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Antigua and Barbuda

Antigua and Barbuda - US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
Antigua and Barbuda is a dual island nation known for its beaches, and is a favorite destination for yachtsmen.
Tourist facilities are widely avai
able.
English is the primary language.
Banking facilities and ATMs are available throughout the island.
Read the Department of State Background Notes on Antigua and Barbuda for additional information.

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

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

Immigration officials are strict about getting exact information about where visitors are staying, and will often request to see a return ticket or ticket for onward travel, as well as proof of sufficient funds to cover the cost of the visitor’s intended stay.
There is a departure tax payable when departing the country.
For further information on entry requirements, travelers can contact the Embassy of Antigua and Barbuda, 3216 New Mexico Avenue NW, Washington, DC
20016, telephone (202) 362-5122, or consulates in Miami.
Additional information may be found on the home page of the Antigua and Barbuda Department of Tourism at http://www.antigua-barbuda.org.

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. 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:
Petty street crime does occur, and valuables left unattended on beaches, in rental cars or in hotel rooms are vulnerable to theft.
There has been an increase in crime in Antigua, including violent crimes, in the last six months.
However, this increase has not, for the most part, affected visitors to the island.
The Government of Antigua and Barbuda has taken steps to improve the effectiveness of the police in responding to crimes.
As everywhere, visitors to Antigua and Barbuda are advised to be alert and maintain the same level of personal security used when visiting major U.S. cities.

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.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
There are many qualified doctors in Antigua and Barbuda, but medical facilities are limited to a public hospital and a private clinic and are not up to U.S. standards.
The principal medical facility on Antigua is Holberton Hospital, on Hospital Road, St. John's (telephone (268) 462-0251).
There is no hyperbaric chamber; divers requiring treatment for decompression illness must be evacuated from the island, to either Saba or Guadeloupe.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars.
Doctors and hospitals often expect immediate cash payment for health services, and U.S. medical insurance is not always valid outside the United States.
U.S. Medicare and Medicaid programs do not provide payment for medical services outside the United States.

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

Traffic in Antigua and Barbuda moves on the left.
Major roads are generally in good condition, but drivers may encounter wandering animals and slow moving heavy equipment.
There is relatively little police enforcement of traffic regulations.
Buses and vans are frequently crowded and may travel at excessive speeds.
Automobiles may lack working safety and signaling devices, such as brake lights.

Please refer to our Road Safety page for more information.
For specific information concerning Antigua and Barbuda driving permits, vehicle inspection, road tax, and mandatory insurance, contact the Antigua and Barbuda national tourist organization offices in New York via e-mail at info@antigua-barbuda.org.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Antigua and Barbuda’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Antigua and Barbuda’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:
Like all Caribbean countries, Antigua can be affected by hurricanes. The hurricane season normally runs from June to the end of November, but there have been hurricanes in December in recent years.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.
Please see 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 Antigua and Barbuda laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Antigua and Barbuda 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 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 living or traveling in Antigua and Barbuda are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov/, and to obtain updated information on travel and security within Antigua and Barbuda.
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 Bridgetown in located in the Wildey Business Park in suburban Wildey, south and east of downtown Bridgetown.
The main number for the Consular Section is (246) 431-0225; after hours, the Embassy duty officer can be reached by calling (246) 436-4950.
The web site for Embassy Bridgetown is http://barbados.usembassy.gov/. Hours of operation are 8:30 a.m. - 4:00 p.m., Monday-Friday, except local and U.S. holidays.

The U.S. Consular Agent, Rebecca Simon, in Antigua provides passport, citizenship and notarial services, and assists Americans in distress.
The Consular Agency is located in Suite #2, Jasmine Court, Friars Hill Rd, St. John’s, Antigua.
Contact information is as follows: telephone 1-268-463-6531, cellular 1-268-726-6531, or e-mail ANUWndrGyal@aol.com. The mailing address is P.O. Box W-1562, St. John’s, Antigua. The Consular Agent is available by appointment only.
The office is closed for local and U.S. Holidays.
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This replaces the Country Specific Information for Antigua and Barbuda dated April 2, 2007, to update sections on Entry/Exit Requirements, Safety and Security, Medical Facilities and Health Information, Traffic Safety and Road Conditions, and Crime.

Travel News Headlines WORLD NEWS

Date: Wed, 21 Mar 2018 18:14:27 +0100
By Gemma Handy

St. John's, Antigua and Barbuda, March 21, 2018 (AFP) - Voters in the hurricane-wracked twin island nation of Antigua and Barbuda headed to the polls Wednesday to elect a new government after Prime Minister Gaston Browne called snap elections.   Browne's Antigua Barbuda Labour Party, which has led the eastern Caribbean country since 2014, is widely expected to secure a second consecutive term.   The prime minister announced general elections on February 24, 15 months before a constitutionally mandated deadline, giving opposition parties less than four weeks to prepare.

And there will be no polling stations on Barbuda, which was battered by Hurricane Irma in September.    As a result, the estimated 400 Barbudans who have since returned home will have to travel to Antigua to cast their ballot. The government has promised to pay for related transport, accommodation and meal expenses.   Just over 51,000 Antiguans and Barbudans are eligible to vote. Voter turnout was around 90 percent in 2014.

Browne says the government wants to protect half a billion US dollars worth of developments currently under construction in the tourism-dependent country, and provide investors with stability.    One of the most prominent -- and controversial -- projects is a $250 million mega resort being built by Hollywood star Robert De Niro on Barbuda which was devastated by Hurricane Irma in September.   Lowering the cost of living in the country of 100,000 people is high on the
agenda.

- Ruling party dominates -
Browne, a former businessman and banker, has pledged to reduce electricity bills, along with the cost of land, and provide more affordable housing, under the slogan "Rebuilding Together." His wife Maria is also running for a seat on an ABLP ticket.   On Sunday, thousands of Browne's supporters donned the party's red colours and walked alongside a motorcade in an event that culminated in a public rally.   The "Delivering Hope" campaign of the main opposition group, the United Progressive Party (UPP), cites revitalization of the tourism and agricultural sectors as key priorities.

Fifty-three candidates will vie for seats in the 17 single-member constituencies -- of which the ABLP currently holds 14 -- in a first-past-the-post system.    The ruling party is alone in presenting a full slate of 17 candidates. The UPP, led by former finance minister Harold Lovell, has put forward 16.    A new party, the Democratic National Alliance, headed by current lawmaker and former UPP representative Joanne Massiah has registered 13 candidates.    There is a handful of smaller parties, a single independent runner and one representing the Barbuda People's Movement (BPM) contesting the small island's sole seat.

Polling stations opened at 6:00 am (1000 GMT) and are due to close at 6:00 pm. Alcohol sales are restricted during those hours and all public schools are closed, as many are serving as polling stations.   Teams representing the Caribbean Community (CARICOM) are observing the elections.   On its path through the Caribbean in September, Irma caused "absolute devastation" on Barbuda where up to 30 percent of properties were demolished, and 95 percent damaged, Browne had said at the time.    After a 10-year hiatus, voters returned Browne's Labour Party to power during the last ballot four years ago, when he pledged to economically transform the country.   The country became fully independent from Britain in 1981.
Date: Sun, 25 Feb 2018 08:04:27 +0100

Georgetown, Guyana, Feb 25, 2018 (AFP) - Antigua and Barbuda, a hurricane-ravaged Caribbean tourist destination, will go to the polls next month more than a year earlier than scheduled, the prime minister said on Saturday.   The two-island nation's parliamentary elections were scheduled for June 2019, but will now be held on March 21, Gaston Browne said.   Voters will select the 17 members of Antigua and Barbuda's House of Representatives, its lower house. Members of the Senate are appointed.   "Our primary focus for calling elections early is not about politics but is about your development. God forbid for there to be change in government," Browne said on radio.

After a 10-year hiatus, voters returned Browne's Labour Party to power during the last ballot in 2014, when he pledged to economically transform the country.   On Saturday, Browne said there had been "significant gains" since and that the government wanted to guard against unpredictability in the investment climate.   He cited cheaper housing for ordinary people, better roads, two Marriott-branded hotels, as well as a new airport on the island of Barbuda, which was battered last year by Hurricane Irma.   On its path through the Caribbean in September, Irma caused "absolute devastation" on Barbuda where up to 30 percent of properties were demolished, and 95 percent damaged, Browne had said at the time.    Labour has ruled Antigua and Barbuda almost continuously since 1949. The country became fully independent from Britain in 1981.
Date: Sat, 9 Sep 2017 18:35:21 +0200
By Gemma Handy

Codrington, Antigua and Barbuda, Sept 9, 2017 (AFP) - Homes, shops and government buildings were destroyed when Hurricane Irma slammed the Caribbean island of Barbuda this week, while a huge stretch of its once glorious 11-mile west coast beach has been wiped out.   Destruction was so widespread that authorities have ordered the entire population of 1,800 to evacuate as Hurricane Jose approached the island over the weekend. 

By mid-day Saturday Jose, a Category Four hurricane, was tracking towards the north-west and no longer expected to hit Barbuda, but it remained under a Tropical Storm warning.   Authorities on Barbuda -- one of the two islands that make up the nation of Antigua and Barbuda -- have only begun to measure the damage caused when Irma struck the island as a powerful Category Five hurricane overnight Tuesday to Wednesday.   "Terrifying," "horrific" and the "worst damage seen in a lifetime" were some of the descriptions from residents as they emerged from their shelters after Irma's passage.    A child died when Irma, the strongest storm ever recorded to form in the Atlantic, struck the island.   Authorities said 30 percent of properties were demolished by the monster storm.

- Surviving in a wardrobe -
Barbudans swapped tales of hiding in wardrobes and showers as 157 mile (252 kilometer) per hour wind from Irma ripped off roofs, uprooted trees and knocked down walls.   Sira Berzas, 40, spent more than an hour huddled in a wardrobe with a friend after Irma tore the roof off the home they were hiding in.   "I have never been so scared in my life. Jackie and I were holding on to each other and basically saying our goodbyes," Berzas told AFP.

When the eye of the hurricane came, she said, "we ran outside in our underwear screaming for help. Luckily there was a police truck which took us to a safer building."   In the rush to safety "we had to leave Jackie's kitten behind," said Berzas, who lost her Pink Sand Beach home, bar and restaurant to the disaster.   Thankfully Houdini lived up to his name. The kitten was later found crouched in a corner of the ruined house, trembling but alive.

- Fleeing Hurricane Jose -
Hundreds of Barbudans were transported on Friday to Antigua via a Venezuelan military plane for safety ahead of Hurricane Jose.   Many have family to visit on the sister island, but others had no idea where they would stay when they arrived.   "I don't know where we are going when we get to Antigua -- or how we will get there," said Beautymey John, who was on a dock waiting to board a boat to safety with her five children.   "I would rather stay here, it doesn't feel right to leave. We have to try and start again," she told AFP.

Other Barbudans also said they were determined to rebuild their homes and livelihoods.   Teacher Maurice George, 30, said the small bag he was taking to Antigua contained the bare essentials, but vowed to return as soon as the secondary school he works in reopens.   "It is heart-breaking to see our island looking like this," he said.   "But where some people see devastation, I see an opportunity to rebuild," he added.
Date: Sat, 19 Mar 2016 13:18:00 +0100

Washington, March 19, 2016 (AFP) - A 6.0-magnitude earthquake hit off the coast of the Caribbean island nation of Antigua and Barbuda Saturday, US experts said, but caused no tsunami warning or immediate reports of damage or injury.   The strong quake, which hit at 1126 GMT, struck at a depth of 24 kilometres (15 miles) with its epicentre located 153 kilometres northeast of the capital of Saint John's, according to the US Geological Survey.
Date: Mon 14 Dec 2015
Source: Antigua Observer [edited]

Prison sources are still complaining that, despite the alleged outbreak of chicken pox at Her Majesty's Prison (HMP), not much has been done to ensure that the virus does not affect more people who either work there or are in custody. A source said since Observer media reported on the incident, last Thu 10 Dec 2015 that there has been another suspected case, bringing the number of affected persons to 19.

The source explained that this occurred even while the other 18 infected persons were already in isolation in the chapel in the prison yard. That source is suggesting that health authorities should to go into the jail to "clean it and spray out the cells" because the virus, according to research, can be picked up from contaminated surfaces.

An official at HMP, who is not authorized to speak with the media, said although the affected inmates are being housed in the chapel away from the rest of the prison population, they are still able to come and go to other parts of the jail, including the washroom and for breaks. Another source indicated that most of the affected persons are on remand and it is highly likely they will be released at any time, and then the virus would likely spread to communities outside the prison walls.

Observer media was unable to reach the prison boss, Superintendent Albert Wade, for comment.

In the meantime, Attorney General Steadroy "Cutie" Benjamin, who has responsibility for the prison, has given assurance that prison authorities have taken adequate steps to control the spread of chickenpox.
======================
[Outbreaks of chickenpox are not uncommon in closed communities where contagious virus can spread rapidly. Chickenpox is a very contagious disease caused by varicella-zoster virus (VZV), a herpes virus. It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. It spreads easily from infected people to others who have never had chickenpox or received the chickenpox vaccine. Chickenpox spreads in the air through coughing or sneezing. It can also be spread by touching or breathing in the virus particles that come from chickenpox blisters and can be transmitted by touching surfaces that have recently be contaminated by open lesions as well. Chickenpox most commonly causes an illness that lasts about 7-10 days.

The classic symptom of chickenpox is a rash that turns into itchy, fluid-filled blisters that eventually turn into scabs. The rash may 1st show up on the face, chest, and back, then spread to the rest of the body, including inside the mouth, eyelids, or genital area. It usually takes about a week for all the blisters to become scabs. Some people who have been vaccinated against chickenpox can still get the disease. However, the symptoms are usually milder with fewer blisters and mild or no fever. About 25 to 30 percent of vaccinated people who get chickenpox will develop illness as serious as chickenpox in unvaccinated persons.

Chickenpox vaccine is safe and effective at preventing the disease. Most people who get the vaccine will not get chickenpox. If a vaccinated person does get chickenpox, it is usually mild -- with fewer blisters and mild or no fever. The chickenpox vaccine prevents almost all cases of severe disease (for further information, see: <http://www.cdc.gov/chickenpox/index.html>). - ProMed Mod.LL]

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

French West Indies US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
The French West Indies consists of the islands of Martinique, Guadeloupe, St. Martin (the French side) and St. Barthélemy. These islands are well develop
d. In St. Martin and St. Barthélemy, English is widely spoken, and U.S. currency is accepted. Read the Department of State Background Notes on France for additional information.

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

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

Visas are generally not required for visitors planning to remain for up to 90 days. For further information, travelers can contact the Embassy of France at 4101 Reservoir Road NW, Washington, DC 20007; telephone 1 202 944-6000; or the nearest French consulate in Atlanta, Boston, Chicago, Houston, Los Angeles, Miami, New York, New Orleans or San Francisco. Visit the web site for the Embassy of France at http://www.info-france-usa.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 latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site at http://travel.state.gov, where the current Worldwide Caution, Travel Warnings, and Travel Alerts can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. 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:
Petty street crime, including purse snatching, occurs throughout the French West Indies. Visitors should take care whenever traveling to safeguard valuables and always lock hotel rooms and car doors.

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.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Good medical care is available throughout the French West Indies. Not all doctors speak or understand English. Hyperbaric chambers are available in Guadeloupe at the Centre Hospitalier Universitaire in Abymes, http://www.chu-guadeloupe.fr/fr/fw_index.asp, and, in Martinique at the Centre Hospitalier Universitaire in Fort de France, http://www.chu-fortdefrance.fr/pages/sommaire.html.
Cases of dengue fever have been reported in Martinique and Guadeloupe.

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 the French West Indies is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving in the French West Indies is on the right side of the road. Children under 12 are not legally allowed in the front seat. Seatbelt laws are strictly enforced.

The roads in the French West Indies are the best in the Eastern Caribbean. Roads are well paved and well maintained. Main roads are well marked; secondary roads and tourist sites are adequately marked. Excellent maps are available and local residents are helpful, especially if greeted in a friendly manner. Both Martinique and Guadeloupe have expressways. Traffic safety is enforced by the police. Night driving can be dangerous, especially in the mountains and on winding rural roads. Public transportation in the form of taxis, vans, and buses is relatively safe. For specific information concerning French West Indies driver's permits, vehicle inspection, road tax and mandatory insurance, contact the French National Tourist Organization offices at: http://www.franceguide.com/.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://www.securite-routiere.gouv.fr/index.html.

