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Albania

Albania US Consular Information Sheet November 04, 2008

 COUNTRY DESCRIPTION

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

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

ENTRY/EXIT REQUIREMENTS

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

SAFETY AND SECURITY

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

CRIME

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

MEDICAL FACILITIES AND HEALTH INFORMATION

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

MEDICAL INSURANCE

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

TRAFFIC SAFETY AND ROAD CONDITIONS

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

AVIATION SAFETY OVERSIGHT

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

CHILDREN'S ISSUES

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

REGISTRATION / EMBASSY LOCATION

 Americans living or traveling in Albania are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within Albania. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Rruga Elbasanit 103, tel. (355)(4) 2247285; fax (355)(4) 2232222. The U.S. Embassy web site is http://tirana.usembassy.gov/ * * * This replaces the Consular Information Sheet dated June 10, 2008, to update sections on Entry and Exit Requirements, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Fri, 9 Mar 2018 16:28:50 +0100

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

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

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

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

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

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

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

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

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

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

[A HealthMap/ProMED-mail map can be accessed at:
Date: Mon, 6 Feb 2017 04:30:32 +0100
By Briseida MEMA

Tirana, Feb 6, 2017 (AFP) - Emira Sela covers her face with her hand to hide a disfiguring abscess, the traumatic result of unregulated cosmetic treatments now rampant across Albania.   The 31-year-old began to worry when wrinkles appeared on her face. Sela's hairdresser told her that a simple injection, costing around 60 euros ($65), would banish the signs of ageing.   "She assured me that I would not risk anything. She even listed well-known names" of women who had undergone such treatment, said Sela.   "I did not think twice, I trusted her without asking questions," said the blonde woman with green eyes, her voice trembling.

Albanian hair and beauty salons lacking expertise and medical supervision are offering such cosmetic treatments, unregulated in a legal vacuum, much to the alarm of qualified doctors.   A single injection of a product whose content and dosage Sela knew nothing about was enough to ruin her life in late August.    Despite antibiotics she has permanent pain, fever and nausea, while the abscess on her right cheek forces her eye to half-close and her face is nearly paralysed.   "I am so disfigured that I tried to commit suicide," said Sela, who lost her job in a bank. Her only hope now is corrective surgery at an Italian hospital, scheduled for this month.

- Desiring Kardashian look -
"There are more and more impostors with syringes," said Panajot Papa, a plastic surgeon at a private clinic in Tirana.   "The problem is also the products... Forbidden in Europe, they enter illegally from Turkey or China."    Eriona Shehu, a dermatologist at Tirana's university hospital, said these unregulated synthetic products, such as injected liquid silicone and acrylamide, were being offered at temptingly low prices.

"Cosmetic interventions have become a lucrative industry. The patient is only a customer, exposed to a number of risks."   Shehu said the desire to look like voluptuous US reality television star Kim Kardashian was "destroying the lives of young Albanian girls looking for beauty".   Albanian doctors say the typical age of clients for such procedures is between 16 and 28.    In the country of about three million people, the demand for cosmetic interventions rose more than 50 percent in 2015, according to a study published by Albania's economic magazine Monitor.

Promotional offers can be seen everywhere, such as a beauty salon advertising 20 percent reductions for three people coming together for treatment during the holiday season.   Papa says he has treated a dozen young women aged between 20 and 27 who suffered complications after having their lips and cheekbones swollen with injected liquid silicone for 40 to 50 euros.    The product has been banned for cosmetic use in countries such as Italy and France for more than 15 years.   Papa said such botched interventions left these women prone to particularly bad swellings during their menstrual period, requiring further treatment -- and he warned they may suffer such symptoms for life.

- Closing legal gap -
Albanian doctors are worried about foreign practitioners who come from Italy, Turkey and Greece to work just for a weekend.   "They may not have a diploma, qualification or licence for these kind of interventions or for assuming the responsibility of a patient's medical follow-up," said Besim Boci, head of the otolaryngology department at Tirana's university hospital.   Due to legal loopholes, the judiciary cannot step in.    A spokesman at Tirana's tribunal, Alba Nikolla, admits that it is currently impossible to "open investigations and prosecute based only on complaints" against practitioners.

But authorities are set to tackle this with a draft law to control cosmetic products and beauty salons, which is due to be introduced in parliament in the next few months.   The law complies with the requirements of the European Union, which Albania aspires to join, and will enable authorities to shut down rogue establishments using synthetic products.    When health is adversely affected, practitioners could be imprisoned for three to 10 years.    Such regulations could go some way to easing the trauma of women like Elisa Lura, a 22-year-old economics student.   She underwent a laser treatment to restore her natural look after paying 50 euros to a neighbourhood salon for permanent eyebrow tattoos, which went wrong. But the laser made things much worse.   "Everything is spoiled!" she said of her face now covered with painful scars.
Date: Wed, 13 Jan 2016 04:21:54 +0100
By Briseida MEMA

Tirana, Albania, Jan 13, 2016 (AFP) - With her sick daughter in the arms, Mira Lela pushes her way through the hallway of the doctor's clinic, crowded with patients ailing from heavy pollution in Albania's capital.   "This is an emergency, she has difficulty breathing," said the tearful woman, forcing open the door to the office of Bardhyl Vaqari, who has worked in the specialist Tirana clinic for more than 20 years.   "An acute asthma attack," said the doctor on seeing the child.   "The number of people with respiratory allergies and cardiovascular problems has greatly increased," he told AFP, adding that the number of patients on the clinic's books has more than doubled to 8,000 in the last four years.

On the noisy and congested streets outside, clapped-out bangers and Hummer trucks cross paths with Mercedes, BMWs and overloaded buses that leave a trail of black smoke and heavy odour.    Having been cut off from the world under a strict communist regime until 1991, the Western Balkan city had just a few hundred cars on its roads in the 1990s.

But today, through a mixture of pride, luxury-seeking and necessity, given the lack of public transport, there are more than 190,000 cars circulating in a city of about one million people.   "Albanians take the car even when going to buy bread in a nearby store. That's why the traffic is overloaded all day and this increases pollution levels," said Altin Duka, a despairing 65-year-old shopkeeper.

The average age of vehicles on Tirana's roads is around 16 years, twice the European average, according to Gani Cupi, deputy manager of Albania's Road Transport Services.    Many of the vehicles do not meet the standards of the European Union, which Albania hopes to join.   "The traffic load, the age of vehicles, their technical condition but also the poor quality of fuel are all factors contributing to the capital's pollution," said Cupi.

- Taxing dilemmas -
In a bid to clean up the air, Albanian authorities considered doubling taxes on ageing vehicles but then dropped such plans. Analysts suggested the cost would weigh too heavily on citizens in one of the poorest countries in Europe.   New cars are already exempt from paying annual tax for the first three years, but authorities in 2012 lifted a levy on the import of old vehicles as the EU considered it a "fiscal discrimination".

Tirana's Mayor Erion Veliaj has pledged to battle against the fumes by increasing the number of green spaces, introducing hybrid buses and improving infrastructure in the city, which is crammed with mostly illegal constructions.   "The number of vehicles does not stop growing," he told AFP, pointing out that about 500 people die in the city each year "because of respiratory or cardiovascular problems related to pollution".

A report this year from the European Environment Agency noted a 20 to 30 percent decrease in Tirana's concentration levels of PM10 and PM2.5 -- damaging particulate matter -- according to data assessment from 2011 to 2013.   But Laureta Dibra, head of the air and climate change department at Albania's Environment Ministry, told AFP that PM10 levels had actually been rising in areas of heavy traffic in recent years.   Tirana remains "among the most polluted cities in Europe", added the director of the National Environment Agency, Julian Beqiri.   "The level of the population's exposure to pollutants is still a problem," he said.

- On your bikes -
In an effort to improve air quality in the capital and educate residents, Tirana organised two car-free days in 2015, when the air was said to be at least four times less polluted than usual.   Worried activists are campaigning to promote the bicycle as a means of transport and a way of life.   Ecovolis, a bike sharing system, rents out at least 200 bicycles from different tations around Tirana, at 60 leke (44 euro cents, $0.47) per bike per hour -- but many people still prefer getting behind the wheel.

