges are "impassable", he said.   "The government has been very slow in responding to the situation since the floods started in the beginning of September," Pongsak told AFP.   Ubon Ratchathani's plight started trending on Twitter this week with the hashtag #SaveUbon.   Aerial shots of the flood-hit plains blanketed with muddy river water were widely shared, as well as photos of stray dogs being rescued by passing boats.

One Twitter user compared the flood response to how quickly the government had mobilised and saved 12 young boys and their football coach from a waterlogged cave last year -- an incident that catapulted Thailand to international attention.   "Only 13 lives stuck in the cave and it was still very high-profile, but this is hundreds of thousands of lives," tweeted Yosita8051. "It's not okay."   Thailand's junta leader-turned-premier Prayut Chan O-Cha tweeted on Saturday that he has told agencies to "expedite assistance" to those in the affected areas.
Date: Fri, 13 Sep 2019 16:44:33 +0200 (METDST)

Niamey, Sept 13, 2019 (AFP) - Niger launched a campaign on Friday to vaccinate more than four million children against measles, one of the biggest causes of child mortality in the country, the health ministry said.

The one-week nationwide vaccination programme aims to "eliminate measles by the end of 2020", Health Minister Illiassou Mainassara said, adding, it "will reach 4.254 million children" aged from 9 months up to the age of five.   "Despite all the efforts made in the fight against communicable diseases, we still note the persistence of localised measles epidemics (in Niger)," Mainassara said on his way to the capital Niamey to launch the campaign.    But some experts say the vaccination programme should have kicked in sooner    "The delay of this campaign which should have happened in 2018 has resulted in ...the emergence of epidemics in several health districts," said Niger's UNICEF representative, Felicite Tchibindat.

Since January this year, 9,741 suspected cases have been documented in Niger resulting in 53 deaths, she said.   "Measles is a serious and extremely contagious viral disease and remains one of the leading causes of early childhood death, while it can be prevented by vaccination," TchibiNdat said.    She believes the children of migrants, refugees and displaced people will especially benefit from the campaign.    Niger's vaccination programme is supported by the World Health Organization (WHO), UNICEF (United Nations Children's Fund) and the Gavi vaccine Alliance.
Date: Fri, 13 Sep 2019 16:08:16 +0200 (METDST)

Nairobi, Sept 13, 2019 (AFP) - Kenya on Friday became the third country to start routinely innoculating infants against malaria, using the world's first vaccine to combat a disease that kills 800 children globally every day.   The vaccine -- lab name RTS,S -- targets the deadliest and most common form of malaria parasite in Africa, where children under five account for two-thirds of all global deaths from the mosquito-born illness.

Kenya joins Malawi and Ghana, which commenced their own pilot programs for the vaccine supported by the World Health Organization (WHO) earlier this year.   The vaccine will be introduced in phases across malaria-endemic parts of western Kenya near Lake Victoria, starting with Homa Bay, the country's health ministry said.   "It's an exciting time for Kenya as we roll out this vaccine in parts of the country where the burden of malaria is the highest," Health Minister Sicily Kariuki said in a statement.   RTS,S will be added to the national immunisation schedule in these areas, given alongside other routine shots for children under two.

The health ministry said 120,000 Kenyan children were expected to be vaccinated under the pilot programme.   The country has distributed insecticide-treated mosquito nets, fumigated homes and improved diagnostics in its fight against malaria.   But the disease remains stubborn. The health ministry says malaria claimed more than 10,000 lives in 2016, and infected millions more.   As in the rest of the world, children in Kenya bear the brunt of the disease.    Up to 27 percent of Kenyan children under five have been infected with the disease, the health ministry said.   "This vaccine represents an additional tool that will boost Kenya's efforts in reducing malaria infections and deaths among children," Kariuki said.   WHO says a child dies roughly every two minutes from malaria somewhere in the world.

- 30 years in making -
Known under its commercial name as Mosquirix, the vaccine was developed over 30 years by British pharmaceutical giant GlaxoSmithKline in partnership with nonprofit PATH and African research institutes.   It is the only vaccine to date to show a protective effect against malaria in young children, WHO says.   It acts against Plasmodium falciparum, the deadliest malarial parasite and the most prevalent in Africa, where illness and death from the disease remain high despite some gains.   The shots, administered over four doses, have been shown in clinical trials to significantly reduce cases of malaria, and malaria-related complications, in young children.   The vaccine prevented about four in 10 cases of malaria and three in 10 cases of the most severe, life-threatening form of the disease, within the trial group, WHO says.

Evidence gained from the vaccine pilot schemes could guide decisions about whether RTS,S is rolled out more widely in future, WHO says.   "This is the most advanced malaria vaccine that we have today. It has been in the making for the last almost three decades," Dr Richard Mihigo, WHO's co-ordinator of immunisation and vaccine development programme, told AFP before the Kenyan launch.   "Children are the most vulnerable group to this severe disease that is malaria, so protecting children can make a big impact in preventing malaria."   The disease kills more than 400,000 people around the world every year. Of these about 290,000 are under five.    Most are in Africa, where more than 90 percent of the world's malaria cases -- and fatalities -- occur.
Date: Fri, 13 Sep 2019 11:40:02 +0200 (METDST)

London, Sept 13, 2019 (AFP) - British Airways has cancelled all its scheduled UK flights for September 27, when company pilots will again strike in a long-running row over pay.   It comes after the carrier cancelled all flights departing and arriving in the UK on Monday and Tuesday owing to BA's first strike by pilots in the company's 100-year history.

In a statement released late Thursday, BA called on the British Airline Pilots Association (BALPA) union "to call off their strike and return to negotiations".    The airline added: "We are very sorry that BALPA's actions will affect thousands more travel plans."   This week's strike sparked travel chaos for about 200,000 passengers, mostly using London's Gatwick and Heathrow airports.   BALPA estimates that the 48-hour strike cost the airline £80 million ($99 million, 89 million euros), but BA has yet to provide a figure.
Date: Tue, 10 Sep 2019 13:02:19 +0200 (METDST)

Khartoum, Sept 10, 2019 (AFP) - Sudan reported four confirmed cases of cholera in Blue Nile Tuesday and said three people had also died of acute diarrhoea in the war-torn state.   Health Minister Akram al-Toum has asked the World Health Organization to send supplies of cholera vaccine immediately, the ministry said.

Ministry and WHO officials have been sent to the affected area.   "There are 37 cases of acute diarrhoea in Blue Nile... There have been three deaths," the ministry said in a statement.   Dozens of people died from acute diarrhoea in Sudan in 2016 after thousands of cases were reported nationwide.   Blue Nile state, which has a large ethnic minority population, has been the focus of a rebellion by the Sudan People's Liberation Army-North since 2011.   The army declared a ceasefire after the  overthrow of veteran president Omar al-Bashir earlier this year.