AVIATION SAFETY OVERSIGHT:
Civil aviation operations in the French West Indies fall under the jurisdiction of French authorities.
The U.S. Federal Aviation Administration (FAA) has assessed the Government of France’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of France’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: In addition to being subject to all French laws affecting U.S. citizens, dual nationals may also be subject to other laws that impose special obligations on French citizens. Although France recognizes dual nationality, dual nationals are considered French citizens and are subject to French laws without regard to the other nationality. For additional information, please see our Dual Nationality flyer.

French customs authorities may enforce strict regulations concerning temporary importation into or export from the French West Indies of items such as firearms, medications, animals, etc. For questions, travelers may wish to contact the Embassy of France or a French Consulate for specific information regarding customs requirements. Please see our information on customs regulations.

The French West Indies can be affected by hurricanes. The hurricane season normally runs from June to the end of November, but there have been hurricanes in December in recent years. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at: http://www.fema.gov/.
Please see 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 French West Indies’ laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the French West Indies 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 living or traveling in the French West Indies 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 French West Indies. Americans without Internet access may register directly with the U.S. Embassy in Barbados, which has jurisdiction over the French West Indies. 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 in Wildey Business Park in St. Michael, Barbados; web site: http://barbados.usembassy.gov/.

The Consular Section is open for American Citizens Services from 8:30am to 4:00pm, Monday-Friday, except Barbados and U.S. holidays. For after-hours service, American citizens may contact the U.S. Embassy in Bridgetown, Barbados, telephone 1-246-436-4950. The U.S. Consular Agent in Martinique, Henry Ritchie, is located at the Hotel Valmeniere #615, Avenue des Arawaks, 97200 Fort de France, telephone (011) (596) (596) 75-6754, fax (011) (596) (596) 70-8501, mobile (011) (596) (696) 93-8406, email: hritchie@sbcglobal.net. Consular Agent Henry Ritchie is available Monday through Friday from 9:00am to 12:00pm, except French and U.S. holidays.
* * *
This replaces the Country Specific Information for French West Indies dated June 7, 2007, to update sections on Entry/Exit Requirements, Safety and Security, Traffic Safety and Road Conditions, Medical Facilities and Health Information, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Thu, 24 May 2018 11:39:42 +0200

Paris, May 24, 2018 (AFP) - The French government is preparing a plan to deal with a new invasion of stinky seaweed that is covering the beaches of some its islands in the Caribbean, causing health problems for residents and threatening key fishing and tourism industries.

The brown sargassum algae "is one more disaster for the West Indies, one which we here probably haven't fully taken into account," Environment Minister Nicolas Hulot told lawmakers in Paris late Wednesday.   Tons of the seaweed began arriving on the islands of Martinique and Guadeloupe several weeks ago, where it has piled up knee deep in some areas over large stretches of shoreline.

It soon begins decaying, producing huge amounts of hydrogen sulphide and other noxious gases which reek of ammonia or rotten eggs and can severely irritate the eyes, nose and throat.   The fumes also damage nearby houses and other property by eating away at metal, while also killing fish and fauna, hurting the local fishing industry.   Officials have closed schools near infested zones, while some islands have been cut off since supply boats and ferries cannot get past the thick banks of seaweed.

The French government has already unlocked three million euros ($3.5 million) of credits for supplying tractors, gas masks and other equipment to remove the seaweed -- though it often returns in a matter of weeks.   "Beyond the urgent response, a new national plan for combatting sargassum will be finalised by mid-June," Hulot said in parliament.   Although researchers are not sure why the seaweed suddenly begins proliferating in the region, "climate change is probably aggravating the problem," Hulot said.

Similar outbreaks have occurred in the Caribbean in recent years, often requiring officials to deploy the army to gather up the seaweed.   But officials then need to figure out what to do with it, since the fumes are so toxic that the algae cannot be used for producing biomass fuel, nor can it be turned into fertiliser.

Currently the only option is to spread it out across acres of isolated land until it fully decays and dries out.   This latest invasion comes as Guadeloupe, Martinique and other French islands are still rebuilding from devastating hurricanes that struck the Caribbean last September, causing millions of euros in damages.
Date: Tue, 19 Sep 2017 19:05:52 +0200

Pointe-à-Pitre, Sept 19, 2017 (AFP) - At least one person was killed as Hurricane Maria battered Guadeloupe, officials said Tuesday, in the first confirmed casualty from the huge storm sweeping the eastern Caribbean.     The person was killed by a falling tree, the local administration said, while two more were reported missing after their ship sank off Desirade, the easternmost island in the French territory's archipelago.   The dead person "did not respect orders to stay inside", authorities said in a statement, adding that "several floods have been signalled" around Pointe-a-Pitre, Guadeloupe's largest city.

Coastal areas around the capital Basse-Terre have also been "submerged".   "All of the archipelago's road networks have been affected by falling trees or branches," it said.   Little damage to buildings had been reported so far, though "some roofs have been ripped off".   Authorities said 40 percent of households in the territory of some 400,000 had no electricity, and 25 percent of landlines had been cut.   The US National Hurricane Center described Maria as "potentially catastrophic" as it pushed northwest towards the Virgin Islands and Puerto Rico.
Date: Wed 7 Jun 2017
From: Aubert Lyderic <lyderic.aubert@santepubliquefrance.fr> [edited]

Since May 2015, the French Caribbean territories experience an outbreak of viral conjunctivitis.

According to the general practitioners (GP) sentinel network, the number of medical consultations due to conjunctivitis during the last 2 weeks (W2017-20 and W2017-21) was estimated between 500 and 600 cases per week in Guadeloupe and 150 and 250 cases per week in Martinique.

The beginning of the outbreak in week 2017-20 [week 14 to 20 May 2017] was confirmed by the GP's network on the 2 territories. Their reports showed that the outbreak had spread in Guadeloupe Archipelago from Marie-Galante island and in Martinique, the center and the south of the island are currently the most affected areas. As of today [Wed 7 Jun 2017], around 35 percent of municipalities of the 2 territories do not report any case. The peak does not seem to have been reached.

In order to determine the etiology of this outbreak, biological samples were performed on conjunctiva and naso-pharynx from cases of conjunctivitis who consulted in emergency departments of the main public hospitals of both territories. The 1st analyses confirmed presence of enteroviruses with significant viral loads. Results from biological investigation of adenovirus are not yet known. Among the conjunctivitis specimens testing positive for enteroviruses, samples were sent to the National Reference Centre for Enteroviruses (Lyon, France) for further characterization.

Outbreaks of viral conjunctivitis occur mainly in tropical countries with high population density, hot and humid climate. They are mostly attributed to adenoviruses and enteroviruses (EV). Enteroviruses are ubiquitous pathogens responsible for a large range of infections. There is no specific antiviral treatment.

In the Caribbean and in the American region, several outbreaks of conjunctivitis have also been reported (Haiti, Dominican Republic, Mexico, French Guiana and Surinam) but the pathogen has not yet been identified.

The source of the week epidemiological bulletin (will be update soon at this link):
-----------------------------------
Aubert Lyderic
National Public Health Agency
Regional Office of French Caribbean Territories
lyderic.aubert@santepubliquefrance.fr
====================
[Conjunctivitis, also known as pinkeye, is an inflammation of the conjunctiva. The conjunctiva is the thin clear tissue that lies over the white part of the eye and lines the inside of the eyelid.

There are a number of different causes, including infectious agents such as Viruses (Adenoviruses, Enteroviruses), Bacteria (gonorrhea or chlamydia), or Allergies to dust, pollen, contact lenses.

Both viral and bacterial conjunctivitis are highly contagious. Each of these types of germs can spread from person to person in different ways. They are usually spread from an infected person to others through:
- close personal contact, such as touching or shaking hands
- the air by coughing and sneezing
- touching an object or surface with germs on it, then touching your eyes before washing your hands. <https://www.cdc.gov/conjunctivitis/about/transmission.html>.

Infectious conjunctivitis caused by some bacteria and viruses can spread easily from person to person, but is not a serious health risk if diagnosed promptly.

As confirmed by laboratory diagnosis in the above report, the causative agent for most of the tested cases was enteroviruses.

Most cases of viral conjunctivitis are mild. The infection will usually clear up in 7 to 14 days without treatment and without any long-term consequences. But in some cases, viral conjunctivitis can take 2 to 3 weeks or more to clear up. An antiviral medication can be prescribed to treat more serious forms of conjunctivitis for which there is a specific treatment, such as those caused by herpes simplex virus or varicella-zoster virus. Antibiotics will not improve viral conjunctivitis. - ProMED Mod.UBA]

[The HealthMap/ProMED maps can be found at:
Guadeloupe, Guadeloupe: <http://healthmap.org/promed/p/57615> and,
Martinique: <http://healthmap.org/promed/p/43638>. - ProMED Mod.MPP]
Date: Sat 8 Mar 2014
Source: European Centre for Disease Prevention and Control (ECDC), [edited]

Communicable Disease Threats Report (CDTR), week 10 (2-8 Mar 2014)
------------------------------------------------------------------
On 6 Dec 2013, France reported 2 laboratory-confirmed autochthonous cases of chikungunya in the French part of the Caribbean island of St Martin. Since then, local transmission has been confirmed in the Dutch part of Saint Martin [St Maarten], on Martinique, St Barthelemy, Guadeloupe, British Virgin Islands, Dominica, Anguilla, and French Guiana. Aruba only reported imported cases. This is the 1st documented outbreak of chikungunya with autochthonous transmission in the Americas. As of 6 Mar 2014, there have been close to 8000 suspected cases in the region. There have been 3 fatalities reported.

Update of the week
------------------
During the past week the number of new cases reported increased in some of the affected areas. No new affected areas or islands were reported. The islands affected are St Martin/St Maarten, Martinique, St Barthelemy, Guadeloupe, Virgin Islands (UK), Anguilla, Dominica, Aruba, Saint Kitts and Nevis, and French Guiana in mainland South America.
===================
[It is good to learn that there are no new localities reporting chikungunya virus infections, either locally acquired or imported. However, with new cases being reported in localities with previously reported cases, the risk of spread to other islands or mainland countries remains real. There is no further information concerning the suspected cases in Merida, Yucatan, Mexico reported in last week's update (see ProMED-mail archive no 20140302.2309812). It is important to know if these cases were confirmed or discarded.

Maps showing the location of the islands mentioned can be accessed at
Date: 3-9 Feb 2014
Source: Pointe Epidemiologique No. 6. French Caribbean Antilles [in French, trans. ProMed Mod.TY, summarized, edited]

Cases since November 2013:
  • St. Martin (susp.) 1450 cases, (probable and conf.) 653 cases.
  • St. Barthelemy (susp.) 270 cases, (probable and conf.) 104 cases
  • Martinique (susp.) 2040 cases, (probable and conf.) 844 cases; increasing
  • Guadeloupe (susp.) 1120 cases, (probable and conf.) 253 cases.

[Weekly graphs and maps for these case locations are provided in the above URL. ProMed Mod.TY]

Other Caribbean localities:
  • British Virgin Islands 6 locally acquired cases
  • St. Maarten 65 locally acquired cases
  • Anguilla 5 locally acquired cases, 1 imported case
  • Dominica 3 locally acquire cases, 1 imported case
  • Aruba 1 imported case from St. Maarten.
More ...

Solomon Islands

Solomon
Islands - US Consular Information Sheet
August 13, 2008
COUNTRY DESCRIPTION:
The Solomon Islands form an Archipelago in the southwest Pacific Ocean about 1,200 miles northeast of Australia.
The capital, Honiara, is locate
on the Island of Guadalcanal.
The Solomon Islands are a parliamentary democracy within the British Commonwealth.
Tourism facilities are limited, particularly outside Honiara.
Read the Department of State Background notes on the Solomon Islands for additional information.
ENTRY/EXIT REQUIREMENTS:
U.S. passport holders do not require visas to enter the Solomon Islands.
Passports, onward/return tickets and proof of sufficient funds for the duration of stay are required.
Visitor permits are granted upon arrival at Henderson International Airport in Honiara.
Visitors may enter any number of times provided the total period in the Solomon Islands does not exceed 90 days in a 12-month period.
Persons arriving on one-way airline tickets must have documentation stating their business, for example, a work permit if taking up employment in the Solomon Islands.
The Solomon Islands government strictly enforces immigration laws, and travelers may face fines and other penalties if they remain in the country beyond the authorized period of stay.
Persons arriving on yachts should visit the nearest immigration office to complete arrival forms for issuance of visitors' permits.

Travelers who plan to
arrive in the Solomon Islands by plane or some other conveyance
but who plan to depart on a yacht should apply for a visitor’s permit before their arrival in the Solomon Islands, to the Director of Immigration (via fax to the U.S. Consular Agent in Honiara at 677-27429).
The application should state the traveler’s arrival date, vessel name and registration details, vessel’s arrival date, approximate time traveler will spend in the Solomon Islands, and it should request entry on a one-way (arrival only) airline ticket.
The Director will issue a permit to be presented at airline check-in.
If the traveler does not have this permit, she/he may be denied boarding.
For more information about entry requirements, travelers may contact the Solomon Islands Mission to the United Nations at 800 Second Avenue, Suite 8008, New York, NY 10017-4709; Tel: (212) 599-6192 or 6193.
Travelers who anticipate the possibility of transiting or visiting Australia are advised to obtain an electronic travel authority (ETA) or visa for Australia before leaving the United States.
An ETA may be obtained for a small service fee at http://www.eta.immi.gov.au/.
Airlines and many travel agents in the United States are also able to issue ETAs.
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:
Since July 24, 2003, the Regional Assistance Mission in the Solomon Islands (RAMSI), a coalition of Pacific Island states that includes military and police forces from Australia and several other Pacific Island nations, has helped the Solomon Islands improve law and order.
.
It is generally safe to walk alone during the day; however, walking alone at night is discouraged.
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 U.S. Consular Agent in Honiara also has available up-to-date safety and security information at (677) 23426 and (677) 94731, or Fax (677) 27429.
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:
Major crimes against travelers are uncommon, although incidences of theft, mugging, and extortion are increasing.
Some 350 RAMSI Police are working alongside Royal Solomon Islands Police (RSIP) to respond to any situation requiring police.

Lawlessness is increasing in Honiara, mostly in the form of petty crime (theft and harassment for money).
The isolated incidents of harassment of expatriates that have increased in Honiara since April 2006 are generally minor and associated with alcohol and fringe elements of the community. House and vehicle break-ins occur, with expatriates particularly targeted.
Some recent episodes have involved violence and the use or threatened use of knives.
Gang-based criminal activity has increased in and around the Burns Creek area in East Honiara, and in the Borderline area, which is close to the Japanese memorial.
It is not advisable to go alone to the Japanese memorial.

Americans should be aware that the public does not distinguish between Australians and Americans.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and to the nearest U.S. Consular Agent in Honiara, or the U.S. Embassy in Port Moresby, Papua New Guinea.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the U.S. Consular Agent or the U.S. Embassy for assistance.
The Consular Agent or Embassy staff can, for example, assist you to find appropriate medical care, to contact family members or friends, and explain how funds may 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 the Solomon Islands is: 999.
Other emergency numbers are:
Ambulance, Hospital - 911
National Disaster - 955
Fire - 988

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Hospitals and pharmacies in the Solomon Islands are limited to population centers and missions.
Since 2001, the quality of medical services has deteriorated seriously, although it is expected to improve as the country’s overall economic condition continues to improve.
The nearest reliable medical facilities are in Australia or New Zealand.
There is a hyperbaric recompression chamber in Honiara at the In-the-Zone Medical Centre, phone (677) 23485 or (677) 23482; however, medical conditions resulting from diving accidents may require medical evacuation to Australia or New Zealand.
Serious medical conditions requiring hospitalization and/or medical evacuation to Australia, New Zealand or the United States can cost thousands of dollars.
The incidence of malaria is high.
Doctors and hospitals often expect immediate cash payment for health services. Travelers who anticipate the possible need for medical treatment in Australia should obtain entry permission for Australia in advance.
Entry permission for Australia can be granted by the Australian High Commission in Honiara, but it is easier to obtain it prior to leaving the United States (see section above on Entry/Exit Requirements)
Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of Solomon Islands.
Per Solomon Islands Immigration Act Cap 60, Section 4 (1) (d) and section 11, subsection (2), an immigration officer can bar a visitor from entering the country or deport an immigrant if he or she refuses to submit to an examination by a government medical officer after being required to do so.

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

Vehicular traffic in the Solomon Islands moves on the left.
Paved roads are found only in and around Honiara, located on Guadalcanal Island.
These two-lane paved roads are poorly marked and have many potholes.
Roads are not well lit at night.
The remaining roads in the Solomon Islands are made of coral or gravel, or are dirt tracks.
Travelers must take care when driving off main roads to avoid trespassing on communal land.
For information concerning the rental and operation of motor vehicles in the Solomon Islands, contact our Consular Agent in Honiara.
Please refer to our Road Safety page for more information.
For specific information concerning Solomon Islands driving permits, vehicle inspection, road tax and mandatory insurance, visit the Solomon Islands Department of Commerce web site at http://www.commerce.gov.sb/.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in the Solomon Islands, the U.S. Federal Aviation Administration (FAA) has not assessed the Solomon Islands’ 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: Customs Information: The Solomon Islands' customs authorities enforce strict regulations concerning temporary importation into or export from the Solomon Islands of items such as firearms and ammunition, sexually explicit material, and certain prescription drugs.
Other items may be subject to quarantine regulations or import duty.
The Solomon Islands' government prohibits the export of military artifacts from World War II.
It is advisable to contact the Solomon Islands' Mission to the United Nations for specific information regarding customs requirements.
Natural Disasters:
The Solomon Islands lie in the South Pacific cyclonic trajectory, and are vulnerable to earthquakes, volcanic eruptions, and sudden tidal movements.
The Pacific cyclone season extends from November through March.
General information regarding disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.

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 the Solomon Islands laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in the Solomon Islands 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:
There is no U.S. Embassy in the Solomon Islands.
However, there is a U.S. Consular Agent in Honiara.
The Consular Agent has general information and forms, such as passport applications, and can be contacted at the United States Consular Agency, Commonwealth Avenue, Point Cruz, telephone number is (677) 23426 or (677) 98367, cell number is (677) 94731, home number is (677) 22539; fax (677) 27429; e-mail keithieusa@solomon.com.sb or us_consular@solomon.com.sb.
For additional information and to download forms, please visit our Virtual Embassy for the Solomon Islands at http://www.usvpp-solomonislands.org/
The U.S. Embassy in Papua New Guinea provides primary assistance for U.S. citizens in the Solomon Islands.
The Embassy is located on Douglas Street, adjacent to the Bank of Papua New Guinea, in Port Moresby.
Use that address for courier service deliveries.
The mailing address is PO Box 1492, Port Moresby, N.C.D. 121, Papua New Guinea; the telephone number is (675) 321-1455; after hours duty officer telephone number is (675) 683-7943; Fax (675) 321-1593.
American citizens may submit consular inquiries via e-mail to ConsularPortMoresby@state.gov.
The web site for the U.S. Embassy in Port Moresby is http://portmoresby.usembassy.gov/.
Americans living or traveling in the Solomon Islands are encouraged to register with the U.S. Embassy in Port Moresby through the State Department’s travel registration web site, and to visit the Consular Agency in Honiara to obtain updated information on travel and security within the Solomon Islands.
Americans without Internet access may register directly with the Embassy or Consular Agency.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
* * *
This replaces the Country Specific Information for the Solomon Islands dated January 17, 2008, to update sections on Crime, Information for Victims of Crime, Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Mon, 23 Oct 2017 06:02:34 +0200

Wellington, Oct 23, 2017 (AFP) - Residents in the Solomon Islands' southeast were warned to stay indoors Monday to avoid showers of ash from a volcanic eruption.   Officials said a lack of scientific equipment made it difficult to monitor the situation on Tinakula island, which lies just north of Vanuatu where 11,000 people were evacuated last month following an eruption on Ambae island.

While the Vanuatu government decided on Friday that the situation on Ambae had settled and people could return home, Solomon Islands officials said they had no indication how long the eruption on Tinakula would continue.    Although Tinakula is uninhabited, about 10,600 people live on the neighbouring Santa Cruz islands.   "Authorities do not have a scientific way to monitor the situation and determine when it will end," the Solomon Islands Broadcasting Corporation (SIBC) quoted National Disaster Management Office director Loti Yates as saying. 

Yates said ashfall on nearby communities and the impact on air travel were the main concerns. An aviation warning has been issued for the Santa Cruz Islands.    "As much as possible, people need to stay indoors," he said, while downplaying the significance of the eruption.   "From what we know currently, the danger of the volcano's impact on Santa Cruz is very small or very limited," he said.   Tinakula, which is frequently active, once had a population of about 130 until an eruption in 1971 forced their permanent evacuation.
Date: Sun, 19 Mar 2017 18:23:14 +0100

Hong Kong, March 19, 2017 (AFP) - A 6.0-magnitude earthquake hit off the Solomon Islands in the early hours of Monday, the US Geological Survey said.   The quake struck at 02:43 am local time (1543 GMT Sunday) at a depth of 4.0 kilometres (2.5 miles), some 170 kilometres north-northeast of the capital city Honiara, the USGS said.   No tsunami warning was issued.

The Solomon Islands are part of the Pacific "Ring of Fire", a zone of tectonic activity known for frequent quakes and volcanic eruptions.    In 2007 an 8.0-magnitude quake in the Solomon Islands claimed 52 lives and left thousands homeless when it created a 10-metre tsunami.
Date: Fri, 20 Jan 2017 01:16:56 +0100

Sydney, Jan 20, 2017 (AFP) - A 6.8-magnitude earthquake hit off the Solomon Islands on Friday, seismologists said, with officials in the Pacific island nation saying there were no initial reports of damage.   The US Geological Survey said quake struck at 10:04 am local time (2304 GMT Thursday) at a depth of 33 kilometres (20 miles) some 70 kilometres west of Kirakira -- the same region where several large tremors struck last month.   The Hawaii-based Pacific Tsunami Warning Center said there was no tsunami threat from the latest shake.   Three strong tremors were felt off Kirakira in December without causing serious damage.

The Solomons National Disaster Management Office (NDMO) said it had not received any damage reports from the remote area.   "We haven't had any information come through," NDMO director Loti Yates told AFP from the capital Honiara.   "It's in the same area as the tremors last month and there are large cracks in the ground. Combined with heavy rain, that could cause landslips but it's too early to say at this stage and we're not making assumptions."   The Solomon Islands are part of the Pacific "Ring of Fire", a zone of tectonic activity known for frequent quakes and volcanic eruptions.    In 2007 an 8.0-magnitude quake in the Solomon Islands claimed 52 lives and left thousands homeless when it created a 10-metre tsunami.
Date: Tue, 20 Dec 2016 06:28:29 +0100

Sydney, Dec 20, 2016 (AFP) - The Solomon Islands was rattled by a strong 6.7-magnitude earthquake Tuesday, the US Geological Survey said, but no tsunami warning was issued and no immediate damage reported.   The quake struck 164 kilometres (101 miles) from the capital Honiara at a depth of 35 kilometres -- the fourth big tremor is just over a week.

"Based on all available data, a destructive Pacific-wide tsunami is not expected," the Pacific Tsunami Warning Center said, while Geoscience Australia estimated damage would only be likely up to 74 kilometres away.   The Solomon Islands are part of the Pacific "Ring of Fire", a zone of tectonic activity known for frequent quakes and volcanic eruptions.    On December 9, a 7.7-magnitude tremor triggered severe shaking and a tsunami warning in the same area, although there were no reports of serious damage. This was followed by a 6.9-magnitude aftershock a day later and another of 6.0 magnitude on Sunday.
Date: Sun, 18 Dec 2016 07:26:39 +0100

Sydney, Dec 18, 2016 (AFP) - A 6.0-magnitude earthquake struck off the Solomon Islands on Sunday, the US Geological Survey said, the third strong tremor off the Pacific nation in less than two weeks.   The quake hit at 4.46pm (0546 GMT) at a depth of 39 kilometres (24 miles) about 83 kilometres west-northwest of Kirakira, the USGS added.   On December 10 a 6.9-magnitude quake struck off Kirakira. The previous day a 7.7-magnitude tremor triggered severe shaking and a tsunami warning, although there were no reports of serious damage.
More ...

Nepal

General:
*******************************
Nepal is regarded as a developing nation which has a great variability of facilities for the tourist depending on the location throughout the country. It is a mountainous country and many travellers to th
s region undertake long arduous treks. It is wise to ensure that your general health will be sufficient for the trip you plan under normal circumstances. Talking your itinerary through with other experienced travellers to this region will be important before you finally book your holiday. The climate varies throughout the year with their monsoon season typically stretching from May to October. During this time significant flooding can occur and the high humidity leads to increased numbers of mosquitoes. Travel to the Terai plains during this period leads to the greatest risk of mosquito borne disease.
Safety & Security:
*******************************
The security situation throughout Nepal has caused quite a degree of concern throughout the past few years. There has been a general increased level of robberies and this has involved tourists on a number of occasions. Those trekking in Nepal are strongly advised to travel with reputable organised groups who will have checked the local situation out carefully before departure. It is very inadvisable to trek alone in Nepal. This is particularly true in the Rasuwa District of the Langtang Area. Airport security in Katmandu has been improved since the hijacking of Indian Airlines flight IC814 in December 1999 but take care of your belongings at all times and never carry anything for strangers no matter how plausible their reason may be.
Health Facilities:
*******************************
The level of Western health facilities in Katmandu and Pokhara are excellent but expensive. Outside of the main city the level of healthcare can be very limited. It is essential that all tourists ensure that they have adequate travel insurance which will cover accidents and evacuation by helicopter. Cover for cancelled flights and loss of belongings is also extremely important. The CIWEC Medical Clinic in Katmandu provides an excellent medical service for travellers and their web page gives extensive advice on travelling throughout Nepal.Telephone numbers Katmandu 228531, or 241732. Web site: www.ciwec-clinic.com
Food & Water Facilities:
*******************************
Katmandu is a large city with a large population and much squalor. The main tourist hotels provide a good degree of hygiene for travellers but those undertaking trekking holidays will leave this relative health security and head to regions of the country where food and water hygiene are very poor. It is essential that all food consumed is freshly prepared and well cooked. Cold vegetables or salads should be avoided as the risk of diseases like amoebiasis and giardiasis is very high. All water should be checked for a smell of chlorine and if this is not present then it should not be used for either drinking or brushing your teeth. Even bottled water from any source outside of the main hotels should be treated with suspicion as in many cases it will be plain untreated tap water.
Rabies risks in Nepal:
*******************************
This viral disease is usually transmitted by the bite (lick or scratch) from any infected warm blooded animal. Usually humans are infected by dogs but cats and monkeys are also frequently implicated. In many of the temples of Nepal there will be a multitude of monkeys and it may be difficult to avoid contact. If you are exposed then urgent medical attention will be required and this will often mean a rapid return to Katmandu. Never treat this disease lightly and always ensure that any contact is followed up as soon as possible.
Altitude Problems:
*******************************
Arriving into Katmandu at 4,500ft usually presents no major difficulty for travellers. However, depending on the actual trek which is proposed you may put yourself at risk of exhaustion, dehydration and altitude sickness. The better tour companies will tailor the actual trek to the abilities of those taking part but try not to allow yourself become attached to a group which will push your health to extremes. Many treks will take travellers to heights reaching 18,000ft.
Malaria risk in Nepal:
*******************************
The main risk of malaria in Nepal will be for those visiting the Terai region. Even here, the significant risk occurs during the monsoon season and for a period afterwards. However, malaria transmission is reported from other regions of the country and this will need to be talked through in depth before you leave home.
Mosquito Borne diseases:
*******************************
Apart from malaria there are two other significant mosquito borne diseases which occur in regions of Nepal. Dengue Fever and Japanese B Encephalitis are both frequently implicated in outbreaks and both diseases can cause severe illness even death. Avoiding mosquito and sandfly bites at all times is essential.
Road & Climbing Safety:
*******************************
The road conditions throughout rural Nepal are poor and care will be required at all times. Many mountainous passes are impassible during the monsoon season and can even be very hazardous at other times throughout the year. In Katmandu the roads are congested, pollution is a significant problem and walkways may be non existent in many places. If undertaking a trek it is important to make sure your general health is sufficient and that you have adequate clothing and shoes to suit both the expected and unexpected.
Local Laws & Customs:
*******************************
The Nepalese customs are very strict regarding importation and exportation of many goods including valuable metals, articles of archeological or religious importance, drugs, arms and communication equipment. Imprisonment can quickly follow any infringement of their rules. Women are advised to dress modestly and generally it is wiser to avoid inappropriate clothing in public such as shorts, sleeveless tops etc.
Vaccination for Nepal:
*******************************
Unless you are entering Katmandu from tropical Africa there are no essential vaccines for entry or exit. We used to receive reports of buses being stopped coming overland from India and for all on board to have evidence of Cholera vaccination. However, this does not appear to be a current problem. Nevertheless, for your own personal health it is recommended that travellers are covered against the following diseases;
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food and water borne disease)
*
Hepatitis A (food and water borne disease)
For those undertaking a longer more rural trip other vaccines may need to be considered including Hepatitis B, Rabies, Japanese B and Meningitis.
Summary:
*******************************
Tourists will need to ensure the highest level of personal care while visiting Nepal at all times. Many of the conditions and situations mentioned above occur frequently in those who forget the basic commonsense rules about travelling healthy.

Travel News Headlines WORLD NEWS

Kathmandu. 6 Sep 2019

If laboratory tests carried out at Sukraraj Tropical and Infectious Disease Hospital today [6 Sep 2019] are anything to go by, roughly 50% of those who visit the hospital with fever and muscle pain are dengue-infected. According to the hospital, of the 372 blood tests done today [6 Sep 2019], 175 tested positive for dengue. "There has been a significant rise in the number of dengue-infected patients at the hospital. Unless people are aware and start working on their own, it is difficult to prevent the infection," said Anup Bastola, spokesperson and consultant tropical medicine physician at Sukraraj Tropical and Infectious Disease Hospital.

- Kathmandu. 19 Sep 2019.The cases of dengue fever are on the rise in Bhaktapur, indicating that it is gradually taking an epidemic turn. In the past 2 weeks, 197 people have been diagnosed with dengue in the district.
12th September 2019
Communication from a medical colleague based in Kathmandu
=======================
Dear friends,  I would like to alert you to a dengue outbreak in Nepal including in Kathmandu. It started in May 2019 in eastern Nepal but has come to Kathmandu in a big way in the past 2 weeks or so. Government figures (http://www.edcd.com.np/) indicates total of 5095 cases in Nepal including 1170 cases from Kathmandu. The government figures underestimate the problem due to underreporting issues. Kathmandu hospitals seem stretched to capacity due to dengue visits and admissions.

This problem is new to Kathmandu as we have had only sporadic cases of dengue in previous years. The public in Kathmandu has never taken mosquito bites seriously since we have not had major vector borne diseases in the past. We hope that the current dengue outbreak has peaked and will slow down once we get cooler nights from end September - early October.

If you have travellers coming this way, please alert them to this and send them with insect repellents and information on mosquito protection measures. DEET is not readily available and other repellent supplies have been depleted. 

Thank you. 
Prativa
======================
Dr. Prativa Pandey
Medical Director
CIWEC Hospital I Travel Medicine Center
prativapandey@ciwec-clinic.com
+977
98510-36742 I
http://www.ciwec-clinic.com/
Date: Sat, 13 Jul 2019 09:52:36 +0200

Kathmandu, July 13, 2019 (AFP) - Floods and landslides triggered by torrential monsoon rains have killed at least 40 people across South Asia in the last two days, officials said Saturday.   The monsoon, which lasts from June to September, causes widespread death and destruction across South Asia each year.   In Nepal, 27 people have died in floods and landslides after heavy rains hit the country's eastern region and the southern plains.

Bishwaraj Pokharel, spokesperson for Nepal Police, added that another 11 people were injured and 15 others reported missing.    Three of the victims were killed when a wall collapsed in the capital Kathmandu.   "Our first priority is life saving rescue and all our resources have been deployed," Home Ministry official Umakanta Adhikari told AFP.

Police used boats to bring people to safety as rivers swelled, inundating their settlements, while parents were seen wading across chest-high waters carrying children on their shoulders.    Nepal's weather department issued a high alert for the southern Sapta Koshi river on Saturday and sent SMS warnings to people in the area.

In neighbouring India 11 deaths have been recorded in the north-eastern states of Assam and Arunachal Pradesh, officials said Friday.  Monsoon floods have inundated 21 districts in Assam, affecting thousands, officials said Friday.

In Bangladesh aid groups were providing rations to Rohingya refugees in the southeast of the country with the UN World Food Programme saying Friday that two people including a child had died.   Last year, more than 1,200 people were been killed across South Asia in monsoon storms with India's Kerala suffering its worst floods in nearly 100 years.
Date: Mon, 27 May 2019 13:48:42 +0200

Kathmandu, May 27, 2019 (AFP) - Nepalese police arrested suspected Maoist activists after three deadly bomb blasts in Kathmandu as a general strike disrupted daily life in much of the South Asian nation on Monday, police said.   Amid a high alert after Sunday's attacks, which were blamed on an outlawed Maoist group, police blew up several suspicious packages.   The group broke away from the country's main communist party, which is now in power, and called the general strike to protest against the death of one of its leaders in police custody.

Police said at least 13 officials from the Maoist group had been arrested on Sunday night and early Monday in different parts of the country.   "Security agencies dealt with suspicious objects found in different areas, mostly outside the capital," said police spokesman Bishwa Raj Pokharel.   While some schools and offices remained closed in Kathmandu, "the effect of the general strike is nominal in the Kathmandu valley but very few vehicles are working outside the capital," the spokesman added.    Four men were killed and seven people injured in three explosions in Kathmandu on Sunday.

A blast inside a shop killed three people, one died in an explosion at a nearby house, whilst two men carrying explosives on a motorbike were among those injured.   There was no immediate claim of responsibility but police said they suspected the Maoist group whose pamphlets were found in a house where one of the explosions took place.

Nepal has enjoyed relative calm since the end of a decade-long civil war in 2006. But some former guerrillas have formed a new group accusing their former leaders of betraying their revolutionary cause.   The group was banned after it was implicated in an explosion that killed one person outside a telecom company office in February.
Date: Sun, 26 May 2019 19:09:29 +0200

Kathmandu, May 26, 2019 (AFP) - Four men died and seven were injured Sunday in three separate explosions in Kathmandu, Nepali police said.   There was no immediate claim of responsibility but police said they suspect involvement of a Maoist splinter group whose pamphlets were found in a house where one of the explosions took place.   A powerful blast inside a shop killed three people and injured four, while the explosion at a home about four kilometres away left one dead and another injured.

Two more were injured when an explosive they were carrying on a motorcycle in the outskirts of Kathmandu exploded.   Security personnel also defused explosives in other areas.    "We are investigating all incidents and have stepped up the security," police spokesman Bishwa Raj Pokharel told AFP.   Pokharel said that seven people have been arrested so far.    The incidents come on the eve of a nationwide strike called the same Maoist splinter group, protesting death of their cadre in a police encounter over a week ago.

Nepal has enjoyed a relatively peaceful environment since the end of a decade-long civil war which concluded with a peace deal struck in 2006.   But some former guerrillas, have broken away, accusing its leaders of betraying their original revolutionary ideals.   In February, the group was implicated in an explosion that killed one person outside the office of a telecom company Ncell, part of Malaysia-based Axiata Group Berhad.    The government outlawed the group following the incident, banning their activities.
More ...

Belgium

Belgium - US Consular Information Sheet
October 03, 2008
COUNTRY DESCRIPTION:
Belgium is a highly developed and stable democracy with a modern economy. Tourist facilities are widely available.
Read the Department of State Background N
tes on Belgium for additional information.
ENTRY/EXIT REQUIREMENTS: Belgium is a party to the Schengen agreement. As such, U.S. citizens may enter Belgium for up to 90 days for tourist or business purposes without a visa. The passport should be valid for at least three months beyond the period of stay. Sufficient funds and a return airline ticket are required. For further details about travel into and within Schengen countries, please see our fact sheet. For further information concerning entry requirements, contact the Embassy of Belgium at 3330 Garfield Street NW, Washington, DC 20008, telephone (202) 333-6900; or one of the Belgian Consulates General in Atlanta, Los Angeles, or New York.Visit the Belgian Embassy web site at http://www.diplobel.org/usa for the most current visa information.
Belgian law requires that everyone carry some form of official identification at all times, which must be displayed upon request to any Belgian police official. A U.S. passport suffices for these purposes.
See the section on Special Circumstances for information on new business visitor and employee registration requirements.
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: Belgium remains largely free of terrorist incidents. Belgian law enforcement and security officials, in close cooperation with neighboring countries, maintain a solid anti-terrorism effort and a peaceful environment for tourists and business. However, like other countries that are members of the Schengen Agreement on free cross-border movement, Belgium’s open borders with its European neighbors allow the possibility for terrorist groups to enter/exit the country with anonymity.
Prior police approval is required for public demonstrations in Belgium, and police oversight is routinely provided to ensure adequate security for participants and passers-by. Nonetheless, situations may develop that could pose a threat to public safety. U.S. citizens are advised to avoid areas where public demonstrations are taking place.
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: Belgium remains relatively free of violent crime, but low-level street crime is common. Visitors should always be watchful and aware of their surroundings, however, because muggings, purse snatchings, and pickpocketing occur frequently, particularly in the major cities. Transportation hubs like the Metro (subway) and train stations are also frequented by thieves who take advantage of disoriented travelers. In Brussels, pickpocketing, purse snatching, and theft of light luggage and laptops are common at the three major train stations -- the North Station (Noordstation or Gare du Nord), the Central Station (Centraal Station or Gare Central) and especially at the South Station (Zuidstation or Gare du Midi). The latter is a primary international train hub, and travelers are advised to pay very close attention to their personal belongings when in the station. Common ploys are to distract the victim by spraying shaving cream or another substance on his or her back or asking for directions while an accomplice steals the luggage. It is a good idea to remain in physical contact with hand luggage at all times, and not to place carry-on luggage on overhead racks in trains.
Another growing problem, especially in Brussels, is theft from vehicles, both moving and parked. Do not leave valuables in plain sight where a thief may spot them. Thieves will sometimes position themselves at stop lights to scan for valuables in stopped cars. If they see a purse or other valuable item they break the window and steal the item before the victim can even react. Expensive car stereos and GPS navigational devices left in plain sight are often stolen from parked cars. Always drive with windows up and doors locked.
Travelers to Brussels should be aware that small groups of young men sometimes prey on unwary tourists, usually at night and often in Metro stations. Items such as expensive mobile phones and MP3 players are often the target. Travelers should carry only a minimum amount of cash, credit cards, and personal identification. Wearing expensive jewelry and watches is discouraged.
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. See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Good medical facilities are widely available in Belgium. The large university hospitals can handle almost every medical problem. Hospitals in Brussels and Flemish-speaking Flanders will probably have English-speaking staff. Hospitals in French-speaking Wallonia may not have staff members who are fluent in English, however. The Embassy Consular Section maintains a list of English-speaking doctors, which can be found on the Embassy web site at http://brussels.usembassy.gov/medical_facilities.html.
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 Belgium is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Belgian urban highways are generally well built and maintained with extensive lighting systems, but rain and fog often reduce visibility. Rural roads are less likely to be illuminated at night. Belgian rules for right-of-way differ from those in the U.S., and new drivers should thoroughly understand these rules before driving in Belgium. For instance, traffic coming from the right generally has priority at uncontrolled intersections and roundabouts, even if coming from a smaller street. The maximum speed limit on Belgian highways is 120 kilometers (72 miles) per hour, but is not always posted except at Belgium’s borders and on roads leaving major airports. The maximum speed in urban areas is normally 50 km (30 miles) per hour. While Belgian authorities strictly enforce speed limits, many Belgians still drive significantly faster than the posted limit. Claims of ignorance may not prevent a significant fine for speeding, which can also lead to the vehicle’s being impounded if the driver is unable to pay the fine on the spot. Belgian police also conduct breath analysis checks for alcohol use, particularly at night and during major holidays.
Roadside assistance and information on road conditions are available in English from Touring Mobilis, tel: 0900 10280. Belgian police will also provide information on road conditions, tel: 02-642-6666. Emergency services are efficient and responsive. By phone within Belgium, for police emergencies dial 101 and for all other emergencies,112.

Please refer to our Road Safety page for more information. Visit the website of Belgium’s national tourist office at http://www.visitbelgium.com/.
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Belgium’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Belgium’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: While most forms of monetary transactions are available (cash, credit cards), U.S. money orders cannot be negotiated in Belgium. Personal checks may only be cleared through a bank at which a person holds an account and clearance can take from two to four weeks. Banks and exchange facilities may refuse U.S. dollar denominations of $50 and $100 if they are not equipped with devices to identify counterfeit currency. Automated Teller Machines (ATMs) are widespread in Belgium and accept most U.S. ATM cards to withdraw funds. Travelers seeking to purchase Euros are more likely to find a more favorable exchange rate at banks than at money exchange facilities located at tourist locations, train stations, and airports. Please see our Customs Information.
Non-EU citizens visiting Belgium and staying in a private residence are required by Belgian law to register with local Commune authorities within three days of their arrival. Any change in visa or resident status must also be requested through Commune authorities and must be completed prior to the expiration of the current status. Given the requirements to change status in Belgium, it is nearly impossible to do so within the 90 days permitted to remain in Belgium without a visa under the Visa Waiver Program.
BUSINESS VISITOR AND EMPLOYEE REGISTRATION REQUIREMENT: Since April 1, 2007 non-Belgian employers and self-employed persons or their employees who carry out short term assignments in Belgium must declare these activities in advance.
This mandatory "Limosa" declaration applies to: (1) Employees and apprentices, who come to Belgium to execute certain temporary work and who, because of the nature of their short term assignment, are not subject to the Belgian social security system; (2) Self-employed people and self-employed apprentices who come to work in Belgium temporarily, irrespective of whether they are subject to the Belgian social security system.
Some exceptions to this general obligation exist. Certain persons may be exempted, especially for short-term assignments. For more information about the Limosa declaration, visit http://www.limosa.be.
For more information about working in Belgium, please see http://www.employment.belgium.be/home.aspx.
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 Belgian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Belgium 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 living or traveling in Belgium 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 Belgium. 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 Brussels is located at 25 Boulevard du Regent. The telephone number from the U.S. is 011-32-2-508-2111. Within Belgium, the telephone number is 02-508-2111. The Embassy’s fax number is 02-511-2725. The Consular Section’s fax number is 02-513-0409. The American Citizen Services Unit of the Consular Section is open from 1:30 to 3:30 p.m. Monday through Friday, except for American and Belgian holidays. Further information can be obtained at the Embassy’s web site at http://belgium.usembassy.gov/
* * *
This replaces the Country Specific Information for Belgium dated March 13, 2008, to update sections on Entry/Exit Requirements.

Travel News Headlines WORLD NEWS

Date: Tue 22 Oct 2019
Source: The Brussels Times [abridged, edited]

Students from the UCLouvain [Catholic University of Leuven] have received an email warning of increased cases of mumps on the campus of Sint-Lambrechts-Woluwe and in the colleges in the municipality [of Brussels-Capital Region].

This information -- widely reported in Belgium -- was confirmed by the spokesperson for the University Isabelle Decoster to Belga.

The total number of infected is currently not known as students can go to doctors across the city. Sick students are asked to stay at home.  [Byline: Jules Johnston]
====================
[HealthMap/ProMED-mail map of Belgium:
Date: Thu 24 Oct 2019
Source: Brussels Times [edited]

Two people in Belgium have been infected with _Listeria_ bacteria that lead to the death of 3 people and a miscarriage over a 2-year period in the Netherlands, a sampling by a federal health centre showed. [See ProMED-mail post Listeriosis - Europe (15): (Netherlands) fatal, WGS, cold cuts http://promedmail.org/post/20191005.6711608, which described a listeriosis outbreak that affected 20 people, 3 of whom died and one woman had a miscarriage, over the past 2 years after eating cold cuts produced by Offerman, a Netherland-based producer. - ProMED Mod.ML]

The cases in Belgium affected a 97-year-old woman and a Dutch national who recently gave birth in Antwerp [Belgium], a study by federal health research centre Sciensano confirmed. Both women were infected with the bacteria in 2018, according to the study, which compared samples of bacteria in the Netherlands with those of Belgian patients infected, HLN reports.

The centre's study comes after three people died and one woman had suffered a miscarriage in the Netherlands after eating meat contaminated with _Listeria_ over a 2-year period, which was reportedly linked to Dutch meat producer Offerman.

In Germany, 2 _Listeria_-related deaths were also reported in the central state of Hesse. [See ProMED-mail post Listeriosis - Europe (16): (Germany) fatal, WGS, meat, healthcare facilities http://promedmail.org/post/20191019.6736570, which described a listeriosis outbreak that affected 40 people, 3 of whom have died, in 12 German states between 2014 and 2019, due to _Listeria_-contaminated meat products manufactured at a processing facility in the German state of Hesse and widely distributed to more than 20 European countries. This German outbreak associated with the Hesse-based meat processing facility is unrelated to the Netherlands/Belgium outbreak associated with the Netherlands-based meat processing facility. - ProMED Mod.ML]

News of the deaths led supermarkets in Belgium to issue recalls for pre-packaged meat, a move they said at the time was precautionary. Offerman, a subsidiary of Belgian food group Ter Beke, has since been shut down in the Netherlands.

The Sciensano study could not identify the cause of the infections in Belgium, since isolated cases, unlike outbreaks, are not subject to follow-ups, Het Nieuwsblad reports.  [Byline: Gabriela Galindo]
==================
[The incriminated meat is refrigerated cold cuts that are not cooked before eating (i.e., ready-to-eat). Cold cuts are well-recognized sources for listeriosis. Even if initial contamination adds only a few _Listeria_ organisms to the food, the contamination can be significant for refrigerated foods because _L. monocytogenes_ can subsequently multiply at refrigerator temperatures to a sufficient number to cause disease. People at increased risk for disseminated listeriosis, which include pregnant women (and their new-borns), adults aged 65 years or older, and people with weakened immune systems, should avoid eating food potentially contaminated with _Listeria_. - ProMED Mod.ML]

[HealthMap/ProMED maps available at:
Date: Wed 25 Sep 2019
Source: Food Safety News (FSN) [edited]

A _Salmonella_ outbreak that sickened almost 200 people at a Belgian school was likely caused by eggs used to make a tartar sauce, according to authorities. The Agency for Care and Health (Zorg en Gezondheid) and Federal Agency for the Safety of the Food Chain (FASFC) investigation detected _Salmonella_ in the freshly prepared tartar sauce. Findings from an online survey of students and teachers also reached the same conclusion on the source.

The Agency for Care and Health had previously received information about a number of students from the school complaining of gastrointestinal illness. Since 14 Sep 2019, no new cases of illness have been reported so the Spermalie Hotel and Tourism School in Bruges [West Flanders] has been allowed to resume normal operation. About 200 students and teachers from the school became ill from 6 Sep 2019 onward. Laboratory analyses of stool samples revealed students and teachers had been affected by _Salmonella_.

The Agency for Care and Health handled the online survey part of the investigation, FASFC took samples of meals served on Tuesdays, Wednesdays, and Thursdays at the school restaurant. The samples were sent to the lab of Sciensano, the Belgian Institute for Health. The online survey showed the tartar sauce was the most likely source of the outbreak.

A total of 65 samples were sent to Sciensano and after analysis of the different dishes, _Salmonella_ was detected in the freshly prepared tartar sauce. Bacteria present in the food appeared to be the same as in the stool samples from patients.

Staff and students were asked to pay particular attention to hand hygiene and those sick were encouraged to stay at home. The kitchen of the school restaurant and all kitchens and related equipment have been cleaned and disinfected. The sale of any raw food was also suspended. Control measures have been verified by environmental sampling and no _Salmonella_ has been detected in lab analysis of these samples.

Belgium reported 2698 confirmed salmonellosis cases in 2016 compared to 3050 the year before.
===========================
[Tartar sauce (<https://en.m.wikipedia.org/wiki/Tartar_sauce>) is based on either mayonnaise (egg yolk, mustard or vinegar, bitartrate, oil) or aioli (olive oil, garlic), with certain other ingredients added. In the UK, recipes typically add to the base capers, gherkins, lemon juice, and dill. US recipes may include chopped pickles or prepared green sweet relish, capers, onions (or chives), and fresh parsley. Chopped hard-boiled eggs or olives are sometimes added, as may be Dijon mustard and cocktail onions.

Salmonellosis is often thought to be associated with cracked eggs or eggs dirty with fecal matter, a problem controlled by cleaning procedures implemented in the egg industry. It is clearly the case, however, that most of the salmonellosis outbreaks linked to eggs were associated with uncracked, disinfected grade A eggs, or foods containing such eggs. The undamaged eggs become contaminated during ovulation, and thus were contaminated with the bacteria before the eggshell was formed. To avoid this, uncooked eggs should only be used as an ingredient, if pasteurized. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Belgium:
Date: Thu, 25 Jul 2019 15:48:48 +0200

Brussels, July 25, 2019 (AFP) - Belgian meteorologists registered record high temperatures on Thursday as western Europe sweltered under a multi-day heatwave that has disrupted transport and triggered safety warnings.   David Dehenauw, chief forecaster at the Royal Meteorological Institute, said a high of 40.6 degrees Celsius (105 Fahrenheit) had been recorded on the Kleine-Brogel military base, in northeastern Belgium.

"New Belgian national record: 40.6 in Kleine Brogel now and it's not finished yet! Unbelievable!" Dehenauw said on Twitter.   The temperature in Belgium exceeded 40 degrees for the second day in a row after it reached 40.2 degrees in Liege, the previous record, on Wednesday.  Thursday's new record is likely to be temporary as temperatures continued to rise in the middle of the afternoon.

In Brussels, the country's reference station, it was a record 38.8 degrees at 15:00 (1300 GMT), compared to 36.8 degrees an hour earlier in Europe's unofficial capital.  Since the beginning of official temperature records in 1833, it has never been so hot.    The previous record of 36.6 was set on in June, 1947.
Date: Fri 17 May 2019
Source: [in French, trans. Corr.SB, edited]

An additional patient, the 19th, was admitted to the hospital in Flanders, [East Flanders province] suffering from legionellosis.

This case comes in addition to the 18 others who have been exposed to _Legionella_ bacteria in the Evergem area [East Flanders], right next to Ghent, and who developed legionnaires' disease, a lung disease that is not transmitted from human to human.

Of the total of 19 patients, 2 men died: one Monday night [20 May 2019] and the other [Wed 22 May 2019], in 2 different Ghent hospitals.

The exact source of _Legionella_ causing the [legionellosis] outbreak in the region has not yet been located. The bacterium normally contaminates people via inhalation of water vapor or micro-droplets, but many exposed individuals do not develop disease.
========================
[This news report above adds 3 cases since the last report posted by ProMED-mail (Legionellosis - Europe (01): Belgium (OV) http://promedmail.org/post/20190514.6468996) for a total now of 19 cases. At the time of the initial report, cooling towers in the vicinity of the Ghent Canal were suspected to be the source of this outbreak. The Ghent Canal separates the town of Evergem, where 7 cases occurred, from the town of Oostakker, where 2 cases occurred. The Ghent-Terneuzen Canal, links Ghent in Belgium to the port of Terneuzen in the Netherlands, thereby providing Ghent with access to the sea (<https://en.wikipedia.org/wiki/Ghent-Terneuzen_Canal>).

A map showing the location of Evergem and this area can be found at
<https://goo.gl/maps/y9Z1tQzbKJa1NkSm7>.

The news report above fails to state where the new cases reside, if _Legionella_ genotypes of the clinical isolates match each other, which would indicate a common source outbreak, and the results of environmental testing for _Legionella_. We await the results of the ongoing investigation. - ProMED Mod.ML]

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

Virgin Islands

British Virgin Islands US Consular Information Sheet
April 03, 2006
COUNTRY DESCRIPTION: The British Virgin Islands (BVI) are a British overseas territory, part of the British West Indies, lying about 60 miles east of Puerto Rico. There are abo
t 50 islands in the BVI, many of them uninhabited. Tortola is the main island; other islands include Virgin Gorda, Jost Van Dyke, and Anegada. Tourist facilities are widely available.
ENTRY/EXIT REQUIREMENTS: For tourist stays of up to six months, U.S. citizens need a valid U.S. passport or other proof of U.S. citizenship (original or certified birth certificate, Certificate of Naturalization or Certificate of Citizenship as well as photo identification), onward or return tickets, and sufficient funds for their stay. Upon initial entry, no more than 60 days will be granted. At the end of 60 days, visitors must report to the Immigration Department's main office in Road Town for an extension. Extensions of up to 90 days are issued at the discretion of the Immigration Officer subsequent to an interview. For further information on travel to the British Virgin Islands, travelers should contact the BVI Department of Immigration at 1-284-494-3471. Visit the Embassy of the British Government web site at for the most current visa information.
See Entry and Exit Requirements for more information pertaining to dual nationality and the international child abduction . Please refer to our Customs Information to learn more about customs regulations.

SAFETY AND SECURITY For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site, where the current Travel Warnings and Public Announcements , including the Worldwide Caution Public Announcement , can be found.

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State's pamphlet A Safe Trip Abroad .
CRIME: Thefts and armed robberies do occur in the BVI. Visitors should take common-sense precautions against petty crime. Avoid carrying large amounts of cash and use hotel safety deposit facilities to safeguard valuables and travel documents. Do not leave valuables unattended on the beach or in cars. Always lock up boats when going ashore.
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.
See our information on Victims of Crime .
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in the British Virgin Islands consists of a small general hospital with an emergency room staffed 24-hrs/day by physicians, several clinics on Tortola, and one clinic in Virgin Gorda. Ambulances staffed with paramedics serve both islands. There are no medical facilities on the other islands. A volunteer organization, Virgin Islands Search and Rescue (VISAR), responds 24-hrs/day to medical emergencies at sea or on outer islands. VISAR transports casualties to the nearest point for transfer to ambulance. To reach VISAR, dial SOS (767) or call on Marine Channel 16.
There is no hyperbaric chamber in the BVI. Patients requiring treatment for decompression illness are transferred to St. John, U.S. Virgin Islands. Most sensitive medical cases are transferred to San Juan, Puerto Rico.
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 internet site at . For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at . Further health information for travelers is available at .
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 British Virgin Islands is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Vehicles drive on the left (the British side) with most steering wheels on the left (the "American" side). Road signs are limited and seatbelts are required by law. Drivers often fail to yield the right-of-way to pedestrians, even at painted crosswalks. Speeding and reckless driving are fairly common in the BVI. Drivers can encounter nighttime drag racing on main thoroughfares and livestock on roads. Roads in Tortola's interior can be steep and extremely slippery when wet. Travelers planning to drive across the island should consider requesting four-wheel drive vehicles and should ensure that tires and brakes are in good operating condition on any rental vehicle. Please refer to our Road Safety page for more information, as well as the website of the BVI's national tourist office and national authority responsible for road safety at
.
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the British Virgin Islands as being in compliance with ICAO international aviation safety standards for oversight of BVI's air carrier operations. For more information, travelers may visit the FAA's Internet web site at .
CUSTOMS REGULATIONS: BVI customs authorities may enforce strict regulations concerning temporary importation into or export from the British Virgin Islands of items such as drugs and firearms. Visitors to BVI carrying firearms must declare them upon entry into any port in the territory. Firearms must be bonded and are held by the proper authorities until time of departure. Contact BVI Customs & Immigration at 1-284-494-3475, the Embassy of the United Kingdom in Washington, D.C. or one of the UK's consulates in the United States for specific information regarding customs requirements. Please see our 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 British Virgin Island laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the BVI 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 .
DISASTER PREPAREDNESS: All Caribbean countries can be affected by hurricanes. The hurricane season normally runs from June to the end of November, but there have been hurricanes in December in recent years. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA).
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website.
REGISTRATION/EMBASSY AND CONSULATE LOCATIONS: Americans living or traveling in the British Virgin Islands are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website , and to obtain updated information on travel and security within the BVI. 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 nearest U.S. Embassy to the BVI is located in Bridgetown, Barbados. The Consular Section is located in the American Life Insurance Company (ALICO) Building, Cheapside, telephone 1-246-431-0225 or fax 1-246-431-0179, email ConsularBridge2@state.gov , or . The U.S. Consular Agent in Antigua, located at Jasmine court, St. John's, tel. 1-268-463-6531, is closer to the BVI and can also assist in some limited non-emergency cases, by previous appointment only.
****
This replaces the British Virgin Islands Consular Information Sheet dated April 26, 2005 to update all sections.

Travel News Headlines WORLD NEWS

Date: Thu 19 Sep 2019
Source: Emerg Infect Dis [edited]

Citation:
Guendel I, Ekpo LL, Hinkle MK, Harrison CJ, Blaney DD, et al.: Melioidosis after Hurricanes Irma and Maria, St. Thomas/St. John District, US Virgin Islands, October 2017. Emerg Infect Dis. 2019; 25(10): 1952-1955. doi: 10.3201/eid2510.180959.

Melioidosis is caused by _Burkholderia pseudomallei_, a saprophytic, gram-negative bacillus endemic to tropical regions worldwide (1). Diagnosis is difficult because of wide-ranging clinical manifestations (2), and this bacterium is innately resistant to many antimicrobial drugs, making treatment options limited, complex, and lengthy (3). Infection occurs by percutaneous exposure, inhalation, or ingestion.

Melioidosis is rare in the USA, and cases are usually travel related (4,5). However, regional endemicity has been documented in Puerto Rico (6), and sporadic human cases have been reported in the Caribbean (5,7). In September 2017, the US Virgin Islands were affected by 2 category 5 hurricanes, Irma and Maria; widespread flooding continued for weeks. We describe the clinical manifestations, management, and outcome of post-hurricane melioidosis cases in 2 women in St. Thomas and St. John, US Virgin Islands.

The study
Despite major damage to the 2 hospitals in the territory during the 2 hurricanes, the Virgin Islands Department of Health (VIDOH) maintained surveillance at both emergency departments. Two isolates were recovered from each patient. Local specimen analysis for organism identification was performed by using the MicroScan WalkAway System (Siemens Healthcare Diagnostics, <https://www.siemens-healthineers.com>). All isolates were confirmed as _B. pseudomallei_ at the CDC. Whole-genome sequencing and single-nucleotide polymorphism analysis were performed (National Center for Biotechnology Information, <https://www.ncbi.nlm.nih.gov>. Genomes from a given patient were clonal to each other. However, representative genomes from both patients had differences (greater than 5600 single-nucleotide polymorphisms), indicating the presence of different strains in these infections. Genomic comparison with a reference panel indicated that the isolates were within the previously described Western Hemisphere clade and subclade associated with the Caribbean (8).

Patient 1 was an 80-year-old female resident of St. Thomas who had a history of cardiomyopathy and type II diabetes mellitus. She came to the emergency department (ED) at Schneider Regional Medical Center (St. Thomas, US Virgin Islands) because of shortness of breath (symptom onset 28 days after Hurricane Irma and 9 days after Hurricane Maria). Her symptoms were worsened orthopnea, increased abdominal girth, and edema, consistent with her symptoms at previous admissions. The patient was admitted for management of acute decompensated heart failure.

The patient had a temperature of 98.5 deg F [36.9 deg C]; diffuse pulmonary crackles; jugular venous distension; normal heart sounds; and bilateral, lower extremity pitting edema. Examination showed a focal area on the anterior left thigh that had a central, firm, warm, erythematous, tender, subcutaneous nodule about 2 cm [approximately 0.8 in] in diameter with a central fluctuant area and a small pinhole. Incision and drainage was performed, and a swab specimen of purulent drainage was sent for culture.

The patient was given intravenous clindamycin (600 mg every 8 h for 5 d) and was discharged while receiving oral clindamycin, but the treatment course was not completed. Cultured wound showed growth of _B. pseudomallei_ at 5 days. However, culture growth was not yet positive before patient discharge. The isolate was susceptible to trimethoprim/sulfamethoxazole (Table 1 [for Tables and Figure, see original URL - ProMED Mod.LL]).

Patient 1 returned to the ED 2 weeks later because of manifestations similar to those at the 1st visit. She was afebrile and admitted for diuresis. The left thigh lesion had progressed into a 2 cm [about 0.8 in], tender, shallow ulcer productive of purulent material surrounded by erythema and a focal area of induration (Figure). Laboratory data reflected a leukocyte count within reference ranges and mild renal insufficiency with estimated glomerular filtration rate of 40.47 mL/min (Table 2). A 2nd wound culture was collected, and the patient was given intravenous meropenem (1 g every 8 h). Culture was presumptively positive for _B. pseudomallei_ and _Serratia marcescens_ after 48 hours, confirmed after 8 days. Both isolates showed the same resistance pattern and were susceptible to meropenem and trimethoprim/sulfamethoxazole: the MIC for meropenem was <1 microgram/mL (Table 2). Meropenem was continued for 8 days, and ulcer improvement was observed. The patient was discharged while receiving oral trimethoprim/sulfamethoxazole (800 mg/160 mg 2x/d) to complete maintenance therapy. The patient completed a 3-month course of trimethoprim/sulfamethoxazole and achieved resolution.

Patient 2 was a 60-year-old female who had diabetes and was a resident of St. John. She was referred to the ED at Schneider Regional Medical Center by her primary care physician because of hyperglycemia, productive cough, and malaise for one week (symptom onset 46 days after Hurricane Irma and 33 days after Hurricane Maria). The patient was admitted to the intensive care unit because of community-acquired pneumonia.

The patient was lethargic and had a temperature of 101 deg F [38.3 deg C]; heart rate was 99 beats/min, respiratory rate 22 breaths/min, and blood pressure 142/81 mm Hg. Blood gas testing showed pO2 of 47.6 mm Hg with an oxygen saturation of 87.2% on 2-liter nasal cannula. A chest radiograph showed a left-sided mild infiltrate, and her leukocyte count was markedly increased (28 300 cells/mm3) (Table 2).

The patient was given intravenous ceftriaxone (1 g/d) and azithromycin (500 mg/d) after blood and sputum cultures were prepared. She required bilevel positive airway pressure but eventually required mechanical ventilation. The patient then became hypotensive and required norepinephrine to maintain a main arterial pressure greater than 65 mm Hg. Ceftriaxone was discontinued, and she was given intravenous piperacillin/tazobactam (3.375 g every 6 h). Trimethoprim/sulfamethoxazole- and ceftazidime-sensitive _B. pseudomallei_ were identified from sputum culture after 72 hours (Table 1). Methicillin-sensitive _Staphylococcus aureus_ and _Candida glabrata_ were also identified. One of 2 blood cultures was positive for gram-negative rods. Piperacillin/tazobactam was discontinued, and the patient was given meropenem (1 g every 8 h).

The patient remained critically ill and was transferred to a tertiary-care hospital in the continental USA. She died in a long-term care facility during October 2018 without showing signs of neurologic improvement.

Isolates from both patients showed susceptibility to routinely tested antimicrobial drugs (10,11). Isolates from patient 1 showed resistance to ceftazidime during preliminary analysis (Table 1). However, broth microdilution confirmatory testing performed at CDC indicated ceftazidime susceptibility, highlighting the need for additional antimicrobial resistance confirmation.

Both patients were interviewed to determine travel history and possible exposure sources. Patient 1 traveled occasionally to the southeastern USA; her last travel date was 3 months before her illness. This patient reported flooding and water damage to her home from the hurricanes but did not report contact with flood waters. Patient 2 reported no travel history before the hurricanes.

VIDOH has investigated and confirmed a subsequent case-patient with pulmonary melioidosis in St. Thomas during December 2018 (I. Guendel et al., unpub. data). This case-patient reported no recent travel and might have had occupational exposure as a professional gardener. This person had 2 risk factors (type II diabetes mellitus and heavy use of alcohol).

Conclusions
Given regional occurrence, detection of melioidosis in the US Virgin Islands is not surprising. Furthermore, emergence of melioidosis after extreme weather events has been well documented, and cases were likely acquired locally from storm-related exposure to flooded soil, surface water runoff, or generation of coarse aerosols (12,13). Although detection of _B. pseudomallei_ has yet to be confirmed in the environment, it might be endemic to the US Virgin Islands, as in Puerto Rico.

In January 2018, melioidosis was listed as a reportable disease in the US Virgin Islands. Future actions include disease education efforts for physicians and laboratory staff because misdiagnosis is common (14). Awareness campaigns highlighting preventive measures for the public are necessary because risk factors are prevalent in the local population (e.g., diabetes and other chronic disease) and might be exacerbated under disaster settings (e.g., respiratory effects and open wounds). VIDOH has implemented rapid diagnostic testing by using Active Melioidosis Detect (InBios International, <https://inbios.com>) on suspected specimens for prompt on-island case identification while routine ED diagnostic cultures are performed (5). All confirmatory testing is conducted at CDC.

References
-------
On Request
======================
[This infection is found primarily in southeast Asia and the Northern Territory of Australia. Despite this, cases of melioidosis have been acquired in other parts of the world including the Americas. Flooding from the increasing number of severe tropical storms related to climate change is increasing.

Melioidosis is a disease of the rainy season in its endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (most common risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption (kava is an herbal member of the pepper family that can be associated with chronic liver disease).

Melioidosis may present at any age but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, and chest pain, and -- although the cough can be nonproductive -- respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright red blood. The lung infection can be rapidly fatal -- with bacteremia and shock -- or somewhat more indolent.

Acute melioidosis septicaemia is the most severe complication of the infection. It presents as a typical sepsis syndrome with hypotension, high cardiac output, and low systemic vascular resistance. In many cases, a primary focus in the soft tissues or lung can be found. The syndrome, usually in patients with risk factor comorbidities, is characteristically associated with multiple abscesses involving the cutaneous tissues, lung, liver, and spleen, and a very high mortality rate of 80-95%. With prompt optimal therapy, the case fatality rate can be decreased to 40-50%.

The melioidosis bacillus is intrinsically insensitive to many antimicrobials, and in fact, bioterrorism strains may be engineered to be even more resistant. _Burkholderia pseudomallei_ is usually inhibited by tetracyclines, chloramphenicol, trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins, carbapenems, ceftazidime, and amoxicillin/clavulanate or ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro activity but poor efficacy, and cefepime did not appear, as well, to be equivalent to ceftazidime in a mouse model. The unusual antimicrobial profile of resistance to colistin and polymyxin B and the aminoglycosides but sensitivity to amoxicillin/clavulanate is a useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis treatment have been reviewed, and it was found that the formerly standard therapy of chloramphenicol, doxycycline, and SXT combination had a higher mortality rate than therapy with ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or ampicillin/sulbactam). The betalactam-betalactamase inhibitor therapy, however, seemed to have a higher failure rate.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick SM (eds). Bioterror: the Weaponization of Infectious Diseases. Totowa NJ: Humana Press, 2008. pp 145-58. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
US Virgin Islands: <http://healthmap.org/promed/p/479>]
Date: Fri 31 Jan 2014
Source NBC News [edited]

The Explorer of the Seas outbreak was caused by norovirus, one of the worst outbreaks in 20 years, the Centers for Disease Control and Prevention (CDC) said. The Explorer of the Seas cruise ship returned to port after hundreds of passengers became ill. Federal health officials confirmed on Friday [31 Jan 2014] that norovirus was the culprit that sickened nearly 700 people on a cruise ship this week, and said it was one of the biggest norovirus outbreaks in 20 years. But the source of the outbreak on the Royal Caribbean ship Explorer of the Seas, which returned early to New Jersey on Wednesday [29 Jan 2014], may never be known, CDC said: "CDC has been investigating the outbreak since last Sunday [26 Jan 2014] but no particular source has been identified and it's quite possible a source won't be identified."

The report comes after passengers streamed off the Caribbean Princess on Friday morning [31 Jan 2014], the 2nd cruise cut short this week amid reports of illness on board. The ship, operated by Princess Cruises, returned to Houston [Texas] a day early with a confirmed outbreak of norovirus. "The ship was forced to return to Houston one day early because we were informed that dense fog was expected to close the port for much of the weekend," the company said in a statement. "The ship did not return early because of the increased incidence of norovirus on board, despite some media reports."

At least 178 people on board became ill during the cruise, according to the cruise line and CDC. Sick patients were quarantined to their rooms, and other passengers said they no longer had access to buffet tongs as crew members handed out hand sanitiser. CDC health officials met the Caribbean Princess at the Bayport Cruise Terminal in Pasadena, Texas. The vessel launched on a 7-day cruise to the western Caribbean on [25 Jan 2014] and had been scheduled to return on Saturday [1 Feb 2014]. Princess Cruises said the outbreak was over by the time the ship returned to Houston. "As a result of our actions, case numbers declined significantly and by the end of the cruise there were no passengers with active symptoms," the company said. "Over the course of the cruise 178 passengers (5.7 per cent) and 11 crew (1 per cent) reported ill to the Medical Center."

CDC officials also helped Royal Caribbean clean up the Explorer of the Seas, and said it had been approved to go back out again with a new batch of passengers Friday afternoon [31 Jan 2014]. Royal Caribbean officials say they cleaned the ship, which carried more than 3000 passengers, 3 times. It's the 3rd cruise ship outbreak to occur this year [2014]. A Norwegian Cruise Line ship, the Norwegian Star, reported that 130 passengers and 12 crew members became ill on 2-week cruise that launched [5 Jan 2014] from Miami.

About 20 million passengers take cruises in the US each year, fuelling a USD 37.8 billion annual industry, according to the American Association of Port Authorities. There were 9 vessel outbreaks in 2013 and 16 in 2012, according to the CDC. Norovirus is a common culprit in outbreaks on cruise ships, in nursing homes, and other confined places. It is a fast-moving gut bug typically spread by infected people or contaminated food or water. Norovirus is the most common cause of acute gastroenteritis in the US, resulting in about 21 million illnesses, between 56 000 and 71 000 hospitalizations and as many as 800 deaths, CDC says.

The virus lingers on surfaces and spreads very easily. Thorough hand washing with hot water and soap and meticulous environmental cleaning can help stop the spread. CDC says it's the season for norovirus. "Norovirus outbreaks wit high attack rates are common during this time of year," the agency said. "Most outbreaks occur between January and April."   [byline: Maggie Fox]
*****
Date: Wed 29 Jan 2014
Source: NBC News [edited]

Beleaguered passengers finally fled a Royal Caribbean cruise ship on Wednesday [29 Jan 2014] after a 10-day vacation cut short by a nasty gut bug that sickened nearly 700 people. One woman aboard the Explorer of the Seas yelled, "We made it!" as the ship docked in Bayonne [New Jersey], 2 days ahead of schedule. Other passengers stood on deck wrapped in blankets to watch the ship pull in. One person was removed from the Explorer of the Seas on a stretcher and taken away by ambulance. Others walked under their own power after the vessel arrived. Several passengers recounted a week full of tension and drama, but also professionalism and care from the cruise line crew.

Still, the ordeal on the 1020-foot ship -- whose relaxing voyage to the US Virgin Islands was thwarted by suspected norovirus -- may linger a little longer for people still showing signs of the fast-moving infection, health officials said. "We have passengers who are still exhibiting active disease," said Burnadette Burden, a spokeswoman for the Centers for Disease Control and Prevention. People who are still sick may be too ill to travel home -- and too contagious to use public transportation like trains and buses, health experts say. Royal Caribbean officials said Wednesday [29 Jan 2014] that they'd pay for hotels or make sure that ill passengers get additional medical care. "Should a guest feel sick enough that they want to go to the hospital, we will arrange for transportation," Royal Caribbean spokeswoman Cynthia Martinez said in an email. "We will work with the small number of guests that still feel ill to make them as comfortable as possible."

At least 630 of the ship's 3071 passengers and at least 54 of the 1166 crew members came down with diarrhea and vomiting -- classic signs of norovirus. Most of the cases occurred early in the cruise, which left New Jersey on [21 Jan 2014], and many passengers had already recovered. It's hard to say that the outbreak was the worst on record because of inconsistencies in record-keeping. But it's a bad one, Burden said. "It would be fair to say this is one of the largest numbers in the last 20 years or so," she said. One of the closest outbreaks to compare occurred in 2006, when a Carnival Cruise ship, the Carnival Liberty, was hit with an outbreak of norovirus that sickened 679 passengers and crew on a November trip to the US Virgin Islands.

CDC officials have not confirmed that norovirus is the culprit on the Explorer of the Seas, though it's a common cause of illness on cruise ships. Officials said testing was delayed by a treacherous winter snowstorm that closed the agency's Atlanta headquarters and results aren't expected until Friday [31 Jan 2014]. But if it is the germ, it's highly contagious for the one to 2 days when people are actively sick -- and for a few days afterward. The virus actually lingers in people's stool for 2 weeks or more, according to the CDC. That means that anyone who fell ill -- and those who were around them -- should pay extra attention to washing their hands and other kinds of cleanliness, said Dr Ruth Lynfield, outgoing head of the public health committee of the Infectious Diseases Society of America.

Cleanliness will be the key for the cruise line, too. Officials said they plan another scrub, a so-called "barrier sanitation" program to ensure that any remaining traces of illness are removed from the ship. Norovirus is a notoriously difficult bug to eradicate, health experts say. "It will be the 3rd aggressive sanitizing procedure the ship has undertaken since we became aware of the issue, and will additionally provide a window of more than 24 hours where there are no persons aboard the ship," officials said in a statement.   [byline: JoNel Aleccia]
******
Date: Fri 31 Jan 2014
Source: CDC, National Center for Environmental Health, Division of
Emergency and Environmental Health Services, Vessel Sanitation Program (VSP) [edited]

Cruise ship: Explorer of the Seas -- voyage dates: 21-31 Jan 2014
-----------------------------------------------------------------
- number of passengers who reported being ill during the voyage out of total number of passengers onboard: 634 of 3071 (20.6 per cent)
- number of crew who reported being ill during the voyage out of total number of crew onboard: 55 of 1166 (4.7 per cent)
- predominant symptoms: vomiting, diarrhea
- Causative agent: Norovirus

Actions: in response to the outbreak, Royal Caribbean Cruise Line and the crew aboard the ship took the following actions:
- increasing cleaning and disinfection procedures according to their outbreak prevention and response plan;
- making announcements to both notify onboard passengers of the outbreak and encourage case reporting;
- collecting stool specimens from ill passengers and crew for submission to the CDC lab;
- making multiple daily reports of gastrointestinal illness cases to the VSP [Vessel Sanitation Program];
- preparing additional crew members to join the ship mid-voyage to assist with case management and intensified sanitation procedures;
- consulting with CDC on plans for: passenger notification procedures and the planned delayed embarkation schedule in Bayonne, NJ on [31 Jan 2014], and disembarkation plans for active cases, terminal, and transport infection control procedures.

One CDC Vessel Sanitation Program epidemiologist, one contract epidemiologist, and one VSP environmental health officer boarded the ship in St Thomas, [US Virgin Islands] and are sailing on the ship as it travels back to port in New Jersey. This team is conducting an epidemiologic investigation, environmental health assessment, and evaluating the outbreak and response activities on board. One additional CDC Vessel Sanitation Program environmental health officer will board the ship upon arrival on [29 Jan 2014] to assist with the evaluation of the disinfection process. The team will continue the investigation and evaluation on the ship thru the boarding of new passengers for the next voyage. 5 clinical specimens were shipped to the CDC lab for testing on [26 Jan 2014].
**************************
Date: Fri 31 Jan 2014
Source: CDC, National Center for Environmental Health, Division of
Emergency and Environmental Health Services, Vessel Sanitation Program (VSP) [edited]

Cruise ship: Caribbean Princess -- voyage dates: 25 Jan-1 Feb 2014
------------------------------------------------------------------
- number of passengers who reported being ill during the voyage out of total number of passengers onboard: 181 of 3102 (5.8 per cent)
- number of crew who reported being ill during the voyage out of total number of crew onboard: 11 of 1148 (0.96 per cent)
- predominant symptoms: vomiting, diarrhea
- causative agent: Norovirus

Actions: in response to the outbreak, Princess Cruise Lines and the crew aboard the ship took the following actions:
- increasing cleaning and disinfection procedures according to their outbreak prevention and response plan;
- making announcements to both notify onboard passengers of the outbreak and encourage case reporting;
- collecting stool specimens from ill passengers and crew for submission to the CDC lab. Samples tested with the vessel's onboard rapid norovirus test were positive for norovirus. The specimens will be sent to the CDC lab for confirmatory analysis;
- making multiple daily reports of gastrointestinal illness cases to the VSP;
- consulting with CDC on plans for: passenger notification procedures and the planned delayed embarkation schedule in Houston, TX on [1 Feb 2014], and disembarkation plans for active cases, and terminal and transport infection control procedures.

Two CDC Vessel Sanitation Program environmental health officers will board the ship in Houston, TX on [31 Jan and 1 Feb 2014] to conduct an epidemiologic investigation, environmental health assessment, and evaluate the outbreak and response activities. Specimens are being collected and will be sent to the CDC lab for testing.
=====================
[ProMED-mail does not normally report outbreaks of norovirus-related gastroenteritis because of their ubiquity during the winter months. (Hence the alternate designation 'winter vomiting bug'). Norovirus infection is very contagious and can be contracted from an infected person, contaminated food or water, or by touching contaminated surfaces. The virus causes acute gastroenteritis with stomach pain, nausea, and diarrhea and vomiting. Anyone can be infected with norovirus and acquire norovirus illness repeatedly throughout life. Norovirus is the commonest cause of acute gastroenteritis in the United States. Each year, it causes 19-21 million cases and contributes to 56 000-71 000 hospitalizations and 570-800 deaths. Norovirus is also the commonest cause of foodborne disease outbreaks in the United States. There's no vaccine to prevent norovirus infection and no drug to treat it.

Norovirus illness is usually not serious. Most people get better in 1 to 3 days. But norovirus illness can be serious in young children, the elderly, and people with other health conditions. It can lead to severe dehydration, hospitalisation but rarely death. Most outbreaks of norovirus illness happen when infected people spread the virus to others. But, norovirus can also spread by consumption of contaminated food or water and by touching contaminated surfaces.

Health care facilities, including nursing homes and hospitals, are the most commonly reported places for norovirus outbreaks in the United States. Over half of all norovirus outbreaks reported in the United States occur in long-term care facilities. Outbreaks of norovirus illness appear to be occurring more frequently in cruise ships and similar environments. - ProMed Mod.CP]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/8vcv>.]
Date: Tue 13 Dec 2011
Source: Virgin Islands Daily News [edited]

The Centers for Disease Control and Prevention [CDC] has linked 5 past cases of Legionnaires' disease -- reported between March 2010 and August 2011 -- with stays at Marriott's Frenchman's Reef and Morning Star Beach Resort and Marriott's Frenchman's Cove [in Saint Thomas], prompting remediation work to the resorts' water systems. The VI [Virgin Islands] Health Department has been "working closely" with a team of CDC specialists to monitor the remediation efforts at the resorts, after an investigation into the 5 past cases, according to a statement the Health Department released Monday [12 Dec 2012].

The illness was found in stateside residents who had been guests at the resorts, said Health Department spokeswoman Eunice Bedminster. They required hospitalization but have since recovered, she said. There have been no reports of employees affected at either site, according to the Health Department statement.

The statement indicates that Frenchman's Reef and Morningstar Beach Resort has hired a consultant who led a cleaning project of the affected areas and treated the water system. Test results show no existence of _Legionella_ bacteria, although the Health Department statement said the test results have not yet been evaluated independently by the CDC.

The Health [Department] had asked the resorts to notify those who could potentially be affected by the bacteria: guests and employees, Bedminster said. The properties asked for an extension on a deadline that had been set, and it was granted, but the deadlines passed last week [week of 5 Dec 2011] without the notification to guests and employees going out, Bedminster said. She did not know if, after the deadline, the properties had made the requested notifications, she said.

The hotel provided The Daily News with a written statement that did not address guest notification: "Marriott takes hotel hygiene and cleanliness very seriously. As soon as we were notified of the possibility of the presence of _Legionella_ bacteria we immediately began to work with the USVI Department of Health (DOH) to address the situation. The Frenchman's Reef and Morning Star Beach Resorts hired a consultant who led a cleaning project of affected areas and the treatment of the water system. The latest test results taken after the implementation of these measures show no existence of _Legionella_ bacteria in the samples tested. We have complied with the recommendations provided by the DOH, and we have successfully addressed the issue at the resort. The DOH has allowed the hotel to remain fully open for business and welcome our guests."

The Daily News spoke with Marriott Frenchman's Reef and Morning Star Beach Resort General Manager Jose Gonzalez Espinosa by phone and asked for comment on the Health Department's assertion that the resort did not make the notifications it was supposed to make by the deadline. Gonzalez would not answer the questions unless they were in writing. The Daily News has a policy against submitting questions in writing because written Q and A stifles and slows follow-up and response. The resort underwent a major renovation during the summer, closing 3 May 2011 and reopening on 6 Oct 2011.

Legionnaires' disease is a pneumonia caused by the _Legionella_ bacteria, which live in warm water supplies, said Dr Lauri Hicks, a medical epidemiologist with the CDC. The bacteria that cause the disease do not pass from person to person. "It really requires exposure to water aerosol that contains _Legionella_," she said, Exposure may occur from showering or with time spent in a whirlpool or hot tub where the bacteria that lead to Legionnaires' disease are present, Hicks said.

Only a fraction of people -- typically those with certain risk factors, such as compromised immune systems -- exposed to the bacteria become ill, she said.

According to the Health Department statement, from 2000 through 2009, a total of 22 418 cases of legionellosis were reported to CDC from the 50 states and the District of Columbia. The CDC informed the Health Department in October [2011] of the 5 Legionnaires' disease cases among past guests at the resorts, and the Health Department asked for the agency's help in investigating. From 18 to 22 Oct 2011, CDC specialists conducted testing, and the properties were alerted about the possible _Legionella_ contamination, Bedminster said. On 3 Nov 2011, the Health Department notified each property of the CDC's conclusive findings and ordered them to immediately work on their water systems, including cleansing, superheating, chlorinating, and hiring a private consultant experienced in eliminating _Legionella_ from building water systems, according to the release. More than 6 weeks later, the Health Department notified the public with the statement it released Monday [12 Dec 2011].

Bedminster said that there had been no delay -- and that remediation work began immediately. "We have worked in good faith with both the resorts during what I have said was a monitoring process. We had some agreed-upon deadlines that had not been met, so we had to let the public know," she said.

Bedminster said that Health Department officials had discussed the possibility of enforcement actions with the Department of Labor and the Department of Planning and Natural Resources to get those deadlines met, but she did not know the outcome of the discussions. "Safeguarding the public's health, including that of employees and guests, from exposure and threats are of the utmost importance to the Department of Health," acting Health Commissioner Mercedes Dullum said in the prepared statement. "DOH will continue to monitor this situation with assistance from the CDC. People should not be discouraged from traveling to or within the US Virgin Islands."  [Byline: Joy Blackburn]
---------------------------------------------
Communicated by:
Denis Green
denis@gatesit.com.au
=======================
[The following has been extracted from the US CDC document Travel-Associated Legionnaires' Disease (<http://www.cdc.gov/legionella/faq.htm>):

"About 20-25 percent of all Legionnaires' disease reported to CDC is travel-associated. Legionnaires' disease is important to diagnose and to report because its identification implies the presence of an environmental source to which other susceptible individuals are likely to be exposed. Clusters of Legionnaires' disease associated with travel to hotels or aboard cruise ships are rarely detected by individual clinicians or health departments; travelers typically disperse from the source of infection before developing symptoms. Therefore, a travel history should be actively sought from patients with community-acquired pneumonia and _Legionella_ testing should be performed for those who have traveled in the 2 weeks before onset of symptoms.

"_Because of the multi-state nature of travel in the US, national-level surveillance is necessary to detect outbreaks of travel-associated Legionnaires' disease. CDC relies upon state and local health departments to conduct this surveillance. Surveillance through the National Notifiable Diseases Surveillance System (NNDSS) is still important for monitoring national trends; all cases should be reported through NNDSS."

"Because of the public health importance of timely reporting, inform CDC of travel-associated cases by emailing about the patient's movements in the 2-10 days before onset."

"Environmental sampling/testing should only be conducted after careful consideration of the epidemiologic evidence linking a case(s) to a particular location."

The following article is linked to the CDC document: Barbaree JM, et al: Protocol for Sampling Environmental Sites for Legionellae. Applied Environmental Microbiol 1987; 53(7): 1454-8 (<http://www.cdc.gov/legionella/files/sampling_protocol1987.pdf>): "Since legionellae not related to disease may be found in many of the sites sampled, an epidemiologic association with the probable source should be established before intervention methods, such as disinfection, are undertaken."

"Random sampling without an epidemiologic evaluation and comparing isolates from the environment and from patients could lead to false conclusions about sources of epidemic strains."

Potential environmental sampling sites for _Legionella_ spp that the CDC document suggests include: internal surfaces of faucets, aerators, and shower heads; and water from incoming water main, holding tanks and cisterns, water heater tanks, decorative fountains, irrigation equipment, fire sprinkler system (if recently used), whirlpools, and spas. Because _Legionella_ may be found in water supplies without linkage to any cases, the actual causative source should be demonstrated by matching the genotype of the environmental isolates with that of any clinical isolates to assure frequently costly corrective measures are carried out on the actual source (<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC86783/>; and <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730281/>).

The Virgin Islands are located in the Leeward Islands of the Lesser Antilles, which form the border between the Caribbean Sea and the Atlantic Ocean. Politically, the eastern islands form the British Virgin Islands and the western ones form the United States Virgin Islands. The US Virgin Islands consist of the main islands of Saint Croix, Saint John, and Saint Thomas (<http://en.wikipedia.org/wiki/United_States_Virgin_Islands >). They can be seen on the HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/1xng>. - ProMed Mod.ML]
Date: Sat 18 Sep 2010
Source: Virgin Islands Daily News [edited]
<http://virginislandsdailynews.com/dengue-outbreak-confirmed-in-1.1018284>

After 19 cases of suspected dengue fever -- and at least one death -- reported in the St Thomas-St John District, the VI Health Department issued a statement Friday [17 Sep 2010] saying that the district is experiencing a dengue fever outbreak. According to the Health Department statement released [Fri 17 Sep 2010], 9 of the 19 suspected cases have been laboratory-confirmed as dengue fever in the St Thomas-St John District since June [2010]. On St Croix, there have been 4 suspected cases with no confirmed cases. There is no requirement in the territory that people with suspected dengue fever undergo testing to confirm whether or not they have the mosquito-borne virus, said Health Department epidemiologist Eugene Tull.

His experience with a 2005 outbreak on St Croix leads him to believe that the number of dengue cases this year [2010] is higher than reported, Tull said, adding that he is now receiving anecdotal information about more cases in the community. According to the release, the strain causing the current outbreak is [dengue virus] type 2, which was responsible for the 2005 outbreak on St Croix.
================
[An interactive HealthMap/ProMED-mail map showing the location of the Virgin Islands in the Caribbean can be accessed at
<http://healthmap.org/r/01tp>. - ProMed Mod.TY]
Date: Fri 27 Aug 2010
Source: Virgin Islands Daily News [edited]
<http://virginislandsdailynews.com/news/dengue-fever-possible-cause-of-death-of-st-john-woman-1.977556>

A St John woman who was transferred last week [week of 16 Aug 2010] to a Miami hospital with possible dengue fever symptoms died there 20 Aug [2010] from complications, her husband said. VI [Virgin Islands] Health Department epidemiologist Eugene Tull said earlier this week [week of 23 Aug 2010] that he had no information about a possible death from dengue fever.

Health Department spokeswoman Eunice Bedminster said Thursday [26 Aug 2010] that the department was not aware of any deaths from the territory's dengue fever cases but had been investigating since receiving inquiries from reporters Monday [23 Aug 2010].

Tull said earlier this week that so far this year [2010], there have been 8 confirmed, laboratory positive cases of dengue fever in the territory, 3 probable cases with lab results pending, and 15 suspected cases. All of those were in the St Thomas/St John District, except for 2 of the suspected cases, which were on St Croix, he said. [Byline: Joy Blackburn]
=====================
[The attribution of the woman's death to dengue virus infection is speculative. ProMED-mail awaits confirmation (or not) as further information becomes available. It is clear, however, that locally acquired dengue virus infections are occurring there.

Maps showing the location of the US Virgin Islands can be accessed at <http://www.worldatlas.com/webimage/countrys/carib.htm>. and the HealthMap/ProMED-mail interactive map at <http://healthmap.org/r/01tp> - ProMed Mod.TY]
More ...

World Travel News Headlines

Date: Fri 17 Jan 2019
Source: Front Page Africa [edited]

The Surveillance Officer of Grand Bassa County Health team has confirmed to FrontPage Africa that there is a Lassa fever outbreak in District 4, Grand Bassa County leading to 3 deaths and 20 others confirmed infected with the virus.

Gabriel B. Kassay said over 60 specimens were taken to Monrovia for testing as a result of the outbreak.  "Out of the 60 plus, over 20 specimens were confirmed affected with Lassa fever," he said, adding that 3 persons have died from the disease at the Liberia Agricultural Company (LAC) concession area in Wee Statutory District.

Kassay said there were several incidents of Lassa fever in the LAC plantation area in 2019.  "According to the Liberia health law, one confirmed case of Lassa fever is considered an outbreak, and so since August 2019, there have been lots of people affected in the LAC area," he said while expressing concern that "the lack of awareness is a major factor" for the frequent cases of the virus in the county.  "The Grand Bassa Health Team has been very instrumental in helping to curtail the spread of the disease in the affected area, but there is a need for awareness in the entire county."

Kassay said the spread of Lassa fever might increase if the citizens are not trained to know the cause and effects of Lassa fever.
=====================
[The number of cases has increased from 9 on 2 Dec 2019 (See Lassa fever - West Africa (43): Liberia http://promedmail.org/post/20191207.6828798) to 20 confirmed cases now. The reported number of deaths remains at 3. The previous ProMED-mail post (see Lassa fever - West Africa (31): Liberia http://promedmail.org/post/20190902.6653653) reported that according to MoH data, a total of 92 suspected cases between 1 Jan-25 Aug 2019, including 21 deaths, have been reported. Of these, 25 cases have been confirmed by RT-PCR (Nimba (9), Bong (10), Grand Bassa (5), and Grand Kru (1)), while 9 remain suspected cases, the release recorded. The case-fatality rate among confirmed cases in that report was stated as 36% (9 deaths out of 25 confirmed cases). Males are mostly affected by the disease (56%) of confirmed cases as compared to females.

Occurrence of Lassa fever cases in areas outside the usual "Lassa fever belt" is of concern, and the Ministry of Health is wise to increase public information and advize citizens about measures that should be taken to avoid infection with the virus. Occurrence of Lassa fever in Liberia is not new, and cases have occurred there sporadically for several years. Between 1 Jan and 27 Jun 2018, 20 cases were laboratory confirmed (see archive no. http://promedmail.org/post/20180711.5898495). Apparently, all those Lassa fever virus infections were acquired by contact with infected rodents or their excretions. Lassa fever virus can be acquired from infected rodents or patients in the hospital. Transmission can occur in health facilities when personal protective equipment is not employed or barrier-nursing practices or biocontainment facilities in the laboratory are not adequate to protect staff from blood and secretions of infected patients.

As mentioned in previous posts, Lassa fever virus transmission to humans occurs when people are in contact with the reservoir rodent host, the multimammate mouse (_Mastomys natalensis_ and _M. erythroleucus_) and the African wood mouse (_Hylomycus pamfi_) or their excreta, as was likely the situation in many of these cases. Rodent control has to be undertaken at the village level with individual households employing the preventive measures listed above. This requires an extensive and continuous public education effort.

Images of the _Mastomys natalensis_ mouse, the rodent reservoir of Lassa fever virus, can be seen at
_M. erythroleucus_ and _Hylomycus pamfi_ at

Date: Sun 19 Jan 2019
Source: Outbreak News Today [edited]

With the arrival of summer when the occurrence of diseases transmitted by mosquitoes, such as yellow fever, increases, the Brazilian Ministry of Health is alerting the population to get vaccinated against the disease.  The alert is mainly focused on the population that lives in the South and Southeast regions of the country due to the confirmation of 38 monkey deaths in the states of Parana (34), Sao Paulo (3), and Santa Catarina (1). In total, 1087 reports of suspected monkey deaths were recorded in the country.

The alert is given because the regions have a large population and a low number of people vaccinated, which directly contributes to the cases of the disease.

The target public for vaccination is people from 9 months of age and 59 years of age who do not have proof of vaccination.

Regarding human cases, 327 suspected yellow fever cases were reported in the same period, of which 50 remain under investigation and one has been confirmed.

The yellow fever vaccine is offered in the National Vaccination Calendar and distributed monthly to the states. In 2019, more than 16 million doses of the yellow fever vaccine were distributed throughout the country. Despite this availability, there is a low demand from the population for vaccination. For 2020, the portfolio acquired 71 million doses of the vaccine, enough to serve the country for more than 3 years.

In 2020, the Ministry of Health will gradually expand yellow fever vaccination to 1101 municipalities in the Northeast states that were not yet part of the vaccination recommendation area. Thus, the whole country now has a vaccine against yellow fever in the routine of services.

Another change in the calendar was that the children started to have a booster vaccine at the age of 4. The decision came because recent scientific studies have shown a decrease in the child's immune response, which is vaccinated very early, at 9 months, as predicted in the child's National Vaccination Calendar. Since 2017, the Ministry of Health has followed the guidelines of the World Health Organization (WHO) to offer only one dose of the yellow fever vaccine in a lifetime.
=========================
[The current expansion of yellow fever in South America raises concern for public health and also about potential conservation problems for susceptible non-human primate species in the continent. Yellow fever virus was introduced into the Americas approximately 400 years ago, yet the complex interactions that were established after its introduction are far from being elucidated. There is a need for more research on the eco-epidemiology of the disease in the continent, especially in the presence of the persistent anthropogenic global environmental change. - ProMED Mod.PMB]

[HealthMap/ProMED-mail map of Brazil:
Date: Sat 18 Jan 2020 03:15 WAT
Source: Actualita [in French, machine trans., edited]
<https://actualite.cd/2020/01/18/rdc-une-maladie-inconnue-fauche-des-vies-kiri-5-morts>

An unknown disease has already killed 5 people at Kiri General Hospital, in the province of Mai-Ndombe, in the west of the Democratic Republic of the Congo (DRC), according to the authorities. The provincial minister of public health has said that all measures are underway to detect [diagnose?] the mysterious disease. "Admittedly, this was an abnormal situation; however, the situation is manageable because we have just gone into this health facility and we have tried to carry out investigations. My collaborators and I took some samples which have quickly been sent to the National Institute for Biomedical Research (INRB) in Kinshasa for the appropriate medical tests which can give us accurate [diagnosis] on this abnormal situation," declared the minister Jean Claude Bola. First, added the same official, "it is not an Ebola epidemic, contrary to the rumour circulating in the Kiri territory and in the social networks."

In an exclusive interview with actualita.cd, the provincial authority also confirmed the deaths. "However, I warn all those who broadcast through the various media and social networks that there is Ebola in Mai-Ndombe that they have neither qualification nor competence to do so, because the only authority having jurisdiction in the provinces to declare an epidemic is the provincial governor," declared Paul Mputu Boleilanga. "Severe and disciplinary sanctions will be reserved against usurpers of power," he threatened. According to provincial authorities, a team from the National Institute of Biomedical Research (INRB), a team is expected in the Kiri territory for "rapid" management of all patients and to determine the disease underlying deaths in this region.
=============================
[Other than the number of deaths and the geographical location of the cases there is no additional information to permit reasonable speculation as to the aetiology or dates of illnesses. ProMED Mod.MPP noted that Ebola denial leads one to suspect this is a viral haemorrhagic fever.

Laboratory tests should confirm or rule out diseases such as yellow fever or Lassa fever. However, there is no indication that these cases are due to a virus or other infectious agent. Toxicants should also be ruled out. Additional information about these or new cases would be appreciated. - ProMED Mod.TY]

[Maps of DR Congo: <http://goo.gl/DM2AT8> and
<http://healthmap.org/promed/p/194> and
<http://healthmap.org/promed/p/65284>]
Date: Fri, 17 Jan 2020 17:48:09 +0100 (MET)

Barcelona, Jan 17, 2020 (AFP) - Spain's Balearic Islands passed a bill Friday aimed at clamping down on alcohol-fuelled holidays in the Mediterranean archipelago which bans happy hours when drinks are offered a discount and open bars.   "This is the first law adopted in Europe which restricts the sale and promotion of alcohol in certain touristic areas," the regional government of the Balearic Islands which have long been a magnet for young German and British tourists, who often drink heavily and enjoy rowdy late-night clubbing.

The restrictions will apply to three areas with a reputation for excess: San Antoni on the island of Ibiza and El Arenal and Magaluf -- which has been nicknamed "Shagaluf" because of its reputation for drunken casual sex -- on Mallorca, the largest of the Balearic's four islands.   The law, which was drawn up in consultation with the tourism industry also bans pub crawls and two-for-one drink offers, prohibits the sale of alcohol in shops between 9:30 pm and 8 am and forbids advertising party boats in the designated areas.   Establishments that break the new rules risk fines of up to 600,000 euros ($669,000) and the threat of being closed down for three years.

The new law also takes aim at the so-called "balconing" craze, the term given to holidaymakers who decide to jump into a swimming pool from a hotel or apartment balcony, a stunt which claims several lives every year.   It bans "balconing" across the entire archipelago and requires hotels to evict anyone who does it. Those caught jumping from balconies face fines of up to 60,000 euros ($67,000).   Up until now only some resorts on the Balearics imposed fines for "balconing".

The regional government of the Balearics said the law, which stiffens measures already introduced in 2015, will "fight excesses in certain tourist zones" and "force a real change in the tourism model of those destinations".   Magaluf made global headlines in 2014 after a video showing a young woman performing oral sex on several men on the dance floor of a nightclub went viral.   Local shops sell souvenir T-shirts with the catchphrase "On it 'till we vomit".

The four islands which make up the Balearics -- Palma de Mallorca, Ibiza, Menorca and Formentera, received nearly fourteen million tourists in 2018, drawn by their crystal clear waters, and in many cases by all-inconclusive package holidays.   The archipelago is Spain's second most visited region. Spain is the world's second most visited country after France.
Date: Fri, 17 Jan 2020 12:55:16 +0100 (MET)

Rennes, France, Jan 17, 2020 (AFP) - Several oyster farmers along France's Atlantic and Mediterranean coasts have been forced to halt sales since December after their sites were contaminated by the highly contagious norovirus, which they blame on overflowing sewage treatment plants.   Authorities ordered the suspensions at 23 of the country's 375 designated fields, and recalls of affected oysters as well as mussels and clams, after tests revealed the virus, which can cause severe vomiting and diarrhoea.

The move came just before the year-end holidays, when oysters are a traditional delicacy on millions of French tables.   "The oysters are not sick. They're carrying the virus because it's in the water they are constantly filtering," Philippe Le Gal, president of France's national shellfish council (CNC), told AFP this week.   "They were in the wrong place at the wrong time," he said, adding the ban had prompted many people to stop eating oysters altogether.   Local officials say oyster farmers are paying the price of insufficient spending on wastewater treatment, with facilities strained to the limit even as development of coastal areas has surged in recent years.

Heavy rains before Christmas prompted treatment basins to overflow, they say, spilling tainted water into rivers.   "This was predictable -- they've kept issuing building permits even though treatment sites are already at full capacity," said Joel Labbe, a senator for the Morbihan region in Brittany.   Oyster farmers are demanding compensation, and a delegation met with agriculture ministry officials in Paris last week warning that more than 400 businesses had been impacted by the sales ban.

This week, angry growers dumped trash bins full of oysters and mussels in front of the offices of the regional ARS health authority in Montpellier over the decision to halt sales from a nearby basin on the Mediterranean coast.   "We're the victims, and we shouldn't have to suffer any financial damages," Le Gal said.
Date: Fri, 17 Jan 2020 04:44:41 +0100 (MET)

Suva, Fiji, Jan 17, 2020 (AFP) - Fiji opened evacuation centres and warned of "destructive force winds" Friday as a cyclone bore down on the Pacific island nation for the second time in three weeks.   Two people were missing after attempting to swim across a swollen river late Thursday when heavy rain fell ahead of the advancing Cyclone Tino, police said.   On the outer islands, locals prepared to go to emergency shelters while many tourists fled beach resorts and made their way to the capital Suva before regional flights and inter-island ferry services were suspended.

The Fiji Meteorological Service said Tino was strengthening as it headed for Fiji's second-largest island, Vanua Levu, warning of wind gusts of up to 130 kilometres per hour (80 mph), heavy rain, coastal flooding and flash flooding in low lying areas.    "I'm preparing to go to an evacuation centre soon with my family and wait for the cyclone to pass," Nischal Prasad, who lost his home in northern Vanua Legu when Cyclone Sarai struck just after Christmas, told AFP.   "Sarai destroyed my house and almost left my family homeless. My daughters had to hide under their bed from the strong winds. It was a scary experience," he said.

Russian tourist Inna Kostromina, 35, said she sought safety in Suva after being told her island resort was in the path of the cyclone.   "We didn't want to get stuck in there and with the authorities warning of coastal flooding, anything can happen. So we decided to move to Suva for now. I think we will be much safer here."    Police said a man and his daughter, believed to be aged nine or 10, were attempting to swim across a flooded river when they were caught in the strong currents.    The incident happened on Thursday before the storm developed into a tropical cyclone, but a police spokesman linked the tragedy to "heavy rain brought about by the current weather system (which) raised the river level".   Although the Pacific islands are popular tourist destinations in summer it is also the cyclone season, and Fiji is being targeted for the second time in three weeks.

In late December, Tropical Cyclone Sarai left two people dead and more than 2,500 needing emergency shelter as it damaged houses, crops and trees and cut electricity supplies.    On its present track, Tino would hit Tongatapu, the main island of neighbouring Tonga, on the weekend.    Two years ago, Tongatapu was hit by Cyclone Gina, with two people killed and nearly 200 houses destroyed.
Date: Thu, 16 Jan 2020 16:38:39 +0100 (MET)
By Hiroshi HIYAMA

Tokyo, Jan 16, 2020 (AFP) - Japan has confirmed a case of a mystery virus that first emerged in China and is from the same family as the deadly SARS pathogen, authorities said Thursday.   It appears to be only the second time the novel coronavirus has been detected outside China, after the World Health Organization (WHO) confirmed a case in Thailand.   Japan's health ministry said a man who had visited the central Chinese city of Wuhan, the apparent epicentre of the outbreak, was hospitalised on January 10, four days after his return to Japan. He reported a persistent fever.

Tests on the patient, who was released from hospital on Wednesday, confirmed he was infected with the new virus.   "This is the first domestic discovery of a pneumonia case related to the new coronavirus," the ministry said in a statement.   "We will continue active epidemiological research while also coordinating efforts with the World Health Organization and related agencies to conduct a risk assessment."   The outbreak has killed one person so far, with 41 patients reported in Wuhan.

The outbreak has caused alarm because the new virus is from the same family as the pathogen that causes SARS (Severe Acute Respiratory Syndrome), which killed 349 people in mainland China and 299 in Hong Kong in 2002 and 2003.   Authorities in Wuhan said a seafood market was the centre of the outbreak. It was closed on January 1.   Japanese authorities said the man had not visited the market and that it was possible he had been in contact with a person infected with the virus while in Wuhan.

- Outbreak in Japan 'unlikely' -
Health ministry official Eiji Hinoshita told reporters that the risk of the disease spreading from the patient was considered low, with careful checks done on those who had been in close contact with him.   "At this point, we feel it is unlikely this will lead to a dramatic outbreak," he said, adding that the patient was no longer suffering a fever and was recuperating at home.

Officials declined to give further information on the man, including his nationality, citing privacy concerns.   Local media said the patient was a Chinese national in his 30s living in Kanagawa, just southwest of Tokyo.   Public broadcaster NHK said he had already recovered and was resting at home, as quarantine officials at Tokyo's Narita airport boosted health checks on all travellers.

The health ministry urged people who develop a cough or fever after visiting Wuhan to wear a surgical mask and "swiftly visit a medical institution".   Hinoshita said Japan would need to be on guard ahead of the Lunar New Year, a popular travel period in China.   "It is expected that Japan will see many visitors from China," he said.   It is not yet clear whether the mystery virus can be transmitted between humans, but on Wednesday authorities said it was possible it had spread inside a family.

The woman diagnosed in Thailand, who is in a stable condition, also said she had not visited the Wuhan seafood market.   And WHO doctor Maria Van Kerkhove on Tuesday said she "wouldn't be surprised if there was some limited human-to-human transmission, especially among families who have close contact with one another".   Hong Kong authorities on Tuesday said several dozen people had been hospitalised with fever or respiratory symptoms after travelling to Wuhan, but no cases of the new virus have so far been confirmed.
Date: 20 Jan 2020
Source: News Joins [In Korean, machine trans. edited]
----------------------------
An unexplained pneumonia in China caused the Korean quarantine authorities to strengthen the quarantine, and a fever-sensing camera is installed to monitor the body temperature of Chinese tourists who entered Korea at Incheon Port 1 International Passenger Terminal. 

Pneumonia confirmed by the new coronavirus, which is prevalent in Wuhan, China, was confirmed for the first time on [20 Jan 2020]. According to health officials, a Chinese woman, A, who arrived at Incheon International Airport on a plane from Wuhan last weekend, was confirmed with pneumonia. The patient showed signs of pneumonia, including high fever and cough. The health authorities entered the airport at the same time, confirmed the symptoms of high fever, suspected pneumonia, and went into quarantine and testing. The Centers for Disease Control immediately quarantined A and entered treatment with a nationally designated quarantine bed. The Centers for Disease Control will hold an emergency press conference at 1:30 pm on [20 Jan 2020] and release the reporter A.
 
Meanwhile, Beijing's Daxing District Health and Welfare Committee said 2 fever patients who had been to Wuhan were confirmed as a new pneumonia patient on [19 Jan 2020]. They are currently being treated at a designated hospital and said they are stable. Daxing District is where Beijing New Airport opened last year [2019]. The Guangdong Provincial Health and Welfare Committee said on [19 Jan 2020] that a 66-year-old man who had visited a relative's home in Wuhan showed fever and lethargy and was diagnosed with Wuhan pneumonia. Confirmation patients have also emerged in Shenzhen, a neighbouring Hong Kong province in southern China, raising concerns that the new pneumonia has already spread throughout China.
 
The Chinese government has said that "there is no basis for human-to-human propagation," but domestic experts pointed out that "the nature of coronavirus is less likely to prevent human-to-human propagation."   [Byline: Esther Toile]
========================
[This is now the 4th international identification of the 2019-nCoV (novel coronavirus) associated illness reported outside of China.  To date, all 4 cases have reported being in Wuhan China in the 14 days preceding onset of illness.  Illness in each involved a history of fever and dry cough.  Cases were reported by Thailand (2 cases) and Japan, and now South Korea.  An update following a Ministry of Health Korea press conference mentioned that there were 5 individuals accompanying this woman, none of whom were currently showing symptoms. (<http://news1.kr/articles/?3821049>).

As mentioned in an earlier post (see Novel coronavirus (10): China (HU, GD, BJ) http://promedmail.org/post/20200119.6898567), there have also been cases confirmed in China outside of Wuhan City, with cases reported in Beijing, Guangdong and possibly Shanghai. It is becoming more difficult to conclude that there has been limited person-to-person transmission as the case numbers are climbing both inside of Wuhan City, elsewhere in China, and in individuals travelling from Wuhan China to other countries (Japan, Thailand and South Korea).

A map of South Korea can be found at:
Date: 15 Jan 2020
Source: Fox News [edited]

CDC is facing criticism over its response to a polio-like illness. The Centers for Disease Control and Prevention has confirmed 10 additional cases of acute flaccid myelitis.  An Ohio teen is determined to walk again despite doctors' warnings that she may not after she contracted a rare polio-like illness that's left her paralyzed from the waist down.  IK, a catcher on her middle school's softball team, said it started with what felt like a cramp in her leg on Christmas. "I just thought, 'Oh gosh, it's just growing pains or a Charley horse,'" NK, the 13-year-old's mother, told News 5 Cleveland.  But the next day, IK couldn't stand on her own, and her worried parents rushed her to Akron Children's Hospital, where she was diagnosed with acute flaccid myelitis (AFM). It's a rare but serious condition that affects the nervous system, specifically the grey matter of the spinal cord, which weakens the body's muscles and reflexes.

Health officials have noticed an increase of cases in children occurring every 2 years since 2014, according to the Centers for Disease Control and Prevention (CDC). And while it often is referred to as a "polio-like" illness, tests so far have tested negative for poliovirus.  Symptoms typically begin with sudden onset of arm or leg weakness and loss of muscle tone and reflexes, but can also include facial droop or weakness, difficulty moving eyes, drooping eyelids, difficulty swallowing,  slurred speech, and pain in the arms and legs.  Severe symptoms may include respiratory failure, or serious neurological complications, according to the CDC. Parents are encouraged to seek medical care right away if a child is suspected of developing any symptoms

Since her diagnosis, IK has been working in physical therapy and has received steroid treatments as well as multiple plasma exchange, according to the news outlet. Her mother said it's been like "a bad dream" for the family as they watch her struggle to gain strength.  "It's a lot, but I just try to go with the flow, just to push through," IK, who has received support from her teammates, classmates and members of the community, told News 5 Cleveland.  [Byline: Alexandria Hein]
======================
[Acute flaccid myelitis (AFM) is a rare but serious condition. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak.

In 2019, there were 33 total confirmed cases in 16 US states
[<https://www.cdc.gov/acute-flaccid-myelitis/cases-in-us.html>].

The case definition for AFM is based on clinical and lab criteria

Clinical Criteria: An illness with onset of acute flaccid limb weakness.
Laboratory Criteria:
Confirmatory Laboratory Evidence: a magnetic resonance image (MRI) showing spinal cord lesion largely restricted to grey matter and spanning one or more vertebral segments. Supportive Laboratory Evidence: cerebrospinal fluid (CSF) with pleocytosis (white blood cell count over 5 cells/mm3) Case Classification:
- Confirmed: Clinically compatible case AND Confirmatory laboratory evidence: MRI showing spinal cord lesion largely restricted to grey matter and spanning one or more spinal segments.
- Probable: Clinically compatible case AND Supportive laboratory evidence: CSF showing pleocytosis (white blood cell count over 5 cells/mm3)

With the high number of cases reported in 2018 and 2019, CDC enhanced AFM surveillance through collection of data at the national level by encouraging healthcare providers to recognize and report to their health departments all patients whom they suspect may have AFM; health departments are being asked to send this information to CDC to help us understand AFM activity nationwide. - ProMED Mod.UBA]

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Date: Sat 18 Jan 2020
From: Guido Calleri <guidocalleri@aslcittaditorino.it> [edited]

90 persons presented to the Infectious Diseases Hospital Amedeo di Savoia, Torino, North-West Italy between 24 Dec 2019 and 10 Jan 2020 after consuming raw sausages from a wild boar hunted in the area of Susa Valley, 50 km [31.1 mi] away from Torino, in late November 2019.

All of them either were symptomatic (fever, muscle and/or abdominal pain, nausea) or had peripheral blood eosinophilia over 500/cmm, or both. IgG serology for trichinella was performed by immunoblot (Trichinella E/S IgG kit, EFFEGIEMME, Milan, Italy) and resulted positive in 48/90 (53.3%), allowing a diagnosis of confirmed trichinella infection.

Otherwise, a diagnosis of suspected trichinella infection was made with a negative serology, probably due to performing the test too early, before the development of antibodies or possibly a false negative result. In a few cases (under 10 cases) an alternative diagnosis was considered.

All patients were treated with oral albendazole 400 mg twice daily for 10 days and prednisone 50 mg/day.

Most likely, all patients were infected after eating meat from a single animal, given the low prevalence of the infection in this area: no human case has ever been detected in Torino province, and only one wild boar has been found positive for trichinella at microscopy in Susa valley in the last 10 years.
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Guido Calleri, Filippo Lipani, Giovanna Paltrinieri, Silvia Faraoni,
Valeria Ghisetti
ASL Citta di Torino, Infectious Diseases Unit and Microbiology Lab,
and ASL TO3,
Department of Prevention
Torino, Piedmonte, Italy
======================
[ProMED thanks Guido Calleri, Filippo Lipani, Giovanna Paltrinieri, Silvia Faraoni, and Valeria Ghisetti for sending us this information. The report underlines that _Trichinella_ are found in wild boars in Europe and should be assessed by a certified laboratory for _Trichinella_ before used for human consumption. Sausages made of smoked meat are especially dangerous, because the temperatures seldom reach what is needed to kill the trichinella larvae. - ProMED Mod.EP]

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