Although Albania's energy minister claims that 95 percent of fuel meets the required standards, even Prime Minister Edi Rama attacked its quality in May last year.   "It is so bad that even a strong car like a Mercedes ends up being bad for Albanians' lungs," he said, calling for urgent measures to improve fuel controls.   The government says restrictions have since been tightened, but those at the frontline of the fumes remain unhappy.   "I come home in the evening with a completely dry throat and a bitter taste my mouth," said Bequir Veseli, 37, a traffic policeman who spends eight hours a day at the centre of a chaotic roundabout.   "I have trouble breathing but what can I do? The next day I have to go back to my post".
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Seychelles

General:
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This group of islands are situated off the eastern coast of Africa in the Indian Ocean. The main Island is Mahe and it has a population of under 100,000. The other two islands with significant popula
ions are Praslin and La Digue. Generally, tourist facilities are well developed throughout these main islands. Elsewhere facilities are poor. The islands enjoy an oceanic tropical climate with only mild variations throughout the year. Rainfall fluctuations do occur with more rainfall occurring between October to April each year.
Safety and Security:
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The majority of tourists visiting the Seychelles will have a very peaceful time and the rate of crime throughout the country is small. However, like many other destinations this situation is changing and there are increasing numbers of reports of petty crime - even on the more popular beaches. Generally it is unwise to leave valuables unattended while you bathe and walking around the main streets in Victoria after dark is not recommended especially for women. All money exchanges must be transacted with official designated dealers and a receipt obtained. Otherwise strict penalties may be enforced.
Health Facilities:
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The level of healthcare in the main tourists resorts is perfectly adequate for most situations but outside these regions the level of care is significantly less. On isolated islands doctors are often unavailable and it may take many hours before you could move to a better equipped location. Always make sure your travel and health insurance is up to date before you leave home.
Food & Water Facilities:
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The level of food and water preparation in the main tourist resorts is excellent but when travelling to isolated regions the standards drop considerably. Consuming foods cooked in local homes will be a significant risk in many circumstances and usually best avoided. However, well cooked fresh fish and other well prepared local delicacies should not present any particular difficulty. As always it is wise to avoid all under cooked bivalve shellfish such as oysters, mussels and clams. Unprepared cold foods like lettuce are also better left untasted and fruit which has been previously peeled will be potentially contaminated. If you peel it yourself it should be fine. Check the tap water smells of chlorine and if not, do not use it for drinking or even brushing your teeth.
Insect Bites and Malaria:
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No malaria risk occurs throughout the Seychelles so prophylaxis will not be required. This is excellent news but you should be aware that mosquitoes can still be a problem and so careful avoidance techniques are required - particularly between dusk and dawn. Dengue Fever has been found on the Islands through there has been no epidemic of the disease for some years.
The risk of Rabies:
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The Seychelles are rabies free but obviously care should still be taken to avoid any contact with warm-blooded animals such as dogs, cats and monkeys. With the difficulties in patrolling the extensive coastline of the Seychelles it is always possible that the disease will be introduced at some stage in the future.
Swimming:
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Take care to listen to local advice before swimming in the sea. Strong currents and various marine life may lead to a severely spoiled holiday. Never swim after a heavy meal or significant intake of alcohol and always swim in the company of others.
Sun Exposure:
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The strength of the sun in the Seychelles throughout the year is significant and this can cause both sunburn and serious dehydration. After a long haul flight it may be tempting to fall asleep beside the hotel pool but this may cause dreadful sunburn and can easily ruin a holiday. Children need to be watched carefully as they are more liable to the effects of the sun, particularly on any fair skinned child. Wearing a light good fitting t-shirt and Increasing their salt intake may be very beneficial.
Road Safety:
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In the Seychelles they drive on the left side of the road but outside the main tourist resorts the roads tend to be very narrow with often shear drops. Barriers are rare and accidents can easily occur. The speed limits are between 25 to 50 mph and both drivers and front seat passengers are required to wear safety belts at all times. There is an ambulance service on the islands of Mahe, Praslin and La Digue which is summonsed by ringing 999.
Local Laws and Customs:
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There are strict regulations regarding import and export of firearms, spear-fishing equipment, fruit and vegetables. When paying for your hotel expenses a credit card must be used in most circumstances. If you have cash you must provide a receipt showing how it was obtained. A casino receipt would be adequate if you have been lucky enough!
Vaccinations for the Seychelles:
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Unless you are entering the islands from tropical Africa there are no essential vaccines for entry or exit. However for your own personal health it is recommended that travellers are covered against the following diseases;
*
Poliomyelitis (childhood booster)
*
Tetanus (childhood booster)
*
Typhoid (food and water borne disease)
*
Hepatitis A (food and water borne disease)
For those undertaking a longer more rural trip other vaccines may need to be considered including Hepatitis B.
Summary:
***********************************
Generally most tourists who maintain the usual commonsense rules stay perfectly healthy while in the Seychelles. Just remember the different climate conditions to your home situation and take care with food and water consumption. Further information is available from the Tropical Medical Bureau.

Travel News Headlines WORLD NEWS

18th Oct 2017
http://www.who.int/mediacentre/news/releases/2017/seychelles-plague-negative/en/ 

Samples from patients in Seychelles suspected to be ill with pneumonic plague tested negative at a World Health Organization (WHO) partner laboratory in Paris, France on Tuesday (17 October).
 
The ten samples were shipped by the Seychelles Ministry of Health and WHO to the collaborating centre for Yersinia at the Institut Pasteur to confirm the status of several suspected and one probable case – a 34-year-old Seychelles national who had returned from Madagascar with plague-like symptoms.

WHO is working with the Seychelles health authorities to reduce the risk of plague spreading from neighbouring Madagascar, which faces an unprecedented outbreak that has killed more than 70 people since August. No plague cases have been confirmed in the Seychelles.
Alongside support for laboratory testing, WHO has deployed experts and medical supplies to the 115-island country. The Organization is also providing guidance for the tracing and treatment of contacts of people who are suspected to have been infected.

“We are working with health authorities to reduce the risk of the spread of plague in the Seychelles by improving surveillance and preparedness,” said Dr. Ibrahima Soce Fall, WHO Regional Emergencies Director for the Africa region.

WHO is advising the Government of Seychelles on the implementation of public health measures that are in line with the WHO International Health Regulations, such as enhanced surveillance, isolation and treatment of suspect cases, contact tracing and prophylactic treatment of potential contacts.

WHO currently assesses the risk of spread of plague in the Seychelles to be low.
Date: Fri 13 Oct 2017
Source: Medical Xpress [edited]

The Seychelles government ordered schools to close [Fri 13 Oct 2017], after the discovery of 2 suspected cases of plague thought to have been brought from Madagascar where the disease has killed scores. The health ministry has also put under surveillance 320 people who have come into contact with the 2 patients. A total of 12 people showing plague-like symptoms have been admitted to hospital and given antimicrobials.

Panic gripped parents on the Indian Ocean archipelago after some students developed fevers in recent days, leading to the school closures.

"We made this decision as a precautionary measure to reassure parents," said Merida Delcy, an adviser to the education ministry, noting that they would not reopen until [Wed 18 Oct 2017], at the earliest.

Preliminary tests on the 2 people, including a Seychellois who returned from Madagascar a week ago, showed they could have plague, the health ministry said.

"It has not yet been confirmed that the 2 people are sick due to plague, samples will be sent this weekend to the Institut Pasteur (in France)," said public health commissioner Jude Gedeon. The results are expected next week [week of Sun 15 Oct 2017].

The sick include a student at Anse Boileau Elementary School on the main island of Mahe where all students have since been given antimicrobials.

As fear of plague spreads, there has been a run on surgical masks which people hope will offer protection against the highly infectious disease. Plague outbreaks are common on Madagascar, 1800 kilometres (1120 miles) to the south, where the disease is endemic. But this year [2017] both bubonic plague, spread by infected rats via flea bites, and the pneumonic type, spread person-to-person, have hit urban areas, including the capital Antananarivo, leaving at least 54 dead.

A Seychellois basketball coach who was visiting Madagascar is among the victims. The Seychelles government has begun to quarantine people who have arrived from Madagascar in the last week [week of Sun 1 Oct 2017]. The latest Madagascar health ministry report this week says 500 cases and 54 deaths [now 561 and 57 - ProMED Mod.LL] have so far been recorded, with around half of each occurring in the capital.
=====================
[There is no confirmation about any cases acquired on Seychelles on the Ministry of Health facebook page <https://www.facebook.com/mohseychellesofficial/>. ProMED awaits confirmation of additional cases of _Y. pestis_ infection on Seychelles in addition to the imported case from Madagascar. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Wed 11 Oct 2017
Source: Seychelles Ministry of Health [summ., edited]

Dr Jude Gedeon met with the media on Wed 11 Oct 2017, to give an update on the pneumonic plague situation in Seychelles. Speaking to several media houses, he addressed the case of pneumonic plague that was confirmed yesterday, 10 Oct 2017. He also stressed on current and additional measures being taken by the Ministry of Health to prevent this from spreading.

New measures being implemented against pneumonic plague:
- everyone entering Seychelles from Madagascar will immediately be referred to the isolation centre in Perseverance [Perseverance Island is an artificial island in Seychelles, lying 2 km (1.3 mi) from the capital Victoria]. - ProMED Mod.LL]
- no foreigners coming to Seychelles from Madagascar will be granted entry. Only Seychelles citizens will be allowed to enter the country.
- a Travel Advisory has been issued, in collaboration with Seychelles Tourism Board requesting all transiting points (Mauritius, Kenya, and Reunion) to redirect all passengers who are not a citizen of Seychelles.
- cargo ships will continue to be monitored as before. If anyone presents with symptoms within less than 7 days of leaving Madagascar, the ship will remain in isolation at sea. If anyone on board is sick, they will receive treatment;
- cruise ships are advised to remain at sea for at least 7 days before entering the port after visiting Madagascar. If it is less than 7 days (incubation period) all passengers and crew will remain under surveillance for the recommended time before entering the country.
*******************************
Date: Wed 11 Oct 2017 12:59 SCT
Source: Seychelles News Agency [edited]

Visitors to Seychelles who have visited Madagascar or transited through that island nation in the last 7 days will be placed under observation by health officials upon arrival to Mahe.

The Minister of Health, Jean-Paul Adam, made the statement in the National Assembly on [Wed 11 Oct 2017] when answering an urgent question from the Leader of the Opposition, Wavel Ramkalawan. Adam was called to the National Assembly after the 1st case of pneumonic plague in Seychelles was confirmed on Tue 10 Oct 2017. The patient is a man who returned to Mahe, the main island, last [Fri 6 Oct 2017], on board the last Air Seychelles flight from Madagascar.

The health minister also confirmed that 258 people are currently under observation and receiving treatment after the case of pneumonic plague was detected. "The 258 includes 41 passengers and 7 crew from the flight, 12 close family members, and 18 staff and patients from the Anse Boileau health centre where the man went when he fell ill."

The man disobeyed instructions given upon his arrival to remain at home for a period of time and attended a party that same evening. The minister explained that the result of the tests conducted on the infected man was sent to the Pasteur Institute in Paris, which confirmed the pneumonic plague.

Adam said that "all the 170 people who were at the party including the 13 staff working at the venue are also under passive surveillance. We were already putting Seychellois and tourists under active observation at their homes or at hotels. But as from today [11 Oct 2017], all those arriving from Madagascar will be put in isolation for 6 days," the Minister said.

Adam added that the authority will be using the Seychelles Coast Guard military academy as the isolation centre located at Perseverance, a reclaimed island on the outskirts of Victoria.

The national airline -- Air Seychelles -- had suspended all flights to Madagascar, following guidance and requests of the Seychelles' Public Health Authority amid concerns over the outbreak of the plague in Madagascar. To date, there are 449 cases confirmed in Madagascar and 48 people have died [now 500 cases and 54 deaths - ProMED Mod.LL]. Air Seychelles is the only airline in the region to suspend all its flights to the island.

The health ministry has also liaised with the Seychelles Fishing Authority to get fishermen who may have travelled to Madagascar recently to report their trips and if necessary to seek advice from health professionals. "We are also in contacts with boats, and we want to urge those who may have travelled to Madagascar informally to stop this practice and to report to their nearest health centres." Adam said this is important for assessment and also "for us to decide if they need to be placed under surveillance for treatment. We are also liaising with travel agents to discourage people from visiting the island."

Seychelles, a group of 115 islands in the western Indian Ocean, is on high alert ever since it was confirmed that a Seychellois basketball coach, who died in a hospital in Madagascar in September 2017, had contracted the plague.
====================
[Seychelles seems to have responded in appropriate ways related to the single importation (so far) of a person who developed pneumonic plague after returning from Madagascar. It is not clear if this case had any relationship to the basketball tournament that had occurred on Madagascar. Since there is no comment in this report regarding institution of antimicrobial prophylaxis to any of the contacts. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps can be accessed at
Date: Sat, 14 Oct 2017 16:49:58 +0200

Mogadishu, Oct 14, 2017 (AFP) - More than 20 people were killed when a car bomb exploded on a busy street in Somalia's capital Mogadishu on Saturday, a police official said.   "Initial reports from emergency departments indicate more than 20 bodies picked up off the street and many more are under the wreckage of buildings destroyed by the blast", said Ibrahim Mohamed, a senior police officer.   Government security official Mohamed Aden said that bombing took place in a busy part of the city.    "There was a huge blast caused by a truck loaded with explosives. It went off at the entrance of a hotel alongside the K5 intersection," he said.   There was no immediate claim of responsibility, but the Al-Qaeda aligned Shabaab carries out frequent suicide bombings in the capital and elsewhere as it fights to overthrow the internationally-backed government.
Date: Fri, 13 Oct 2017 16:03:29 +0200

Victoria, Seychelles, Oct 13, 2017 (AFP) - The Seychelles government ordered schools to close Friday, after the discovery of two suspected cases of plague thought to have been brought from Madagascar where the disease has killed scores.   The health ministry has also put under surveillance 320 people who have come into contact with the two patients.

A total of 12 people showing plague-like symptoms have been admitted to hospital and given antibiotics.   Panic gripped parents on the Indian Ocean archipelago after some students developed fevers in recent days, leading to the school closures.   "We made this decision as a precautionary measure to reassure parents," said Merida Delcy, an adviser to the education ministry, noting that they would not reopen until Wednesday at the earliest.
 
Preliminary tests on the two people, including a Seychellois who returned from Madagascar a week ago, showed they could have plague, the health ministry said.   "It has not yet been confirmed that the two people are sick due to plague, samples will be sent this weekend to the Institut Pasteur (in France)," said public health commissioner Jude Gedeon.   The results are expected next week.   The sick include a student at Anse Boileau Elementary School on the main island of Mahe where all students have since been given antibiotics.

As fear of plague spreads, there has been a run on surgical masks which people hope will offer protection against the highly infectious disease.   Plague outbreaks are common on Madagascar, 1,800 kilometres (1,120 miles) to the south, where the disease is endemic. But this year both bubonic plague, spread by infected rats via flea bites, and the pneumonic type, spread person-to-person, have hit urban areas, including the capital Antananarivo, leaving at least 54 dead.

A Seychellois basketball coach who was visiting Madagascar is among the victims. The Seychelles government has begun to quarantine people who have arrived from Madagascar in the last week.   The latest Madagascar health ministry report this week says 500 cases and 54 deaths have so far been recorded, with around half of each occurring in the capital.
More ...

Mauritania

Mauritania US Consular Information Sheet
September 23, 2008
COUNTRY DESCRIPTION:
Mauritania is a developing country in northwestern Africa.
Arabic is the official language, but French is widely used and several local languages are als
spoken.
Tourist facilities in the capital, Nouakchott, are adequate, but limited or non-existent elsewhere.
Read the Department of State Background Notes on Mauritania for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport and a visa are required, as is evidence of a yellow fever vaccination.
For the most current visa information, contact the Embassy of the Islamic Republic of Mauritania, 2129 Leroy Place NW, Washington, DC
20008, tel. (202) 232-5700, or the Mauritanian Permanent Mission to the UN, 211 East 43rd Street, Suite 2000, New York, NY 10017, telephone (212) 986-7963 or 8189, or e-mail Mauritania@un.int.
Overseas, inquiries should be made at the nearest Mauritanian embassy or consulate.

See our information on dual nationality, the prevention of international child abduction and Customs regulations.

