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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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Kyrgyzstan

Kyrgyzstan Republic - US Consular Information Sheet
August 29, 2008
COUNTRY DESCRIPTION:
The Kyrgyz Republic, a mountainous country of five million people, is undergoing political and economic change. Tourist facilities are not highly deve
oped, and many of the goods and services taken for granted in other countries are not yet widely available. Read the Department of State Background Notes on the Kyrgyz Republic for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. American citizens can obtain a one-month single-entry, non-extendable tourist visa upon arrival at the “Manas” International Airport outside Bishkek for a $36 fee without invitation or sponsorship. Newly enacted legislation requires that all foreigners present in the Kyrgyz Republic for more than sixty days register with the Kyrgyz Department of Visa and Passport Control. Failure to do so may cause difficulties when exiting the country. Individuals traveling to Kyrgyzstan to perform religious work or work in affiliation with any religious organization in any capacity are required by Kyrgyz law to declare so on their visa applications. Failure to do so may lead to difficulties with local law enforcement as it is considered a violation of Kyrgyz law to engage in activities not matching the purpose of travel indicated on an individual’s visa. In general, travelers should apply for the correct category of visa for their purpose of travel. Travelers cannot obtain a tourist visa at land borders or other airports. American citizens visiting the Kyrgyz Republic are not required to register with the Office of Visas and Registration. The Embassy recommends that Americans traveling in the Kyrgyz Republic also obtain Kazakh visas, as commercial air travel out of the Kyrgyz Republic is limited and Americans may need to travel through Kazakhstan to return to the United States. For further information regarding entry/exit requirements, contact the Embassy of the Kyrgyz Republic at 2630 Massachusetts Avenue, NW, Washington, DC 20008, telephone: (202) 338-5141, fax: (202) 742 6501. Visit the Embassy of the Kyrgyz Republic web site at http://www.kgembassy.org/ for the most current visa information.

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

SAFETY AND SECURITY:
The Department of State urges U.S. citizens to avoid all travel to rural areas along the Kyrgyz-Uzbek and Kyrgyz-Tajik borders, and all areas to the south and west of the provincial capital of Osh. Security conditions in these parts of the southern Kyrgyz Republic differ from security conditions in the north, and the threat of violence against foreigners in the southern Kyrgyz Republic continues. Hostage-taking incidents involving foreigners occurred during the summers of 1999 and 2000, including one incident in the summer of 2000 involving American citizens. In 2007, there were reports of attempted “bride-kidnappings” in rural areas. While foreigners are not believed to be intentional targets, an American female was held against her will for several days in one reported incident. In 2006, suspected militants attacked a border post on the Kyrgyz-Tajik border, and ensuing skirmishes took place between the militants and Kyrgyz military forces throughout the southern Batken region. Land mines in Batken Oblast and near the Kyrgyz-Tajik border continue to be a concern. There are currently restrictions for U.S. Government employees traveling to areas of the Kyrgyz Republic south and west of Osh and in rural areas along the Kyrgyz-Uzbek border because of the volatile security situation in these areas.
Supporters of extremist groups such as the Islamic Movement of Uzbekistan (IMU), the Islamic Jihad Union (IJU), al-Qaeda, and the Eastern Turkistan Islamic Movement remain active in Central Asia. These groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests in the region, including in the Kyrgyz Republic. Terrorist attacks involving the use of suicide bombers have previously taken place in neighboring Uzbekistan. Terrorists do not distinguish between official and civilian targets. Because of increased security at official U.S. facilities, terrorists are seeking softer civilian targets such as residential areas, clubs and restaurants, places of worship, hotels, schools, outdoor recreation events, resorts, beaches, maritime facilities, airports and aircraft.
In 2005-2007, there were several large-scale demonstrations and protests. Demonstrations in Bishkek have occurred in front of the Presidential Administration building (White House) and on Alatoo Square in the city center. The Embassy does not always have advance information regarding new demonstrations. Therefore, all Americans are reminded to remain vigilant and are urged to avoid the vicinity of all protests, because even protests that are intended to be peaceful can turn confrontational and possibly escalate into violence.
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 pamphletA Safe Trip Abroad.
CRIME: The U.S. Embassy advises U.S. citizens to exercise caution in urban areas of the Kyrgyz Republic due to the high rate of violent crime against foreigners. Travelers arriving at Manas International Airport should arrange their transportation from the airport in advance. Foreign travelers have been the victims of extortion by airport taxi drivers, who appeared in some cases to be colluding with airport personnel to identify their victims. Travelers should not take public transportation or walk after dark, and should be extremely cautious in or near hotels, bars, parks and all places that attract an expatriate clientele. The Kyrgyz Republic has a high rate of violent crime due to unemployment and a large number of organized gangs. Muggings often occur after dark and can be quite violent, leaving the victim severely injured. Other common crimes include auto theft, mugging, and pick pocketing in crowded places such as markets, Internet cafes and on public transportation. U.S. citizens have been the victims of such crimes as rape, assault, kidnapping and robbery while in urban and rural parts of Kyrgyzstan, and there have been reports of U.S. citizens who were robbed by groups of young men who had followed them back to their residences from hotels and bars. Police officers rarely speak English and no victims’ assistance programs are available. Medical and psychiatric care for victims is limited.
Harassment and extortion by people who purport to be Kyrgyz police officers are common. According to Kyrgyz law, any person claiming to be a police officer must show identifying documents on demand. U.S. citizens should not act upon requests by people, whether in civilian dress or in police uniform, if they have no official identification. Also U.S. citizens should not get into cars with someone they do not know, even if the person claims to be a police officer.

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

The local equivalent to the “911” emergency lines in Kyrgyzstan are: 101 for fire; 102 for police;
103 for first aid ambulance (state-funded); 151 (from landline), 0 312 684466 (from landline or cellphone); and 161 for rescue service (under the Ministry of emergency situations.)

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical services in the Kyrgyz Republic are extremely limited. Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities. The U.S. Embassy strongly recommends that travelers to the Kyrgyz Republic carry medical evacuation insurance in case of emergency. The Consular Section of the U.S. Embassy in Bishkek maintains a list of foreign-trained and local physicians who have agreed to give medical assistance to Americans. This list is available on the Embassy web site at http://bishkek.usembassy.gov.
Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of Kyrgyzstan. There is no legal requirement for HIV/AIDS testing during the visa application or registration process. Kyrgyz law does state that if a foreign citizen refuses to submit to HIV/AIDS testing when requested while in Kyrgyzstan, that person could be deported. Please verify this information with the Embassy of Kyrgyzstan at http://www.kgembassy.org before you travel.

Tuberculosis is an increasingly serious health concern in Kyrgyzstan. For further information, please consult the CDC's Travel Notice on TB available at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.

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 Kyrgyz Republic is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Most of the Kyrgyz Republic’s road infrastructure consists of two-lane roads, which are all in various states of disrepair, and are poorly marked and lit. Many local drivers tend to disobey fundamental traffic laws – such as stopping at red lights. As a result, driving can be very dangerous. Accidents involving severe injury and/or death are not uncommon.
Drivers must exercise particular caution to avoid uneven pavement, potholes and open drains and manholes. Night driving should be avoided, as roads are inadequately lit. In winter, roads are seldom plowed and ice and snow make the poor driving conditions even more hazardous. Pedestrians routinely walk in the road, often wearing dark clothes at night, necessitating even greater caution for drivers. Mountain roads in the Kyrgyz Republic are often narrow and treacherous, and may close without notice due to snow, ice or rockslides. Guardrails and barriers preventing falling rocks are often missing. The Kyrgyz Republic does not have a roadside assistance infrastructure. Towing companies do not exist. Although mechanics are available in cities there is little organized oversight or certification of their practices or abilities. Rest areas are infrequent and very primitive. Service stations are generally available in and near cities, but the fuel they provide may be adulterated or of poor quality.
The road between Almaty, Kazakhstan and Bishkek, Kyrgyz Republic, is especially treacherous at night or during poor weather. Americans and other travelers have been killed in traffic accidents on that road, and travel at night is not recommended.
Generally, speed limits are 60 km per hour in the cities and 90 km per hour in rural areas. Kyrgyz law mandates that all automobile passengers wear seat belts and that motorcycle riders wear helmets. International driving permits are recognized in the Kyrgyz Republic.

Drivers may face harassment by traffic police, who have been known to demand payment for arbitrary "fines" for purported infractions.

The Kyrgyz Republic has a "zero tolerance" policy for driving under the influence of alcohol.
Public transportation in the Kyrgyz Republic is limited to buses, taxis, and very few intercity trains. Travelers should be particularly careful when using public transportation. Buses tend to be very crowded and can be unsafe and unreliable. Taxis too can be dangerous. Due to the danger of theft or assault, travelers should avoid entering a cab that already contains passengers. Taxis are seldom metered, and travelers should negotiate a fare prior to entering a cab and be aware that cab drivers often try to charge foreigners a high fare. Drivers of vehicles that are not taxis are often willing to drive people for fares. However, U.S. citizens should avoid using any of these "private taxis" and unmarked taxis.

Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office and national authority responsible for road safety at insert site here.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in the Kyrgyz Republic, the U.S. Federal Aviation Administration (FAA) has not assessed the Kyrgyz Republic’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Kyrgyz customs authorities may enforce strict regulations concerning temporary importation into or export from the Kyrgyz Republic of items such as antiquities or hunting trophies. It is advisable to contact the Embassy of the Kyrgyz Republic in Washington at 2630 Massachusetts Avenue, NW, Washington, DC 20008, telephone: (202) 338-5141, fax: (202) 742 6501 or at http://www.kgembassy.org/ for specific information regarding customs requirements.
The Kyrgyz Republic is a cash-only economy. The banking system is not well developed. ATMs are available, but the security of these machines remains untested. A hotel or bank may, on occasion, accept traveler’s checks or credit cards, but the fees can be as high as 20 percent for traveler’s checks.
U.S. citizens are encouraged to carry a copy of their U.S. passport with them at all times, so that, if questioned by local officials, proof of identity and citizenship are readily available.

In accordance with the Vienna Convention on Consular Relations and certain bilateral treaties, a consular officer from the U.S. Embassy must be given access to any U.S. citizen arrested in the Kyrgyz Republic. U.S. citizens who are arrested or detained should ask that the U.S. Embassy be contacted immediately. This is generally recognized, though there can be a sizeable delay in notification times depending on the local authorities’ interpretation of the case’s legal status.
The Kyrgyz Republic is an earthquake-prone country. 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.
Hunting and trekking are popular sports for locals and tourists in the Kyrgyz Republic; however, American citizens traveling to the Kyrgyz Republic should know that hunting in the Kyrgyz Republic without proper licenses is illegal. It is illegal to import or own firearms in the Kyrgyz Republic without a permit issued by the Kyrgyz government. Foreign hunters who do not have official permission to hunt or take trophies out of the country may face criminal and civil charges. Both hunting and trekking infrastructures are underdeveloped with limited services, especially in the high mountainous regions popular with trekkers and hunters. Avalanches and landslides are common in these mountainous regions, often cutting off villages for weeks at a time. These villages and hunting areas are in isolated, rugged, mountainous areas inaccessible by the limited rescue services available in the Kyrgyz Republic. Americans traveling to the Kyrgyz Republic to hunt or trek need to be aware of the risks involved. The Embassy recommends that all Americans register with the Embassy in Bishkek for the duration of their stay in the country.
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 Kyrgyz Republic’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in The Kyrgyz Republic 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 Kyrgyz Republic 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 the Kyrgyz Republic. Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy in Bishkek is located at 171 Prospect Mira, 720016 Bishkek, Kyrgyz Republic. The phone number is 996-312-551-241, fax: 996-517-777-202, and web site: http://bishkek.usembassy.gov
* * *
This replaces the Country Specific Information for the Kyrgyz Republic Dated January 8, 2008, to update sections on Country Description, Entry/Exit Requirements, Crime, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Wed 9 Jan 2019
Source: AKIpress [abridged, edited]

A total of 722 cases of measles have been registered since the beginning of 2018 in Kyrgyzstan compared with one case in January through November 2017, the National Statistics Committee reports.

[Full story is available only by subscription.]
=====================
[HealthMap/ProMED-mail map:
Date: Wed 21 Nov 2018 14:26 KGT
Source: Kazakh Telegraph Agency (KazTAG] [edited]

KyrTAG [Kyrgyzstan Telegraph Agency] reports 2 people have been hospitalized in the Jalal-Abad region with anthrax assumption. "2 inhabitants of Suzak district have been hospitalized with anthrax assumption. The lab tests made in Jalal-Abad have shown a negative result, we sent the analysis to Osh for a repeated research," said Usen Zhorobayev, head of center of state sanitary-epidemiological surveillance of the Suzak district. In his words, the hospitalized men had been butchering a cow. The patients are in satisfactory condition
=============================
[To find Suzak in western Kyrgyzstan, go to:
<http://www.fallingrain.com/world/KG/03/Suzak.html>.

For a description of Jalal-Abad region, go to

Outbreaks in Jalal-Abad are an overflow of infection from the enzootic state of this disease in the adjoining Fergana Valley of Uzbekistan. Jalal-Abad is in western Kyrgyzstan at the head of the Fergana Valley. The Fergana Valley is rife with livestock anthrax. Without a coordinated vaccination-control program between the 2 countries in this region, we will continue to see outbreaks there. In spite of an initial negative test result, not uncommon with human cases, the authorities are assuming a greater probability of cutaneous anthrax based on the exposure history of these 2 farm workers. A pity they did not get their veterinary colleagues to test what was still available from this dead cow. - ProMED Mod.MHJ]

[HealthMap/ProMED-mail map of Kyrgyzstan:
Date: 27 Jun 2018
Source: Interax Kazakhstan [edited]

Nine people have been hospitalized with suspected anthrax infection in the Jalal-Abad region of southern Kyrgyzstan, Mamatzhan Miyanov, the coordinator of the healthcare ministry for the Jalal-Abad region, told Interfax on Wednesday [27 Jun 2018].
Date: Tue 13 Mar 2018
Source: XinHuaNet [edited]

A total of 14 people, including 4 children, were hospitalized after a mass botulism food poisoning outbreak in southern Kyrgyzstan, the Health Ministry said [Tue 13 Mar 2018]. It said 3 of them are in a serious condition. An epidemiological investigation has been conducted and all patients have received the botulinum antitoxin.

The first case of food poisoning in the city of Uzgen in the Osh region was reported on [Sun 11 Mar 2018]. According to preliminary data, the poisoning occurred due to eating homemade canned vegetable salad. A month earlier [February 2018], 17 people in southern Kyrgyzstan were hospitalized for the same reason; 2 of the 7 children affected died in that outbreak.
======================
[It is unclear if these clusters are related. Most clusters of botulism are associated with home prepared food. - ProMed Mod.LL]

[HealthMap/ProMED-mail map:
Date: Tue 5 Sep 2017 16:10
Source: Evening Bishjkek [in Russian, trans. ProMED Mod.NR, edited]

Currently in the at-Bashy district of Naryn region 3 recorded cases of anthrax infection are in the hospital, and 15 under the supervision of experts. Doctors say that the locals butchered the carcass of an animal, and 10 days later the 1st symptoms of this dangerous infection appeared on the skin of the wrist areas and forearms.

People have turned to professionals with complaints of ulcers. Then on [Wed 30 Aug 2017] 3 people were hospitalized in the Infectious Diseases Department. Tests confirmed the preliminary diagnosis. Doctors have checked all sick family members and friends, and currently they are under surveillance.

The incubation period of the infection is 10-14 days.[Actually it can be as short as 3 days and up to 60 days. - ProMED Mod.MHJ] At the end of this period, if there is no suspicion, patients are discharged from the hospital. "This disease is curable, it is treatable by conventional antibiotics. It's just included in the list of especially dangerous infections classifications of the World Health Organization. The main sources of infection are animals", - said the Director of the Republican center of Quarantine and Especially Dangerous Infections the Sabyrzhan of Abdykaimov.

It is likely that the meat of an infected animal got into the markets. According to some reports, some infectious contaminated products were located in the market town of Tokmak. Now multiple site checks are in hand by the Investigative Department. In addition, the market site and the territory around the cattle slaughter site have been quarantined, say doctors. And veterinary control has been initiated, along with the population being educated.

However, the situation is aggravated by the confused information from the sick individuals. They can't exactly tell where the infected meat was sent, said Abdykaimov. "One says that the meat is buried. Another says sold. Now this is in the hands of the investigating authorities and veterinary services. They don't say what happened: just stopped someone in a car; it was loaded, and they left. And where, on what car - they don't specify. The investigating authorities are handling this, but we in Public Health are doing our best to explain what should happen," - said Abdykaimov.  [Byline: Rodion Reshetov]
====================
[Comment by ProMED Mod.NP. In the territory of the Republic there are 1219 natural foci of anthrax. Concreted and enclosed only 1000 of them. Vaccination of cattle is held only periodically, delayed due to problems with funding and vaccine supplies, increasing the risk disease anthrax in both animals and humans. Annually in the territory of the Republic there are nearly 20 cases of anthrax in people. In this case, the situation is compounded by the fact that there is no accurate information on location of infected meat, which can lead to new cases of the disease. - ProMED Mod.NP]

[Public Health as it really is and not as shown on television. People get confused and, fearing legal action, may make up stories. My thanks to my colleague Natalia. It seems that circulation of the news in English is limited and widely available in Kyrgyz. - ProMED Mod.MHJ]

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

Marshall Islands

Introduction
 
After almost four decades under US administration as the easternmost part of the UN Trust Territory of the Pacific Islands, the Mar
hall Islands attained independence in 1986 under a Compact of Free Association. Compensation claims continue as a result of US nuclear testing on some of the atolls between 1947 and 1962. The Marshall Islands hosts the US Army Kwajalein Atoll (USAKA) Reagan Missile Test Site, a key installation in the US missile defense network.
 
Geography
 
Located in the Oceania region its consists of two archipelagic island chains of 29 atolls, each made up of many small islets, and five single islands in the North Pacific Ocean, about half way between Hawaii and Australia
 
Climate
 
tropical; hot and humid; wet season May to November; islands border typhoon belt

Travel News Headlines WORLD NEWS

Date: Fri, 29 Nov 2019 03:01:21 +0100 (MET)

Majuro, Marshall Islands, Nov 29, 2019 (AFP) - More than 200 people have been forced to flee their homes, after they were inundated by freak waves in the Marshall Islands capital Majuro.   Swells averaging five metres (16 feet) washed rocks and debris onto roads, temporarily cutting access to the international airport at the peak of the flooding on Wednesday.   The Red Cross set up evacuation centres at two schools, with local churches and Majuro's mosque also offering help to fleeing residents.

The Marshall Islands are one of the Pacific nations on the front line of climate change, causing increasingly intense weather phenomena and storm surges linked to rising seas.   Climate researcher Murray Ford said such factors may have played a role in this week's flooding but were not the main cause.   "The key driver of this current inundation appears to be a large swell which has arrived from a more northerly direction than the typical trade wind swell," he said.   "This particular event would be best described as a large swell, meeting a high, but not unusually high tide."   Disaster response officials were expected to complete a damage assessment on Friday.
8 Aug 2019

The Republic of the Marshall Islands declares dengue emergency, restricts travel. 1st case of DEN-3 confirmed on Ebeye Island; 21 cases probable.

HealthMap/ProMED-mail map of Marshall Islands:
Date: Mon, 28 May 2018 01:20:00 +0200

Majuro, Marshall Islands, May 27, 2018 (AFP) - Haze from the Kilauea volcano eruption in Hawaii blanketed the Marshall Islands 3,700 kilometres (2,300 miles) away on Sunday, as officials warned it would continue moving west.   The haze, a phenomenon known as "vog" or volcanic smog, "is spreading across Micronesia," the US National Weather Service based in Guam said.

The volcano on Hawaii's Big Island is now in its fourth week of eruptions.   Meteorologists advised residents on the Marshall Islands with respiratory problems to stay indoors while airlines and shipping companies were warned to be aware of "lower visibilities".

The Guam weather office said haze produced by Kilauea would spread farther westward and reach Kosrae, Pohnpei and possibly Chuuk in the Federated States of Micronesia over the next few days.   Kilauea is the world's most active volcano and one of five on Hawaii's Big Island.   It started erupting on May 3, prompting about 2,000 people to flee from their mountainside homes.   Scientists believe the volcanic activity may be a precursor to a major eruption similar to the one that shook the island in the mid-1920s.
Date: Fri 4 May 2018
Source: CDC. MMWR Morb Mortal Wkly Rep 2018; 67(17):504-5 [edited]

ref: Hofmeister MG, McCready JA, Link-Gelles R, et al. Notes from the field: Increase in hepatitis A virus infections -- Marshall Islands, 2016-2017. MMWR Morb Mortal Wkly Rep 2018; 67:504-5. doi: 10.15585/mmwr.mm6717a5
------------------------------------------------------------------------
In mid-September 2016, a case of hepatitis A virus (HAV) infection was reported to the Marshall Islands Ministry of Health and Human Services (MOHHS). On 4 Nov 2016, MOHHS received laboratory confirmation of 4 additional cases, prompting activation of an outbreak investigation by the MOHHS Exposure Prevention Information Network (EPINet) team and solicitation of technical assistance from the Pacific Island Health Officers' Association, the WHO, and CDC. CDC began participating in the investigation by providing technical assistance remotely at that time. CDC provided remote assistance throughout the course of the investigation. In April 2017, the CDC-affiliated coauthors traveled to the Marshall Islands to provide in-person technical assistance.

To characterize the outbreak, the MOHHS EPINet Team, with assistance from CDC, conducted an investigation through in-person interviews and medical chart abstractions. A probable HAV outbreak case was defined as an acute illness with onset of any signs or symptoms consistent with acute viral hepatitis (such as fever, anorexia, nausea, vomiting, diarrhoea, fatigue, dark urine, clay-colored stool, or abdominal pain) on or after 1 Sep 2016, and either jaundice or elevated serum aminotransferase levels; a confirmed case met the probable case definition and also had either a positive immunoglobulin M (IgM) antibody to HAV on laboratory testing or an epidemiologic link to a confirmed case.

>From September 2016 (epidemiologic week 37) through July 2017 (epidemiologic week 28), 194 outbreak-associated hepatitis A cases (168 confirmed and 26 probable) were reported by MOHHS (Figure [available at the source URL above. - ProMED Mod.LL]). Illness onset dates ranged from 12 Sep 2016 through 11 Jul 2017. The median age of infected persons was 8 years (range equal to 2-76 years), 57 percent of patients were male, 91 percent were Marshallese, and 11 percent were hospitalized. No deaths were reported. Persons younger than 25 years accounted for 90 percent of cases, and 92 percent of patients were residents of the capital, Majuro. The most commonly reported signs and symptoms were jaundice (92 percent), nausea (76 percent), anorexia (75 percent), and dark urine (68 percent). Clay-colored stool (10 percent) was less commonly reported.

Complete contact information was available for 102 (53 percent) patients. A total of 1143 contacts were identified, with a mean of 11 contacts identified per patient (range equal to 2-60). Among the identified contacts, 902 (79 percent) received post-exposure prophylaxis (PEP) with hepatitis A vaccine. Some contacts were identified outside the recommended PEP window of 14 days after exposure, and 14 contacts were infants who were too young to be vaccinated (1). 7 contacts refused vaccination.

The EPINet team disseminated public information about the outbreak and recommendations on hygiene and vaccination through radio shows, mass text messages, posters, and school presentations; developed standardized case reporting and interview tools; and expanded case finding through investigation of contacts. Hepatitis A vaccine is not currently included in the Marshall Islands routine childhood immunization schedule. Marshall Islands began immunization of contacts of patients with hepatitis A in January 2017 and then launched a comprehensive immunization campaign targeting school-aged children on Majuro in February 2017, which ultimately covered approximately 70 percent of the total kindergarten through 8th grade student population. Once the vaccine supply was replenished in April 2017, a 2nd immunization campaign was directed at high school students aged 14-19 years on Majuro. In total, approximately 12,500 doses of hepatitis A vaccine were administered to school-aged children and adult contacts of patients in response to the outbreak. No additional cases were reported as of 30 Aug 2017.

Before this outbreak, the last HAV outbreak in the Marshall Islands occurred approximately 25 years ago. Since then, approximately 5 hepatitis A cases per year have been reported (MOHHS, unpublished data, 2017). HAV infection is typically acquired through faecal-oral transmission, either from direct person-to-person contact or consumption of contaminated food or water. In this outbreak, transmission occurred primarily through direct person-to-person contact, and despite extensive measures, the initial source of HAV infection was not identified.

HAV infection occurs in 3 distinct epidemiologic patterns (high, intermediate, and low endemicity) associated with hygiene and sanitation, access to clean drinking water, household crowding, and socioeconomic conditions (2). As socioeconomic conditions and sanitation improve, areas transition from high to intermediate endemicity, which is associated with an increased incidence of symptomatic clinical disease and potential for outbreaks. Hepatitis A-related hospitalizations and mortality also increase as the age of infection shifts from early childhood, when disease is typically asymptomatic or mild, to adolescence and adulthood, when illness is more likely to be severe (2).

Before this outbreak, HAV was thought to be endemic in the Marshall Islands; however, this outbreak demonstrates that the country might be undergoing an epidemiologic transition toward intermediate endemicity (3). Health officials are evaluating the potential costs and benefits of incorporating routine hepatitis A vaccination in Marshall Islands as a means of reducing ongoing transmission and preventing outbreaks.

References
-----------------
1. Advisory Committee on Immunization Practices, CDC: Update: prevention of hepatitis A after exposure to hepatitis A virus and in international travelers. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR Morb Mortal Wkly Rep 2007; 56(41): 1080-84; available at
2. Wasley A, Fiore A, Bell BP: Hepatitis A in the era of vaccination. Epidemiol Rev 2006; 28: 101-11; available at
3. Jacobsen KH: The global prevalence of hepatitis A virus infection and susceptibility: a systematic review. Geneva, Switzerland: World Health Organization; 2009; available at
===================
[This posting underscores the importance of the kind of epidemiologic pattern of HAV in an area and certainly suggests that this island nation has improved hygiene and sanitation to transition to intermediate endemicity where routine childhood HAV vaccination bears consideration. The current outbreaks in a variety of areas in the USA (including parts of Michigan, Utah, and Kentucky) affecting certain cohorts of adults (who were old enough not to be immunized as children) underscore immunization.

The Marshall Islands (<https://en.wikipedia.org/wiki/Marshall_Islands>), officially the Republic of the Marshall Islands, is an island country located near the equator in the Pacific Ocean, slightly west of the International Date Line. Geographically, the country is part of the larger island group of Micronesia. The country is spread out over 29 coral atolls, comprising 1156 individual islands and islets. Politically, the Marshall Islands is a presidential republic in free association with the United States, with the USA providing defense, subsidies, and access to USA-based agencies such as the Federal Communications Commission and the United States Postal Service. - ProMED Mod.LL]

[HealthMap/ProMED-mail map
Date: Sat, 3 Feb 2018 05:50:34 +0100

Majuro, Marshall Islands, Feb 3, 2018 (AFP) - Emergency services were put on standby Saturday in Majuro, as rising king tides threatened to flood the capital of the low-lying Marshall Islands.

The national weather service warned "major inundation" was possible from Saturday evening through to Tuesday at peak tide periods in the Pacific island nation, highlighting its vulnerability to rising sea levels.   "We're on stand-by through Tuesday," Public Works Minister Tony Muller said Saturday as the 30,000 population of Majuro Atoll braced for the expected floods.    Heavy equipment, including bulldozers, was being positioned at critical locations around Majuro so emergency crews can respond quickly in the event of flooding, he said.

Majuro is barely a metre above sea level and the single road along the 30-mile (50-kilometre) length of the coral atoll is often blocked during serious flooding by coral, rocks, sand and garbage tossed up by waves.   The National Disaster Management Office has been placed on high alert and used its mass text messaging system for the first time Friday to issue a high tide advisory.

The US National Weather Service in nearby Guam issued an advisory Saturday morning warning "major inundation of one to two feet is possible, especially during high tides inside the lagoon".   King tides, which are extremely high tides, are a natural phenomenon early in the year in the Marshall Islands caused by the strong gravitational pull from a new or full moon when the moon is at its closest to the earth.
More ...

Netherlands Antilles

Netherland Antilles US Consular Information Sheet
May 12, 2008
COUNTRY DESCRIPTION:
The five islands of Bonaire, Curaçao, Saba, St. Eustatius (or “Statia”) and St. Maarten (Dutch side) comprise the Netherlands Antilles, an autonomous
art of the Kingdom of the Netherlands. Tourist facilities are widely available. Read the Department of State Background Notes on the Netherlands Antilles 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 document compliant with the Western Hemisphere Travel Initiative, 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. Based on current projections, we expect to begin production of the passport card in June 2008 and be in full production in July 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.
The U.S. Consulate recommends traveling in the Netherlands Antilles with a valid U.S. passport to avoid delays or misunderstandings. A lost or stolen passport is also easier to replace when outside the United States than other evidence of citizenship. Visitors to the Netherlands Antilles may be asked to show onward/return tickets or proof of sufficient funds for their stay. Length of stay is granted for two weeks and may be extended for 90 days by the head office of immigration. For further information, travelers may contact the Royal Netherlands Embassy, 4200 Linnean Avenue, N.W., Washington, D.C. 20008, telephone (202) 244-5300, or the Dutch Consulate in Los Angeles, Chicago, New York, Houston or Miami. Visit the web site for the Embassy of the Netherlands at http://www.netherlands-embassy.org/homepage.asp for the most current visa information.

We have more information pertaining to dual nationality and international child abduction. Please refer to our customs information to learn more about customs regulations.

SAFETY AND SECURITY:
Drug-related organized crime exists within the Netherlands Antilles but has not directly affected tourists in the past.
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, including 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., 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: In recent years, street crime has increased, especially in St. Maarten. Valuables, including passports, left unattended on beaches, in cars and hotel lobbies are easy targets for theft, and visitors should leave valuables and personal papers secured in their hotel. Burglary and break-ins are increasingly common at resorts, beach houses and hotels. Armed robbery occasionally occurs. The American boating community has reported a handful of incidents in the past, and visitors are urged to exercise reasonable caution in securing boats and belongings. Car theft, especially of rental vehicles for joy riding and stripping, can occur. Incidents of break-ins to rental cars to steal personal items have been reported by American tourists. Vehicle leases or rentals may not be fully covered by local insurance when a vehicle is stolen. Be sure you are sufficiently insured when renting vehicles and jet skis.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
Please see our information for American Victims of Crime Overseas.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is generally good in Curaçao and St. Maarten, but may be limited on the other three islands. Hospitals have three classes of services i.e.: First Class: one patient to a room, air conditioning etc.; Second Class: two to six patients to a room, no air conditioning; Third Class: 15 to 30 people in one hall. Patients are accommodated according to their level of insurance.
Bonaire: The San Francisco hospital is a medical center (35 beds) with decompression facilities. The hospital has an air ambulance service to Curaçao and Aruba.
Curaçao: St. Elizabeth hospital is a public hospital that may be compared to midrange facilities in the United States. St. Elizabeth's hospital has a decompression chamber and qualified staff to assist scuba divers suffering from decompression sickness. Several private clinics provide good to excellent medical service.
St. Maarten: St. Maarten Medical Center (79 beds) is a relatively small hospital where general surgery is performed. Complex cases are sent to Curaçao.
Statia: Queen Beatrix Medical Center (20 beds) is a medical facility well equipped for first aid. Surgery cases are sent to St. Maarten.
Saba: Saba Clinic (14 beds) is a well-equipped first aid facility. Surgery cases are sent to St. Maarten. The Saba Marine Park has a decompression chamber and qualified staff to assist scuba divers suffering from decompression sickness.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith.
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning the Netherlands Antilles is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving in the Netherlands Antilles is on the right hand side. Right turns on red are prohibited, and traffic conditions require somewhat defensive driving. Local laws require drivers and passengers to wear seat belts and motorcyclists to wear helmets. Children under 4 years of age should be in child safety seats; children under 12 should ride in the back seat.
Nonexistent or hidden and poorly maintained street signs are the major road hazard in the Netherlands Antilles. Therefore, drivers should proceed through intersections with caution. Roads in the Netherlands Antilles are extremely slippery during rainfall. Night driving is reasonably safe in the Netherlands Antilles as long as drivers are familiar with the route and road conditions. Most streets are poorly lit or not lit at all. In Curacao, drivers should be aware of herds of goats that may cross the street unexpectedly. In Bonaire, wild donkeys may also cross the road.
Taxis are the easiest, yet most expensive form of transportation on the islands. As there are no meters, passengers should verify the price before entering the taxi. Fares quoted in U.S. dollars may be significantly higher than those quoted in the local currency. Vans are inexpensive and run non-stop during daytime with no fixed schedule. Each van has a specific route displayed in the front of the windshield. Buses, which run on the hour, have limited routes. The road conditions on the main thoroughfares are good to fair.
See road safety information at the following sites; http://www.curacao.com, http://www.statiatourism.com, http://www.sabatourism.com, http://www.infobonaire.com, http://www.st-maarten.com/.
Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the Netherlands Antilles’ Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the Netherlands Antilles’ 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:
Dutch law in principle does not permit dual nationality. However, there are several exceptions. For example, American citizens who are married to Dutch citizens are exempt from the requirement to abandon their American nationality when they apply to become a Dutch citizen by naturalization. For detailed and specific information on this subject, contact the Embassy of the Netherlands in Washington or one of the Dutch consulates in the U.S. In addition to being subject to all Dutch laws affecting U.S. citizens, dual nationals may also be subject to other laws that impose special obligations on Dutch citizens.
Time-share buyers are cautioned about contracts that do not have a "non-disturbance or perpetuity protective clause" incorporated into the purchase agreement. Such a clause gives the time-share owner perpetuity of ownership should the facility be sold. Americans sometimes complain that the timeshare units are not adequately maintained, despite generally high annual maintenance fees. Because of the large number of complaints about misuse of maintenance fees, particularly in St. Maarten, prospective timeshare owners are advised to review the profit and loss statement for maintenance fees. Investors should note that a reputable accounting firm should audit profit and loss statements.
Potential investors should be aware that failed land development schemes involving time-share investments could result in financial losses. Interested investors may wish to seek professional advice regarding investments involving land development projects. Real estate investment problems that reach local courts are rarely settled in favor of foreign investors.
An unusually competitive fee to rent vehicles or equipment could indicate that the dealer is unlicensed or uninsured. The renter is often fully responsible for replacement costs and fees associated with any damages that occur during the rental period. Visitors may be required to pay these fees in full before leaving the Netherlands Antilles and may be subject to civil or criminal penalties if they cannot or will not make payment.
Netherlands Antilles customs authorities may enforce strict regulations concerning temporary importation into or export from the Netherlands Antilles. For example, it is strictly prohibited to export pieces of coral and/or seashells. Please see our information on customs regulations.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offences. Persons violating the laws of the Netherlands Antilles, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the Netherlands Antilles are severe, and convicted offenders can expect long jail sentences and heavy fines. The Netherlands Antilles has strict gun control laws; even a stray bullet in a suitcase can trigger a fine or time in jail. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues web site.
REGISTRATION / EMBASSY LOCATION:
American citizens residing or traveling in the Netherlands Antilles 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 Netherlands Antilles. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Consulate General is located at J.B. Gorsiraweg #1, Willemstad, Curaçao, telephone (599-9) 461-3066; fax (599-9) 461-6489; e-mail address: acscuracao@state.gov.
* * *
This replaces the Country Specific Information dated May 7, 2007, to update the Entry/Exit, Crime, Traffic Safety and Road Conditions, and Registry / Embassy Location sections.

Travel News Headlines WORLD NEWS

Date: Thu, 16 May 2019 23:41:35 +0200

Washington, May 16, 2019 (AFP) - The Church of Scientology said Thursday all the passengers from a cruise ship that was quarantined over a measles case had been cleared to leave.    "All passengers and crew (100%) of the Freewinds have been fully cleared of any possible risk of being infected by the measles or infecting others," the organization said in a statement.   "All passengers and crew are free to come and go as they wish," a spokesman added to AFP.

The infected individual was a member of the crew who, according to the Church, had fully recovered and was given a clean bill of health a week ago. She had been earlier confined on the ship.   The ship, which is based in Willemstad on the island of Curacao in the Dutch West Indies, was quarantined after its arrival in Saint Lucia on April 30.   It remained there for two days before returning to Willemstad on May 4 where local authorities ordered a fresh quarantine to give them time to confirm the passengers were either immunized or had no risk of contracting the virus.
Date: Sat, 4 May 2019 20:37:18 +0200
By Sara MAGNIETTE

The Hague, May 4, 2019 (AFP) - The Dutch territory of Curacao said Saturday it would do what is needed to prevent measles spreading from a Scientology cruise ship, after a crew member came down with the disease.   The Freewinds, which left the Caribbean island of St. Lucia on Friday, arrived back in its home port of Curacao at around 9:00 am (1300 GMT) Saturday, according to myshiptracking.com.

The Curacao government said in a statement that it would "take all necessary precautions to handle the case of measles on board of the Freewinds," including vaccinations.   "An investigation will also be done to determine who will be allowed to leave the ship without (posing) a threat to the population of Curacao," it said.   "It is imperative to make all efforts to prevent a spread of this disease internationally."   Dutch broadcaster NOS reported that three health officials had boarded the boat to examine those on board. Only people able to prove that they have been vaccinated against measles or had already had the disease would be able to leave the boat, its correspondent there reported.

- Anti-vaccine movement -
The Church of Scientology says the 440-foot (134-meter) vessel is used for religious retreats and is normally based in Curacao.   The vessel had arrived in St Lucia from Curacao on Tuesday, when it was placed under quarantine by health authorities there because of a measles patient, said to be a female crew member.   According to NOS, the crew member concerned is a Danish national, who arrived in Curacao from Amsterdam on April 17. It was only when the boat was at sea, on route to St Lucia, that a doctor discovered she had measles, their correspondent said.

The resurgence of the once-eradicated, highly contagious disease is linked to the growing anti-vaccine movement in richer nations, which the World Health Organization (WHO) has identified as a major global health threat.   The authorities in Curacao nevertheless urged local people not to panic, as the risk of the disease spreading in this case was fairly low.   Several people did however visit the cruise ship between April 22 and April 28 before it set sail for St Lucia and the authorities asked them to make themselves known to health officials.

Officials said the Freewinds had travelled between Curacao, St Lucia and another Dutch-held island, Aruba, several times towards the end of April.   There were about 300 people aboard the ship, according to Saint Lucia authorities, which placed the vessel in quarantine. They said they provided 100 doses of measles vaccine at no cost.   The Scientology church, founded by science fiction writer L Ron Hubbard in 1953, did not respond to requests for comment.   Its teachings do not directly oppose vaccination, but followers consider illness a sign of personal failing and generally avoid medical interventions.
Date: 4 Jul 2017
From: Harry Vennema <harry.vennema@rivm.nl> [edited]

On several of the Caribbean islands, epidemics of viral conjunctivitis are ongoing. Recently, general practitioners in the overseas territories of the Netherlands reported an increased incidence of this syndrome.

As of 26 May 2017, an outbreak of conjunctivitis occurred in a nursing home on Bonaire. In total, 14 patients and 13 healthcare workers presented with conjunctivitis. Patients were between 71 to 94 years of age. The number of new cases peaked in week 20 through 22. After week 22, a significant reduction was seen (1-3 new cases per week). Initially, conjunctival swabs from 5 patients were tested for the presence of adenovirus by PCR; all 5 were negative.

Subsequently, swabs from 4 patients were analyzed for the presence of enterovirus by RT-PCR, and all 4 were positive. The enterovirus from 3 samples was further characterized by partial VP1 sequence analysis. In all 3 samples, the enterovirus was characterized as Coxsackievirus A24, which belongs to Enterovirus C. Coxsackievirus A24 has been identified frequently as the causative agent of epidemic viral conjunctivitis. The strain from Bonaire is at least 5 percent different from any of the previously isolated and sequenced CV-A24 strains available in Genbank in a 330nt VP1 fragment. The strain involved in the most recent outbreak of CV-A24 conjunctivitis on La Reunion in 2015 is 6 percent different from the Bonaire 2017 strain.

[Andert Rosingh, Yingbin Celestijn-Wu, Fundashon Mariadal Hospital, Clinical Microbiology, Kralendijk, Bonaire, Caribbean Netherlands Annelies Riezebos, University Medical Centre Utrecht, Medical Microbiology, Utrecht, Netherlands Harry Vennema, Kim Benschop, Johan Reimerink, Hans van den Kerkhof, National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, Netherlands]
--------------------------------------------
Harry Vennema
National Institute for Public Health and the Environment
Centre for Infectious Disease Control
Bilthoven, Netherlands
=========================
[ProMED thanks Harry Vennema and colleagues for this report.  Acute hemorrhagic conjunctivitis (AHC) is characterized by sudden onset of painful, swollen, red eyes with subconjunctival haemorrhages and excessive tearing. Most cases are self-limited but highly contagious, with the potential for causing considerable illness. Adenoviruses and picornaviruses can cause AHC outbreaks (1). Among picornaviruses, enterovirus 70 and coxsackievirus A24 variant (CA24v) have caused large outbreaks of AHC[2].

Coxsackieviruses are transmitted primarily via the fecal-oral route and respiratory aerosols, although transmission via fomites is possible. The viruses initially replicate in the upper respiratory tract and the distal small bowel. They have been found in the respiratory tract up to 3 weeks after initial infection and in feces up to 8 weeks after initial infection[3]. The potential for exponential spread is, therefore, quite considerable.

It is important to understand that sequential outbreaks of AHC due to CA24v might occur in the same location after a considerable period, and public health precautions are necessary to control these outbreaks.

References:
1. Hierholzer JC, Hatch MH. Acute hemorrhagic conjunctivitis. In: Darrell RW, editor. Viral diseases of the eye. Philadelphia: Lea & Febiger; 1985. p. 165-96.
2. Kono R. Apollo 11 disease or acute hemorrhagic conjunctivitis: a pandemic of a new enterovirus infection of the eyes. Am J Epidemiol. 1975;101:383-90.

[A HealthMap/ProMED-mail map can be accessed at:
Date: Published ahead of print 7 Dec 2015
Source: American Journal of Tropical Medicine & Hygiene Published on line doi:10.4269/ajtmh.15-0308 [edited]

Noellie Gay, Dominique Rousset, Patricia Huc, Severine Matheus, Martine Ledrans, Jacques Rosine, Sylvie Cassadou, and Harold Noel. Seroprevalence of Asian Lineage Chikungunya Virus Infection on Saint Martin Island, 7 Months After the 2013 Emergence.

Abstract
--------
At the end of 2013, chikungunya virus (CHIKV) emerged in Saint Martin Island, Caribbean. The Asian lineage was identified. 7 months after this introduction, the seroprevalence was 16.9 percent in the population of Saint Martin and 39.0 percent of infections remained asymptomatic. This moderate attack rate and the apparent limited size of the outbreak in Saint Martin could be explained by control measures involved to lower the exposure of the inhabitants. Other drivers such as climatic factors and population genetic factors should be explored. The substantial rate of asymptomatic infections recorded points to a potential source of infection that can both spread in new geographic areas and maintain an inconspicuous endemic circulation in the Americas.
--------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
===================
[Asymptomatic or very mild infections may be an important source of infectious blood meals for vector mosquitoes. These infections should not be overlooked in epidemiological assessments of chikungunya virus outbreaks and implementation of control measures in the field. - ProMed Mod.TY]
Date: Wed, 26 Aug 2015 16:43:59 +0200 (METDST)

Miami, Aug 26, 2015 (AFP) - Tropical storm Erika took aim at the Lesser Antilles Wednesday as storm warnings went up there and in Puerto Rico in anticipation of heavy rains, US forecasters said.   With winds of 75 kilometres (45 miles) per hour, Erika was 540 kilometres (335 miles) east of Antigua at 1200 GMT, the Miami-based National Hurricane Center reported.

Advancing at a speed of 28 kilometres (17 miles) per hour, it was expected to sweep over the Lesser Antilles Wednesday night and then head toward Puerto Rico and the Virgin Islands.   Tropical storm warnings were up in Puerto Rico, the Virgin Islands, Antigua and Barbuda, Guadeloupe, Montserrat, St Kitts and Nevis, Anguilla, Saba, St Eustacia and St Maarten.

A US Air Force hurricane hunter aircraft that flew into the storm found it was slightly increasing in strength.   "Some slow strengthening is forecast during the next 48 hours," the hurricane centre said.   According to the NHC's projections, Erika could become a hurricane by the end of the week, or early next, as it nears Florida.   But "the intensity forecast remains very uncertain," it said.

Erika is arriving on the heels of Danny, the season's first hurricane which petered out before reaching the Caribbean.   Experts said earlier this month that there was a 90 percent chance the 2015 hurricane season in the Atlantic would be less active than usual.
More ...

World Travel News Headlines

Date: Fri, 13 Dec 2019 16:41:23 +0100 (MET)
By Mariëtte Le Roux and Joseph Schmid

Paris, Dec 13, 2019 (AFP) - French commuters gritted their teeth for a ninth day of public transport strikes Friday, with unions vowing to keep up their protest against a pension overhaul through the holidays unless the government backs down.   Officials have said they are ready to negotiate, with Education Minister Jean-Michel Blanquer meeting teachers' representatives on Friday to try and stave off another day of class shutdowns.   "It was an intense and frank meeting... but we still need details, and maintain our call to strike on Tuesday," Stephane Crochet of the SE-Unsa union said.

Unions are hoping for a repeat of 1995, when they forced a rightwing government to back down on pension reforms after three weeks of metro and rail strikes just before Christmas.   The prospect of a protracted standoff has businesses fearing big losses during the crucial year-end festivities, and travellers worried that their Christmas plans may be compromised.   "Right now it's a catastrophe here, but we're hoping there will be a solution before Christmas," Frederic Masse, a foie gras producer at the huge Rungis wholesale food market south of Paris, told AFP on Friday.

The capital city was again choked by huge traffic jams as most metro lines remained shut, only a handful of buses and trams were running, and one in four TGV trains were cancelled.   "I'm sick of this, and I won't be able to keep working if it goes on," Zigo Makango, a 57-year-old security agent, told AFP onboard a bus in the Bobigny suburb northeast of Paris.   To get home at night Makango said he has to use taxis, but "my boss doesn't reimburse me for that".

- 'Historic reform' -
President Emmanuel Macron on Friday expressed his "solidarity" with people impacted by the strike, "but I want the government to continue its work" in forging a single pension system, a key campaign promise.   "It's a historic reform for the country," he told journalists at an EU summit in Brussels. 

The overhaul unveiled by Prime Minister Edouard Philippe would do away with 42 separate regimes, some of which offer early retirement and other benefits to public-sector employees such as train drivers, dockers and even Paris Opera employees.   But Philippe angered unions further by proposing a reduced payout for people who retire at the legal age of 62 instead of a new, so-called "pivot age" of 64.

They have called for new mass demonstrations for next Tuesday, the third since the action started on December 5 in the biggest show of strength in years by France's notoriously militant unions.   Philippe insisted on Twitter that "My door is open and my hand outstretched".   But Laurent Brun of the hard-line CGT union, the largest among public-sector workers including those at rail operator SNCF, has already warned "There won't be any Christmas truce" unless the government drops the plan entirely.

- France divided -
A poll released Thursday by the Elabe institute found France evenly divided on Philippe's plan, with 50 percent for and 49 percent against.  But 54 percent rejected the mooted 64-year cutoff for a full pension, and 54 percent supported the protest.

Staff at four of France's eight oil refineries were on strike Friday, affecting output and raising fears of shortages down the line.   And both Paris operas, the Garnier and the Bastille, again cancelled Friday performances and others through the weekend.   Macron's government insists the changes will make for a fairer system and help erase pension system deficits forecast to reach as much as 17 billion euros ($19 billion) by 2025.   The average French person retires at just over 60, years earlier than most in Europe or other rich OECD countries.
Date: Fri, 13 Dec 2019 14:05:22 +0100 (MET)

Milan, Dec 13, 2019 (AFP) - More than 300 flights were cancelled Friday in Italy due to a planned one-day strike by workers from Alitalia and Air Italy.   Alitalia said in a statement that 315 flights were cancelled on Friday, with another 40 cancelled Thursday night and Saturday morning. It was not immediately clear how many flights were cancelled at Air Italy.   The 24-hours strike, which involves pilots, flight attendants and ground personnel, was called by three unions to draw attention to what they called "the ongoing crisis at Alitalia and Air Italy."

The strike was felt most in Sardinia, with about 30 flights cancelled.    Money-losing Alitalia has been under special administration since 2017 when employees rejected a restructuring plan that would have laid off 1,700 workers out of an approximately 11,000.   The government has so far looked for buyers without success.    Unions plan to meet on Tuesday with Economy Minister Stefano Patuanelli.    A potential consortium of buyers for the ailing carrier fell apart last month after Atlantia, which operates Rome's airports, pulled out.
Date: Fri, 13 Dec 2019 05:24:44 +0100 (MET)
By Neil SANDS

Wellington, Dec 13, 2019 (AFP) - Adventure tourism is a key part of New Zealand's international appeal but the White Island volcano eruption is a tragic reminder that such activities carry genuine risk that must be better explained to travellers, experts say.   The South Pacific nation offers a wealth of adrenaline-fuelled pursuits, from heli-skiiing on snow-capped mountains to ballooning and blackwater rafting through caves.

Some, such as bungee-jumping, jet-boating and zorbing -- where you hurl yourself down a hill inside an inflatable ball -- were invented or popularised in a country that prides itself on catering to intrepid visitors.   The tourism industry as a whole is among New Zealand's biggest earners, generating about NZ$16.2 billion ($10.7 billion) and attracting 3.8 million international visitors annually.     "Adventure tourism is a massive sector in New Zealand. We are promoting ourselves as the adventure capital of the world," professor Michael Lueck, a tourism expert at Auckland University of Technology, told AFP.

New Zealand is also renowned for its rugged landscapes, which feature prominently films such as Kiwi director Peter Jackson's "Lord of the Rings".   Day-trips to White Island combined both, taking tourists including cruise ship passengers to a desolately beautiful island off the North Island coast where they could experience the thrill of standing on an active volcano.   Instead, at least 16 people are believed to have died and dozens suffered horrific burns when 47 tourists and guides were caught on the island during Monday's eruption.

The disaster has raised questions about why tourists were allowed on a volcano where experts had recently raised threat levels, as well as broader issues about the regulation of risky activities in the tourism sector.   "There will be bigger questions in relation to this event," Prime Minister Jacinda Ardern told parliament after the eruption.   "These questions must be asked, and they must be answered."

- 'Slapdash' or world's best? -
The disaster on White Island -- also known as Whakaari -- is not the first mass-fatality accident to affect tourists in New Zealand.   In 2015, seven people were killed when a scenic helicopter flight crashed into Fox Glacier. Two years earlier, a hot-air balloon claimed 11 lives and in 2010 nine died when a plane carrying skydivers plunged into a paddock.

Briton Chris Coker's son Brad, 24, died in the skydive plane crash and since then he has campaigned from afar for tighter regulations in New Zealand's adventure tourism sector.   "In my opinion, the New Zealand authorities... are still slapdash about tourist safety," Coker told news website stuff.co.nz after the White Island eruption.   "To run tourists there is insane. I know they signed a waiver and so on, but it's not really taking care of people."

Trade body Tourism Industry Aotearoa disputes such assessments, saying operators are "working within a world's best regulatory framework", but could not eliminate risk completely.   "Operators put safety first, but adventure activity inherently carries some risk and it's critical that 'adventure' remains in adventure tourism," TIA chief executive Chris Roberts told AFP.   "Operators take all practical actions to minimise the risks and the safety culture of individual operators remains the key factor in preventing accidents."

Roberts said the issue was not tourism operators, but the alert system they relied on at volcanic destinations such as White Island, which attracts about 17,000 visitors a year.   The GeoNet monitoring agency raised White Island's threat level in the week before the eruption but also advised current activity "does not pose a direct hazard to visitors".   "The reviews need to look at the science and specifically the guidance provided about volcanic activity, and whether the operating practices followed for the past 30 years need to change," Roberts said.

- 'Understand the risks' -
Travel companies such as White Island Tours brief customers before setting off and require them to sign a waiver declaring they understand the risk, as well as supplying equipment such as hard-hats and gas masks.   However, some relatives of those affected by the eruption have expressed scepticism that their loved ones truly appreciated the potential danger they faced.   Options for legal redress are limited under New Zealand's Accident Compensation Commission scheme, which covers victims' medical bills and provides modest compensation but does not allow civil suits for damages.

Neither Roberts nor Lueck expected the White Island eruption to hit international arrivals in New Zealand, which have continued to climb despite major earthquakes in 2011 and 2016.   The nature of any review arising from White Island remains uncertain, but Lueck said at the very least tourists needed to be better informed about any risks.   "Operators and tourism boards should have tourists understand what these risks are, and not brush over quickly signing a waiver," he said.   "Only then can tourists make an informed decision and decide whether or not they want to take that particular risk."
Date: Thu, 12 Dec 2019 21:25:36 +0100 (MET)

Kinshasa, Dec 12, 2019 (AFP) - Twenty-three cases of Ebola have been recorded in four days in eastern Democratic Republic of Congo, where deadly violence is hampering efforts to end the 16-month-old epidemic, authorities said on Thursday.   Ten cases were recorded on Tuesday alone in Mabalako in North Kivu province, after six on Monday, according to the Multisectoral Committee for Epidemic Response (CMRE).   Three out of the six were practitioners of traditional medicine, it said.

On Wednesday, three cases were recorded in North Kivu, including one in the Biena neighbourhood -- which has had no new Ebola cases for the last 85 days.   More than 2,200 people have died since the epidemic was declared on August 1, 2018.   As of November 22, the rate of new cases had fallen to 10 per week.   CMRE said "security reasons" -- attacks on Ebola health workers and sites by armed groups and angry youths -- had "paralysed" work in the key zones of Beni, Biakato and Mangina.   The attacks led to a pullout of locally-employed Ebola workers in Biakato by the UN's World Health Organization (WHO) and Doctors Without Borders (MSF).
Date: Thu, 12 Dec 2019 15:59:23 +0100 (MET)

Juba, Dec 12, 2019 (AFP) - Devastating flooding in South Sudan following a fierce drought could tip parts of the country into famine in the next few months, the World Food Programme (WFP) warned on Thursday.   According to the UN refugee agency nearly one million people were affected by floodwaters that submerged entire towns, compounding an already dire humanitarian situation after six years of war.

The WFP said that 5.5 million people are expected to be going hungry in early 2020 -- the time at which the population is generally benefiting from their harvest in October and November of the previous year.   An earlier harvest failed due to drought. This time crops have been washed away.    "The number of people in need is likely to increase because of the catastrophic level of destruction caused by floods since October following a drought that hammered parts of the country earlier in the year," the agency said in a statement.

The floods wiped out 73,000 metric tons of potential harvests as well as tens of thousands of cattle and goats, said the WFP.   "We know the problems that we've been having in South Sudan, but the rains and the floods have led to a national disaster and are much worse than anyone could have anticipated," said WFP Executive Director David Beasley.    "In fact, if we don't get funding in the next few weeks and months, we are literally talking about famine. We need support, we need help and we need it now."   The agency estimated its needs at $270 million (242 million euros) for the first half of 2020.   South Sudan declared a "man-made" famine affecting around 100,000 people in 2017. 

The term "famine" is used according to a scientific system agreed upon by global agencies, when at least 20 percent of the population in a specific area has extremely limited access to basic food; acute malnutrition exceeds 30 percent; and the death rate exceeds two per 10,000 people per day for the entire population.   "Famine in South Sudan was defeated after four months in 2017 by a concerted large-scale humanitarian response," said the WFP.   "Experts now say the country's food security outlook has never been so dire."   Political instability is also high as President Salva Kiir and his rival Riek Machar have again delayed their formation of a power-sharing government, this time by 100 days until February 2020.
Date: Wed, 11 Dec 2019 09:33:13 +0100 (MET)
By Holly ROBERTSON

Sydney, Dec 11, 2019 (AFP) - Up to 20,000 protesters rallied in Sydney on Wednesday demanding urgent climate action from Australia's government, as bushfire smoke choking the city caused health problems to spike.   Sydney has endured weeks bathed in toxic smoke as hundreds of blazes have raged across the countryside, with hospitals recording a 25 percent increase in the number of people visiting emergency departments last week.   On Tuesday smoke alarms rang out across Australia's biggest city, with thick haze triggering smoke alarms and forcing buildings to be evacuated, school children to be kept indoors, and ferries to be cancelled.   The devastating fires have focused attention on climate change, with scientists saying the blazes have come earlier and with more intensity than usual due to global warming and a prolonged drought.   Police estimated the crowd size at 15,000, organisers put the figure at 20,000.

Many of the protestors voiced anger at the government's silence in the face of the crisis.   "The country is on fire" said 26-year-old Samuel Wilkie attending his first climate protest. He described politicians' response as "pathetic".    "Our government is not doing anything about it," said 29-year-old landscape gardener Zara Zoe. "No one is listening, no one is doing anything."   Prime Minister Scott Morrison -- a staunch backer of Australia's vast coal industry -- has said little about the smoke since the crisis began, preferring to focus on fire-hit rural communities.   Organiser Chloe Rafferty said that had created anger at the conservative government's inaction.   "I think the wider public can see that we are not expecting the climate crisis in the future but we are facing the climate crisis now," she told AFP.   "People are experiencing it in their day-to-day lives."   As well as a rise in people visiting hospitals with smoke-related health symptoms, the number of emergency calls for ambulances spiked 30 percent last week.    "For most people, smoke causes mild symptoms like sore eyes, nose and throat," top health department official Richard Broome said.   "However, people with conditions like asthma, emphysema and angina are at greater risk because the smoke can trigger their symptoms."

Smoke from bushfires is one of the biggest contributors to air pollution in Australia, releasing fine particles that can lodge deep within people's lungs and cause "severe" health impacts over time, according to scientist Mick Meyer from government-funded scientific research agency CSIRO.   "The impact of smoke on people remote from the fires may, on occasion, substantially exceed the direct injury to people within the fire zone," he wrote in The Conversation.   "But we currently lack the operational tools to understand the extent of these impacts or to manage them."   Six people have been killed and more than 700 houses destroyed in bushfires this fire season.   Though the human toll has been far lower than the deadliest fire season in 2009 -- when almost 200 people died -- the scale of this year's devastation has been widely described as unprecedented.   Three million hectares (7.4 million acres) of land has been burnt -- the size of some small countries -- and vast swathes of koala habitat scorched.   Official data shows 2019 is on track to be one of the hottest and driest years on record in Australia.
Date: Tue 3 Dec 2019
Source: Trinidad Express [abridged, edited]

The number of local deaths from the influenza virus has risen to 24. At the Health Ministry's update last week, 16 fatalities were reported from the flu, with Health Minister Terrence Deyalsingh appealing to citizens -- especially those considered at-risk -- to get vaccinated.
Date: Sat 30 Nov 2019
Source: The New Indian Express, Express News Service [edited]

According to official data, 14 swine flu [influenza A/H1N1] deaths across the state were recorded this year [2019] till [17 Nov 2019]. The figure is slightly less than the previous year's [2018] toll of 17. The total number of H1N1 swine flu-positive cases [has] also come down this year [2019] compared with 2018 from 402 to 325. Health officials are setting up isolation wards in hospitals as a preventive measure.

As the winter season has set in and the minimum temperatures are coming down, health officials are instructing the public to take precautions in order to stay away from being infected by swine flu. The health department has initiated steps to set up district-[wide] swine flu testing facilities and isolation wards in every district hospital, area hospital, and community health centre.

As per the requirement of treatment procedure, the government has to set up special isolation wards in all government hospitals and provide protection kits to the healthcare staff, especially to those who will attend to the patients suffering from the flu. Across the state, Visakhapatnam registered the highest number of positive swine flu cases and deaths. Out of 325 positive cases, 180 alone were reported from Visakhapatnam, of which 8 died. West Godavari district registered 3 deaths, and Anantapur, East Godavari, and Srikakulam registered one death case each.

All the district health officials have been instructed to intensify awareness camps and screening centres. As part of the action plan, isolation wards with 5-10 beds are to be set up in every teaching, district, and area hospital. A sufficient stock of drugs, masks, and PPE [personal protective equipment] kits are to be made available. Currently, there are 18 labs eligible for conducting confirmation test in the state. "We are creating awareness by distributing pamphlets and putting up screening centres at bus stops and railway stations," DMHO [district medical and health officer] Dr. TSR Murthy said.

Symptoms of swine flu are generally similar to that of seasonal flu. These include cough, fever, sore throat, stuffiness, runny nose, body aches, headache, chills, fatigue, diarrhoea, and vomiting. Later on, breathlessness, chest pain, drowsiness, low blood pressure, sputum mixed with blood, and bluish discoloration of nails also develops.
Date: Thu 28 Nov 2019
Source: GDN Online [edited]

Two expatriates living in Oman died after contracting the seasonal influenza (H1N1) or swine flu in the governorate of Dhofar -- the 1st in July and the 2nd in August [2019]. They were among 78 confirmed cases of swine flu registered at the Sultan Qaboos Hospital over the first 9 months of 2019 in the governorate.

The hospital authorities reported a total of 599 registered suspected cases of H1N1 between January and last September [2019]. Doctors working at Sultan Qaboos Hospital dealt overall with 1779 cases of respiratory infections during the same period.

Patients most vulnerable to the respiratory viruses are those over 18 years, particularly pregnant women; those suffering from chronic illnesses, kidney and heart diseases, liver problems, diabetes, asthma, blood disorders, and HIV/AIDS; and even health workers, according to Muscat Daily.
Date: Wed 11 Dec 2019
Source: UNICEF/WHO Situation report 11 Dec 2019 [edited]

Highlights
- 5 new human cases reported in the past week
- In response to 1st human vaccine-derived poliovirus type 1 (VDPV1) case from the island province of Basilan, in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), outbreak immunization was conducted
in Maluso, Basilan, with bivalent oral polio vaccine (bOPV) against polio type 1, vaccinating 13 547 children under 10 years old (102% of the target).
- Currently 9 human cases confirmed with circulating VDPV type 2 (cVDPV2), 1 case with VDPV1, 1 case with cVDPV1, and 1 case with immunodeficiency-related VDPV type 2 (iVDPV2).
- A case with VDPV1 from Sultan Kudarat is pending genetic analysis; 1 case of cVDPV1 from Malaysia was confirmed as genetically linked to the Basilan case.
- Synchronized polio vaccination campaign conducted on [25 Nov 2019 - 10 Dec 2019] (including 2 days of extension) vaccinated 4 309 566 children under 5, which is 98% of the target total of 4.4 million children under 5. A total of 1 395 365 children under 5 were vaccinated in National Capital Region (NCR), which is 109% of the target, and 2 914 201 (94%) in Mindanao.
- DOH planning to conduct outbreak immunization with bOPV targeting 710,296 children under 10 in the Sulu Archipelago, Zamboanga City, and Lambayong, Sultan Kudarat, on [6-12 Jan 2020].
- Current polio outbreak resulting from persistently low routine immunization coverage, and poor sanitation and hygiene.
- Philippines is affected by both cVDPV1 and cVDPV2. cVDPV is considered a public health emergency of international concern (PHEIC).

cVDPV1
---------
- In response to the 1st human case confirmed with VDPV1 from Maluso, Basilan (BARMM), outbreak immunization was conducted in the area with bOPV for children under 10 years old, vaccinating 13,547 children under 10 years of age (102% of the target).
- A cVDPV1 case in Sabah state, Malaysia, was confirmed to be genetically linked to the Basilan case by the Victorian Infectious Diseases Reference Laboratory (VIDRL) in Australia. Since the 2 viruses are genetically linked, they are both classified as circulating.
- A new VDPV1 case from Sultan Kudarat (Region XII) was confirmed on [6 Dec 2019] and is pending further genetic analysis.
- All 13 cVDPV1 environmental samples found in Manila are genetically linked.

cVDPV2
---------
- All 9 human cases and 17 environmental samples confirmed with cVDPV2 are genetically linked. All human cases were reported from Mindanao (BARMM and Region XII), whereas environmental samples were found in NCR and Davao.
- All samples were tested by the National Polio Laboratory at the Research Institute for Tropical Medicine (RITM), whereas sequencing and genetic analysis is done at the NIID in Japan, and additional genetic characterization is provided by the United States Centers for Disease Control and Prevention (CDC).
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[Given the identification of the cVDPV1 case in Malaysia that is genetically related to the VDPV1 case in Basilan, it is now clear there are at least 2 separate cVDPV outbreaks in the Mindinao region of the Philippines: one of the outbreaks is associated with cVDPV2, and the other with cVDPV1 and one outbreak of cVDPV1 in the Manila Metropolitan area (although only environmental samples have been positive without AFP (acute flaccid paralysis) cases as yet.) What all these areas have in common is pockets of populations with suboptimal vaccination coverages. Clearly, we await further information on the genetic profiling of the newly identified VDPV1 case in Sultan Kudarat, also located in southern Philippines. Note that Basilan Island, Sultan Kudarat, and Sabah state in Malaysia, while all in the same general area, are not contiguous, each being on a different island. In. total, there are 11 cases of AFP in the Philippines that are attributable to infection with a VDPV.

A map showing the provinces in the Philippines can be found at

HealthMap/ProMED-mail map of the Philippines: