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Anguilla

Anguilla US Consular Information Sheet
March 03, 2009
COUNTRY DESCRIPTION: Anguilla is a British overseas territory in the Caribbean, part of the British West Indies. It is a small but rapidly developing island with particularly well-developed
ourist facilities.

ENTRY/EXIT REQUIREMENTS:
The Intelligence Reform and Terrorism Prevention Act of 2004 requires all travelers to and from the Caribbean, Bermuda, Panama, Mexico and Canada to have a valid passport to enter or re-enter the United States. U.S. citizens must have a valid U.S. passport if traveling by air, including to and from Mexico.
If traveling by sea, U.S. citizens can use a passport or passport card. We strongly encourage all American citizen travelers to apply for a U.S. passport or passport card 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.

In addition to a valid passport, U.S. citizens need onward or return tickets, and sufficient funds for their stay.
A departure tax is charged at the airport or ferry dock when leaving. For further information, travelers may contact the British Embassy, 19 Observatory Circle NW, Washington, DC
20008; telephone (202) 588-7800; or the nearest consulate of the United Kingdom in Atlanta, Boston, Chicago, Dallas, Los Angeles, New York, Denver, Houston, Miami, Orlando, Seattle, or San Francisco. Visit the British Embassy web site 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:
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

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

CRIME:
While Anguilla's crime rate is relatively low, both petty and violent crimes
do occur. Travelers should take common-sense precautions to ensure their personal security, such as avoiding carrying large amounts of cash or displaying expensive jewelry. Travelers should not leave valuables unattended in hotel rooms or on the beach. They should use hotel safety deposit facilities to safeguard valuables and travel documents. Similarly, they should keep their lodgings locked at all times, whether they are present or away, and should not leave valuables in their vehicles, even when locked.

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 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 emergency line in Anguilla is 911.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
There is only one hospital, Princess Alexandra Hospital (telephone: 264-497-2551), and a handful of clinics on Anguilla, so medical facilities are limited.
Serious problems requiring extensive care or major surgery may require evacuation to the United States, often at considerable expense.

There are no formal, documented HIV/AIDS entry restrictions for visitors to and foreign residents of Anguilla, but there have been anecdotal reports of exclusion.
Please verify this information with the British Embassy before you travel.

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.
For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site.
Further health information for travelers
is available from the WHO.

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

Unlike the U.S., traffic in Anguilla moves on the left. The few roads on the island are generally poorly paved and narrow. While traffic generally moves at a slow pace, with the increasing number of young drivers in Anguilla, there are occasional severe accidents caused by excessive speed. Although emergency services, including tow truck service, are limited and inconsistent, local residents are often willing to provide roadside assistance. For police, fire, or ambulance service dial 911.

Please refer to our Road Safety page for more information.
Visit the Government of Anguilla web site for further road safety information.

AVIATION SAFETY OVERSIGHT:
Civil aviation operations in Anguilla fall under the jurisdiction of British authorities. The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Anguilla’s air carrier operations.
For more information, travelers may visit the FAA web site.

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 Anguilla laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Anguilla 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 Anguilla 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 Anguilla. 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 with consular responsibility over Anguilla is located in Bridgetown, Barbados in the Wildey Business Park in suburban Wildey, southeast 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.
Visit the U.S. Embassy Bridgetown online for more information.
Hours of operation are 8:30 a.m. – 4:30 p.m. Monday through Friday, except Barbadian and U.S. holidays.
* * *
This replaces the Country Specific Information for Anguilla dated April 2, 2008, to update sections on Country Description, Entry/Exit Requirements, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Sat, 9 Sep 2017 19:31:32 +0200

Paris, Sept 9, 2017 (AFP) - France's meteorological agency on Saturday issued its highest warning for the Caribbean islands of St Martin and St Barts as Hurricane Jose bore down, three days after they were hit by Hurricane Irma.   The alert warned of a "dangerous event of exceptional intensity," with winds that could reach 120 kilometres (75 miles) per hour, and strong rains and high waves.

St Barts is a French overseas territory, as is the French part of St Martin, which is divided between France and the Netherlands.   Twelve people were killed on the two islands by Hurricane Irma, thousands of buildings were flattened and the authorities are struggling to control looting.   The French state-owned reinsurer CCR on Saturday estimated the damage at 1.2 billion euros ($1.4 billion).   Irma is now heading for Florida, where a total of 6.3 million people have been ordered to evacuate, according to state authorities.
Date: Tue 29 Apr 2014
Source: National Institute for Public Health and the Environment [edited]

1 Oct 2013-29 Apr 2014 (week 18) St Maarten - Since the last report (week 15 [17?]) 52 new cases have been confirmed among St Maarten residents. Up to 29 Apr 2014, now a total of 343 confirmed cases have been reported. One of these confirmed cases was hospitalized.

The median age of the confirmed patients was 44 years, range 4-92 years. Of those cases for which gender was available, 201 were female and 130 were male.

- On 6 Dec 2013, the 1st indigenous chikungunya [virus infection] case of St Maarten was reported. Retrospectively, the 1st patient with suspected complaints was reported in mid-October 2013 in St Martin.
------------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
=====================
[The report also has graphs showing case numbers over time.

Maps of St Martin/St Maarten can be accessed at
Date: 5-11 May 2014
Source: Institut de Veille Sanitaire (French Institute for Public Health Surveillance, InVS) [edited]

Cases since the beginning of the outbreak in December 2013:
- St Martin: (susp) 3240 cases; deaths 3; stable.
- St Barthelemy: (susp) 500 cases; stable.
- Martinique: (susp) 24 180; deaths 3; increasing.
- Guadeloupe: (susp) 13 600 cases; deaths 1; increasing.
- French Guiana: (susp) not available; (probable or confirmed) 122 cases with 83 locally acquired; increasing, with a new cluster in Kourou and 2 near Cayenne.
======================
[The 16 May 2014 report from Guyaweb (<http://www.guyaweb.com/actualites/news/sciences-et-environnement/le-chik-revient-kourou-setend-cayenne-desormais-saint-laurent/>) states that there are 2 new cases in Saint-Laurent-du-Maroni, overlooking the Suriname River, of which one is certainly autochthonous, and a new focal point occurred in Kourou with 4 cases.

Maps of the area can be seen at
and <http://healthmap.org/promed/p/35574>. - ProMed Mod.TY]
Date: 7-13 Apr 2014
Source: INVS Point Sanitaire No. 14 [in French, trans. ProMed Mod.TY, edited]

Cases since the beginning of the outbreak in December, 2013:
- St. Martin: (susp.) 2980 cases, (probable and conf.) 793 cases; Deaths 3; Decreasing.
- Saint Barthelemy: (susp.) 460 cases, (probable or confirmed) 135 cases; Decreasing.
- Martinique: (susp.) 16 000, (probable or confirmed) 1473 cases; Deaths 2; Increasing.
- Guadeloupe: (susp.) 4710 cases, (probable or confirmed) 1261 cases; Deaths 1; In epidemic status.
- French Guiana: (susp.) 7 cases with 4 locally acquired, (probable or confirmed) 39 cases with 26 locally acquired) 30 cases; (imported) 16 cases; Moderate to increasing; Half of probable and confirmed cases are located in Kourou; however indigenous cases have also been recorded from the Cayenne Matoury, Remire and Macouria communities.
=================
[Maps showing case distributions on each island can be accessed at the above URL. - ProMed Mod.TY]
Date: Thu 27 Mar 2014
Source: The Daily Herald [edited]

As St. Maarten continues to take measures to combat the spread of the chikungunya virus, the number of cases continues to climb.

Health Minister Cornelius de Weever announced on Wednesday [26 Mar 2014], that the total number of confirmed chikungunya cases thus far stood at 224.

De Weever also announced that government will be signing a Memorandum of Understanding (MOU) with French St. Martin as a means of collectively responding to the mosquito threat that puts the population at risk. He said both sides have been working closely together to address the dengue and chikungunya threats.

The MOU will cover, amongst other things, a regular exchange of epidemiological information on vector-borne diseases and collectively publishing and representing data collected under the agreement.

The need for collective information campaigns and enhancement of the mosquito vector-control programme will also be included in the MOU. The MOU also describes the need for planning execution and evaluation of collective responses to the chikungunya threat.
=========================
[The increase in the number of chikungunya virus infections over the past week in St. Maarten is of concern, rising from 123 cases to 224 cases. This number is confirmed in another report that also indicates that there are an additional 325 suspected cases (<http://www.rivm.nl/dsresource?type=pdf&disposition=inline&objectid=rivmp:239786>).  - ProMed Mod.TY]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/35574>.]
More ...

Morocco

General
********************************************
Morocco is a North African country and a favourite destination for many Irish tourists. The climate, relative shortness of the flights and the idyllic swimming conditions encourage many to vis
t.
Safety & Security
********************************************
The border regions of the country can be volatile and travellers planning to visit away from the main tourist routes should take extra precautions. The Western Sahara region is still in dispute though there has been an official cease-fire in place since 1991. The possibility of unexploded mines exists though it should be remembered that this area is many miles away from the normal tourist resorts. The level of street crime in Morocco is low but growing. Busy market places, parks and beaches are popular locations for petty criminals. Tourists should take care not to flaunt personal wealth and to avoid travelling away from the main tourist zones late at night. Travelling alone is a particular risk and only authorised guides and taxis should be used. Tourists have been threatened with serious injury at knife point if they have refused to purchase cannabis.
Laws & Customs
********************************************
It is an Islamic country and ladies in particular should take care to dress modestly. Islamic festivals can cause significant changes to occur which affect tourists including the holy month of Ramadan when all street cafés close until 5.30pm each day as strict Muslims do not eat during the daylight hours. The main tourist hotels continue to serve food as normal but many shops will remain closed. During these times tourists will need to carefully check their tickets and any travel arrangements may need to be changed. Banks and larger shops will remain open between 9am and 3pm Monday to Friday. Drug offences are treated very seriously and those visiting the Rif Mountains should realise this is a major cannabis growing area. Visitors with Arabic Bibles or those involved in any perceived outreach activity may find they are subjected to prolonged interrogation.
Health Facilities
********************************************
The level of health care available in many of the main hotels and resorts is perfectly adequate but care should be taken if your illness necessitates admission. Communication in English may be difficult and many medications will be unavailable. Frequently small private hospitals are used where standards vary greatly. Check that your travel insurance provides adequate cover for repatriation if required.
Food & Water Facilities
********************************************
The food and water provided in many of the main tourist resorts is very satisfactory but variations can easily occur and travellers should be careful at all times. Lettuce, undercooked bivalve shellfish (mussels, oysters, clams etc) and untreated water are all frequently implicated in sickness among travellers. Eating previously peeled fruit is also unwise and should be avoided. Bottled water purchased from main shops or hotels should be used for drinking and brushing your teeth.
Insect Bites & Mosquitoes
********************************************
There is only a very small risk of malaria transmission throughout Morocco and prophylaxis is not recommended for the majority of tourists. However, sandflies do abound during the summer months and can transmit a nasty disease known as Leishmaniasis. These small flies tend to hover close to the ground in shaded areas and can easily bite without the individual noticing. It is essential to use good insect repellent when at risk and to report any slow healing bite or sore to a doctor after your return home.
Sun Exposure
********************************************
The level of sun exposure in Morocco during the summer months can be intense. Take care to avoid the midday sun and use high sun blocking creams at all relevant times. Take particular care of children while in such a hot climate. Extra water and salt will be required to replace the amounts lost through perspiration. Salted crisps and nuts will be a useful source of salt.
Water Sports & Activities
********************************************
Many tourist locations in Morocco offer extended water sport facilities for tourists. Always check out what the standard of care is before agreeing to take part. Ask tourists who arrived before you and check with your holiday representative if possible. Confirm that good safety procedures are in place and that your travel insurance covers any accidents as a result of your activities.
Cash Facilities
********************************************
Traveller’s cheques and credit cards are accepted in many of the main tourist resorts. ATM machines are available in Casablanca and Rabat. It may be difficult to reconvert Moroccan money back to sterling and so care should be taken not to change too much initially until you clarify your expenses.
Travel by Train
********************************************
To visit other parts of the country many travellers use the train journey south from Tangier. However, be wary of any invitation from fellow passengers to alight at Asilah rather than continuing the journey south. A number of tourists have been held hostage and forced to make credit card transactions or cash withdrawals before being freed.
Road Transport
********************************************
Many tourists to Morocco hire motorbikes or cars to see more of the country. This is regarded as a high-risk activity and special care will be required at all times. Driving practices throughout Morocco are poor and traffic signals do not always function. Modern freeways link the main cities of Tangier, Rabat, Fez and Casablanca. Flash flooding can occur during the rainy season (November – March).
Rabies
********************************************
Rabies does occur in Morocco and it is essential that you avoid any and all contact with at risk animals. Typically this includes dogs, cats and monkeys but this viral disease can infect any warm-blooded animal. Take particular care to warn children to avoid animals and to report any contact as soon as possible.
Vaccinations
********************************************
There are no essential vaccines for entry into Morocco from Ireland. However most tourists are advised to consider adequate cover against:
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food and water disease)
*
Hepatitis A (food and water disease)
Those planning a longer or more rural trip will also need to consider cover against diseases like Hepatitis B and Rabies.
Summary
********************************************
The majority of tourists visiting Morocco will remain very healthy and well. However, following simple precautions against food and water disease and sun exposure will be essential.

Travel News Headlines WORLD NEWS

Date: Fri, 15 Nov 2019 01:13:41 +0100 (MET)
By Sophie PONS

Dakhla, Western Sahara, Nov 15, 2019 (AFP) - In the heart of disputed Western Sahara, a former garrison town has become an unlikely tourist magnet after kitesurfers discovered the windswept desert coast was perfect for their sport.  In Dakhla, an Atlantic seaport town punctuated with military buildings in Morocco-administered Western Sahara, swarms of kitesurfers now sail in the lagoon daily.y    "Here there is nothing other than sun, wind and waves. We turned the adversity of the elements to our advantage: that's the very principle of kitesurfing," said Rachid Roussafi. 

After an international career in windsurfing and kitesurfing, Roussafi founded the first tourist camp at the lagoon at the start of the 2000s.    "At the time, a single flight a week landed in Dakhla," the 49-year-old Moroccan said.   Today, there are 25 a week, including direct flights to Europe.   "Dakhla has become a world destination for kitesurfing," said Mohamed Cherif, a regional politician.

Tourist numbers have jumped from 25,000 in 2010 to 100,000 today, he said, adding they hoped to reach 200,000 annual visitors.    The former Spanish garrison is booming today with the visitor influx adding to fishing and trade revenue.   Kitesurfing requires pricey gear -- including a board, harness and kite -- and the niche tourism spot attracts well-off visitors of all nationalities.    Peyo Camillade came from France "to extend the summer season", with a week's holiday costing about 1,500 euros ($1,660). 

Only the names of certain sites, like PK 25 (kilometre point 25), ruined forts in the dunes and the imposing and still in-use military buildings in Dakhla, remind tourists of the region's history of conflict.   In the 1970s, Morocco annexed Western Sahara, a former Spanish colony, and fought a war with the Algeria-backed Polisario Front from 1975 to 1991, when a ceasefire deal was agreed.   A United Nations mission was deployed to monitor the truce and prepare a referendum on Western Sahara's independence from Morocco, but it never materialized.   Without waiting for the political compromise that the UN has been negotiating for decades, hotels have sprouted from the sand along the coast, and rows of streetlights on vacant lots announce future subdivisions.

- 'Good communication' -
"The secret to success is to develop kitesurfing with good communication focused on the organisation of non-political events," said Driss Senoussi, head of the Dakhla Attitude hotel group.    Accordingly, the exploits of kitesurfing champions like Brazilian Mikaili Sol and the Cape Verdian Airton Cozzolino were widely shared online during the World Kiteboarding Championships in Dakhla last month.   The competition seemed to hold little interest for Dakhla's inhabitants however.

Only a few young people with nothing to do and strolling families found themselves on the beach for the finals.   Just as rare are the foreign tourists who venture into the town of 100,000 residents to shop.   Like her friends, Alexandra Paterek prefers to stay at her hotel, some 30 kilometres (19 miles) from downtown.    "Here is the best place in the world for learning kitesurfing," said the 31-year-old Polish stewardess.    On her understanding of the broader regional context, she said: "It's an old Spanish colony and they have good seafood, for sure."

Like many tourists, she was under the impression that the area belonged to Morocco, as the destination tends to be marketed in the travel industry as "Dakhla, Morocco".   That angers the Polisario, which wants independence for the disputed region and tried last year in vain to sue businesses it said were "accomplices to the occupying military power."   The independence movement is now focused on challenging commercial deals between Morocco and the European Union that involve Western Sahara, according to the group's French lawyer Gilles Devers.   Moroccan authorities are looking actively for investors for their development projects on the west coast, the most ambitious being the Dakhla Atlantique megaport with a budget of about $1 billion to promote fishing.

- Environmental concerns -
On the lagoon, surrounded by white sand and with its holiday bungalows, "there is a struggle between developing aquaculture and tourism," said a senior regional representative, who spoke on condition of anonymity.    "One has less impact on the environment, but the other generates more revenue and jobs," said the representative, adding that "pressure from real-estate investors is very high."

With the influx of tourists, the protection of the environment has become a major concern.   "Everything is developing so quickly... we need to recycle plastic waste and resolve the issue of wastewater," said Rachid Roussafi.    Daniel Bellocq, a retired French doctor, worries for the future of this lagoon, that was "once so wild" that he has kitesurfed in for 20 years.   "There is green algae that wasn't there before, it's becoming a septic tank," he said.   Regional councillor Cherif, though, insists the bay is clean, saying: "All the hotels are equipped with wastewater management systems."   For him, the real threat is from plastic waste, whether it is dropped by tourists or brought by sea currents.
Date: Fri, 27 Sep 2019 06:34:45 +0200 (METDST)
By Sophie Pons

Casablanca, Morocco, Sept 27, 2019 (AFP) - In Morocco, the struggle against HIV has been so successful in recent years that campaigners worry about losing funding for combatting the virus, but for people living with the disease it remains a heavy stigma.   In Casablanca, a group therapy workshop offers HIV patients a rare opportunity to speak openly about their disease.   "Here I feel normal, I'm treated like a human being," said Zineb, a 29-year-old mother.

Organised by the Association for the Fight Against AIDS (ALCS), on a recent Thursday the workshop brought 12 HIV patients together with a psychologist and a therapist.   The ALCS also organises follow-up therapeutic care in hospital, and prevention and screening campaigns, with funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria.   These programmes were developed shortly after the first HIV case was detected in Morocco in 1986.   This early start is partly why UNAIDS, the Joint United Nations Programme on HIV/AIDS, calls Morocco a "model country" for its HIV response.   Thanks to improved screening, access to treatment and monitoring, new HIV infections in Morocco declined by 42 percent between 2010 and 2016, compared to an average reduction of four percent across the rest of the Middle East and North Africa.

Morocco had 350 deaths from AIDS in 2018, from a population of about 35 million.   But some groups remain vulnerable, with intravenous drug users, men who have sex with other men, and sex workers accounting for two thirds of Morocco's 21,000 identified cases.   And the stigma attached to those infected remains high, even within the family.   "My mother treated me like a murderer. For a long time I felt alone in the world," said Youssef, a 28-year-old who has twice attempted suicide.   Like other HIV patients interviewed by AFP, he asked to be identified by a pseudonym.   And all of them -- save for a 40-year-old considered very lucky by the group -- have either hidden their illness or been rejected by loved ones.

- 'Don't tell him anything' -
In this conservative Muslim society, where sex outside marriage and homosexuality are illegal, HIV patients seldom talk publicly about the virus.   "The subject is taboo, because the infection is linked to sex, itself a taboo subject in Morocco," said Yakoub, a 25-year-old ALCS worker.   "The social rejection is such that some (HIV patients) lose everything: family, friends, work, home," he said.

Zineb, like many HIV patients, hides her medication to conceal her illness.   For 10 years, the former teen mother has told her family that she is being treated for diabetes. "My 17-year-old son knows nothing, I can't bring myself to tell him, I'm too afraid," she said with a sad smile.   "Once you're sick, you're no longer a person," said Sakina, a mother who says she never speaks of her illness except with doctors, the ALCS staff and other HIV patients.

Like 70 percent of HIV positive women in Morocco, Sakina was infected by her husband. She cannot bring herself to tell her 15-year-old son that he is also infected.    She has always lied to him but she can "no longer sleep at night", she told the group through tears.    "My advice: above all, don't tell him anything," said a young man.   "For your sake, let him find out from someone else," another group participant suggested.   Then the psychologist interjected to say that private sessions are available to "reflect on these difficult questions".

The shame of HIV is so entrenched, it even permeates the medical establishment.   "For 30 years we've been talking about it, the virus is well known but the discrimination is still there," said Dr Kamal Marhoum El Filali, head of the infectious diseases department at Ibn Rochd Hospital in Casablanca, which hosts an ALCS branch.    "The stigmatisation isn't just from society but also from medical staff within the hospital environment."

Amina, another group therapy participant, experienced this first hand.   "When I went to the hospital to give birth, no one wanted to take care of me, no one wanted to touch me, I ended up in intensive care," she recalled indignantly.   Others in the session though were grateful for the care they had received.    "We are lucky to be under the care of the infectious diseases department: we are well cared for compared to others, considering the lack of funding and disrepair in Moroccan hospitals," said another participant

- 'Victim of own success' -
The emergency room at Ibn Rochd is sometimes overwhelmed with doctors each seeing up to 40 patients a day.   But the infectious diseases department is always spotlessly clean, providing personalised support as ALCS staff liaise with the medical teams.   But how much money Morocco will receive to continue its fight against HIV will be determined at a three-yearly conference for the Global Fund in October.   With funding declining globally and controversy surrounding the management of UNAIDS, ALCS president Mehdi Karkouri fears financial cuts.   "We are a victim of our own success: because our results are good, we risk losing funding," he said.
Date: Mon, 2 Sep 2019 21:08:54 +0200 (METDST)

Rabat, Sept 2, 2019 (AFP) - Morocco authorities said Monday they had found the body of a person missing after a flood hit a football pitch, bringing to eight the number of people killed in last week's tragedy.   The flood took place when a nearby river burst its banks in the southern region of Taroudant on Wednesday.   A 17-year-old boy and six elderly men were killed and have since been buried, while rescuers continued the search for an eight victim who was swept away by the flood, authorities said.

The last body was found some 20 kilometres (12 miles) from the village of Tizret near where an amateur football tournament had been taking place.   Photographs and videos shared on social media showed muddy waters carrying away people who had clambered on top of a building flattened by the flood.   Authorities have opened an investigation and the government has promised to take several measures to avoid such tragedies in the future.   Morocco's national weather service had warned of the risk of stormy rains on Wednesday afternoon in several provinces.    The heavy downpour followed a dry spell, making the floods more violent, local media reported.

Floods are common in Morocco. In late July, 15 people died in a landslide caused by flash floods on a road south of Marrakesh.   In 2014, floods killed around 50 people and caused considerable damage in the south of the country.   Between 2000 and 2013, a series of 13 major floods killed a total of 263 people in Morocco and caused considerable damage to infrastructure worth $427 million, according to the World Bank.   A study published in 2015 pointed to multiple failures in infrastructure maintenance, prevention, warning and emergency management.
Date: Thu, 29 Aug 2019 00:08:33 +0200 (METDST)

Rabat, Aug 28, 2019 (AFP) - At least seven people died Wednesday when a river burst its banks and flooded a village football pitch where a game was being played in south Morocco, local authorities and a witness said.   Eight men who had sought refuge in the changing rooms were swept away in the floodwater after heavy showers hit the Taroudant region late in the day, an eyewitness told AFP on condition of anonymity.   "We're in shock, I'm 64 years old and I've never seen such a downpour," the witness said.

Search and rescue operations were under way to find further victims, officials said.   Photographs and videos shared on social media showed muddy waters carrying away people who had clambered on top of a building flattened by the flooding.    Morocco's national weather service had warned of the risk of stormy rains on Wednesday afternoon in several provinces.    The heavy downpour followed a dry spell, making the floods more violent, local media reported.   Floods are common in Morocco. In late July, 15 people died in a landslide caused by flash floods on a road south of Marrakesh.
Date: Fri, 26 Jul 2019 15:26:58 +0200

Rabat, July 26, 2019 (AFP) - Moroccan emergency crews pulled 15 bodies from the mud after a rare summer downpour triggered a landslide that buried a minibus, authorities said Friday, providing the first official toll.   The victims -- eleven women, three men and one child -- were found in the bus buried some 20 metres (more than 60 feet) under the masses of earth and rock dislodged by the rain, local authorities said.    "There are no survivors," they said in a statement.

The official toll comes after public broadcaster 2M reported Friday morning that 16 bodies had been recovered.   The bus was buried Wednesday evening when a deluge in the Atlas mountains south of Marrakesh triggered flash flooding.   Images released by the authorities show excavators working to dig a path to the bus, more than 24 hours after it was engulfed by the debris.

A weather alert on Tuesday warned of storms in several provinces in the North African country, which rarely receives summer rains.   Investment in Morocco's road network has largely focused on the main transport arteries and many rural areas can be reached only by dirt tracks that are vulnerable to extreme weather.   Every year, nearly 3,500 people are killed on the North African country's roads.
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Turkmenistan

Turkmenistan - US Consular Information Sheet
March 02, 2009
COUNTRY DESCRIPTION:
Turkmenistan is a Central Asian nation roughly the size of California.
It shares borders with Kazakhstan, Uzbekistan, Afghanistan, and Iran.
Turkmen
stan gained its independence in 1991 during the dissolution of the Soviet Union.
Primarily a desert country, it has a population of around six million people. Tourist facilities, especially outside of the capital city of Ashgabat, are not highly developed.
Many of the goods and services taken for granted in North American and Western European countries are not yet available. Travel within the country can be difficult due to limited infrastructure and government-imposed internal travel restrictions.
Read the Department of State Background Notes on Turkmenistan for additional information.
ENTRY/EXIT REQUIREMENTS:
American citizens must have a valid passport and visa and/or letter of invitation from the Government of Turkmenistan to enter and exit Turkmenistan.
To apply for a visa, all U.S. citizens must complete an application and have a letter of invitation approved by the State Migration Service (SMS), formerly known as the State Service for the Registration of Foreigners (SSRF), in Ashgabat.
An individual or organization in Turkmenistan must submit the letter of invitation on behalf of an American citizen to the SMS accompanied by a copy of the traveler's passport ID page.
Each traveler’s passport must be valid for at least 6 months following the date of the application.
The SMS requires at least 15 working days for approval.
The U.S. Embassy in Ashgabat does not issue letters of invitation to citizens interested in private travel to Turkmenistan.
Applications for a visa can be submitted to the Embassy of Turkmenistan in Washington, D.C., or directly to the SMS in Ashgabat.
Under local law, a traveler with a stamped and approved invitation letter may also obtain a visa at the Ashgabat International Airport upon arrival in Turkmenistan; however, some travelers have reported difficulties with airlines not boarding passengers who only have approved invitation letters in lieu of a visa for onward travel to Turkmenistan.
Travelers are strongly recommended to obtain a visa before traveling.

The price for the visa will vary according to the intended length of stay.
For an additional charge, the SMS can extend a visa in Ashgabat beyond its initial validity.
Any traveler arriving without a visa or without the documents necessary to obtain a visa will be denied entry and may be held at the airport or border until the traveler has secured transportation out of Turkmenistan.
Based on past incidents, the Embassy discourages travelers from planning to use transit visas in lieu of obtaining tourist visas through a travel agency.
The U.S. Embassy in Ashgabat is unable to intervene with Turkmenistani authorities regarding the admission of private travelers to Turkmenistan.
Travelers departing Turkmenistan must have a current valid visa or they will be denied exit until they have extended the validity of the visa through their departure date.
In addition, U.S. citizens traveling in Turkmenistan should be aware that they need special permission from the SMS to travel to areas of the country that have been restricted by the Government of Turkmenistan, including almost all border areas.

Upon arrival at an airport or border entry point, foreigners will be charged approximately $12 for an immigration card issued by Turkmen authorities.
All foreigners are required to carry this immigration card for the duration of their stay in Turkmenistan.
Authorities will collect the immigration card upon departure.
Those departing Turkmenistan from the Ashgabat airport and flying with a non-Turkmenistani flagged carrier are required to pay a $25 departure fee.

In addition to the immigration requirements mentioned above, foreigners are subject to local registration requirements.
Americans who plan to stay more than three working days in Turkmenistan must register with the SMS.
SMS offices are located in all of Turkmenistan's five major cities: Ashgabat, Dashoguz, Mary, Turkmenabat and Turkmenbashy.
Foreigners who plan to travel outside of the city in which they will register must inform the SMS in advance; otherwise travelers will face fines or deportation.
One day prior to their departure from Turkmenistan foreigners must return to an SMS office to register the departure.
Foreigners should be registered and deregistered at the SMS in the city in which their sponsoring organization is located.
Foreigners who fail to register their departure may be prevented by immigration authorities from leaving the country until they have done so.
The penalties for remaining in Turkmenistan with an expired visa or for failing to register with SMS include fines, arrest, and/or deportation.
Foreigners who are deported for these violations may be prohibited from returning to Turkmenistan for up to five years.
American citizens in Turkmenistan are strongly urged to ensure that their visas do not expire and that they register with SMS upon arrival and upon departure.

Visitors holding tourist visas organized by a travel agency must stay in hotels; other visitors may stay in private accommodations whose owner must register the visitor's presence.
Visit the Embassy of Turkmenistan web site for the most current visa information.

Several popular travel guides discuss traveling by “ferry” across the Caspian Sea from Baku, Azerbaijan, to the port of Turkmenbashy in western Turkmenistan.
Some travelers have faced problems attempting to travel to Turkmenistan by boat.
Travelers should be aware that these “ferries” are in fact cargo ships that take on some passengers incidental to their primary function.
Passengers are generally not provided food or water on these ships, and sleeping and sanitary facilities are likely to be rudimentary.
Travelers should be aware that ships arriving at the port of Turkmenbashy often wait days offshore for outgoing ships to vacate the dock to allow incoming ships to disembark.
Some travelers have spent more than a week offshore while their ship awaited permission to enter the port, and they have run out of stores of food and water, or had their Turkmen visas expire before they could be used.
For this and other reasons travelers, especially those who plan to enter Turkmenistan by boat, are discouraged from using transit visas to enter Turkmenistan.

At Ashgabat International Airport, most airlines do not accept payment for tickets by credit card, or in any currency other than US dollars or Turkmen manat.
Travelers planning direct transit through Turkmenistan en route to another country should be aware that if they are stranded due to a missed connection, they will not be allowed to leave the arrival detention area until they are able to buy a ticket for an onward flight out of Turkmenistan.
For this reason, the Embassy discourages travelers from planning to directly transit through Ashgabat International Airport.

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:
Those considering travel to Turkmenistan should take the country's proximity to regions of past and current instability into account before making any plans.
The Government of Turkmenistan has designated many areas throughout the country as “restricted zones,” particularly the border areas next to Iran, Uzbekistan, and Afghanistan, the entire region of Dashoguz (including Dashoguz city), and areas of the Caspian coast.
Travel to these areas by foreigners is forbidden without special permission from the Government of Turkmenistan.
Turkmenistan Airlines, the national airline, will not sell a ticket to any traveler who intends to travel to a “restricted zone” without proof of permission from the government.
Travelers who wish to visit a “restricted zone” must have a valid passport and visa and must apply to the Ministry of Foreign Affairs for a special permit.
There is a minimum processing time of 10 working days for these permits.

Visible police and military presence in Turkmenistan is common.
Both uniformed and plainclothes officials frequently ask to see passports, visas, migration cards, and SMS registrations.
Travelers should ask to see identification if they are not certain that the person requesting the information is an official.
These documentation checks, and residence and vehicle searches, are common.
Security personnel maintain checkpoints on major roads.

Security personnel may at times place foreign visitors under surveillance.
Hotel rooms, telephones, and fax machines may be monitored, and personal possessions in hotel rooms may be searched.
Taking photographs of anything that could be perceived as being of military or security interest, such as government buildings, may result in problems with authorities.
Visitors should ask whether buildings may be photographed.

Supporters of extremist groups such as the Islamic Movement of Uzbekistan, 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 Turkmenistan.
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, restaurants, places of worship, hotels, schools, outdoor recreation events, resorts, beaches, maritime facilities, and commercial aircraft.

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

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

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

CRIME:
Although the government's official policy is to report that there is no violent crime, there are incidents of assault, rape, and murder sometimes directed at foreigners.
Prostitution, heroin use, and economic conditions are all factors contributing to the incidence of violent crimes.
Petty theft is common in crowded public places such as the local bazaars.
Visitors should take appropriate measures to safeguard their passports and valuables in such areas.
Also, visitors should not leave their valuables in plain view within a parked vehicle.
Several recent cases suggest that there has been an increase in theft from parked vehicles.

Foreign visitors, including American citizens, present an attractive target for criminals.
Travelers should exercise the same common sense, good judgment, and caution as they would in any major U.S. city.
For instance, one should avoid carrying large sums of money in public.
Travelers should avoid walking alone after dark, and women specifically should avoid being alone in isolated areas.
Most taxis are not regulated by any government licensing agency and drivers are usually private citizens looking to make money.
The majority of cars will not have seat belts or other safety devices, and drivers may not have had any formal driver training.
For safety reasons, visitors should strongly consider hiring a private car and driver through their travel agency or hotel.
There is one government-owned and regulated taxi company, operating in Ashgabat, which charges a flat fee of 45,000 Old Turkmen Manat/9 Denominated Turkmen Manat (about $3.25 at the February 2009 exchange rate) for a one-way trip within Ashgabat city limits.
Its telephone number is: (993 12) 32-97-75.
If using local unregulated taxis, passengers should always negotiate fares with taxi drivers in advance, and extreme caution should be used when using taxis after dark, especially when there are other passengers in the vehicle.

Prostitution is illegal, and prostitutes have been known to accompany men to their residences or hotel rooms in order to steal from them, sometimes with the help of an accomplice.
The authorities will generally consider any woman leaving a discotheque with a foreign man late at night to be a prostitute, and on that basis, the foreigner may be detained.
In recent years, at least one foreigner was kept in jail for fifteen days on charges of soliciting prostitution.
Travelers should be aware that U.S. law provides for criminal prosecution in U.S. federal courts of American citizens who have solicited a prostitute under the age of 18 while traveling abroad.

Police can ask anyone to present identity papers at any time, but authorities are especially aggressive late at night.
Even if valid papers are presented, the police may ask for a bribe.
For this reason, those going from place to place late at night should consider using a trusted driver.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing these products back to the United States may result in forfeitures and/or fines. More information on this serious problem is available from the U.S. Department of Justice, Computer Crime & Intellectual Property Section.

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, help you find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local equivalent to the “911” emergency line in Turkmenistan is 03.
Please see our information on Victims of Crime, including possible victim compensation programs in the United States.

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 Turkmenistan’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Turkmenistan 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.

SPECIAL CIRCUMSTANCES:
Turkmenistan has a cash-only economy.
However, several new hotels accept credit cards.
Vnesheconombank and the National Bank of Pakistan cash traveler’s checks and personal checks for a fee, although cashing a personal check is a lengthy process that could require up to two months.
Vnesheconombank also accepts Visa for cash advances, for a fee.

Although the manat is the official currency, U.S. dollars are widely accepted and are required as payment for certain goods and services.
Travelers may wish to bring sufficient U.S. currency to exchange into manat to cover expenses not payable in U.S. Dollars.
Old U.S. dollar bills (issued before 1990) and/or those in poor condition (with tears, writing or stamps) are not acceptable forms of currency in Turkmenistan.
Banks frequently do not have small bills for change.
In 2008, the government of Turkmenistan unified its dual currency exchange rate by bringing the commercial and governmental exchange rates together.
This change occurred incrementally, contributing to wild currency speculation by average citizens, many of whom keep their savings in U.S. dollars in their homes, rather than in bank accounts.
As a result, the banks, at times, have imposed limits on the amount of currency that could be exchanged by an individual on a particular day.
Travelers should check with their travel agencies to discuss options for currency exchange if a limitation should happen during their visit to Turkmenistan.

Turkmenistan customs authorities may enforce strict regulations concerning temporary importation into or export from Turkmenistan of items such as carpets, jewelry, musical instruments, pieces of art, archaeological artifacts, antiques, protected animals, etc.
It is advisable to contact the Embassy of Turkmenistan in Washington for specific information regarding customs requirements.
Travelers who wish to take carpets out of Turkmenistan must obtain a certificate from the Carpet Museum in central Ashgabat indicating that the carpet is not of historical value.
Some private shops may have carpets for sale for which they have already obtained certificates; buyers should be sure to ask about customs certificates before purchasing any carpet.
In addition, buyers may have to pay a tax calculated according to the size of the carpet.
Travelers who have purchased other items that could be perceived to be of historical value, such as jewelry, have also reported difficulties in taking these items out of Turkmenistan.
Turkmenistan's indigenous dog, the Alabay, is considered a national treasure and is banned for export without prior permission.
American citizens should also check to ensure that any item they intend to bring into the United States is permitted by U.S. customs regulations.

U.S. citizens are encouraged to carry a copy of their U.S. passports and visas with them at all times, so that, if questioned by local officials, proof of identity and U.S. citizenship, are readily available.

Travelers to Turkmenistan should be aware that there are several types of poisonous snakes and insects indigenous to the country. Even in cities, it is common to encounter cobras and scorpions, especially in areas covered with tall grass.
Travelers are advised to be alert to these dangers to avoid being bitten or stung. Please see our Customs Information sheet.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in Turkmenistan is limited and well below North American and Western European standards.
All visitors are strongly advised to purchase medical evacuation insurance to cover costs associated with transporting them to adequate medical facilities in the event of serious illness or injury.
Such travel can be expensive if undertaken under emergency conditions, and absent this insurance, medical evacuation travel may be logistically impossible on an emergency basis.
Travelers with medical conditions should consult their regular physician to determine whether travel to Turkmenistan is advisable in light of the level of available health care.
Resident American citizens travel to Western Europe or North America for treatment of any serious medical condition.
The U.S. Embassy maintains a list of public hospitals and English-speaking physicians in the country, however the standard of care at these hospitals cannot be considered comparable to Western standards.
Basic medical supplies, including disposable needles, anesthetics, and antibiotics are often in short supply.
Two private clinics have foreign medical practitioners (generally Turkish) who may be available for consultations and treatment; these clinics, however, have refused in some cases to admit patients with serious conditions, regardless of the patient’s ability to pay for treatment.
Even at these hospitals, the standard of care is low compared to Western standards.
Travelers requiring prescription medications should bring sufficient supplies of all necessary medications and appropriate documentation to ensure no problems with customs officials upon arrival.

Some HIV/AIDS entry restrictions exist for visitors to and foreign residents of Turkmenistan.
Currently, HIV tests are not required for applicants requesting tourist visas; however, should an individual be discovered to be HIV positive, that status would be grounds for denial of a visa or deportation.
All individuals requesting residence visas are required to submit to an HIV test.
Please verify this information with the Embassy of Turkmenistan before you travel.
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.
For information about outbreaks of infectious diseases abroad, consult the World Health Organization’s (WHO) web site.
Further health information for travelers is available from the WHO.
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 Turkmenistan is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Road conditions in Turkmenistan make driving difficult and sometimes dangerous.
Most roads outside of major cities are narrow, riddled with potholes, unlit at night, and without proper road signs.
Driving at night on these roads should be avoided.
City roads are better in comparison to rural routes but may be hazardous due to potholes, uncovered manholes, poor lighting, and heavy pedestrian traffic.
Pedestrians frequently cross against traffic and create dangerous conditions.
Traffic accidents involving serious injury to drivers, passengers, and pedestrians are common.

In general, visitors should use caution when driving in Turkmenistan.
Drivers pay little attention to lanes and other road markings, with weaving and sudden lane changes a common occurrence (usually without use of a turn signal).
Drivers will often encounter cars going the wrong way on one-way streets or divided highways.
Cars also frequently make left-turns from the right lane and vice-versa.
Pedestrians regularly walk or stand in the middle of busy streets during the day and night, often without paying attention to oncoming traffic.

Roadside assistance does not exist in Turkmenistan, where vast stretches of highway are often unmarked.
Police checkpoints (where cars are required to stop and register) are a common feature on major routes between cities.
The U.S. Embassy in Ashgabat has received reports that police stationed at checkpoints may arbitrarily fine motorists.
Local law requires that traffic fines be paid within 12 hours.
If a fine is not paid within that period, the amount may double every 12 hours up to 72 hours, after which time the vehicle in question may be seized.

Travelers who wish to drive in Turkmenistan must have a valid international driving permit.
Foreigners who plan to reside in Turkmenistan must apply for a local driver's license with the Road Police Department of the Ministry of Internal Affairs of Turkmenistan.
American citizens who want more specific information about driving in Turkmenistan should contact the Embassy of Turkmenistan at 2207 Massachusetts Ave. NW, Washington DC
20008, telephone (202) 588-1500.
Please refer to our Road Safety page for more information.
For specific information concerning Turkmenistan driving permits, vehicle inspection, road tax and mandatory insurance, contact the Turkmenistan National Tourist Organization offices at its Permanent Mission in New York.
The address is: 136 East 67th Street, NY, NY 10021.
The phone number is 1-212-472-5921.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Turkmenistan, the U.S. Federal Aviation Administration (FAA) has not assessed Turkmenistan’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.

Travelers may experience significant delays, unexpected re-routing, and sudden cancellations of flights, including those of Turkmenistan Airlines (Turkmenhowayollary), the national airline.
Travelers have reported difficulties securing reservations and purchasing tickets from Turkmenistan Airlines on both domestic and international flights, which are routinely overbooked.

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 Turkmenistan are encouraged to register with the 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 Turkmenistan.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at 9 1984 (Pushkin Street), off Magtymguly Street, tel. (993-12) 35-00-45; fax (993-12) 39-26-14.
The Consular Section can also be contacted by e-mail.
The Consular Section is open for American Citizens services every Monday through Friday afternoon, excepting holidays.
American Citizens are requested to call for an appointment for services except in cases of emergency.
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This replaces the Country Specific Information for Turkmenistan dated September 2, 2008 without substantive changes.

Travel News Headlines WORLD NEWS

Date: Fri, 9 Sep 2016 19:53:02 +0200

Avaza, Turkmenistan, Sept 9, 2016 (AFP) - Turkmenistan strongman President Gurbanguly Berdymukhamedov on Friday opened a giant five-star hotel worth over $100 million, shaped like a cruise ship, at the country's main Caspian Sea resort.   The 13-floor, 350-room hotel is the biggest in Turkmenistan's Avaza tourist zone, which the government is trying to promote despite an incredibly restrictive visa regime for foreigners.

"The purpose of this resort is to create the best conditions for interesting recreation time for the Turkmen people," Berdymukhamedov said of Avaza, adding that the hotel was called "Gami", or "Boat" to symbolise "the boat of our friendship."    "And since we are on a boat, we will be having nautical pasta -- a cheap Soviet pasta dish with minced pork and beef -- for lunch," he joked, before the dish was served to officials, diplomats and journalists at the ceremonial lunch.   The Central Asian country's leader, 59, also quoted a nautically-themed poem by Russian wordsmith Mikhail Lermontov.   The 90-metre by 200 metre (300 by 650 feet) white marble-clad hotel was built to echo a "snow-white ocean ship" a representative of the state company that ordered it built, told AFP.

A giant portrait of Berdymukhamedov spanned three floors of the building as dancers performed in front of it.   The hotel was built by the Turkish construction and logistics firm Ekol.   Hydrocarbon-rich Turkmenistan's secretive government has a reputation for lavish spending on frivolous architectural projects, even in times of economic crisis.   The country devalued its manat currency by around twenty percent in early 2015 under pressure from low prices for hydrocarbons, which account for practically all of the country's exports.

On the black market the currency's value can fetch up to 6 manats to the dollar against an official rate of 3.5 to the dollar, down from 2.8 to the dollar in 2014.    Despite Berdymukhamedov officially encouraging belt-tightening, the country has continued to spend heavily on infrastructure ahead of the 2017 Asian Indoor and Martial Arts Games it will host in the capital Ashgabat.

In 2013 Ashgabat earned a Guinness World Record as the city with the highest density of white marble-clad buildings.    "If the marble was laid out flat, there would be one square metre of marble for every 4.87 m³ of land," Guinness said at the time.   The city also hosts a golden statue of Berdymukhamedov and a similar statue of predecessor Saparmurat Niyazov, which once rotated with the movements of the sun.
Date: Wed, 6 Apr 2016 16:21:20 +0200

Ashgabat, Turkmenistan, April 6, 2016 (AFP) - Turkmenistan has passed a law making HIV tests mandatory prior to marriage, state media reported on Wednesday, in a sign the reclusive Central Asian state fears the spread of a disease it has always downplayed.    The law is the closest the highly secretive state of 5 million has come to acknowledging a public health threat from the disease which is prevalent throughout the former Soviet Union.

The law, which aims to "create conditions for healthy families and prevent the birth of HIV-infected children" was published in the state newspaper on Wednesday and is effective immediately.    An official from the country's national AIDS Center, speaking on condition of anonymity, told AFP that the new law was "very necessary" given the "high risk" of the spread of the virus.   The official cited use of intravenous drugs, mostly sourced from neighbouring Afghanistan, and prostitution as the main means of transmission.

Other than "persons entering marriage", the legislation also enforces HIV tests for blood donors, "persons suspected of narcotics use", prisoners, citizens of foreign countries applying for work visas and stateless persons.    According to the law signed by President Gurbanguly Berdymukhamedov, the government will guarantee anonymity and free treatment for sufferers of the disease.

Turkmenistan, which remains largely closed to the outside world, has always downplayed the prevalence of HIV, a disease that attacks the human immune system and is transmitted from person to person via bodily fluids.   In 2002, the health ministry, which does not publish data on infectious diseases, claimed the country had only two cases of HIV and that both patients had been infected outside Turkmenistan.
Date: Tue, 21 Jul 2015 17:03:00 +0200 (METDST)

Ashgabat, Turkmenistan, July 21, 2015 (AFP) - Health-obsessed former Soviet Turkmenistan is the country with the world's lowest proportion of smokers, World Health Organisation chief Margaret Chan said during a visit to the isolated nation on Tuesday.    Chan said that  just 8 percent of the population smoked, according to WHO figures.   "Recently a WHO overview showed that in Turkmenistan only 8 percent of the population smokes," Chan told the country's authoritarian President Gurbanguly Berdymukhamedov, who is a dentist by training.   "This is the lowest national indicator in the world. I congratulate you on this achievement," she said at a health forum in the capital Ashgabat.

Cited by state media, Chan noted that the country ratified the Framework Convention on Tobacco Control in 2011 by which time it had already banned smoking in public places.   Also speaking at the forum, Vera Luiza da Costa e Silva, Head of the Convention Secretariat, challenged the Central Asian state to drive smoking down to five per cent of the population in the coming years.   In 1990, 27 percent of Turkmen males over 15 and 1 percent of females smoked.

A decade later Turkmenistan banned smoking in public places, state buildings and the army, as well as all forms of tobacco advertising.   By comparison, 31.1 percent of the global male population over the age of 15 smoked in 2012, while 6.2 percent of females were smokers.   President Berdymukhamedov, in power since the death of eccentric predecessor Saparmurat Niyazov in 2006, is a keen equestrian, while Niyazov campaigned against smoking and built a 36-kilometre "path of health" into the mountains surrounding Ashgabat which government officials were forced to walk.   This April the gas-rich country of more than five million held a month of public exercises and sporting events under the slogan "health and happiness."
Date: Wed, 1 Jul 2015 17:54:35 +0200 (METDST)

Ashgabat, Turkmenistan, July 1, 2015 (AFP) - Turkmenistan reported its hottest June on record Wednesday, as a heat wave envelops former Soviet Central Asia.   "June 2015 was the hottest June since 1891 when records began. Daytime temperatures exceeded 40 degrees Celsius in the shade 16 times," a spokeswoman at Turkmenistan's state meteorological service in the capital Ashgabat told AFP Wednesday.   She noted that Tuesday, when temperatures reached 47.2 degrees Celsius, was the hottest June day in Ashgabat in the recorded history of the energy-rich country.   Many Muslims fasting for the Ramadan holy month in the secluded Caspian state have taken time off work and are shutting themselves away in air conditioned rooms, one observant Muslim who did not wish to be named told AFP.

In Kazakhstan temperatures, while set to vary in the coming week, remain very high in the southern regions of the country.   "In the afternoon the streets are empty," said Shafarat Sataeva, 72, from the southern region of Kyzylorda, where temperatures reached 42 degrees Celsius in the shade on Wednesday, the highest anywhere in the country.   In Tajikistan over 50 people including three Russian soldiers stationed at Russia's military base in the country drowned in mountain rivers and lakes as they sought to cool themselves.   The country's meteorological service said temperatures are expected to pass 40 degrees Celsius in the capital Dushanbe and warned of mudflows from high levels of glacial melt in the mountainous country.
Date: Tue, 15 Jul 2014 05:22:34 +0200 (METDST)
by Igor Sasin

AVAZA, Turkmenistan, July 15, 2014 (AFP) - Better known for its inhospitable desert plains than beach breaks, isolated ex-Soviet Turkmenistan this month welcomed an unlikely group of visitors: a sun-tanned crop of the world's top windsurfers.   Bordering Iran and Afghanistan, the energy-rich Central Asian country played host to a leg of the windsurfing World Cup at a sparkling new Caspian Sea resort that authorities hope can turn the once hermit state into a water sports hub.

International competitors bobbed and weaved through the foaming surf as their sails glistened in the sweltering heat -- an unfamiliar sight in a nation that until 2006 was cut off from the rest of the world by the eccentric two-decade rule of former dictator Saparmurat Niyazov.   "This is such a chance for me!" said a joyous Orazmyrat Arnamammedov, one of only a handful of windsurfers in Turkmenistan.   "It's happiness for me to take part in a competition with sportsmen who are known around the world," the 32-year-old sports instructor told AFP.

Turkmenistan is on a drive to promote itself as a destination for sports, adventure travel and even beach holidays in a bid to boost tourist numbers from the current 15,000 visitors per year.   "Holding world-class windsurfing competitions will be a significant step, taking Turkmenistan to a new level," President Gurbanguly Berdymukhamedov said at the opening of the Turkmenistan PWA World Cup windsurfing event.

Turkmen officials said holding sporting championships is part of the government's plan to develop tourism.   Next year the country will host the world championship in belt wrestling -- a traditional form of the sport -- in November and the 2017 5th Asian Indoor-Martial Arts Games.   "Sports and travel are the new trend for international tourism in Turkmenistan," said an official in the state tourism committee who asked not to be named.

- Resort rising from desert -
The sprawling Caspian Sea town of Avaza, which hosted the windsurfing competition from its 16 kilometres of beach, is a key part of that plan.    By 2020 Ashgabat hopes to transform the desert resort, whose name means "singing wave" in Turkmen, into a vast complex that can compete with Turkey's huge southwestern sea resort of Antalya.   "Avaza has every chance of becoming a major attraction for tourists, both from neighbouring countries and also from overseas," Berdymukhamedov said recently.   "In this part of the Caspian, the water is exceptionally clean and there are good beaches and a mild climate."   Since work started in 2007, six hotels and other accommodation for some 7,000 visitors has been built by mainly Turkish firms at a cost of around $2 billion (1.5 billion euros). 

But the resort -- where US pop star Jennifer Lopez was jetted in to perform last summer -- is set to grow into a vast complex with at least 60 hotels, as well as sanatoriums, rest homes, cottages and camp sites, that the the state tourism committee boasts will be "up to world standards".   An artificial river runs through the town and a new airport has been opened in the nearby city of Turkmenbashi.    A winter sports stadium with an ice rink and a 2,000 seat Palace of Congress are also in the pipeline, with the total price tag for the development expected to hit $7 billion.

- 'Why go to Avaza?' -
But some locals are not convinced that the Turkmen resort can bring in the crowds.   A week's package holiday for international visitors costs around $1,500, said Mukhamet Begliyev, who works at a private travel agency.   "Even if someone rich enough turns up, what do we have to offer except the sea and the hotels? The entertainment sphere isn't developed at Avaza at the moment," Begliyev said.   The "international" airport in Turkmenbashi so far only accepts domestic flights and getting a visa to the country is still a major hurdle.

For the moment that means the resort is largely attracting domestic holidaymakers, although Turkmenistan's low wages mean it is beyond the means of many.    For 28-year-old Gozel Akhundova from Dashoguz, a city in the country's north, even a brief stay in an Avaza hotel at $70 a night was an expensive treat.   "We'll only spend three days here. If it was cheaper, we'd stay longer," she said.   And the fledgling resort still has a long way to go to compete with more established holiday spots.     "Why should I go to Avaza, when there is Antalya?" asked Akhmet, a 22-year-old student in Ashgabat who said he planned to holiday in Turkey this summer.   "The service is good, there's plenty of fun activities and it's cheap," he said.
More ...

Turks and Caicos Islands

Turks & Caicos US Consular Information Sheet
November 17, 2008
COUNTRY DESCRIPTION:
The Turks and Caicos Islands are a British Overseas Territory comprising a small archipelago of eight major islands and numerous uninhabited keys, 500 mile
southeast of Miami.
Most tourist facilities are located on Providenciales ("Provo") Island.
The U.S. dollar is the unit of currency and the larger hotels and shops accept credit cards.
The U.S. Embassy in Nassau, Bahamas, has jurisdiction for consular matters in the Turks and Caicos.
ENTRY/EXIT REQUIREMENTS:
U.S. citizens do not need to obtain visas to visit the Turks and Caicos Islands.
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 either a WHTI-compliant document (such as a valid U.S. passport or passport card) or both a government-issued photo identification and a document showing their U.S. citizenship (for example, a certified U.S. birth certificate or certificate of nationalization).
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.
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.

Visit the British Embassy web site at http://ukinusa.fco.gov.uk/en for the most current entry information, including any visa requirements.
Information about dual nationality or the prevention of international child abduction can be found on our website.
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 Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the United States and Canada, or for callers outside the United States and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Petty street crime does occur.
Visitors should not leave valuables unattended in their hotel rooms or on the beach.
Visitors should make sure that their hotel room doors are securely locked at all times.
In the Turks and Caicos, carrying illegal/undeclared firearms or ammunition is a very serious crime, as is possession of illegal narcotics.

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

The local equivalent to the “911” emergency line in the Turks and Caicos Islands is 999 or 911.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are available but limited in the Turks and Caicos Islands.
There is a small public hospital on Grand Turk and a private clinic on Provo, which has a hyperbaric chamber.
Most serious medical problems require medical evacuation by air from the Turks and Caicos to the United States.

The Turks and Caicos Islands do not have a pathologist to perform services in cases of death.
Medical examiners from neighboring countries visit the island regularly to provide this service.
It can take up to two weeks for the Government of the Turks and Caicos Islands to release the remains of the deceased under normal circumstances, and severe weather during the hurricane season could delay the process even more.The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of the Turks and Caicos Islands.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s website at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning the Turks and Caicos Islands is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Driving in the Turks and Caicos Islands is on the left.
Traffic tends to be light, and the terrain is flat.
When entering roundabouts and other intersections without signs or traffic signals, drivers are required to give way to those on their immediate right.
Driving under the influence of alcohol is illegal, and drivers convicted of the offense may face fines, detention, or both.
Wild donkeys are a common sight and often walk on the roads, presenting a hazard to drivers, especially at night.
Road signs are not prevalent, but as there are few roads on the island, finding one's way with a tourist map is generally not a problem.
Drivers should be alert for unmarked hazards such as blind intersections or changes in road conditions.
Primary roads are generally drivable in both urban and rural areas.
Secondary roads are often unpaved, and have ruts and potholes.
Be aware that, in the event of a breakdown, roadside assistance is generally not available.
For emergencies, drivers may call 999 or 911 for police, fire, or medical assistance.
Visitors require a valid driver's license from their country of residence.
Safety of public transportation in the Turks and Caicos is generally good.
Most car and motor scooter rental agencies will not rent to anyone under the age of 21.
A government tax is levied on all car and motor scooter rentals (insurance is extra).Please refer to our Road Safety page for more information.
Visit the website of the country’s national tourist office at http://www.turksandcaicostourism.com.

AVIATION SAFETY OVERSIGHT:
Civil aviation operations in the Turks and Caicos Islands fall under the jurisdiction of British authorities.
The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the UK’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:
The importation of firearms to the Turks and Caicos is strictly forbidden without prior approval in writing from the Commissioner of Police.
U.S. citizens may contact the Turks and Caicos Customs Department at (649) 946-2867 for specific information regarding customs requirements. Please see our Customs Information.

The Turks and Caicos Islands, like all countries in the Caribbean basin, are vulnerable to hurricanes.
Hurricane season officially runs from June 1 to November 30, although hurricanes have been known to occur outside that time period.
Visitors to the Turks and Caicos Islands during hurricane season are advised to monitor weather reports in order to be prepared for any potential threats.
General information about disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov
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 Turks and Caicos laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in the Turks and Caicos are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans residing or traveling in the Turks and Caicos Islands 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 Turks and Caicos Islands.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at 42 Queen Street, Nassau, The Bahamas.
It is next to the McDonald’s Restaurant on Queen Street and may be reached Monday-Friday at telephone (242) 322-1181 x4406; after-hours (242) 328-2206; fax (242) 356-7174.
The U.S. Embassy web site is http://nassau.usembassy.gov.
Office hours are from 9:00 a.m. to 11:00 a.m. and 1:00 p.m. to 3:00 p.m. Monday-Thursday; 9:00 a.m. to 11:00 a.m. Friday (except for U.S. and Bahamian holidays).
* * *
This replaces the Country Specific Information for the Turks and Caicos Islands dated March 14, 2008, without substantive changes.

Travel News Headlines WORLD NEWS

Date: Wed, 4 Sep 2019 23:41:56 +0200 (METDST)

St. John's, Antigua and Barbuda, Sept 4, 2019 (AFP) - Masked gunman have shot dead a 71-year-old British holidaymaker in a robbery on the tourist paradise of Turks and Caicos, police said Wednesday.

The victim had been visiting a friend in the British territory, around 150 miles (200 kilometres) north of Haiti, when two assailants burst into the home shortly after 11:00 pm Tuesday (0300 GMT Wednesday).   They demanded money, but it was not immediately clear how the situation escalated before the gunmen made off with an undisclosed amount of cash, a ring and a watch, said police spokeswoman Takara Bain.   The friend was treated for non-life threatening injuries at a private residence in Cooper Jack on the tiny island's south coast.

It is the second murder in three days in the archipelago, home to just 35,000 people, taking the 2019 homicide toll to 10, Police Commissioner Trevor Botting said in a statement.   A shooting at a nightclub in Providenciales on Saturday night left one man dead and a second wounded.   "This spike in gun crime simply has to change," Botting said. "No one should be happy with how gun crimes are increasing in the Turks and Caicos Islands."   Earlier this year, the US State Department warned travellers to "exercise increased caution" when visiting the archipelago 600 miles (970 kilometres) southeast of Miami.
Date: Tue, 6 Aug 2019 20:04:36 +0200 (METDST)

St. John's, Antigua and Barbuda, Aug 6, 2019 (AFP) - Three American tourists have drowned in the Turks and Caicos Islands after apparently getting caught in a fast-moving tide fueled by high winds, authorities and local residents said Tuesday.   The victims -- two men and a woman -- were from two families from Texas who were spending the holidays together, along with their two girls, police said.

They had been exploring scenic Bambarra Beach on the sparsely populated island of Middle Caicos when disaster struck on Monday, police and local residents said.   The children were plucked from the ocean by rescuers and were being cared for by local social welfare services.   The body of a 34-year-old woman washed ashore shortly after the incident. Searchers scouring the beaches recovered the second body a few hours later. The third was discovered early this morning with assistance from the US Coast Guard.   Residents said the families may have been attempting to cross the half-mile distance through shallow water from Bambarra Beach to nearby Pelican Cay.

Police Commissioner Trevor Botting described the incident as a "terrible tragedy."   "Five tourists from two families got into difficulties in the waters off Middle Caicos. Whilst two children were thankfully recovered alive from the water, two adults related to one of the girls were recovered but sadly they had died. One other man, related to the other child, was found early today and has also died," he said.   The tragedy has triggered calls locally for increased warning signs on the islands' often deserted beaches.   The Turks and Caicos Islands is British overseas territory that consists of two island chains southeast of the Bahamas.
Date: 12 Jun 2017
Source: TC weekly News [edited]

The Ministry of Health is advising the public of an increase in the number of cases of conjunctivitis in the Turks & Caicos Islands [TCI].

Conjunctivitis, also called "pink eye," is defined as an inflammation of the conjunctiva and can be caused by viruses, bacteria, or an allergy. It can affect children and adults.

Viral conjunctivitis is typically caused by a virus that can also cause the common cold. A person may have symptoms of conjunctivitis alone or as part of a general cold syndrome like fever, a sore throat and runny nose.

Viral conjunctivitis is highly contagious; usually people catch it from touching something that has been in contact with an infected person's eye (e.g. door handle, towel or pillow case), and then that person touches his or her eyes.

Some of the most common symptoms of conjunctivitis are pink or red eyes; the eyes might secrete a gooey liquid or become itchy or burn, get stuck shut, especially when you 1st wake up. These symptoms tend to last for several days.

The ministry stated in a press release: "The treatment depends on the cause. When pink eye is caused by a virus, antibiotics will not help. You can use warm or cool compresses to relieve the pain and irritation in the eyes.

"Most cases of pink eye go away on their own without treatment, but it is best to see your primary care physician if you are experiencing these symptoms so that you can be treated properly.

"Simple hygiene measures can help minimise transmission to others. Adults or children with bacterial or viral conjunctivitis should not share handkerchiefs, tissues, towels, cosmetics, or bed sheets/pillows with uninfected family or friends. Hand washing is an essential and highly effective way to prevent the spread of infection. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds.

"Teach children to wash their hands before and after eating and after touching the eyes, coughing or sneezing. Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available."

Anyone with viral conjunctivitis should remain home from school and work to avoid spreading the virus to others.
================
[The report above does not specify any laboratory confirmation of the conjunctivitis cases.

Conjunctivitis can result from many causes, including viruses, bacteria, allergens, contact lens use (especially the extended-wear type), chemicals, fungi, and certain diseases. Viral conjunctivitis can be caused by the following viruses, with adenoviruses being the most common cause: adenoviruses, picornaviruses (particularly enterovirus 70 and coxsackievirus A24), measles virus, and several herpes viruses.

Viral conjunctivitis is highly contagious. Most viruses that cause conjunctivitis are spread through hand-to-eye contact by hands or objects that are contaminated with the infectious virus. Hands can become contaminated by coming into contact with infectious tears, eye discharge, faecal matter, or respiratory discharges.

Many of the viruses that cause conjunctivitis may be associated with an upper respiratory tract infection, cold, or sore throat. - ProMED Mod.UBA]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Mon 9 May 2016
Source: Outbreak News Today [edited]

Health officials on the Caribbean island group, Turks and Caicos (TCI), are reporting a significant increase in chickenpox [varicella] cases during the 1st 4 months of 2016.

As of the end of the week of 23 Apr 2016, a total of 327 cases have been reported for the year. Of these, 41 (13 percent) were reported by persons younger than 5 years old and 296 (87 percent) were reported by persons older 5 years old.

These cases were reported by TCI Hospital on Providenciales 234 (72 percent) and Grand Turk 5 (1 percent); with 28 cases in North Caicos and 60 (18 percent) cases in clinics in Providenciales. In summary, the majority cases are being reported from Providenciales (90 percent).

By comparison, in all of 2015, a total of 98 cases of chickenpox were reported by TCI Hospital in Providenciales.

Chickenpox is a common, usually benign childhood disease caused by the varicella-zoster virus (VZV), a member of the herpes family. This virus causes 2 distinct diseases; varicella (chickenpox) is the primary infection, and later when VZV reactivates, herpes zoster (shingles).

Chickenpox is highly contagious and is spread by coughing and sneezing, by direct contact, and by aerosolization of the virus from skin lesions. You can also get it by contact with the vesicle secretions from shingles.

The disease is characterized by fever and a red, itchy skin rash of that usually starts on the abdomen, back, or face and then spreads to nearly all parts of the body. The rash begins as small red bumps that appear as pimples or insect bites. They then develop into thin-walled blisters that are filled with clear fluid which collapse on puncture. The blisters then breaks, crusts over, and leaves dry brown scabs.

The chickenpox lesions may be present in several stages of maturity and are more abundant on covered skin rather than exposed. Lesions may also be found in the mouth, upper respiratory tract, and genitals.

Chickenpox is contagious from 1-2 days before the rash forms and continues until all the lesions are crusted over (usually about 5 days).

This disease is more serious in adults than in children. Complications of chickenpox are rare, but include pneumonia, encephalitis, and secondary bacterial infections.

Infection with this virus usually gives lifelong immunity, although 2nd attacks have been documented in immunocompromised people. The viral infection remains latent, and disease may recur years later as shingles.

The TCI Ministry of Health strongly advises persons affected with chickenpox to remain at home during their sick leave period to prevent further spread of this illness within the community and schools.  [Byline: Robert Herriman]
=====================
[Varicella-zoster virus, a member of the herpesvirus family is the causative agent for chickenpox. Humans are the only reservoir of the virus, and disease occurs only in humans. After primary infection as varicella (chickenpox), the virus remains dormant in the sensory-nerve ganglia and can reactivate at a later time, causing herpes zoster (shingles).

Varicella occurs worldwide. In temperate climates, varicella tends to be a childhood disease, with peak incidence among preschool and school-aged children during late winter and early spring. In these countries, less than 5 percent of adults are susceptible to varicella. In tropical climates, the highest incidence was described in the driest, coolest months; overall, infection tends to be acquired later in childhood, resulting in higher susceptibility among adults than in temperate climates, especially in less densely populated areas.

All people, including those traveling or living abroad, should be assessed for varicella immunity, and those who do not have evidence of immunity or contraindications to vaccination should receive age-appropriate vaccination. Vaccination against varicella is not a requirement for entry into any country (including the United States), but people who do not have evidence of immunity should be considered at risk for varicella during international travel.

Varicella vaccine contains live, attenuated varicella-zoster virus. Single-antigen varicella vaccine is licensed for people aged 12 months and older, and the combination measles-mumps-rubella-varicella (MMRV) vaccine is licensed only for children 1-12 years. CDC recommends varicella vaccination for all people aged 12 months and older without evidence of immunity to varicella who do not have contraindications to the vaccine: 1 dose for children aged 1-4 years and 2 doses for people aged 4 years and older. The minimum interval between doses is 3 months for children aged less than 13 years and 4 weeks for people aged 13 years and older. Contraindications for vaccination include allergy to vaccine components, immune-compromising conditions or treatments, and pregnancy. When evidence of immunity is uncertain, a possible history of varicella is not a contraindication to varicella vaccination. Vaccine effectiveness is approximately 80 percent after 1 dose and 95 percent after 2 doses.

(Excerpted and edited from

Maps of the Turks and Caicos Islands may be accessed at
and <http://healthmap.org/promed/p/48358>. - ProMED Mod.LK]
Date: 7 Jul 2014
Source: TC Weekly News [edited]

Pet owners are being cautioned about a tick disease which is becoming a problem in dogs in the Turks and Caicos Islands. Licensed veterinarian Mark Woodring said that the disease, babesiosis, can be transmitted by bites from ticks.

Infected dogs show a number of signs, including decreased appetite, weight loss, fever, an enlarged abdomen, and dark orange or yellow skin and urine. The disease causes the dog's red blood cells to be destroyed, leading to pale gums and fatigue due to anemia. All dogs, including potcakes, (the local indigenous dog of the islands) can be infected. Some breeds are more susceptible to infection, especially greyhounds and all pitbull breeds, both purebred and mixed.

Woodring said that this disease can develop in a dog without ticks after an infected dog bites him or her, even playfully. He said that an infected female will pass along the disease to her puppies before birth.

"Accurate testing for babesiosis can be done with blood sent to the US for DNA studies, but most cases in the TCI are diagnosed by experienced veterinarians based on signs and physical exam. Although the disease is treatable with antibiotics, not every dog responds."

Early treatment is best, but even then, the disease can be fatal. The veterinarian said that another problem is that since 2012, the antibiotics most commonly used to treat tick-borne diseases have tripled in cost.

"Some antibiotics are in very short supply worldwide, to the point of restricting veterinarians from even ordering the medication. Preventing babesiosis means treating dogs and their environments to limit tick exposure."

He said that many prescription and non-prescription flea and tick prevention medications as well as yard treatments like Diatomaceous Earth and chemical preparations are available.

"This can be a difficult, expensive and frustrating task, as ticks eventually can become resistant to most products. To stop the spread of babesiosis, infected dogs should be treated with a full course of antibiotics."

Even after a dog recovers, he or she may still carry the disease. Females who have had the disease, even healthy-appearing ones, should not be bred. Adopting puppies from previously infected dogs or dogs with an unknown infection history is risky. Puppies are more likely to die from it than adult dogs.

Woodring said that the good news is that dogs cannot transmit this to humans.
===============
[Canine babesiosis is a disease caused by the intra-erythrocytic protozoan parasites _Babesia canis_ and _Babesia gibsoni_. Babesiosis is transmitted by ticks to susceptible canine hosts. _Rhipicephalu ssanguineus_ is the most common tick vector in the United States. Splenectomized dogs, immunocompromised dogs and young dogs between the ages of 2 and 8 months are most susceptible to infection. Canine babesiosis occurs worldwide. Within the United States, it is most common in the southeast. Although canine babesiosis is considered uncommon in the U.S., it is of clinical significance due to its morbidity and mortality. It is an important differential when history and clinical signs are consistent with infection and other more common diseases have been ruled out.

Hemolytic anemia and hypotensive shock are typical clinical syndromes of infection. Hemolytic anemia results from direct erythrocyte damage by the parasite, and both intravascular and extravascular immune-mediated destruction of red blood cells. Infection can produce thrombocytopenia, the mechanism of which consists of immune-mediated destruction and sequestration in the spleen. Physical examination reveals splenomegaly, lymphadenomegaly, fever and, less frequently, lethargy, vomiting, hematuria, and icterus. Hypotensive shock results from the release and production of vasoactive amines and cytokines which produce vasodilation. It most often occurs in puppies with the peracute form of the disease. Death may occur and is seen most often in _B. gibsoni_ infections and in puppies affected with _B. canis_ and _B.gibsoni_. Chronic infections, subclinical carrier states and atypical canine babesiosis may also occur.

Infection with _B. canis_ or _B. gibsoni_ is definitively diagnosed by demonstration of the parasites on red cells. Blood smears may be stained with Diff-Quik or preferably Wright's or Giemsa stain.

The most effective drugs used in the treatment of canine babesiosis include diminazene aceturate, phenamidine isethionate, and imidocarb dipropionate, which are not available or approved for use in the United States. Treatment of canine babesiosis in the U.S. is, therefore, mostly aimed at treating signs. The majority of babesia cases diagnosed in dogs in the U.S. are caused by the less virulent strains of _B. canis_, and dogs frequently recover from these infections naturally with supportive therapy. Clindamycin has been successfully used to treat canine babesiosis and may be considered in refractory or more severe and virulent infections.

Prevention of canine babesiosis is mostly aimed at controlling the vector. It is an important aspect since treatment is not always successful. The environment should be treated to decrease tick numbers, dogs should be treated to control tick infestations, and ticks should be removed from parasitized animals as quickly as detected.

Recently, a vaccine which minimizes the severity of infection was developed. The vaccine is reported to be 70 to 100 percent effective in diminishing the pathologic effects which typically ensue upon infection. The vaccine is currently available in Europe where canine babesiosis is a more common life-threatening disease.

Blood transfusion poses a significant risk to recipient animals; therefore, it is recommended that donor animals be tested for infection with babesia organisms. Splenectomy prior to testing significantly improves the likelihood of finding organisms in a blood sample from an infected donor.

Portions of this comment were extracted from:

Turks and Caicos Islands, a British Overseas Territory, may be located on the interactive HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/6007>. - ProMed Mod.TG]
More ...

Mexico

General Information
************************************
Mexico is becoming a very popular destination for Irish travellers. The country has many well known tourist destinations including the idyllic resort of Acapulco on the Pacific Ocean and t
e Yucatan Peninsula stretching out between the Caribbean and the Gulf of Mexico. There is a rapidly developing economy and luxury hotels are widely available throughout the country. Tourist facilities in the more remote regions (seldom visited by tourists) may be very limited.
Climate
************************************
The country experiences a wide temperature profile with cool to cold temperatures on the mountainous ranges to a hot sub-tropical climate on the sea coasts. There is a rainy season from June to October and a dry season from November to May each year. Temperatures in April May and June tend to be in the mid 20’s centigrade. The southern and eastern regions tend to experience the heaviest rainfall.
Food & Water
************************************
Some tourists visiting Mexico will undertake a trekking holiday for part of their time in the country. This will bring them out from the major cities into many of the poorer regions of the country. In these areas the level of food and water hygiene may be poor and travellers need to exercise continuous caution in this regard. Typically great care should be taken with the consumption of any cold foods. Lettuce would be a common cause of illness and should be avoided. Undercooked shellfish (prawns, oysters, mussels etc.) should be avoided at any time. The risk of contamination with a variety of diseases is just too high.
Street Vendors
************************************
Many of the larger towns have a number of street vendors selling their produce on the side of the road. In general purchases of food from these vendors should be avoided. This is especially true with regard to buying ‘freshly squeezed’ fruit juice drinks. In some cases potentially contaminated tap water may have been used to supplement the supply. Another particular risk in Mexico involves the purchase of water melons from the market place. These are usually sold by their weight and it is reported that certain vendors may inject them with tap water to increase their value. Be sensible and take care.
Rabies
************************************
This is another viral disease that occurs throughout Mexico. 69 cases of human Rabies were reported in 1990 but this figure has dropped to 24 in 1995. The disease is transmitted through the bite of any infected warm blooded animal (dog, cats, monkey etc.). Animals should be avoided at all costs and any bite (lick or scratch) should be immediately washed out with water and then have a strong antiseptic applied. The individual should then always seek urgent competent medical attention. Cycling in the early morning is a high risk time. Dogs may become agitated and run out at the bicycle.
Protection against Mosquitoes & Sandflys
************************************
Travellers will need to exercise care against mosquito bites throughout the year and this has become particularly important due to regular outbreaks of Dengue Fever. This viral disease has swept through the Caribbean region over the past decade and Mexico has also been involved. There were approx. 4,500 cases during 1995 with about 16 deaths. More recently (Oct ‘99) the disease has been reported close to the US border with over 5000 patients affected. The disease seldom kills travellers but causes a severe flu like illness and pronounced skin rash in many of those infected. It is an unpleasant disease and can leave an individual ill for many weeks after infection. The mosquitoes can bite during the day or night. Most tourists should take care against mosquitoes by;
*
Using adequate Insect Repellent
*
Covering up well with pale coloured clothing
*
Refraining from using Perfumes or Aftershaves at the risk times for bites.
Malaria
************************************
For many tourists to Mexico the chance of contracting malaria is negligible. The disease does occur in some of the country and those planning to trek through the rural areas may be advised to consider prophylaxis. The states most affected are Oaxaca, Hiapas, Sinaloa, Campeche, Quintana Roo, Nayarit, Tabasco, Michoacán, Chihuahua and Hidalgo. The risk extends throughout the year and visitors to these regions always should consider adequate malaria prophylaxis.

Larva Migrans
************************************
Walking on the beach above the high tide mark in many of the hotter countries without shoe covering may expose the traveller to infection with the Larva Migrans parasite. Mexico is no exception. This minute worm penetrates through the skin and causes a significant irritation just under the skin in those infected. The rash moves and becomes very itchy. Treatment is straightforward once a diagnosis is reached. Travellers walking along the beaches (above the high tide mark) should always wear shoe covering and avoid sitting straight on the sand.
Vaccinations
************************************
No vaccines are essential for entry to Mexico however, in most cases, short term travellers will be advised to consider vaccination cover for;
*
Tetanus (childhood booster)
*
Typhoid (food & water borne)
*
Hepatitis A (food & water borne)
For those undertaking a trekking holiday (or those who will live in the region for some months) vaccination cover against Rabies (animal bites), Meningococcal Meningitis (air borne) and Hepatitis B (accidents) may need to be considered.
General Health
************************************
Further information on staying healthy while abroad may be obtained from the Tropical Medical Bureau.

Travel News Headlines WORLD NEWS

Date: Thu, 9 Jan 2020 17:49:58 +0100 (MET)

Mexico City, Jan 9, 2020 (AFP) - Mexico's Popocatepetl volcano dramatically spewed a fiery cloud of ash and rock into the sky Thursday, though it did not prompt authorities to raise their eruption alert level.   "Popo," as the volcano is known, exploded early in the morning, belching "a moderate amount of ash and incandescent material" from its crater, the National Disaster Prevention Center wrote on Twitter.   The explosion created a cloud of ash that reached 3,000 meters (1.9 miles) into the air.

The authorities, however, left the volcano's alert level at "Yellow Phase Two," which instructs people to remain at least 12 kilometres (7.5 miles) from the crater and be prepared for a possible evacuation.   Popocatepetl, which means "smoking mountain" in the indigenous Nahuatl language, has not had a massive eruption in more than a millennium, but has shown increased activity in the past 26 years.   It is considered one of the world's most dangerous volcanoes, because some 25 million people live within a 100-kilometer (60-mile) radius.
Date: Mon, 30 Dec 2019 02:39:19 +0100 (MET)

San Cristóbal de las Casas, Mexico, Dec 30, 2019 (AFP) - At least 11 people died and seven were injured on Sunday when a car and a van carrying tourists crashed on a highway in Mexico's southern Chiapas state, local prosecutors said.   "Eleven people were killed and seven more were injured," the prosecutor's office said in a statement, adding an investigation had been opened into the accident's cause.

According to reports from local authorities, the victims included tourists traveling in the van to San Cristobal de las Casas, one of the most visited cities in Chiapas state.   During the Christmas and New Year's holiday season, traffic is heavier on Mexico's roads and accidents occur more frequently.
Date: Sat, 21 Dec 2019 00:03:55 +0100 (MET)

Mexico City, Dec 20, 2019 (AFP) - Six people were injured Friday when two enormous cruise ships operated by US-based Carnival collided off Mexico's Caribbean coast, the company said.   "Oh my God!" a man can be heard saying in a dramatic video of the Carnival Glory crashing into the Carnival Legend as it docked at the popular island resort of Cozumel.   "Someone could have died!" he said.

Videos posted online show the 290-meter (952-foot) Glory slowly arcing through the azure water off Cozumel toward the 294-meter (963-foot) Legend, then making impact with a loud boom.   The Legend's massive bow then scraped along the back of the Glory, leaving the tip of the other ship's stern a mangled jumble of wreckage.   "Carnival Glory was in the process of docking when it made contact with Carnival Legend which was already docked," the company said in a statement.   "Six guests with minor injuries have presented themselves to the Carnival Glory medical centre for evaluation."

Carnival said it was still assessing the damage, but insisted there was no impact on the seaworthiness of either ship or their itineraries.   "We have advised guests from both ships to enjoy their day ashore in Cozumel," it said.   According to Carnival, the Glory weighs 110,000 tons and has capacity for 2,980 guests and 1,150 crew. The Legend weighs 88,500 tons and has capacity for 2,124 guests and 930 crew.
Date: Mon 11 Nov 2019
Source: Pan American Health Organization (PAHO)

Mexico has become the 1st country in the world to receive validation from the World Health Organization (WHO) for eliminating dog-transmitted rabies as a public health problem. "Eliminating [dog-transmitted] rabies doesn't happen by accident," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "It takes political resolve, careful planning, and meticulous execution. I congratulate the Government of Mexico on this wonderful achievement and hope many other countries will follow its example."

Rabies causes 60,000 deaths each year, mainly in Asia and Africa. In Latin America and the Caribbean, new cases of rabies were reduced by more than 95 percent in humans and 98 percent in dogs since 1983.

"By eliminating human rabies transmitted by dogs, Mexico is showing the world that ending infectious diseases for the next generation is possible and is the right way forward," said PAHO Director, Carissa F Etienne.

Mexico's achievement
--------------------
In order to achieve elimination, the country has implemented a national strategy for the control and elimination of rabies. This includes free, mass vaccination campaigns for dogs, that have taken place since the 1990's with more than 80 percent coverage; continuous and effective surveillance; public awareness-raising campaigns; timely diagnosis; and the availability of post-exposure prophylaxis in the country's public health services.

As a result, the country went from registering 60 cases of human rabies transmitted by dogs in 1990, to 3 cases in 1999, and zero cases in 2006. The last 2 cases occurred in 2 people from the State of Mexico, who were attacked in 2005 and presented symptoms in 2006.

The validation process
----------------------
WHO considers a country to be free of rabies after registering 2 years of zero transmission of rabies to humans. However, there was previously no process to verify the achievement of this goal, until this was developed by PAHO/WHO. Mexico became the 1st country in the world to begin this in December 2016.

The validation process was extensive and included the creation of a group of independent international experts established by PAHO/WHO. It also included the preparation, by Mexico, of an almost 300-page file containing all historical information about the situation of rabies in the country. PAHO and its specialized center in veterinary public health, PANAFTOSA, accompanied and supervised the implementation of the validation process throughout.

The group of experts carried out a mission to Mexico in September 2018 to review the file and verify the country complied with all WHO requirements. In September 2019, the group recommended the Director General of WHO and PAHO validate the elimination.

Moving forward
--------------
In order to sustain elimination, PAHO/WHO recommends continuing all rabies prevention, surveillance and control actions, particularly as rabies virus continues to circulate among wild animals such as bats.

PAHO collaborated with the countries of the Americas to eliminate rabies through technical cooperation, staff training, periodic meetings between those responsible for the issue in-country, and through the provision of recommendations on international standards. As of September 2019, there have been zero cases of rabies transmitted by dogs in humans in the Americas.

In addition to rabies, Mexico eliminated onchocerciasis in 2015 and trachoma in 2017, 3 of the more than 30 infectious diseases and related conditions that PAHO's new Communicable Disease Elimination Initiative in the Region of the Americas has set as a goal for elimination from the continent by 2030.
===================
[This is certainly an outstanding achievement and should be celebrated by all. It is also an example to other countries.  Of course, someone acquiring rabies from a bat would be outside of this situation. This WHO/PAHO validation specifically refers to rabies acquired from dog bites. This is a great milestone. Congratulations Mexico! - ProMED Mod.TG]

[HealthMap/ProMED-mail map of Mexico:
Date: Sat, 21 Sep 2019 00:59:40 +0200 (METDST)

Mexico City, Sept 20, 2019 (AFP) - Lorena made landfall Friday as a Category 1 hurricane, lashing the turquoise waters of popular beach destination Los Cabos on Mexico's Baja California peninsula.   "The eye of Hurricane Lorena is now passing over the coast of Los Cabos," Mexico's hurricane monitor, CONAGUA, wrote on Twitter.

The hurricane, which has been churning up the Pacific coast, first made landfall Thursday in west-central Mexico, then was briefly downgraded to a tropical storm before moving back over the water and regaining strength.   According to CONAGUA, Lorena was packing sustained winds of 140 kilometres (87 miles) per hour as it battered Los Cabos, making it a Category One hurricane on the scale of one to five.   After moving slowly northwest throughout the morning, it ground to a halt 70 kilometres from the beach town of Cabo San Lucas, dumping torrential rain on the area.

The US National Hurricane Center said the storm was expected to pour up to 20 centimetres (eight inches) of rain on the region, which "may result in flash flooding."   It warned that the storm's trajectory was "highly uncertain."   "Some weakening is forecast during the next 48 hours if Lorena moves inland. If the hurricane moves over the Gulf of California, it could strengthen instead," it said in its 2100 GMT update.

Lorena already buffeted west-central Mexico with strong winds, torrential rain and high waves, leading officials to cancel school in the affected areas.   Authorities suspended classes in Los Cabos for Friday, and ordered all boats and ships to remain docked.   The army said it had deployed troops to set up 14 emergency shelters in case they were needed.
More ...

World Travel News Headlines

Date: Mon, 27 Jan 2020 01:07:04 +0100 (MET)

Wuhan, China, Jan 27, 2020 (AFP) - China's central government said on Monday that the nationwide total of confirmed infections from a deadly respiratory virus had risen to 2,744, with 769 new cases coming to light.   However, it said no new deaths were confirmed outside of Hubei province, which had earlier reported 24 new fatalities to bring the national total to 80 dead.
Date: Sun, 26 Jan 2020 22:16:28 +0100 (MET)

Beijing, Jan 26, 2020 (AFP) - Chinese authorities have ordered the extension of a public holiday in an effort to contain an epidemic that has killed 56 people and infected nearly 2,000 worldwide, state-run media reported.   A working group chaired by Premier Li Keqiang to tackle the outbreak decided on Sunday "to reduce population flows" by extending the Spring Festival holiday which had been scheduled to end on January 30, state news agency Xinhua said.   It was not immediately clear how long the extension is.

The group also ordered changes to "the starting dates of schools" and "people to work from home by working online."   "The meeting stressed that the country is at a crucial time in the prevention and control of the novel coronavirus outbreak, urging Party committees and governments at all levels to take more 'decisive, powerful and orderly, scientific and well-planned' measures to effective curb the spread," Xinhua reported.   In a bid to slow the spread of the respiratory virus, the government had previously locked down hard-hit Hubei, a province in central China that is at the outbreak's epicentre, in an unprecedented operation affecting tens of millions of people.

The previously unknown virus has caused global concern because of its similarity to the Severe Acute Respiratory Syndrome (SARS) pathogen, which killed hundreds across mainland China and Hong Kong in 2002-2003.   Originating in Hubei's capital of Wuhan, the virus has spread throughout China and across the world -- with cases confirmed in around a dozen countries including as far away as the United States.   Several countries were making arrangements to evacuate their citizens from Wuhan, where an eery calm pervades as new restrictions prohibit most road traffic in the metropolis of 11 million.
Date: Sun, 26 Jan 2020 21:47:53 +0100 (MET)

Washington, Jan 26, 2020 (AFP) - US health authorities said Sunday there are now five confirmed cases of the coronavirus in the United States and more are expected.   Nancy Messonnier, head of the respiratory disease section at the Centers for Disease Control and Prevention, said around 100 people in 26 states are being investigated for the virus, which originated in the Chinese city of Wuhan.

Of the confirmed cases, all five people had travelled to Wuhan, Messonier said during a conference call with reporters.   "Every case we have had in the United States is someone who has had direct contact in Wuhan," she said.   Messonier said there are two cases in California and one each in Arizona, Illinois and Washington state. Until now the toll was three.   While Chinese officials have launched an extraordinary emergency response, Messonier insisted that the health risk for Americans in general remains low "at this time."
Date: Sun, 26 Jan 2020 13:44:57 +0100 (MET)

Lagos, Jan 26, 2020 (AFP) - Nigerian health authorities have announced stepped-up emergency measures to tackle a rise in Lassa fever cases after 29 people died this month.   "As at 24th of January 2020, 195 confirmed cases and 29 deaths had been reported in 11 states," the Nigeria Centre for Disease Control (NCDC) said in a statement Saturday.   A national emergency operations centre had been activated to coordinate the response "to the increasing number of Lassa fever cases" across the country.

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

The number of cases usually climbs in January due to weather conditions during the dry season.    Almost 90 percent of the recent confirmed cases have been in Edo, Ondo and Ebonyi states in southern Nigeria, but their have also been deaths in the north.

The NCDC said that compared to the same period last year the fatality rate had dropped from 23.4 percent to 14.8 percent.    It encouraged Nigerians to "practise good hygiene and take measures to protect themselves and their families".   Nigeria, Africa's most populous nation with a population of some 200 million, has five laboratories with the capability to diagnose Lassa fever.
Date: Sun, 26 Jan 2020 12:18:19 +0100 (MET)

Beijing, Jan 26, 2020 (AFP) - Two Chinese provinces and three cities have ordered citizens to wear face masks in public, to help control the spread of a deadly virus.   The measure is required in the provinces of Guangdong in the south and Jiangxi in the centre, plus the eastern city of Nanjing, Ma'anshan city in Anhui province, and Xinyang city in Henan, according to local authorities.   China's industry and information technology ministry has said it would "spare no effort in increasing supply" after demand for masks skyrocketed.
Date: Sun, 26 Jan 2020 04:03:51 +0100 (MET)

Hong Kong, Jan 26, 2020 (AFP) - Hong Kong's Disneyland announced it was shutting its doors on Sunday until further notice over the deadly virus outbreak in central China, a day after city authorities classified the crisis as an emergency.   "As a precautionary measure in line with prevention efforts taking place across Hong Kong, we are temporarily closing Hong Kong Disneyland park out of consideration for the health and safety of our guests and cast members," the park said in a statement.
Date: 26 Jan 2020
Source: MENAFN [edited]

Two more polio cases have surfaced from Landikotal tehsil in Khyber tribal district, after which the number of reported cases in Khyber Pakhtunkhwa has reached 4 this year [2020].

According to the Emergency Operations Centre (EOC), a 2-year-old [male child] from Nekikhel and another child from Torwela have been diagnosed with polio. The samples of these 2 children were sent for laboratory tests in 2019, so these cases will be counted in the tally of 2019, which stands at 141 now.

The 2 cases in Landiktoal were reported 2 days after the emergence of 3 new polio cases in Qambar, Dadu and Sajawal districts of Sindh. Among them, 2 children contracted the crippling disease in 2019, but the cases were confirmed on Friday [24 Jan 2020].

On [21 Jan 2020], the 1st case of polio in Pakistan in 2020 surfaced in Lakki Marwat, the district with the highest number of cases in 2019.

The year 2019 was worse for Pakistan in polio eradication efforts, as 141 cases surfaced in Pakistan, including 96 cases in KP. Most cases in KP surfaced in Lakki Marwat, where 32 children were diagnosed with the crippling disease. In 2018, only 12 cases were reported, while in 2017, 8 cases were reported.

Currently, Pakistan and Afghanistan are the only 2 countries in the world which have not fully eradicated polio. The main cause behind the emergence of so many polio cases is refusal of parents to cooperate with the vaccination teams. According to media reports citing Health Ministry data, over a million parents refused to cooperate with vaccination teams in 2019. Most of the refusal cases were reported in April last year [2019] when rumours spread in Peshawar that many children had fainted after consuming vaccination drops. A total of 1 089 087 parents refused to give vaccination drops to their children in 2019.

The emergence of so many polio cases in Pakistan, particularly in KP, has brought the federal and provincial governments under pressure over their performance and strategy to control the spread of disease.

Experts believe that polio vaccination efforts cannot succeed completely until the refusing parents are convinced to cooperate with vaccination teams.
==================
[The End Polio Pakistan website has not added all of the media reported cases as yet, so it's a bit difficult to follow at times and know which cases were 2019 onset and which were 2020 onset. The above media report clearly states 2019 onset and puts the tally for 2019 as 141 cases, but the media reports from Friday's [24 Jan 2020] report is less clear (see Poliomyelitis update (10): global, Pakistan (BA, SD) http://promedmail.org/post/20200124.6911971).

A good map of Pakistan showing districts and provinces can be found at:
Date: Fri 24 Jan 2020
Source: SciTechDaily [abridged, edited]

Citation: Amman BR, Bird BH, Bakarr IA, et al. Isolation of Angola-like Marburg virus from Egyptian rousette bats from West Africa. Nat Commun. 2020; 11:510.  <https://doi.org/10.1038/s41467-020-14327-8>

Scientists have detected Marburg virus in fruit bats in Sierra Leone, marking the 1st time the deadly virus has been found in West Africa. A total of 11 Egyptian rousette fruit bats tested positive for active Marburg virus infection. Research teams caught the bats separately in 3 health districts.

The presence of Marburg virus, a close relative to Ebola virus that also causes hemorrhagic disease in people, was detected in advance of any reported cases of human illness in Sierra Leone. However, the virus's presence in bats means people who live nearby could be at risk for becoming infected. No outbreaks have been reported to date.

The findings, based on PCR, antibody, and virus isolation data, were officially published today [24 Jan 2020] in the journal Nature Communications. Preliminary findings were announced earlier in December 2018 to ensure rapid notification to the citizens of Sierra Leone and the international health community.

The paper highlights the value of collaborating with government and key stakeholders across human, animal, and environmental sectors to engage at-risk communities about the discovery, address health concerns, and communicate risk-reduction strategies before recognized spillovers occur.

Marburg virus was detected by projects led by the Centers for Disease Control and Prevention, the USAID-funded PREDICT project led by the One Health Institute at the UC Davis School of Veterinary Medicine; Njala University, Sierra Leone; and the University of Makeni, Sierra Leone.

"Finding Marburg virus in bats in Sierra Leone before any known cases in people is a huge success, as public health officials and doctors can now include Marburg virus among the possible causes when diagnosing hemorrhagic fever cases in the region," said Tracey Goldstein, co-principal investigator and pathogen detection lead for the PREDICT project from the UC Davis One Health Institute.

To date, there have been 12 known outbreaks of Marburg virus, with the most recent in Uganda in 2017. The largest and deadliest outbreak occurred in Angola in 2005 when 227 people died. Five of the new strains identified among the Marburg-positive bats in Sierra Leone were genetically similar to the strain that caused the outbreak in Angola. This is the 1st time scientists have detected these Angolan-like strains in bats.

The virus-positive bats were all Egyptian rousette bats, the known reservoir for Marburg virus, which primarily feed on fruit. Infected bats shed the virus in their saliva, urine, and feces. Egyptian rousette bats are known to test-bite fruits, urinate, and defecate where they eat, potentially contaminating fruit or other food sources consumed by other animals or people, particularly children. These bats sometimes serve as a food source for local populations as well. People may be exposed to Marburg virus through bat bites as they catch the bats.

Following the announcement of the preliminary findings by the government of Sierra Leone, the PREDICT team worked with government partners, universities, and other key stakeholders to develop and implement evidence-based public health messaging across national, district, and local community levels in Sierra Leone.  "Over a year ago, we worked with our Sierra Leone government colleagues to inform people across the country as fast as possible of this new health risk and remind people not to harm or come in contact with bats," said Brian Bird from the UC Davis One Health Institute and global lead for Sierra Leone and Multi-Country Ebola operations for PREDICT-USAID. "I'm very proud of that work and our teams now that this full report is available."
----------------------------------------------
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
and
Mary Marshall
===========================
[The initial report of this finding, prior to this publication, was posted by ProMED-mail (Marburg virus disease - Sierra Leone (02): bats, additional information http://promedmail.org/post/20181223.6221436) when the virus was detected for the 1st time in fruit bats in Sierra Leone.

According to the CDC (<https://www.cdc.gov/vhf/marburg/index.html>), Marburg virus was 1st recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany, and in Belgrade, Yugoslavia (now Serbia). A total of 31 people became ill, initially laboratory workers followed by several medical personnel and family members who had cared for them; 7 deaths were reported. The 1st people infected had been exposed to imported African green monkeys or their tissues while conducting research. One additional case was diagnosed retrospectively.

The reservoir host of Marburg virus is the African fruit bat, _Rousettus aegyptiacus_. Fruit bats infected with Marburg virus do not show obvious signs of illness. Primates (including humans) can become infected with Marburg virus, and may develop serious disease with high mortality.

Ebola virus is closely related to Marburg virus. "Ebola viral RNA fragments were found in an oral swab from a greater long-fingered bat (_Miniopterus inflatus_), captured in 2016 in Liberia's Sanniquellie-Mahn district, which borders Guinea. The bat, which lives in many parts of Africa, roosts in caves and feeds on insects. Scientists had previously found 2 other Ebola species in a related insect-eating bat, _M. schreibersii_. However, most other evidence has pointed to fruit bats as the carriers of Ebola Zaire, Epstein says [J Epstein, veterinary epidemiologist at EcoHealth Alliance in New York City and a member of the PREDICT consortium]. "What it really says to me is that this is a virus that has multiple hosts, and it might be regionally dependent as to which species carries it."

Supporting the variety of bat hosts for Ebola, the bat implicated in the initiation of the West African Ebola virus outbreak in December 2013 was _Mops condylurus_, long-tailed insect-eating bats, that were previously suspected in an outbreak of the Sudan strain of Ebola virus, which is related to the Zaire strain. - ProMED Mod.LK]

[HealthMap/ProMED-mail map:
Date: Sat, 25 Jan 2020 11:49:16 +0100 (MET)
By Su Xinqi, Jerome TAYLOR

Hong Kong, Jan 25, 2020 (AFP) - Hong Kong on Saturday declared a new coronavirus outbreak as an "emergency" -- the city's highest warning tier -- as authorities ramped up measures to reduce the risk of further infections.   The announcement came as city leader Carrie Lam faced criticism in some quarters over her administration's response to the crisis.

Of the five people who have tested positive for the virus in Hong Kong so far, four arrived via a newly built high-speed train terminal which connects with the mainland.   That led to calls from some medical experts and politicians to limit, or even halt, arrivals from China, the epicentre of the outbreak with 41 people dead.

Lam held emergency meetings with health officials on Saturday morning after returning from Davos.   "Today I declare the lifting of the response level to emergency," she told reporters.   Schools and universities, which are currently on a Lunar New Year break, would remain closed until 17 February, Lam said.   All mainland arrivals to Hong Kong will now need to sign health declaration forms, she added, while public events including a new year gala and next month's marathon, would also be called off.    "We haven't seen serious and widespread infections (in Hong Kong), but we are taking this seriously and we hope to be ahead of the epidemic," Lam said.

- Tragic past -
Hong Kong has a recent experience of deadly viral outbreaks.    Nearly 300 people were killed by SARS in 2003, a tragedy that left a profound psychological impact on one of the most densely populated places on earth.   The city's ability to combat the crisis was hampered by moves in mainland China to cover up and play down the outbreak, leaving a lasting legacy of distrust among many Hong Kongers.   Animosity towards the mainland has intensified in recent years as Beijing tightens political control over the semi-autonomous territory.

The outbreak also comes at a sensitive time for Lam, who currently boasts record low approval ratings after seven months of pro-democracy protests.   "We must stand united so that we can prevent and control the disease," she said, in a nod to the political unrest.   The often violent protests have battered Hong Kong's reputation for stability and helped tip it into recession, with the recent virus outbreak compounding the city's economic woes.

Hospitals are already struggling with the winter flu season, but officials are isolating anyone with a history of travel to central China and those exhibiting respiratory tract infections that look similar to the virus.   So far some 300 people have been tested and monitored for the virus. Quarantine centres have been set up in remote holiday parks for anyone found to have come into close contact with people who tested positive.   On Saturday, officials announced a newly built but still-empty public housing block would be used for medical staff on the frontline who did not want to risk returning to their families.
Date: Sat, 25 Jan 2020 06:46:59 +0100 (MET)
By Mahmut Bozarslan and Fulya Ozerkan in Istanbu

Elazig, Turkey, Jan 25, 2020 (AFP) - A powerful earthquake has killed at least 20 people and injured more than 1,000 in eastern Turkey, as rescue teams searched through the rubble of collapsed buildings for survivors on Saturday.    At least 30 people were missing following the magnitude 6.8 quake on Friday night, which had its epicentre in the small lakeside town of Sivrice in the eastern province of Elazig.   "It was very scary, furniture fell on top of us. We rushed outside," 47-year-old Melahat Can, who lives in the provincial capital of Elazig, told AFP.   President Recep Tayyip Erdogan said all steps were being taken to aid people affected by the quake, which caused widespread fear.   "We stand by our people," Erdogan said on Twitter.

The Turkish government's disaster and emergency management agency (AFAD) said the quake hit Sivrice at around 8.55 pm (1755 GMT). Turkey lies on major faultlines and is prone to frequent earthquakes.    Turkish television showed images of people rushing outside in panic, as well as a fire on the roof of a building.   Interior, environment and health ministers, who were in the quake zone, said the casulties were in Elazig province and in the neighbouring province of Malatya, which lies to the southwest.

At least 20 people died and 1,015 others were wounded, according to AFAD.   "There is nobody trapped under the rubble in Malatya but in Elazig search and rescue efforts are currently under way to find 30 citizens," Interior Minister Suleyman Soylu said on Friday.   Rescue teams were searching for survivors trapped in a five-storey collapsed building in a village some 30 kilometres from Elazig, according to AFP journalists at the scene. One person was pulled alive from the rubble.   Emergency staff and people waiting at the scene lit fires in the streets to stay warm in freezing temperatures.   Sports centres, schools and guest houses had been opened to accommodate quake victims in Malatya.

- 'Everybody is in the street' -
Sivrice -- a town with a population of about 4,000 people -- is situated south of Elazig city on the shores of Hazar lake -- one of the most popular tourist spots in the region and the source of the Tigris river.   The lake is home to a "Sunken City", with archaeological traces dating back 4,000 years in its waters.

The tremor was felt in several parts of eastern Turkey near the Iraqi and Syrian borders, the Turkish broadcaster NTV reported, adding that neighbouring cities had mobilised rescue teams for the quake area.   "Everybody is in the street, it was very powerful, very scary," said Zekeriya Gunes, 68, from Elazig city, after the quakes caused a building to collapse on her street.   "It lasted quite long, maybe 30 seconds," added Ferda, 39. "I panicked and was undecided whether to go out in this cold or remain inside."

The US Geological Survey assessed the magnitude as 6.7, slightly lower than AFAD, adding that it struck near the East Anatolian Fault in an area that has suffered no documented large ruptures since an earthquake in 1875.   "My wholehearted sympathy to President @RTErdogan and the Turkish people following the devastating earthquake that has hit Turkey. Our search and rescue teams stand ready to assist," Greek Prime Minister Kyriakos Mitsotakis wrote on Twitter.   In Athens, the Greek premier's office said later that Mitsotakis had spoken by phone to Erdogan.   "The Turkish president... said Turkish teams had the situation under control for now and that it would be re-evaluated in the morning," his office added.

In 1999, a devastating 7.4 magnitude earthquake hit Izmit in western Turkey, leaving more than 17,000 people dead including about 1,000 in the country's largest city Istanbul.    In September last year, a 5.7-magnitude earthquake shook Istanbul, causing residents to flee buildings in the economic capital.   Experts have long warned a large quake could devastate the city of 15 million people, which has allowed widespread building without safety precautions.