SAFETY AND SECURITY:
There is increasing activity by the terrorist group Al Qaeda in the Islamic Maghreb (AQIM) in Mauritania.
On December 24, 2007, terrorists shot and killed four French tourists and wounded a fifth near the town of Aleg, in southeastern Mauritania.
On December 26, 2007, terrorists killed four soldiers near the town of El Ghallaouiya in northern Mauritania.
These two attacks were followed by an attack on the Israeli Embassy and an adjoining nightclub frequented by westerners early in the morning of February 1, 2008.
The perpetrators of these attacks are believed to be linked to AQIM.
These are the first attacks that have occurred in Mauritania since June 2005, when members of the terrorist group GSPC (now known as AQIM) attacked a military outpost based at Lemgheity, near the Algerian and Malian borders.
In the attack, they killed or wounded about 35 soldiers.
Travelers should avoid all non-essential travel to the Hodh El Charghi region of southeastern Mauritania due to increased AQIM activities in the border area.
Official Americans continue to travel to the town of Atar, although AQIM has also talked about targeting Westerners there.
Travelers should check http://mauritania.usembassy.gov for current Consular Warden messages concerning Mauritania.

Travelers should exercise prudence and caution when traveling in Mauritania.
They should not venture outside of urban areas unless in a convoy and accompanied by an experienced guide, and even then only if equipped with sturdy vehicles and ample provisions.
The U.S. Embassy in Nouakchott has received reports of banditry and smuggling in the more remote parts of Mauritania.
Landmines also remain a danger along the border with the Western Sahara and travelers should cross only at designated border posts.
The U.S. Embassy recommends that travelers avoid travel in regions north and east of Zouerate, Ouadane, and Tichit unless with a government escort.
Travelers planning overland trips from Mauritania to Morocco, Algeria, Senegal or Mali should check with the U.S. Embassy in Nouakchott before setting out.
For more information about travel in Mauritania, please see the section “Traffic Safety and Road Conditions” below.

The Mauritanian military led a bloodless coup on August 6, 2008.
There has been increased political unrest following the coup, but no violence.
There have also been increased political gatherings and street demonstrations.
The police have been using tear gas to break up some anti-coup demonstrations.
An increased police presence and additional vehicle controls may also be expected.
U.S. citizens should avoid large crowds and maintain security awareness at all times.

In Nouakchott and other major cities in Mauritania, there is an increased security presence and additional checkpoints.
Police routinely conduct road blocks at which they may ask for proof of identity and drivers’ licenses.
These checkpoints should be respected.
Americans visiting Mauritania should be prepared for such inquiries and carry their identification cards at all times.
It is best to drive cautiously and be prepared to stop at short notice.

American citizens should be aware of their surroundings at all times and maintain good personal security practices, including always locking their homes and cars.
They should avoid established patterns and take care not to draw attention to themselves.
When going out, they should avoid being part of large, highly visible groups of Westerners and when in restaurants or cafes, avoid sitting in areas that are easily visible from the street.

Although U.S. citizens are generally welcomed in Mauritania, there were reports of anti-American incidents such as threats and stoning of vehicles, following the 1998 U.S.- and British-led intervention in Iraq, and demonstrations outside the Embassy during the 2003 U.S. intervention in Iraq.
Some Muslim extremists have occasionally perceived Christian non-governmental organizations as a threat.
However, local authorities closely monitor political violence and religious extremist groups.

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

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

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

CRIME:
Crime in Mauritania is moderate but steadily increasing.
Most incidents occur in the cities and larger towns, and are petty crimes such as pick pocketing and the theft of improperly secured and openly visible valuables left in vehicles.
Most criminal activity occurs at night and walking alone at night is not advisable.
Residential burglaries and robberies, particularly at the beaches in Nouakchott, are not uncommon.
In Nouakchott, travelers should avoid the beach at night.
During the day, beach-goers should travel in large groups or stay in popular areas because of the increase in the number of thefts and robberies, some involving injury to victims, reported there in the past several years.
Violent crimes and crimes involving the use of weapons are rare, but increasing.
Rapes and assaults have occurred and, in some instances, involved the American community.
Foreign tourists, including Americans, might be targeted for kidnapping in Mauritania.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Mauritania are limited.
There are few modern clinics or hospitals beyond the capital and a few major towns.
At local pharmacies, some medicines are difficult to obtain; travelers are advised to bring their own supplies.

Malaria is a serious and sometimes fatal disease.
Chloroquine-resistant P. falciparum malaria is a severe form of the disease that is found in many parts of western Africa, including Mauritania.
Because travelers to Mauritania are at high risk for contracting malaria, they should take one of the following anti-malarial drugs:
mefloquine (Lariam™), doxycycline, or atovaquone/proguanil (Malarone™).
The Centers for Disease Control and Prevention (CDC) have determined that a traveler who is on an appropriate anti-malarial drug has a greatly reduced chance of contracting the disease.
In addition, other personal protective measures, such as the use of insect repellents, may help to reduce malaria risk.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what anti-malarial drugs they have been taking.
For additional information on malaria, protection from insect bites, and anti-malarial drugs, please visit the CDC travelers’ health web site at http://www.cdc.gov/malaria/.

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

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

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

Public transportation is not safe and road conditions in Mauritania are generally poor, particularly in the interior.
Overland travel is difficult and roadside assistance is almost nonexistent.
The country’s size and harsh climate make road maintenance and repair especially problematic.
Mauritania has only about 2,070 km (1,286 miles) of surfaced roads, 710 km (441 miles) of unsurfaced roads, and 5,140 km (3,194 miles) of unimproved tracks.
Drivers should not offer rides to hitchhikers, nor should visitors to Mauritania accept rides offered by strangers.


The traditional route to Nouadhibou, prior to the completion of a paved road, was along the beach during low tide.
Some travelers continue to use this route, as do visitors to coastal fishing villages and other points of interest, and smugglers and others who try to avoid the security checkpoints that are often established along the asphalt roads.
Pedestrian visitors to the beach should exercise caution because of the beach’s use as a route for motorized vehicles.

U.S. citizens traveling overland for long distances in Mauritania should travel in convoys and be sure to have suitable four-wheel drive vehicles, a local guide, an adequate supply of water and food, and a second fuel reservoir.
Multiple vehicles are recommended in case of breakdown.
A Global Position Satellite (GPS) receiver and satellite phone are essential when traveling in remote areas.
Visitors are urged not to travel alone into the desert.

Driving in Mauritania is treacherous, and we encourage travelers to hire a trained local driver.
Traffic patterns differ considerably from American-style “rules of the road,” and many Mauritanians drive without regard to traffic signs or rules.
Roadway obstructions and hazards caused by drifting sand, animals, and poor roads often plague motorists; when combined with the number of untrained drivers and poorly maintained vehicles, heightened caution is imperative at all times.
Drivers should be alert to conditions and always wear their seat belts.
Motorcycle and bicycle riders should wear helmets and protective clothing.
Nighttime driving is discouraged.

The telecommunications infrastructure is limited and cellular telephone coverage is not wide spread.
For those traveling outside the major urban areas, it is recommended to have a satellite telephone readily available.

Please refer to our Road Safety page for more information.

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

SPECIAL CIRCUMSTANCES:
Mauritanian customs authorities may enforce strict regulations concerning the temporary import or export of items such as firearms, narcotics, alcoholic drinks and pork products.
Contact the Embassy of Mauritania in Washington, DC for specific information regarding customs regulations.

The local currency is the ouguiya, and it may not be imported or exported.
Credit cards can be used only at a few hotels in the capital, Nouakchott, and the northwestern city of Nouadhibou.
ATM machines are available only in Nouakchott.
Major foreign currencies are changeable in banks and numerous currency exchanges; however, this service is not always available without advanced notice or prior arrangement.
There is a risk of getting fraudulent bank notes even from banks which often do not have the security means to detect fake bank notes.
Furthermore, credit card fraud is a problem, so it is strongly advisable to pay hotel bills in cash.

Islamic ideals and beliefs in the country encourage conservative dress.
Sleeved garments and below-the-knee skirts are recommended, and people should avoid wearing shorts.
Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Mauritania’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession or use of, or trafficking in illegal drugs in Mauritania 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 Mauritania 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 Mauritania. 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 between the Presidency building and the Spanish Embassy on Rue Abdallaye.
The postal address is B.P. 222, Nouakchott, telephone (222) 525-2660/2663, 525-1141/45, or 525-3038 (ext. 5441), and fax (222) 525-1592.
The Consular Section may be contacted by e-mail at ConsularNKC@state.gov
* * *
This replaces the Consular Information Sheet dated April 29, 2008, to update the section on Safety and Security.

Travel News Headlines WORLD NEWS

Date: Mon 30 Apr 2018
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/crimean-congo-hemorrhagic-fever-case-reported-mauritania-28755/>

The Mauritania Ministry of Health has reported a confirmed case of Crimean-Congo haemorrhagic fever [CCHF] in Ould Yengé commune, Guidimaka region located in the southern-most part of the country. The case-patient is a 58-year-old male herder from Elghabra locality who became ill on [16 Apr 2018] (reportedly) after tending to a sick cow days earlier. He presented to a private clinic the same day [16 Apr 2018] with high fever, arthralgia and headache. He was admitted, managed for an unspecified medical condition and discharged on [18 Apr 2018].

The following day [19 Apr 2018], he developed bleeding from the gums and nose, and was admitted to the regional hospital where he was transfused and subsequently discharged on [20 Apr 2018], following an apparent clinical improvement. On [21 Apr 2018], the case-patient's health deteriorated and he was taken to Guerou health centre, from where he was immediately referred to Cheikh Zayed hospital in Nouakchott on [22 Apr 2018].

A blood specimen was obtained and shipped to the national public health laboratory. The test result released on [24 Apr 2018] was IgM positive for Crimean-Congo haemorrhagic fever. A total of 32 close contacts, including 10 health workers and 4 family members, have been listed and are being followed up. Efforts to identify other close contacts are ongoing.

The case-patient used public transportation and a taxi at various stages of his movement during the course of illness. Preliminary investigations also established that all the 4 healthcare facilities that managed the case-patient did not apply appropriate infection prevention and control measures, potentially indicating a higher number of contacts.

According to the WHO, Crimean-Congo haemorrhagic fever is a widespread disease caused by a tick-borne virus (_Nairovirus_) of the _Bunyaviridae_ family. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10-40 percent. CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north - the geographical limit of the principal tick vector.

The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats. Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites.

Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vector. The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.
=======================
[There is need to emphasize inter-sectoral collaboration involving health, veterinary and entomology/environmental services to map the areas of vector distribution. Furthermore, awareness messages among the high exposure groups should be widespread as CCHF vector propagates from May onwards leading to higher transmission rates in summer. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map:
Guidimaka Region, Mauritania: <http://healthmap.org/promed/p/25044>]
Date: Mon 27 Nov 2017
Source: Outbreak News Today [edited]

Following cases of Crimean-Congo haemorrhagic fever (CCHF) reported this spring and summer [2017], the Mauritania Ministry of Health has reported an addition CCHF case last week [week ending Sun 26 Nov 2017] in a 48-year-old male farmer from Haye Sakin community in Dar Nairn, at the outskirt of the capital city, Nouakchott. He fell sick on the [11 Nov 2017] and was later treated and discharged last week.  The frequency of these events affirms the relative prevalence of the pathogen and the reservoir and vector for CCHF virus (Hyalomma ticks) in the country.

According to the WHO, Crimean-Congo hemorrhagic fever is a widespread disease caused by a tick-borne virus (Nairovirus) of the _Bunyaviridae_ family. The CCHF virus causes severe viral haemorrhagic fever outbreaks, with a case fatality rate of 10-40 percent.  CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north - the geographical limit of the principal tick vector. The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats.

Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vector.

The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.
=========================
[Crimean-Congo hemorrhagic fever (CCHF), an acute viral disease in humans, is characterized by extensive ecchymoses, bleeding, and hepatic dysfunction and is associated with a 30 percent case-fatality ratio (World Health Organization Crimean-Congo haemorrhagic fever. Fact sheet no. 208. Geneva: the Organization; 1998). It is caused by CCHF virus (genus _Nairovirus_, family _Bunyaviridae_).

CCHF is a zoonosis transmitted to large and small mammals and birds by ticks. Although the virus has been isolated from several genera and species of ixodid ticks, the main group of vectors involved in CCHF virus transmission appears to be ticks of the genus _Hyalomma_ (Hoogstraal H. The epidemiology of tick-borne Crimean-Congo haemorrhagic fever in Asia, Europe, and Africa. J Med Entomol. 1979;15(4):307-417.). Immature ticks acquire the virus by feeding on infected small vertebrates. Once infected, they remain infected throughout their development and, when they are mature, transmit the infection to large animals, such as livestock. Transovarian transmission has also been demonstrated.

The circulation of CCHF virus and the high prevalence of infected animals and ticks have been well documented in Mauritanian farming areas since 1983 (Gonzalez JP, LeGuenno B, Guillaud M, Wilson ML. A fatal case of Crimean-Congo haemorrhagic fever in Mauritania: virological and serological evidence suggesting epidemic transmission. Trans R Soc Trop Med Hyg. 1990;84(4):573-6).

Mauritania experienced a fairly large CCHF outbreak in 2003, involving 38 cases with a case fatality rate of 28.6 percent. Over 90 percent of the cases (35/38) were resident in Nouakchott. In 2017, the WHO reported confirmation of a 3rd CCHF case in Boutilimit as well as in 2 patients referred from Mauritania to Dakar, Senegal who tested positive between May and June 2017. These cases had also originated from the capital city Nouakchott. This may be indicative of the relative prevalence of the reservoir and vector for the CCHF virus (Hyalomma ticks) in the country.

Even though the country has established adequate diagnostic capacity, which facilitated rapid confirmation of cases; the national authorities and partners need to carry out extensive outbreak investigations, including seroprevalence studies, to determine the potential risk for continued CCHF outbreaks in humans and institute effective prevention and control measures, with a strong animal health component  (<http://apps.who.int/iris/bitstream/10665/258794/1/OEW34-192582017.pdf>).

The case reported in this report is a farmer admitted in early
November [2017], however no exposure history is mentioned. - ProMED Mod.UBA]

[HealthMap/ProMED-mail map Nouakchott, Nouakchott, Mauritania:
Date: 28 Aug 2017
Source: Outbreak News Today [edited]

On 24 Aug 2017, the Mauritania Ministry of Health notified WHO of a confirmed case of Crimean-Congo hemorrhagic fever (CCHF) in a 47-year-old shepherd, from Arafat Village in Mohammedia, Boutilimit Prefecture, located about 150 km southeast of the capital, Nouakchott.

In May 2017, health officials reported 2 imported cases of Crimean-Congo hemorrhagic fever (CCHF) in Senegal imported from Mauritania. A 3rd imported case was reported in June 2017.

He developed headache, muscle and joints pains and diarrhea on 20 Aug 2017 and sought medical attention. He was treated with anti-malarial medicines and analgesics.

After 2 days, he returned for medical care as his condition worsened. He was tested for CCHF because of bleeding manifestations and was IgM positive for Crimean-Congo haemorrhagic fever by enzyme-linked immunosorbent assay (ELISA). The patient is still hospitalized and in stable clinical condition.

Mauritania experienced a fairly large CCHF outbreak in 2003, involving 38 cases with a case fatality rate of 28.6 percent. According to the WHO, Crimean-Congo hemorrhagic fever is a widespread disease caused by a tick-borne virus (Nairovirus) of the Bunyaviridae family. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10-40 percent.

CCHF is endemic in Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north, the geographical limit of the principal tick vector. The hosts of the CCHF virus include a wide range of wild and domestic animals such as cattle, sheep and goats.

Animals become infected by the bite of infected ticks, and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vectors.

The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.  [Byline:  Robert Herriman]
==================
[An outbreak of Crimean-Congo hemorrhagic fever was documented in Nouakchott, the capital of Mauritania in 2003. The index case was detected on 18 Feb 2003. By 21 Mar 2003, the Ministry of Health of Mauritania had reported a total of 35 cases (18 laboratory confirmed) of Crimean-Congo haemorrhagic fever (CCHF), including 6 deaths [Crimean-Congo hemorrhagic fever - Mauritania (04) http://promedmail.org/post/20030324.0732].

In the period from February to August 2003, 38 persons were infected with Crimean-Congo hemorrhagic fever (CCHF) virus; 35 of these persons were residents of Nouakchott. The 1st patient was a young woman who became ill shortly after butchering a goat. She transmitted the infection to 15 persons in the hospital where she was admitted and 4 members of her family. In Nouakchott, 2 disease clusters and 11 isolated cases were identified. Of the patients not infected by the 1st case-patient, almost half were butchers, which suggests that the primary mode of animal-to-human transmission was direct contact with blood of infected animals.

Cattle heavily infested with ticks were more likely to be CCHFV seropositive, and vector control to reduce the tick burden can result in reduced seroprevalence. Cattle are noted as the most sensitive indicator of low-level CCHFV circulation because they tend to be highly infested with _Hyalomma_ spp. ticks, which are the most common vectors of CCHF  [<http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0004210>].

The circulation of CCHF virus and the high prevalence of infected animals and ticks have been well documented in Mauritanian farming areas since 1983 [Crimean-Congo haemorrhagic fever and Rift Valley fever in south-eastern Mauritania. Saluzzo JF, Digoutte JP, Camicas JL, Chauvancy G Lancet. 1985 Jan 12; 1(8420):116].

Since then, this is the latest case reported from that country, with history of exposure to livestock. - ProMed Mod.UBA]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/13859>.]
Date: Sat 3 Jun 2017, 11:08 AM
Source: Alakhbar [in French, trans. Mod.AB, edited]

A suspected case of Rift Valley fever (RVF) was discovered at the Nouakchott Hospital Center according to a source for Alakhbar.

The patient is a 37-year-old Mauritanian. He was isolated upon his arrival at the hospital after the 1st medical tests revealed the existence of fever. Further in-depth analyzes are required for confirmation.

The Mauritanian health authorities have often denied the existence of the virus in its 1st appearances.

RVF is a disease that mainly affects animals but can contaminate humans either by mosquito bites or by contact with blood, physiological fluids, or organs of infected animals. The RVF virus was 1st identified in 1931 during an investigation of an epidemic affecting sheep in a Rift Valley farm in Kenya.
=====================
[If this case were to be definitively confirmed in the laboratory, it would have occurred almost 18 months after the series of cases, including 4 fatal cases, which Mauritania had experienced over various provinces in October 2015. At the same time, at least 4 foci of the disease occurred in sheep and goats in Brakna region (Aleg, Tidjikja, Magta-Lahjar, Kiffa).

The recent episode of RVF in Niger (September 2016 to February 2017) could be the cause of the re-emergence of the disease in Mauritania because, although these 2 countries do not share a common border, there is an incessant movement of livestock between the different areas of the Sahel where nomadism is a widespread lifestyle. It would appear that veterinary surveillance in these areas is sub-optimal, and this would explain why the detection of human cases precedes that of animal cases at the origin of these cases. - ProMED Mod.AB]

[RVF virus likely is endemic in parts of Mauritania, with cases of human and domestic animals occurring sporadically there. ProMED Mod AS provided an excellent comment on RVF previously; "Rift Valley fever (RVF) is a peracute or acute zoonotic disease of domestic ruminants. It is caused by a single serotype of a mosquito-borne virus of the _Bunyaviridae_ family (genus _Phlebovirus_). The disease occurs in climatic conditions favouring the breeding of mosquito vectors and is characterised by abortion, neonatal mortality, and liver damage. The disease is most severe in sheep, goats and cattle. Older, non-pregnant animals, although susceptible to infection, are more resistant to clinical disease. There is considerable variation in the susceptibility to RVF of animals of different species. Camels usually have an inapparent infection with RVF virus (RVFV), but sudden mortality, neonatal mortality, and abortion occur, and abortion rates can be as high as in cattle.

"Humans are susceptible to RVFV and are infected through contact with infected animal material (body fluids or tissues) or through bites from infected mosquitoes. RVFV has also caused serious infections in laboratory workers and must be handled with biosafety and biocontainment measures. It is recommended that laboratory workers be vaccinated if possible.

"RVFV is endemic in many African countries and may involve several countries in the region at the same time or progressively expand geographically over the course of a few years. In addition to Africa, large outbreaks have been observed in the Arabian Peninsula and some Indian Ocean Islands. These generally, but not exclusively, follow the periodic cycles of unusually heavy rainfall, which may occur at intervals of several years, or the flooding of wide areas favouring the proliferation of mosquitoes.

"Rainfall facilitates mosquito eggs to hatch. _Aedes_ mosquitoes acquire the virus from feeding on infected animals and may potentially vertically transmit the virus so that new generations of infected mosquitoes may hatch from their eggs. This provides a potential mechanism for maintaining the virus in nature, as the eggs of these mosquitoes may survive for periods of up to several years in dry conditions. Once livestock is infected, a wide variety of mosquito species may act as the vector for transmission of RVFV and can spread the disease.

"Low level RVF activity may take place during inter-epizootic periods. RVF should be suspected when exceptional flooding and subsequent abundant mosquito populations are followed by the occurrence of abortions, together with fatal disease marked by necrosis and haemorrhages in the liver that particularly affect newborn lambs, kids and calves, potentially concurrent with the occurrence of an influenza-like illness in farm workers and people handling raw meat.

"During an outbreak, preventive measures to protect workers from infection should be employed when there are suspicions that RVFV-infected animals or animal products are to be handled.

"The above and much more information is available at

ProMED would appreciate receiving additional information including laboratory results about this case and any new ones that might appear as they become available, in addition to information on presumed location of infection as the diagnosis was made in the capital city, but no mention of where the individual came from. - ProMED Mod.TY]

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

A HealthMap/ProMED-mail map can be accessed at:
Date: Tue 22 Mar 2016
Source: Points Chaud [in French, trans. Mod.MPP, edited]

A Mauritanian who came from Angola with yellow fever died on Monday [20 Mar 2016] at the Friendship Hospital. According to the Mauritanian community in Angola, the deceased had contracted the disease in Angola and decided to return to the country 2 days ago on a plane from a Moroccan company. His situation deteriorated after having been transferred to the Friendship Hospital where he died on Monday [20 Mar 2016].

It's not known whether the health authorities of the country had or did not have any concept of the severity of his disease. It's known that Angola presently has an epidemic of yellow fever ongoing that has already killed [more than] 158 people.

Yellow fever is a serious disease transmitted by insects that proliferate in standing water in dirty locations and places with waste.
=====================
[This is yet another case where a yellow fever virus infected individual travelled to a distant country in Africa. YF-infected individuals have travelled from Angola to the DR Congo and to Kenya. The risk of ongoing transmission in Mauritania is unknown, but health authorities there should be vigilant. - ProMED Mod.TY]

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More ...

World Travel News Headlines

31st May 2019

A volcano on the Indonesian island of Bali erupted Friday, spewing a plume of ash and smoke more than 2,000 metres (6,500 feet) into the sky. Mount Agung, about 70 kilometres from the tourist hub of Kuta, has been erupting periodically since it rumbled back to life in 2017, sometimes grounding flights and forcing residents to flee their homes.
Mount Agung is about 70 kilometres from the tourist hub of Kuta

The latest shortly before noon on Friday shot a cloud of volcanic ash high into the sky, but caused no disruption to flights, Indonesia's geological agency said.  Agung remained at the second highest danger warning level, and there is a four-kilometre no-go zone around the crater.

Last summer, dozens of flights were cancelled after Agung erupted, while tens of thousands of locals fled to evacuation centres after an eruption in 2017.

The last major eruption of Agung in 1963 killed around 1,600 people.

Indonesia is situated on the Pacific "Ring of Fire", a vast zone of geological instability where the collision of tectonic plates causes frequent quakes and major volcanic activity.

31st May 2019

Heatwaves across India have exacted heavy casualties this year, including dozens of deaths by sunstroke and other heat-related causes. The deaths have been mainly reported from states like Maharashtra (particularly Vidarbha), Andhra Pradesh (mainly Rayalseema) and Telangana, due to the temperature extremes in these regions. What's worrying is, a study suggests that the heatwave conditions are likely to increase from next year and continue till 2064 because of El Niño Modoki and depletion in soil moisture. Here's how the heatwave is taking a toll in the above states.

Maharashtra

Parts of Maharashtra have been reeling under high temperatures accompanied by severe heatwave condition during this summer. According to a report in The Times Of India, a 50-year old man in Beed succumbed to death because of heatstroke recently, taking the overall number to 8. Reports show a total of 456 cases of heat-related illnesses in Maharashtra this summer. Last year, the number of cases reported was 568. However, the death toll this year is more than last year's figure of 2 victims.

Regions like Nagpur and Akola show the most number of deaths and illnesses in the Vidarbha region. About 163 cases of heat-related illness were reported in Nagpur and 76 ailments were reported in Latur region. Recently, Chandrapur in Maharashtra (which lies 150km south of Nagpur) registered a day temperature of 48°C, the highest recorded in India this summer.

Andhra Pradesh

Parts of Andhra Pradesh have been experiencing temperatures of 45°C and more since the last few days. These conditions have persisted in the state after the heavy rains caused by Cyclone Fani.

Two women going on a two-wheeler and covered themselves with scarfs to protect themselves from the heat wave, in Vijayawada
(Mahesh G, TOI, BCCL, Vijayawada.)

Three people have died in Andhra Pradesh due to heat-related causes this year. Also, 433 people have been diagnosed with heatstroke. Earlier this month, electrical transformers had blown up in many parts of Krishna and Guntur districts, disrupting power supply for more than five hours and intensifying the effects of heatwave conditions and the severe temperatures.

In 2015, Andhra Pradesh experienced the most number of heat deaths in the country: 1,369 people died that year from heat-related illnesses.

Telangana

Seventeen people have succumbed in Telangana over the last 22 days. However, the number of unconfirmed deaths is expected to be higher. The region saw 541 heat-related deaths in 2015, and 27 in 2018. The farmers and those who work in the sun are usually the ones to be affected the most by high temperatures and heatwave conditions.

As heat blankets the country, make sure you stay protected. Follow official guidelines and do not step out in the Sun, especially in the afternoon hours, unless absolutely necessary.

(With inputs from The Times Of India.)

11th June 2019
https://afro.who.int/news/confirmation-case-ebola-virus-disease-uganda

Kampala, 11 June 2019 - The Ministry of Health and the World Health Organization (WHO) have confirmed a case of Ebola Virus Disease in Uganda. Although there have been numerous previous alerts, this is the first confirmed case in Uganda during the Ebola outbreak on-going in neighbouring Democratic Republic of the Congo.

The confirmed case is a 5-year-old child from the Democratic Republic of the Congo who travelled with his family on 9th June 2019. The child and his family entered the country through Bwera Border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness. The child was transferred to Bwera Ebola Treatment Unit for management. The confirmation was made today by the Uganda Virus Institute (UVRI). The child is under care and receiving supportive treatment at Bwera ETU, and contacts are being monitored.

The Ministry of Health and WHO have dispatched a Rapid Response Team to Kasese to identify other people who may be at risk, and ensure they are monitored and provided with care if they also become ill. Uganda has previous experience managing Ebola outbreaks. In preparation for a possible imported case during the current outbreak in DRC, Uganda has vaccinated nearly 4700 health workers in 165 health facilities (including in the facility where the child is being cared for); disease monitoring has been intensified; and health workers trained on recognizing symptoms of the disease. Ebola Treatment Units are in place.

In response to this case, the Ministry is intensifying community education, psychosocial support and will undertake vaccination for those who have come into contact with the patient and at-risk health workers who were not previously vaccinated.  

Ebola virus disease is a severe illness that is spread through contact with the body fluids of a person sick with the disease (fluids such as vomit, faeces or blood). First symptoms are similar to other diseases and thus require vigilant health and community workers, especially in areas where there is Ebola transmission, to help make diagnosis. Symptoms can be sudden and include:
  • Fever
  • Fatigue
  • Muscle pain
  • Headache
  • Sore throat
People who have been in contact with someone with the disease are offered vaccine and asked to monitor their health for 21 days to ensure they do not become ill as well.

The investigational vaccine being used in DRC and by health and frontline workers in Uganda has so far been effective in protecting people from developing the disease, and has helped those who do develop the disease to have a better chance of survival. The Ministry strongly urges those who are identified as contacts to take this protective measure.

Investigational therapeutics and advanced supportive care, along with patients seeking care early once they have symptoms, increase chances of survival.

The Ministry of Health has taken the following actions to contain spread of the disease in the country:
  • The District administration and local councils in the affected area have been directed to ensure that any person with Ebola signs and symptoms in the community is reported to the health workers immediately and provided with advice and testing.
  • The Ministry of Health is setting up units in the affected district and at referral hospitals to handle cases if they occur.
  • •Social mobilization activities are being intensified and education materials are being disseminated.

There are no confirmed cases in any other parts of the country.

The Ministry is working with international partners coordinated by the World Health Organization.

The Ministry of Health appeals to the general public and health workers to work together closely, to be vigilant and support each other in helping anyone with symptoms to receive care quickly. The Ministry will continue to update the general public on progress and new developments.
Date: Mon, 10 Jun 2019 14:24:43 +0200

Lima, June 10, 2019 (AFP) - Peru has declared a health emergency in five regions, including Lima, after the deaths of at least four people linked to Guillain-Barre syndrome, an autoimmune disorder that attacks the nervous system.   Health Minister Zulema Tomas said Sunday that in addition to the deaths there were currently 206 cases of the disease.   "We have an outbreak, there has been a brusque increase" since June 5, Tomas said on state-run TV Peru, adding that health authorities were taking steps to control and contain the disease.

While the syndrome is not contagious, a 90-day health emergency was declared because the current cases "have unusual and atypical characteristics that require rapid or immediate initial treatment," Peru's Institute of Neurological Sciences said.   The precise cause of the disorder is unknown, but most cases develop after a person has been sick with diarrhoea or a respiratory infection.

The Centers for Disease Control and Prevention in the US says its research suggests that the syndrome is "strongly associated" with the Zika virus, a mosquito-borne illness.   The regions affected by GBS include three on the country's northern coast -- Piura, Lambayeque, La Libertad -- tourist destinations known for their archaeological sites and beaches.   Also included was the central region of Junin and Lima, which has nine million inhabitants.   Two deaths were reported in Piura, one in La Libertad and another in Junin.
Date: Mon, 10 Jun 2019 16:39:03 +0200

Madrid, June 10, 2019 (AFP) - Three tourists have fallen from their hotel balconies in Spain's Balearic Islands in recent days, one of them dying on impact, police said Monday as the summer season in the party archipelago begins.   The incidents came as Britain's foreign office warned holidaymakers heading to Spain against "balcony falls" and asked them not to "take unnecessary risks... particularly if you're under the influence of drink or drugs."   On Friday in Magaluf, a party resort notorious for its booze-fuelled tourism, a 19-year-old British man fell to his death from the second floor of his hotel, Spain's Civil Guard police force said.

A spokesman said police were looking at two theories -- either "he threw himself off voluntarily, or he fell by accident."   He did not know whether the victim had consumed drugs or alcohol.   On Thursday, a 35-year-old German man fell from the second floor of his hotel too, this time in Palma de Majorca, and was seriously injured, police said.   A source close to the probe, who declined to be named, said the man had drunk, dozed off, woken up and subsequently fallen from the balcony, possibly disorientated.   And on Monday, an Australian man in his early thirties fell from the second floor of his hotel in Ibiza and was seriously hurt, police said, without giving further details.

Balcony falls happen every year in the Balearic Islands and other party resorts in Spain, most of them due to excessive drinking or drug-taking/   Some are accidental slips, while others happen when tourists miss while trying to jump into pools or onto another balcony -- a practice known as "balconing."   The British foreign office's online travel advice for Spain has an entire section warning against "balcony falls".   "There have been a number of very serious accidents (some fatal) as a result of falls from balconies," says the website.    "Many of these incidents have involved British nationals and have had a devastating impact on those involved and their loved ones."
Date: Mon, 10 Jun 2019 06:44:54 +0200

Sydney, June 10, 2019 (AFP) - Australian police said Monday they were scouring bushland for a Belgian teenage tourist missing in a popular surf town for more than a week.   Theo Hayez, an 18-year-old backpacker, was last seen on May 31 at a hotel in the coastal tourist town of Byron Bay -- some 750 kilometres (470 miles) north of Sydney -- New South Wales state police said.   "We have a large amount of resources searching... in bushland that is towards the east and northeast of the town," police Chief Inspector Matthew Kehoe said in a statement.   "We are advised that this disappearance is completely out of character for him."   Police said they were alerted to his disappearance on Thursday after he failed to return to a hostel he was staying in.   Hayez's passport and personal belongings were all left at the hostel, and police believe he had not made any financial transactions since his disappearance or used his mobile phone.
Date: Sat 8 Jun 2019
Source: New Jersey 101.5 [edited]

The potentially deadly Powassan tick-borne virus has been confirmed in 2 Sussex county residents, one of whom died last month [May 2019], state health officials confirmed [Sat 8 Jun 2019].

The Powassan virus is spread by the deer tick [_Ixodes scapularis_]. The illness is rarer than Lyme disease, which is also spread by the tick, but 10% of people who contract the [Powassan virus] illness die from it.

A Department of Health official on [Sat 8 Jun 2019] said that the department had not determined the cause of death for the patient who died last month [May 2019] but said that lab results this week [week of 3 Jun 2019] confirmed that he had the virus.

A 2nd victim continues to recover at home.

Symptoms of the virus include brain swelling, meningitis, fever, headache, vomiting, weakness, confusion, loss of coordination, trouble speaking, and memory loss. Symptoms can appear a week to a month after a tick bite, although some people show no symptoms and do not require treatment.

There is no vaccine or cure for the disease. Treatment includes hospitalization, support for breathing, and intravenous fluids.

Prevention involves the same precautions that should be taken to avoid Lyme disease: avoid wooded areas with tall grasses, use insect repellent while outdoors, and check for ticks after being outdoors.

Powassan [virus] -- first discovered in Powassan, Ontario, in 1958 -- has been confirmed in recent years in New Jersey, with one case each in 2013, 2014, and 2015, and 4 cases in 2017, the most recent year for which data is available. The cases were reported in Sussex, Warren, Morris, and Essex counties.

Between 2008 and 2017, there were 125 confirmed cases in the entire country and 9 deaths.

A person who said they were close to the man who died last month [May 2019] posted on Facebook that the man was bitten in the arm by a tick while gardening and fell ill about 2 weeks later. The Facebook post said that there was no bull's-eye mark around the bite -- a known tell-tale sign for Lyme infection. About a day before he was hospitalized, the man reported feeling like he was coming down with a cold and had a high fever.

State health department's tip sheet for preventing Powassan [virus infection]:
- avoid contact with ticks by avoiding wooded areas with high grass;
- when hiking, stay on the center of the trail;
- picnic in areas away from wooded and bushy areas;
- keep children on playground equipment and away from tall grass and shrubs;
- when outdoors, apply insect repellents;
- wear light-colored clothes so it is easy to see and remove ticks;
- wear long-sleeve shirts and pants;
- tuck long pants into socks so ticks cannot crawl under pants;
- do tick checks every couple hours while outdoors and before coming indoors;
- if you see a tick during tick checks, remove it right away;
- keep grass mowed short;
- keep children's toys, playground equipment, pools, and lawn furniture at least 15 feet [4.6 m] from wooded areas;
- create a woodchip or mulch border between your yard and wooded areas;
- keep areas under bird feeders and pet dishes clean, so they do not attract animals that may carry ticks;
- keep trash in closed containers or areas so it does not attract animals that may carry ticks.  [Byline: Sergio Bichao]
=======================
[Powassan virus is endemic in New Jersey, and cases occur there sporadically. The tick vector is the deer tick, _Ixodes scapularis_. Humans become infected with POWV during spillover transmission from the natural transmission cycles. In humans, POWV can be a causative agent of a severe neuroinvasive illness, with 50% of survivors displaying long-term neurological sequelae. Individuals living or visiting areas where the deer tick occurs, should follow the above recommendations to avoid tick bites. If a tick is found feeding, it should be removed with forceps or tweezers grasping the tick at skin level and then gentle, constant force applied. The tick should never be removed by grasping it with thumb and forefinger, as squeezing the tick may cause inoculation of contents containing the pathogenic agent into the feeding site.

POWV was recognized as a human pathogen in 1958, when a young boy died of severe encephalitis in Powassan, Ontario, Canada. In that case, POWV was isolated from the brain autopsy. There are 2 distinct genetic lineages now recognized: POWV (lineage I) and deer tick virus (lineage II). Since the index case in 1958, over 100 human cases of POWV have been reported, with an apparent rise in disease incidence in the past 16 years. This recent increase in cases may represent a true emergence of POWV in regions where the tick vector species are prevalent, or it could represent an increase in POWV surveillance and diagnosis. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of New Jersey, United States:
New Jersey county map:
Date: 6 Jun 2019
Source: Washington Post [edited]

Dominican government officials released more-detailed autopsy results on Thursday [6 Jun 2019] for 3 American tourists who died at adjacent beach resorts owned by the same hotel company during the last week of May 2019.

All 3 victims experienced eerily similar symptoms and internal trauma before their deaths, according to a news release from Dominican authorities. Pathologists said autopsies showed the 3 had internal haemorrhaging, pulmonary oedema, and enlarged hearts.

Toxicology reports are pending [These are likely to be the most interesting. - ProMED Mod.TG].

A U.S. State Department official said authorities have not yet established a connection between the 30 May 2019 deaths of 49-year-old CAD, and 63-year-old NEH, both of Prince George's County, MD, and the death on 25 May 2019 of 41-year-old MSW of Pennsylvania.

The FBI is providing Dominican law enforcement with "technical assistance with the toxicology reports," the State Department official said.

MSW had just checked into the Luxury Bahia Principe Bouganville, in the town of San Pedro de Macoris, and was taking pictures from her room balcony when she started to feel ill.

Less than 2 hours later, she was dead, local authorities said.

The bodies of CAD and HEH were found inside their room at the Grand Bahia Principe La Romana after relatives grew concerned because they had not checked out of the resort.

The hotels are located next to each other on the island's southern coast, about 60 miles from the tourist-heavy Punta Cana area.

Dominican authorities initially did not run toxicology tests for MSW because there were no signs of violence, said Ramon Brito, a spokesman for the National Police's special tourism unit. After the Maryland couple was found, investigators ordered a set of tests to determine whether anything the 3 Americans consumed may have led to their deaths, Brito said.  [Byline: Arelis R. Hernandez]
Date: 31 May 2019
Source: 4 News [edited]

The Alachua County Health Department is warning residents that there are 12 confirmed cases of mumps, primarily from college students at the University of Florida.  "This is a little more than usual," says Steve Orlando, University of Florida spokesman.

Alachua County normally receives around 2 reported cases a year, and UF believes more students could be infected.  "So, it's curious because these are individuals who are vaccinated, and that's what we are seeing nationwide," says Paul Myers, Alachua County Health Department administrator.

Officials say it is still unclear why there has been an uptick with the virus. So far, the CDC shows 736 people have contracted mumps nationwide in 2019.

"The sharing of the utensils, sharing of the cups, sharing of the water bottles, you know it is a very common thing for students to share those things, and that's exactly the kind of thing that could lead to transmission," says Orlando.
Date: Sat 8 Jun 2019
Source: Business Standard [edited]

As many as 14 children have died due to acute encephalitis syndrome (AES) in the district, while over a dozen are admitted in hospitals with high fever and other symptoms of the infection.

Sunil Shahi, Superintendent of Shri Krishna Medical College and Hospital (SKMCH), told ANI, "We have received 38 patients so far; most of them have a deficiency of glucose in their blood. Of these, 2 have also tested JE [Japanese encephalitis] positive; the overall casualty till now is 14."

Dr Gopal Sahni, head of Critical Care Unit, said, "When heat and humidity rise, the body's sweat cannot evaporate. The humidity level is over 50 per cent in the last few days. We have about 15 such children admitted in the hospital currently, and 89 such cases come regularly."

Encephalitis is a viral infection, which causes mild flu-like symptoms such as a fever or a headache.
=======================
[Again, this year (2019), cases of AES and JE are appearing in north-western India. Of the 14 AES cases, 2 tested positive for JE. The aetiology of the remaining cases is not stated, but the majority are reported as hypoglycaemic. As noted previously, frequently, in reports of JE cases in India, acute encephalitis syndrome (AES) of undefined aetiology is often mentioned with JE cases that are a minority of those hospitalized.

The determination of the aetiology or aetiologies of AES has been confusing and elusive. Various etiological agents have been proposed in recent years as responsible for AES cases. AES has continued to be attributed to a variety of aetiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). Recently, scrub typhus has been implicated in many AES cases. A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in acute encephalitis syndrome (AES). Unfortunately, existing surveillance for AES does not include routine testing for dengue. Dengue accounts for 5% of AES cases in India, especially in the absence of laboratory evidence for other pathogens tested. Dengue should be added to the list of possible AES etiological agents.

Reference:
Vasanthapuram Ravi, Shafeeq Keeran Shahul Hameed, Anita Desai, Reeta Subramaniam Mani, Vijayalakshmi Reddy, et al.: Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): Results from a 4-year AES surveillance study of Japanese encephalitis in selected states of India. International Journal of Infectious Diseases. 2019. doi: <https://doi.org/10.1016/j.ijid.2019.01.008>.

Maps of India:

[HealthMap/ProMED map available at: