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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
===================
[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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United States of America

FCO - UK information on the United States
Updated: 25 July 2002

SUMMARY
Most visits to the United States are trouble-free. However, visitors should continue to be vigilant about their personal security.

SAFETY AND SECURITY<
R />Travellers to the United States should use common sense and take basic precautions.

If staying in a hotel, do not leave your door open at any time.

Do not wear ostentatious jewellery and avoid walking in obviously run down areas.
If arriving at night, take a taxi to your hotel and collect your hire car the next day.
If departing on an evening flight avoid leaving luggage and souvenirs in view in your hire car during the day. Thieves are targeting these vehicles and stealing the contents.
Drive on main highways and use well-lit car parks.

Do not stop if your car is bumped from behind. Instead, indicate to the other driver to follow you to the nearest public area and call for police assistance.
Do not sleep in your car on the roadside or in rest areas.
LOCAL LAWS AND CUSTOMS
Travellers wishing to visit Canada during their stay should contact the Canadian Consulate and US Immigration and Naturalisation Service for entry clearance requirements. If travellers have 90 day visa waiver for US, they should not wait until the end of their stay to travel between US and Canada. Travellers must not overstay past expiration date of their visa as they may risk being denied entry in either country or be deported. Travellers need to carry passports, round trip airline tickets showing their confirmed departure for return from US or Canada to country of origin, and they may need to show proof of sufficient funds to cover their stay.

Travellers should be aware that the age of consent varies from state to state in the US, as does the age at which someone may legally buy and consume alcohol.
ENTRY REQUIREMENTS
Foot and Mouth Disease:
Travellers are prohibited from carrying into the US any agricultural products, particularly animal products – including dairy products – that could spread FMD. (Some hard cheeses and canned meats are permitted. If you are in any doubt, you must check with a US customs or US Department of Agriculture (USDA) official immediately on arrival in the airport terminal). Passengers are required to tick the appropriate box on the US Customs declaration form if they have recently visited a zoo, or been on a farm or in contact with livestock. Passengers are specifically required to identify any farm contacts to US Customs and USDA officials. All luggage is subject to inspection. Penalties for not declaring farm visits or prohibited items can run to $1,000.

All US ports of entry and airports are on heightened alert to ensure that passengers, luggage and cargo are checked as appropriate. This includes placing additional inspectors and dog teams at airports to check incoming flights and passengers.

USDA are saying that soiled shoes, clothing or luggage will be disinfected on arrival. Food products and any other items suspected of potentially carrying the FMD virus will be confiscated and destroyed.
HEALTH
Medical treatment can be very expensive; there are no special arrangements for British visitors. The British Embassy and Consulates-General cannot assist with medical expenses.

Travellers who are HIV-positive
Travellers to the United States who are HIV-positive are not eligible, under current United States visa law, to travel visa free under the Visa Waiver Programme. They are required to apply for a visa and a waiver of the ineligibility before travelling. US immigration authorities state applicants’ details will remain confidential and an applicant’s HIV status will not/not be declared on their passport. For more details contact the US Embassy in London.
GENERAL
Comprehensive travel and medical insurance is essential.
NATURAL DISASTERS
Visitors to the United States will be aware of reports of large-scale wild and forest fires throughout the country. Those travelling to affected areas should be particularly vigilant and pay attention to advice from local authorities and press and radio announcements about personal safety and how to avoid starting fires. Further information can be obtained from the National Interagency Fire Centre, 3833 S. Development Avenue, Boise, Idaho, 83705-5354; tel: +1 208 387 5512; Website: www.nifc.gov

Travel News Headlines WORLD NEWS

Date: Tue, 20 Aug 2019 23:46:29 +0200 (METDST)

Los Angeles, Aug 20, 2019 (AFP) - The jam-band Phish announced Tuesday that plague-infected -- yes, that plague -- prairie dog colonies had forced the cancellation of overnight camping and vending for its annual concert series near Denver.   The band will still play over the Labor Day holiday weekend but said in a statement that health officials overseeing Colorado's Rocky Mountain Arsenal National Wildlife Refuge urged precautionary measures like restricting parking and camping to prevent potential spread of the disease.   "We recognize the tremendous inconvenience this may cause for those who had planned on camping," said Phish, a rock band known for its improvisation and hardcore fan base.   Officials had closed parts of the 15,000-acre refuge starting in July, a statement from the US Fish & Wildlife Service said. Some were re-opened in recent days but several trails remain closed.   Today the plague can be treated with antibiotics but is best known for killing 60 percent of Europe's population during the Black Death of the Middle Ages.

The last epidemic in the United States was in the 1920s in Los Angeles.   Humans can contract the easily spreadable plague from fleas that transmit it from infected rodents, as well as from coming into contact with infected bodily fluids or by inhaling coughed-up bacteria.  

Many dedicated Phish fans had decried the lack of information concerning the August 30-September 1 concerts in the lead-up to Tuesday's announcement: "People are already changing their plans. People are mad," fan Keegan Lauer told a local CNN affiliate of the confusion.   "People are Phish fans and Phish fans that are mad are really mad."
Date: Mon 19 Aug 2019
Source: Centers for Disease Control and Prevention (CDC) [edited]

Viral hepatitis, outbreaks, hepatitis A outbreaks
-------------------------------------------------
Since March 2017, CDC's Division of Viral Hepatitis (DVH) has been assisting multiple state and local health departments with hepatitis A outbreaks, spread through person-to-person contact.

The hepatitis A vaccine is the best way to prevent HAV infection.

The following groups are at highest risk for acquiring HAV infection or developing serious complications from HAV infection in these outbreaks and should be offered the hepatitis A vaccine in order to prevent or control an outbreak:
- people who use drugs (injection or non-injection);
- people experiencing unstable housing or homelessness;
- men who have sex with men (MSM);
- people who are currently or were recently incarcerated; and
- people with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C.

One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% seroprotection in healthy individuals for up to 11 years.

Pre-vaccination serologic testing is not required to administer hepatitis A vaccine. Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable.
[further information available at URL above]
=============================
[Overall, the top 4 states for HAV cases remain Kentucky, Ohio, Florida and West Virginia.

As the numbers of cases continue to raise in a number of states, and news of smaller (so far) outbreaks occur in others, the question at the end of ProMED-mail post http://promedmail.org/post/20190104.6241686 by a Kentucky official -- "This is a disease of developing countries. One has to ask: Why are we seeing it in the USA?" -- is more and more relevant. We are seeing these outbreaks because of the inability to deal with marginalized populations among our midst. The dramatic cutbacks in public health infrastructure in some of these states clearly feed the fire of these outbreaks. They must be addressed by bolstering public health resources and education and directly addressing the needs of these marginalized populations. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Fri 16 Aug 2019
Source: Fox News [edited]

A 7 year old girl from Mt Vernon, Ohio has been infected with a rare mosquito borne virus that, in severe cases, can cause encephalitis, or an inflammation of the brain. The girl, who was not identified, has been confirmed to have La Crosse virus (LACV), local news outlet Knox Pages reported, citing the Knox County Health Department. It wasn't immediately clear where or when the girl was infected.

La Crosse virus is typically caused by a bite from an infected eastern tree-hole mosquito [_Aedes triseriatus_], which "lays its eggs in tree holes and man-made containers" and "typically bites during the day", according to the Centers for Disease Control and Prevention (CDC).

A rare disease -- there is an average of 70 cases in the United States each year, according to the federal health agency -- LACV can make a person feel ill with fever, headache, nausea, vomiting, and fatigue. Most people begin to notice symptoms 5 to 15 days after they are bitten. In severe cases, however, LACV can lead to encephalitis -- though this is commoner in children under 16 "and is often accompanied by seizures," says CDC. "Coma and paralysis occur in some cases," it added.

The disease is diagnosed through blood and spinal fluid tests. There's no specific treatment for the mosquitoborne ailment. "Antibiotics are not effective against viruses, and no effective anti-viral drugs have been discovered. Severe illnesses are treated by supportive therapy which may include hospitalization, respiratory support, IV fluids, and prevention of other infections," CDC added, noting that most people infected make a full recovery.

People are most at risk for LACV if they live in wooded areas. Most cases in the US have occurred in upper Midwestern, mid-Atlantic and southwestern [sic. southeastern] states. Ohio, specifically, sees about 20 cases of the disease each year, according to the Knox Pages.

The best way to prevent LACV and other mosquitoborne ailments is by draining standing water -- like in birdbaths, buckets or on pool covers -- which can serve as a breeding ground for these insects. Other preventative measures include covering skin with long-sleeved pants and shirts while outside and using insect repellent containing DEET or another EPA-recognized ingredient.  [byline: Madeline Farber]
=======================
[The previous case of La Crosse virus encephalitis in Ohio was in a boy, also 7 years old. Severe neurological cases of La Crosse virus encephalitis mainly occur in pre-school age children. They are seldom fatal, but prolonged hospitalization and sequelae including personality changes, may occur.

As noted earlier, La Crosse encephalitis virus (LACV) is a member of the California serogroup of arboviruses. A map of the distribution of California virus serogroup neuroinvasive disease cases (mainly LACV cases) shows 3 major focal geographic areas: (1) in the unglaciated areas of south eastern Minnesota/south western Wisconsin/north western Illinois, (2) Ohio, where this case occurred, and (3) the central Appalachian Mountain areas of Virginia/West Virginia and North Carolina/Tennessee, (see the CDC map at <http://www.cdc.gov/lac/tech/epi.html>).

Cases may occur earlier in the summer season than other arthropod-borne viruses because the virus can be transovarially transmitted by the infected female to her eggs, so that emerging adults may already be infected and ready to transmit the virus without the need to take an infectious blood meal from an infected forest mammal. It is wise to eliminate fresh water catchments, which are breeding sites of _Aedes triseriatus_, the La Crosse virus vector mosquito. The Asian tiger mosquito _Aedes albopictus_ can also transmit the virus.

The CDC has a good summary of LACV, its epidemiology, geographic distribution, and clinical characteristics at

An image of _Aedes triseriatus_ can be seen at

[HealthMap/ProMED map available at:
Ohio, United States: <http://healthmap.org/promed/p/237>]
Date: Fri 16 Aug 2019
Source: CBS Boston [edited]

The Massachusetts Department of Public Health has confirmed a 2nd human case of eastern equine encephalitis [EEE] in the state on Friday [16 Aug 2019]. Officials also raised the risk level for EEE to "critical" in 10 more towns in central and eastern Massachusetts.

The department said the new EEE case is in a man between the ages of 19-30 in Grafton. As a result, Grafton, Hopkinton, Northbridge, Shrewsbury, Southboro, Upton, and Westboro are all at "critical risk" for EEE.  The wife of the Grafton man diagnosed with EEE says he is in his late 20s and lives near a farm. The couple asked not to be identified but told WBZ he was diagnosed after having a seizure.  A goat in Bristol County has also tested positive for EEE, leading officials to put Easton, Norton and Raynham at critical risk as well. A total of 19 communities across the state are at critical risk now, and 18 are at high risk.

The department said it is working with local boards of health and mosquito control experts to work on "appropriate public health response activities."  "The most intense level of EEE activity is still being seen in Bristol and Plymouth Counties," said Public Health Commissioner Monica Bharel in a statement. "However, in active EEE years, the virus may move outside of southeastern Massachusetts. This is evidence of that movement, and residents in the area of increased risk should use mosquito repellent and avoid outdoor activities at night."  Less than a week ago, the department confirmed the 1st human case of EEE in Massachusetts since 2013. The infected man is over 60 and lives in southern Plymouth County.

So far, EEE has been found in 288 mosquito samples.  "[The] history here in Massachusetts [is that] the mosquitos test positive, but the people don't, so this is a little bit unusual," said Dr. Michael Hirsh of the Worcester Division of Public Health.  He said weather may be to blame. "Whenever there is a winter that doesn't have a really hard frost, if it's much more mild, the mosquitoes don't really ever knock off from last year."  Residents should make efforts to avoid mosquito bites, which can spread EEE, including using insect repellent, being aware of peak mosquito hours (dusk to dawn), wearing long sleeve shirts and pants when outside, draining standing water from around your home, replacing window screens, and protecting your animals from mosquitos.

EEE symptoms can range from a stiff neck, headache and lack of energy to dangerous complications like inflammation and swelling of the brain.  The risk of EEE will remain until the 1st killing frost.
========================
[There was a recent human eastern equine encephalitis (EEE) case in Massachusetts, the 1st human case that ProMED-mail has posted this year (2019), and now a 2nd case in that state and the 3rd in the eastern USA.

So far this year (2019), all of the EEE cases other than in humans posted on ProMED-mail have been in horses, indicating that this has been an active EEE virus transmission season. The case above again reminds us that human cases occur as well. As usual, the equine cases have occurred in the eastern states and a midwestern state in the USA. There is a vaccine available for equine animals, and their owners are wise to have them vaccinated. There is no commercially available vaccine for humans, so avoidance of mosquito bites is the best preventive measure.

Additional information on EEE is available on the CDC website at
<https://www.cdc.gov/EasternEquineEncephalitis/>. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Massachusetts, United States: <http://healthmap.org/promed/p/224>]
Date: Thu 15 Aug 2019
Source: Morristown Daily Record [edited]

An outbreak of hepatitis A with 23 confirmed cases has been traced to a food handler who worked in the kitchen of a private Morris County country club, state officials said on Thu 15 Aug 2019. One infected individual remained "seriously ill" on Thu 15 Aug 2019, according to New Jersey Department of Health spokeswoman Donna Leusner.

Patrons of the Mendham Golf and Tennis Club are anxiously awaiting a Mon 19 Aug 2019 deadline for the incubation period to pass for the infectious liver disease, which in some cases can lead to liver failure. Secondary cases related to the food handler may develop until 19 Aug 2019, which is 50 days from the date the food handler was last infectious," a Mendham Township fact sheet advised.

The employee's diagnosis was reported to Morris County and state officials on 5 Jul 2019. Learning his job involved handling of food, he "was excluded from work, and a review of other food handlers for vaccination and proof of immunity was conducted," Leusner said.

Mendham Township officials followed by sending a letter to club members, recommending anyone who dined at the club between 9 Jun 2019 and 30 Jun 2019 to seek advice from their medical provider. Individuals who have been exposed but have not been vaccinated against hepatitis A may receive a "post-exposure prophylaxis" in the form of an injection of vaccine or immune globulin.

Club management is cooperating with efforts to identify possible infected individuals, township health department officials said. An onsite investigation of the facility's food-service operations on 25 Jul 2019 "revealed compliance with hand hygiene and glove use. No food which may have been handled by the infected food handler was noted."

We have taken a number of actions to safeguard our members, guests, and employees," club general manager Joseph Kelly wrote in a statement.

The club is working closely with the Morris County Office of Health Management and New Jersey State Department of Health and following all recommendations to address the situation and keep members informed, Kelly wrote.

During the 25 Jul 2019 inspection, health department officials also provided the club's staff with further instruction on food handling, employee hygiene, food storage, dating of foods, "and other pertinent regulatory items."

Officials also requested increased cleaning of restroom facilities and possible fomites (such as doorknobs and common surfaces) and scheduled an onsite food handling class, held 6 Aug 2019. That training included interactive activity with food handlers to emphasize the importance of handwashing.

Hepatitis A virus is found in the stool of infected people, according to a New Jersey Department of Health fact sheet. People become infected by swallowing the virus, which can happen when infected people do not wash their hands properly after using the bathroom then touch food that is eaten by someone else. The virus also can be spread when childcare workers change an infected child's diaper and without washing their hands touch another object, such as a toy, that a child places in his or her mouth.

Some people who contract hepatitis A may show no initial symptoms. Others may experience symptoms including fever, fatigue, stomach pain, diarrhea, poor appetite, vomiting, dark yellow urine, and yellow skin or eyes (jaundice).  [Byline: William Westhoven]
=========================
[It is likely, but unstated, that the food handler index case was un-immunized, and this substantial cluster could have been avoided if routine immunization of food handlers was the rule. Spillover of HAV from the multi state large epidemic involving the homeless and/or substance abusing populations into food handlers seems to be frequent, given the number of reports on Google. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
New Jersey, United States: <http://healthmap.org/promed/p/232>]
More ...

Colombia

Colombia - US Consular Information Sheet
August 13, 2008

COUNTRY DESCRIPTION:
Colombia is a medium-income nation of some 44 million inhabitants.
Its geography is very diverse, ranging from tropical coastal areas and rainforests t
rugged mountainous terrain.
Tourist facilities in Colombia vary in quality and safety, according to price and location.
Security is a significant concern for travelers, as described in the Department of State’s Travel Warning for Colombia.
Read the Department of State Background Notes on Colombia for additional information.

ENTRY/EXIT REQUIREMENTS:
All U.S. citizens who are not also Colombian citizens must present a valid U.S. passport to enter and depart Colombia, and to return to the United States.
Dual U.S-Colombian citizens must present a Colombian passport to enter and exit Colombia, and a U.S. passport to return to the United States.
Be aware that any person born in Colombia may be considered a Colombian citizen, even if never documented as such.
U.S. citizens born in Colombia or who otherwise have Colombian citizenship, will need both a Colombian passport and a U.S. passport for the trip.
U.S. citizens traveling to Colombia do not need a Colombian visa for a tourist stay of 60 days or less.
Travelers entering Colombia are sometimes asked to present evidence of return or onward travel, usually in the form of a round-trip plane ticket.
Americans traveling overland must enter Colombia at an official border crossing.
Travelers arriving by bus should ensure, prior to boarding, that their bus will cross the border at an official entry point.
Entering Colombia at unauthorized crossings may result in fines or incarceration.
Travelers planning to enter Colombia over a land border should carefully read our information on Traffic Safety and Road Conditions below.
The length of stay granted to travelers is determined by the Colombian immigration officer at the point of entry and will be stamped in your passport.
Extensions may be requested by visiting an office of the Colombian immigration authority, known as the Departamento Administrativo de Seguridad, or DAS, after arrival in Colombia.
Fines are levied if a traveler remains in Colombia longer than authorized, and the traveler cannot leave Colombia until the fine is paid.
Any traveler possessing a Colombian visa with more than three months’ validity must register the visa at a DAS immigration office within 15 days of arrival in Colombia or face fines.
The DAS immigration office in Bogota is located at Calle 100 and Carrera 11B.
No arrival tax is collected upon entry into Colombia, but travelers leaving by plane must pay an exit tax at the airport, in cash.
The tax varies with the dollar/peso exchange rate, but is usually between $50 and $70.
Some airlines include all or a portion of this tax in the cost of your airline ticket; check with your airline to find out how much you will have to pay at the airport.
U.S. citizens whose U.S. passports are lost or stolen in Colombia must obtain a new U.S. passport before departing.
They must then present the new passport, along with a police report describing the loss or theft, to a DAS office.
Information about obtaining a replacement U.S. passport in Colombia is available on the U.S. Embassy’s website at http://bogota.usembassy.gov.
Contact information for DAS is available in Spanish at http://www.das.gov.co.
The Embassy in Bogotá or the U.S. Consular Agency in Barranquilla can provide guidance on contacting DAS when you apply for your replacement passport.
For further, specific guidance on Colombian entry requirements, including information about Colombian visas, travelers should contact the Colombian Embassy at 2118 Leroy Place NW, Washington, DC 20008; telephone (202) 387-8338; website: http://www.colombiaemb.org; or the nearest Colombian consulate.
Consulates are located in Atlanta, Boston, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, San Francisco, and San Juan, Puerto Rico.

Also see the Department of State’s general information on Entry and Exit Requirements.
Visit the Embassy of Colombia website at http://www.colombiaemb.org for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
ADDITIONAL EXIT REQUIREMENTS FOR MINORS:
To prevent international child abduction, Colombia has implemented special exit procedures for Colombian children under 18 who are departing the country without both their mother and their father or a legal guardian.
These procedures apply even if the child is also a U.S. citizen.
Complying with the procedures can be complex and time-consuming, especially if an absent parent is outside Colombia at the time.
Advance planning is essential.

The procedures are as follows: Upon exiting the country, the person traveling with the child (or the child him/herself) must present a certified copy of the child’s birth certificate, along with written, signed authorization from the absent parent(s) or legal guardian.
The authorization must explicitly grant permission for the child to travel alone, with one parent, or with a third party, by name.
When a parent is deceased, a notarized copy of a death certificate is required instead of written authorization.
When one parent has sole custody of the child, that parent may present a custody decree instead of the other parent’s written authorization.
If the documents to be presented originated in the United States, they must first be translated into Spanish and then signed in front of a Colombian consul at a Colombian consulate.
Then, upon arrival in Colombia, the documents must be presented to the Colombian Ministry of Foreign Affairs for certification of the consul’s signature.

Alternatively, the documents can be translated into Spanish, then notarized by a notary public in the United States, and authenticated by requesting an apostille from the competent authority in the state where the documents were prepared.
The document, translation, and apostille can then be presented to immigration officers at the airport when the child travels.
If the documents originated in Colombia and are written in Spanish, only notarization by a Colombian notary is required.
For documents originating in countries other than the United States or Colombia, please inquire with the Colombian embassy serving that country.
In cases where the absent parent refuses or is unable to provide consent, the other parent can request assistance from the Colombian child protective service, Instituto Colombiano de Bienestar Familiar (ICBF).
In appropriate cases, ICBF will investigate and may issue a document that will allow the child to travel without both parents’ consent.
This process may take a significant amount of time and is not within the control of the U.S. government.
SAFETY AND SECURITY:
Violence has decreased markedly in many urban destinations, including the cities of Bogota, Medellin, Barranquilla, and Cartagena.
Cali has made less progress combating crime than most other large cities.
The level of violence in Buenaventura remains high.
Small towns and rural areas of Colombia can be extremely dangerous due to the presence of narco-terrorists.
Common crime remains a significant problem in many urban and rural areas, as described in the section on crime below.

The incidence of kidnapping in Colombia has diminished significantly from its peak at the beginning of this decade.
Nevertheless, terrorist groups, including the Revolutionary Armed Forces of Colombia (FARC), and other criminal organizations, continue to kidnap and hold civilians for ransom or as political bargaining chips.
No one is immune from kidnapping on the basis of occupation, nationality, or other factors.
On July 2, 2008, the GOC effected a successful military rescue of three Americans, Ingrid Betancourt, and eleven members of the Colombia security forces. President Uribe called on the FARC to release the remaining hostages and seek peace. Although the U.S. government places the highest priority on the safe recovery of kidnapped Americans, it is U.S. policy not to make concessions to kidnappers.
Consequently, the U.S. government’s ability to assist kidnap victims is limited.

Official and personal travel by U.S. Embassy employees outside most urban areas is subject to strict limitations and reviewed by security officers on a case-by-case basis.
U.S. Embassy employees are allowed to travel by air, but inter- and intra-city bus transportation is off limits to them.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ website at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the United States and Canada, or for overseas 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:
Although the threat of terrorism has decreased in most of Colombia’s cities, they nevertheless experience much of the same crime that is seen in comparably sized cities throughout the region.
Robbery and other violent crimes, as well as scams against unsuspecting tourists, are common in urban areas.
Generally speaking, if you are the victim of a robbery, you should not resist.
Some of the most common methods used by criminals in Colombia are noted below:
Robberies of ATM customers:
Tourists and others have been robbed after using automatic teller machines (ATMs) on the street.
In some cases, robbers have used motorcycles to approach their victims and later flee the scene.
Americans are urged to use ATMs only inside shopping malls or other protected locations.
Driving to and from the location – rather than walking – provides added protection.
When using an ATM, you should be on the lookout for anyone watching or following you.

Robberies of taxi passengers:
Robbery of taxi passengers is a serious problem in Bogota.
Typically, the driver – who is one of the conspirators – will pick up the passenger and then stop to pick up two or more armed cohorts, who enter the cab, overpower the passenger, and take his/her belongings.
If the passenger has an ATM card, the perpetrators may force the passenger to withdraw money from various ATM locations.
Such ordeals can last for hours.
In almost every case of taxi-related crime, the victims have been riding alone and have hailed taxis off the street.
Rather than hailing a taxi, you should use the telephone dispatch service that most taxi companies offer.
Many hotels, restaurants, and stores will call a taxi for you, and the taxi usually arrives within minutes.
When a taxi is dispatched by telephone, the dispatcher creates a record of the call and the responding taxi.

Robberies while departing airports:
U.S. citizens arriving at major Colombian airports have occasionally been victimized by armed robbery while en route from the airport to their hotel or home.
The perpetrators typically scout out victims at the airport and then follow their vehicles before robbing the occupants at a stoplight.
Travelers should remain vigilant at airports and report to local airport police if they suspect they are being observed.
Robberies on Hiking Trails:
Several U.S. citizens were robbed in 2007 while hiking on nature trails in and around Bogota.
Because hiking trips generally take place in isolated settings, participants are especially vulnerable.
Hikers in Colombia are more protected if they travel in large groups.
Use of disabling drugs:
The Embassy continues to receive reports of criminals in Colombia using disabling drugs to temporarily incapacitate tourists and others.
At bars, restaurants, and other public areas, perpetrators may offer tainted drinks, cigarettes, or gum.
Typically, victims become disoriented or unconscious, and are thus vulnerable to robbery, sexual assault, and other crimes.
Avoid leaving food or drinks unattended at a bar or restaurant, and be suspicious if a stranger offers you something to eat or drink.
Counterfeit money scam:
U.S. citizens in Colombia routinely fall victim to a scam in which purported undercover police officers approach them on the street and request to examine their money, supposedly to determine if it is counterfeit.
The “officers,” who are in fact criminals, then flee with the money.
In a variation of this scam, the thieves may ask to see jewelry.
Legitimate Colombian police officers do not make such requests.

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

The local equivalent to the “911” emergency line in Colombia is 112 for police and 119 for fire.
There will not be an English speaker answering the phone[g1] .

See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care is adequate in major cities but varies greatly in quality elsewhere.
Emergency rooms in Colombia, even at top-quality facilities, are frequently overcrowded and ambulance service can be slow. Many private health care providers in Colombia require that patients pay for care before treatment, even in an emergency.
Some providers in major cities may accept credit cards, but those that do not may request advance payment in cash.
Uninsured travelers without financial resources may be unable to obtain care, or relegated to seeking treatment in public hospitals where care is far below U.S. standards.
The Embassy regularly receives reports of U.S. citizens in Colombia who have died or suffered complications from liposuction and other elective surgeries intended to treat obesity.
Before undergoing such a procedure in Colombia, the Department of State recommends that you consult with your personal physician, research the credentials of the provider in Colombia, and carefully consider your ability to access emergency medical care if complications arise.
It is important to confirm that your medical insurance provides coverage in Colombia, to include treatment of complications from elective procedures or medical evacuation if necessary.
Should you suffer complications as a result of medical malpractice, collecting damages from your surgeon may be difficult.
Colombia has seen a recent increase in the use of unregulated drugs that purport to enhance sexual performance.
Several American tourists recently died after using these substances, which come in liquid, powder, or tablet form.
You are urged to seek guidance from a physician before ingesting any such substances in Colombia.
Travelers to the capital city of Bogota may need time to adjust to the altitude of 8,600 feet, which can affect blood pressure, digestion, and energy level, and cause
mild dyspnea with exercise, headaches, sleeplessness, , and other discomfort.
Travelers should drink liberal fluids to maintain hydration,, and should avoid strenuous exercise unti they have acclimated to the altitude.
Travelers with circulatory or respiratory problems should consult a physician before traveling to Bogota or other high-altitude locations.
Information on vaccinations and other health precautions, such as safe food and water and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s website at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

Colombia has imposed HIV/AIDS travel restrictions on groups of travelers subject to restrictions or bans.
Entry is restricted to PLWHA (customs officials on the lookout). A waiver may be requested from the Colombian embassy (Source: NAM April 2006, USSD December 06).
Please inquire directly with the Embassy of Colombia at http://www.colombiaemb.org before you travel.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm that 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 Colombia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Due to the security environment in Colombia, U.S. government officials and their families are not permitted to travel by road between most major cities.
They also cannot use inter- or intra-city bus transportation, or travel by road outside urban areas at night.
All Americans in Colombia are encouraged to follow these same precautions.
Traffic laws in Colombia, including speed limits, are often ignored and rarely enforced, creating dangerous conditions for drivers and pedestrians in major cities.
Under Colombian law, seat belts are mandatory for front-seat passengers in a private vehicle.
Car seats are not mandatory for children, but a child under ten is not permitted to ride in a front seat.
It is against the law to talk on a cellular phone while driving in Colombia, and violators may be fined.
While driving outside major cities, it is mandatory to drive with your lights on.
If an accident occurs, the involved parties must remain at the scene and not move their vehicles until the authorities arrive; this rule is strictly enforced, and moving a vehicle or leaving the scene of an accident may constitute an admission of guilt under Colombian law.
Americans seeking to import their own vehicles into Colombia should consult with their nearest Colombian consulate for information on Colombian taxes and licensing rules, which can be complicated and bureaucratic.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Colombia’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) safety standards for oversight of Colombia’s air carrier operations.
For more information, please visit the FAA’s website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Colombia employs strict screening procedures for detecting narcotics smuggling at its international airports.
Americans and other travelers are occasionally questioned, searched, fingerprinted, and/or asked to submit to an abdominal x-ray upon arrival or departure.
Most airport inspectors do not speak English, and travelers who do not speak Spanish may have difficulty understanding what is asked of them.
Please refer to the section on Criminal Penalties for further information on the strict enforcement of Colombia’s drug laws. Please see our Customs Information.
CUSTOMS REGULATIONS:
Travelers generally must not enter or exit Colombia while carrying cash or other financial instruments worth more than 10,000 U.S. dollars.
Colombian authorities may confiscate any amount over $10,000, and may initiate a criminal investigation into the source of the money and the traveler’s reasons for carrying it.
Recovery of the confiscated amount requires a lengthy, expensive legal process and may not always be possible.
Americans wishing to send large sums of money to or from Colombia should contact their nearest Colombian consulate, or speak with Colombian customs officials, and should also consider seeking advice from an attorney or financial professional.

Colombian law prohibits tourists and business travelers from bringing firearms into Colombia.
Illegal importation or possession of firearms may result in incarceration.

In many countries around the world, counterfeit and pirated goods are widely available. Buying or selling them is illegal in Colombia, and bringing them back to the United States may result in forfeitures and fines.

Colombian law forbids the export of pre-Columbian objects and other artifacts protected by cultural patrimony statutes.
Under an agreement between the United States and Colombia, U.S. customs officials are obligated to seize pre-Columbian objects and certain colonial religious artwork when they are brought into the United States.
Please contact the Embassy of Colombia in Washington or one of Colombia's consulates in the United States for detailed customs guidance.
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 Colombia’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
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.

If you are arrested, the U.S. government cannot request your release.
Colombia and the United States do not have a prisoner transfer agreement, and so any sentence for a crime committed in Colombia is ordinarily served in a Colombian prison.
Penalties for possession, use, or trafficking of illegal drugs in Colombia are severe, and convicted offenders can expect long prison sentences under harsh conditions, with significant expense and great hardship for themselves and their families.
Colombian police make multiple arrests daily for drug trafficking at major airports, and have sophisticated means for detecting illegal drugs in baggage or on your person.
Travelers are sometimes requested to undergo an x-ray to ensure that they are not smuggling narcotics within their own bodies.
There are more than 30 Americans incarcerated in Colombia for attempting to smuggle drugs out of the country.

The hardships resulting from imprisonment do not end even after release from prison:
Colombian law requires that serious offenders remain in the country to serve a lengthy period of parole, during which the offender is given no housing and may lack permission to work.
As a result, family members must often support the offender, sometimes for more than a year, until the parole period expires.
DISASTER PREPAREDNESS: Colombia is an earthquake-prone country.
Flooding and mudslides also sometimes occur in parts of the country.
General information about natural disaster preparedness is available from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.
If a serious natural disaster occurs in Colombia, the Embassy will publish important information for American citizens on its website at http://bogota.usembassy.gov.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
REGISTRATION / EMBASSY LOCATION: Americans residing or traveling in Colombia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Colombia.
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 Calle 24 Bis No. 48-50 Bogotá, D.C. Colombia.
Mailing address:
Carrera 45 No. 24B-27 Bogotá, D.C. Colombia.

In case of a serious emergency that jeopardizes the health or safety of an American citizen in Colombia, please call the Embassy at (571) 315-0811; Embassy fax: (571) 315-2197;
Consular Section phone: (571) 315-1566. The Embassy’s American Citizens Services office provides routine information at http://bogota.usembassy.gov.
For questions not answered there, inquiries may be sent by email to ACSBogota@state.gov.
Email messages are answered by the next business day.
The Embassy’s American Citizens Services office is open for passport applications, notary services, and routine in-person inquiries from 8:30 a.m. to 12:00 noon Monday through Thursday, excluding U.S. and Colombian holidays.
Inquiries concerning Social Security and other federal benefits can be made in-person from 2:00 to 3:00 p.m. Monday through Thursday, except holidays.
The American Citizens Services fax number is (571) 3152196/7.
The U.S. Consular Agency in Barranquilla, which accepts passport applications and performs notarial services, is located at Calle 77B, No. 57-141, Piso 5, Centro Empresarial Las Americas, Barranquilla, Atlantico, Colombia; telephone (575) 353-2001; fax (011-57-5) 353-5216.
The Consular Agency is not staffed to respond to after-hours emergencies; in case of an emergency in the Barranquilla/north coast area, please contact the Embassy in Bogota at (571) 315-0811.
*

*

*
This replaces the Country Specific Information issued May 29, 2008, to update sections throughout.

Travel News Headlines WORLD NEWS

Date: Sat 2 Mar 2019
Source: Outbreak News Today [edited]

Health officials are reporting a malaria outbreak in Cauca department in southwestern Colombia, according to a RCN Radio report (computer translated).

The outbreak has affected 322 people in the rural areas of Guapi and Timbiqui: (the towns of Calle larga, Belen, San Agustin, Pascualero, and Cascajero (in Guapi) and in the mining area of Santa Maria, Chacon Playa, and Coteje (in Timbiqui).

The strain of malaria was identified as _Plasmodium falciparum_. The report notes it was indicated that the presence of malaria was recorded in sites never considered endemic, which would be related to factors such as climate change and issues associated with mining that exacerbated the situation.

"This required an immediate displacement of our surveillance team to deal with this outbreak. Visits were made to the area where the cases were presented to make diagnoses with rapid tests and to initiate immediate treatments, "said the department's Health Secretary, Hector Andres Gil Walteros.

On the other hand and as a preventive action, 402 mosquito nets were delivered to 107 homes, benefiting more than 600 inhabitants in the outbreak areas, and treatment was given to the affected people.
=======================
[The Cauca Department is located south of Cali and is considered a malaria risk area by the CDC, see map here:
<https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/yellow-fever-malaria-information-by-country/colombia#5317>.

According to the text an outbreak is highly unusual in the area and mining is mentioned as a likely explanation. Mining especially illegal gold mining create numerous new breeding sites and there is usually a lack of control in the form of larvicidal spraying. - ProMED Mod. EP]

[Maps of Colombia:
Date: Tue, 11 Dec 2018 22:14:43 +0100

Bogota, Dec 11, 2018 (AFP) - The abandoned building where Colombian drug lord Pablo Escobar lived will be covered in posters paying tribute to the victims of his Medellin Cartel before it is torn down next year.   The exhibition is part of a move by municipal authorities to tell the other side of Escobar's story -- that of his victims -- to counter a surge of television series glamorizing his life and that of his cartel.   "Respect our pain, honour our victims (1983-1994). 46,612 fewer lives," reads the message on one of the posters that now greet Medillin's "narco-tourists" flocking to the Monaco apartment block.

Portraits of slain journalist Guillermo Cano, gunned down in 1986, former presidential candidate Luis Carlos Galan and police chief Valdemar Quintero -- both murdered in 1989 -- are emblazoned over a message that reads, in English: "It is not fiction, it is reality."   Mayor Federico Gutierrez told reporters that the tourist site had become a "symbol of illegality."   "Now, there are messages that should lead us to reflect," he said.   The posters will remain affixed to the building until municipal workers tear it down on February 22, more than 25 years after Escobar was shot dead by police in 1993.     The former luxury block will be replaced by a municipal park.
Date: Tue 4 Dec 2018 08:48 AM COT
Source: El Tiempo [in Spanish, machine trans., abridged, edited]

Department health authorities turned on the alarms in Santander after the National Institute of Health confirmed the 1st case of measles in a 6-year-old child from Venezuela residing in Bucaramanga.

The Secretary of Health of Santander, Luis Alejandro Rivero Osorio, explained that "this minor who arrives from Venezuela does not have any vaccines. Fortunately, in the department we try to make sure that parents have their children up to date with their vaccinations."

Rivero Osorio emphasized that the protocols of treatment and follow-up were already activated in the event cases are presented from the Hospital Local del Norte, where the minor from the state of Valencia [Venezuela] was treated, to give attention also to the family and to avoid the spread of the virus.

In Santander there are about 50 possible cases of measles pending confirmation, and since the beginning of this 2018 hospitals and health centres remain alert to the risk posed by the massive arrival of Venezuelans to the region without the complete set of vaccines.
=====================
[Vaccinations are scarce in Venezuela with the current economic situation. As a consequence, vaccine-preventable diseases such as measles are being spread as people leave Venezuela seeking work or new lives in neighboring countries. See next report. - ProMED Mod.LK]

[HealthMap/ProMED-mail maps:
Date: Wed 21 Nov 2018
Source: Outbreak News Today [extracted, edited]

A measles outbreak in Colombia has prompted the Centers for Disease Control and Prevention (CDC) to issue a travel notice last week.

Between March and October this year [2018], Colombia has reported 129 confirmed measles cases.

Of the 129 confirmed cases, 45 were imported, 75 were import-related (25 cases of secondary transmission among persons coming from Venezuela and 50 related to imported cases among Colombians), and 9 with the source under investigation. No deaths have been reported.

The cases were reported in the departments of Antioquia, Arauca, Atlantico, Bolivar, Cauca, Cesar, La Guajira, Magdalena, Norte de Santander, Risaralda, Sucre, and in the districts of Barranquilla, Bogota, Cartagena, and Santa Marta.

Cartagena District and Norte de Santander Department account for 65 percent of the total confirmed cases.

CDC says travellers to Colombia should make sure they are vaccinated against measles with the MMR (measles, mumps, and rubella) vaccine.
Date: Thu, 11 Oct 2018 18:45:51 +0200

Bogota, Oct 11, 2018 (AFP) - Eleven people were killed when a landslide swept away part of a town in central Colombia's coffee-growing region amid heavy rainfall, emergency officials reported Thursday.   Colombia's UNGRD disaster risk management unit said seven females and four males were buried in the landslide that struck the Los Andes suburb of the town of Marquetalia.   Four other people were injured.

Searches for possible missing persons were suspended because of continued heavy rains, it said.   The town is located in the coffee-growing department of Caldas.   "Of the 11 people dead, four were minors, six aged between 20 and 50 years old and one was an older adult," the UNGRD said in statement.   Marquetalia Mayor Luis Carlos Betancourt told journalists the mountain town had been hit by torrential rainfall late Wednesday.   The South American country is currently experiencing its second rainy season, with mountainous regions and part of the Caribbean coast on alert.
More ...

Benin

Benin - US Consular Information Sheet
April 28, 2008

COUNTRY DESCRIPTION:
Benin is a developing country in West Africa. Its political capital is Porto Novo. However, its administrative capital, Cotonou, is Benin's largest city and the
site of most government, commercial, and tourist activity. Read the Department of State Background Notes on Benin for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. Visas are not routinely available at the airport. Visitors to Benin should also carry the WHO Yellow Card (“Carte Jaune”) indicating that they have been vaccinated for yellow fever. Contact the Embassy of Benin for the most current visa information. The Embassy is located at: 2124 Kalorama Road NW, Washington, DC 20008; tel: 202-232-6656.

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:
U.S. citizens should avoid crowds, political rallies, and street demonstrations and maintain security awareness at all times.
U.S. citizens should not walk on the beach alone at any time of day. It is also highly recommended not to carry a passport or valuables when walking in any part of the city. Travelers should carry a notarized photocopy of the photo page of their passport (see Crime section). They should not walk around the city after dark, and should take particular care to avoid the beach and isolated areas near the beach after dark.
The ocean currents along the coast are extremely strong and treacherous with rough surf and a strong undertow, and several people drown each year.

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

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

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

CRIME: Street robbery is a significant problem in Cotonou. Robbery and mugging occur along the Boulevard de France (the beach road by the Marina and Novotel Hotels) and on the beaches near hotels frequented by international visitors. Most of the reported incidents involve the use of force, often by armed persons, with occasional minor injury to the victim. Travelers should avoid isolated and poorly lit areas and should not walk around the city or the beaches between dusk and dawn. Even in daylight hours, foreigners on the beach near Cotonou are frequent victims of robberies. When visiting the beach, travelers should not bring valuables and should carry only a photocopy of their passport. If you are a victim of crime, you should contact the U.S. Embassy immediately. There has been a continued increase in the number of robberies and carjacking incidents after dark, both within metropolitan Cotonou and on highways and rural roads outside of major metropolitan areas. Motorists are urged to be wary of the risk of carjacking. Keep the windows of your vehicle rolled up and the doors locked. Stay alert for signs of suspicious behavior by other motorists or pedestrians that may lead to carjacking, such as attempts to stop a moving vehicle for no obvious reason. Travelers should avoid driving outside the city of Cotonou after dark and should exercise extreme caution when driving in Cotonou after dark (see Traffic Safety and Road Conditions below). Overland travel to Nigeria is dangerous near the Benin/Nigeria border due to unofficial checkpoints and highway banditry.
Travelers should avoid the use of credit cards and automated teller machines (ATMs) in Benin due to a high rate of fraud. Perpetrators of business and other kinds of fraud often target foreigners, including Americans. While such fraud schemes in the past have been largely associated with Nigeria, they are now prevalent throughout West Africa, including Benin, and are more frequently perpetrated by Beninese criminals. Business scams are not always easy to recognize, and any unsolicited business proposal should be carefully scrutinized. There are, nevertheless, some indicators that are warnings of a probable scam. Look out for:

Any offer of a substantial percentage of a very large sum of money to be transferred into your account, in return for your "discretion" or "confidentiality";

Any deal that seems too good to be true;
Requests for signed and stamped, blank letterhead or invoices, or for bank account or credit card information;
Requests for urgent air shipment, accompanied by an instrument of payment whose genuineness cannot immediately be established;
Solicitations claiming the soliciting party has personal ties to high government officials;
Requests for payment, in advance, of transfer taxes or incorporation fees;
Statements that your name was provided to the soliciting party either by someone you do not know or by "a reliable contact";
Promises of advance payment for services to the Beninese government; and
Any offer of a charitable donation.
These scams, which may appear to be legitimate business deals requiring advance payments on contracts, pose a danger of both financial loss and physical harm. Recently more American citizens have been targeted. The perpetrators of such scams sometimes pose as attorneys. One common ploy is to request fees for “registration” with fictitious government offices or regulatory authorities. The best way to avoid becoming a victim of advance-fee fraud is common sense – if it looks too good to be true, it probably is. Travelers should carefully check out any unsolicited business proposal originating in Benin before committing any funds, providing any goods or services, or undertaking any travel. For additional information, please see the Department of State’s Bureau of Consular Affairs brochure, International Financial Scams.

Scams may also involve persons posing as singles on Internet dating sites or as online acquaintances who then get into trouble and require money to be "rescued." If you are asked to send money by someone you meet online please contact the U.S. Embassy before doing so.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical facilities in Benin are limited and not all medicines are available. Travelers should bring their own supplies of prescription drugs and preventive medicines. Not all medicines and prescription drugs available in Benin are USFDA-approved. Malaria is a serious risk to travelers to Benin. For information on malaria, its prevention, 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 website at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

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

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

With the exception of the road linking Cotonou in the south to Malanville on the border with Niger in the north, and from Parakou in central Benin to Natitingou in the northwestern part of the country, roads in Benin are generally in poor condition and are often impassable during the rainy season. Benin's unpaved roads vary widely in quality; deep sand and potholes are common. During the rainy season from mid-June to mid-September, dirt roads often become impassable. Four-wheel drive vehicles with full spare tires and emergency equipment are recommended.
Most of the main streets in Cotonou are paved, but side streets are often dirt with deep potholes. Traffic moves on the right, as in the United States. Cotonou has no public transportation system; many Beninese people rely on bicycles, mopeds, motorbikes, and zemidjans (moped taxis). All official Americans are required to wear safety helmets when on a motorcycle and are strongly discouraged from using zemidjans. Travelers using zemidjans, particularly at night, are much more vulnerable to being mugged, assaulted or robbed. Buses and bush taxis offer service in the interior.
Gasoline smuggled from Nigeria is widely available in glass bottles and jugs at informal roadside stands throughout Cotonou and much of the country. This gasoline is of unreliable quality, often containing water or other contaminants that can damage or disable your vehicle. Drivers should purchase fuel only from official service stations. There are periodic gas shortages, which can be particularly acute in the north of the country where there are few service stations.
U.S. citizens traveling by road should exercise extreme caution. Poorly maintained and overloaded transport and cargo vehicles frequently break down and cause accidents. Drivers often place branches or leaves in the road to indicate a broken down vehicle is in the roadway. Undisciplined drivers move unpredictably through traffic. Construction work is often poorly indicated. Speed bumps, commonly used on paved roads in and near villages, are seldom indicated. Drivers must be on guard against people and livestock wandering into or across the roads. Nighttime driving is particularly hazardous as vehicles frequently lack headlights and/or taillights, and brake lights are often burned out.
With few exceptions, Cotonou and other cities lack any street lighting, and lighting on roads between population centers is non-existent. The U.S. Embassy in Cotonou prohibits non-essential travel outside of metropolitan areas after dusk by official Americans and strongly urges all U.S. citizens to avoid night driving as well. There have been numerous carjackings and robberies on roads in Benin after dark, several of which resulted in murder when the driver refused to comply with the assailants' demands. The National Police periodically conduct vehicle checks at provisional roadblocks in an effort to improve road safety and reduce the increasing number of carjackings. When stopped at such a roadblock, you must have all of the vehicle's documentation available to present to the authorities.
Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office at http://www.benintourisme.com.

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

SPECIAL CIRCUMSTANCES:
U.S. citizens are advised to keep a notarized photocopy of the photo page of their passport with them at all times when traveling in Benin.
The Embassy has had a few reports of officials requesting a "gift" to facilitate official administrative matters (e.g., customs entry). Such requests should be politely but firmly declined.
It is prohibited to photograph government buildings and other official sites, such as military installations, without the formal consent of the Government of Benin. In general, it is always best to be courteous and ask permission before taking pictures of people. Beninese citizens may react angrily if photographed without their prior approval.
Obtaining customs clearance at the port of Cotonou for donated items shipped to Benin from the United States may be a lengthy process. In addition, to obtain a waiver of customs duties on donated items, the donating organization must secure prior written approval from the Government of Benin. Please contact the U.S. Embassy in Cotonou for more detailed information.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 Benin laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Benin 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 Benin are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Benin. Americans withoutInternet access may register directly with the U.S. Embassy. 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 Rue Caporal Anani Bernard in Cotonou. The Embassy's mailing address is B.P. 2012, Cotonou, Benin. The 24-hour telephone numbers are (229) 21-30-06-50, 21-30-05-13, and 21-30-17-92. The Embassy’s general fax number is (229) 21-30-06-70; the Consular Section’s fax number is (229) 21-30-66-82; http://cotonou.usembassy.gov/.
* * *
This replaces the Country Specific Information for Benin dated August 17th, 2007 to update sections on Safety and Security and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Fri, 10 May 2019 19:38:30 +0200
By Hazel WARD and Daphne BENOIT

Paris, May 10, 2019 (AFP) - French special forces have freed two French hostages, an American and a South Korean in northern Burkina Faso in an overnight raid in which two soldiers died, authorities announced Friday.   The operation was launched to free two French tourists who had disappeared while on holiday in the remote Pendjari National Park in neighbouring Benin on May 1.

But during the raid, the French troops were surprised to discover two women also in captivity, with top officials saying they had been held for 28 days.    The French tourists were identified as Patrick Picque, 51, and Laurent Lassimouillas, 46, but the women's identities were not immediately clear.     "No one was aware of (the women's) presence," French Defence Minister Florence Parly told reporters, while French armed forces chief Francois Lecointre said.   "We know little about these other two hostages," Parly told reporters, saying that even Seoul and Washington did not appear to be aware the pair were in increasingly unstable Burkina Faso.    The raid was approved by French President Emmanuel Macron in what was seen as the last opportunity to stop the hostages being transferred to lawless territory in Mali to the north.

Parly said it was "too early to say" who had snatched the two French nationals from Benin, which has long been an island of stability in a region where Islamist militants are increasingly active.   "The message to terrorists and criminal gangs is clear: those who attack France and its nationals know that we will not spare any effort to track them down, find them and neutralise them," she said.   Four of the six kidnappers were killed in the raid.    French forces, helped by intelligence provided by the United States, had been tracking the kidnappers for several days as they travelled across the semi-desert terrain of eastern Burkina Faso from Benin to Mali.   They seized the opportunity to prevent "the transfer of the hostages to another terrorist organisation in Mali," Lecointre said, referring to the Macina Liberation Front (FLM).   The FLM is a jihadist group formed in 2015 and headed by a radical Malian preacher, Amadou Koufa. It is aligned with Al-Qaeda in the region.

- US intelligence support -
In a statement, Macron congratulated the special forces on the operation, in which he also expressed sorrow over the death of the two soldiers "who gave their lives to save those of our citizens".   And Parly thanked authorities in Benin and Burkina Faso for their help with the "complex operation", as well as the United States which provided intelligence and support.

The operation was also made possible by the presence of France's Operation Barkhane, which counts some 4,500 troops deployed in Mali, Burkina Faso, Niger and Chad to help local forces battle jihadist groups.   American special forces and drones are also known to operate in the violence-wracked Sahel region, which France fears could become further destabilised as jihadist groups are pushed out of north Africa, Iraq and Syria.   Burkina Faso has suffered from increasingly frequent and deadly attacks attributed to a number of jihadist groups, including the Ansarul Islam group, the Group to Support Islam and Muslims (GSIM) and Islamic State in the Greater Sahara.

- Relief and sadness -
The French tourists -- Patrick Picque who works in a Paris jewellery shop, and Laurent Lassimouillas a piano teacher, -- went missing with their guide on the last leg of their holiday in usually peaceful Benin.   The Pendjari wildlife reserve, which is famed for its elephants and lions, lies close to the porous border with Burkina Faso.   The badly disfigured body of their guide was found shortly after they disappeared, as well as their abandoned four-wheel Toyota truck.   The two freed men will be flown back to France on Saturday, alongside the South Korean woman, where they will be met on arrival by Macron and other top French officials.   Washington thanked the French forces for freeing the American hostage, with France saying she would likely be "repatriated independently" from the other three. 

The two dead French soldiers were named as Cedric de Pierrepont and Alain Bertoncello, decorated naval special forces members born in 1986 and 1991 respectively.   They were part of the prestigious Hubert commando unit of the French naval special forces which was deployed to the Sahel at the end of March.   A total of 24 French soldiers have died in the region since 2013 when France intervened to drive back jihadist groups who had taken control of northern Mali. The last death was on April 2.
Date: Tue 15 Jan 2019
Source: Punch [edited]

The Kwara state government has confirmed 2 cases of Lassa fever infecting a husband and wife in the state.

Speaking with newsmen on Tuesday [15 Jan 2019] at a news briefing, the Kwara commissioner for health, Alhaji Usman Rifun-Kolo, said the outbreak of Lassa fever was identified in a farm settlement in Taberu, Baruten local government area.

He explained that the 2 cases of the disease affected a husband and wife, natives of Benin republic, which shares a border with the state. He added that the husband and wife are farming in Baruten. "These cases of Lassa fever originated from Benin republic, whose citizen have interrelations with people in the Baruten area," he said.

According to him, the husband and wife were diagnosed in a health facility, and the state government had already deployed a disease-surveillance team to identify those who have been in contact with the patients.

Rifun-Kolo further explained that the surveillance team identified 4 people with a history of fever in the area. He said that the 4 cases raised suspicion of Lassa fever, which prompted them to take samples from the individuals for further investigation. He noted that the 4 individuals have commenced treatment in Taberu, Baruten LGA.
=====================
[The above report states that the couple was infected in Benin, although the timeline when that may have occurred is not given. The report also mentions 4 individuals in the Kwara state who had a history of Lassa fever, implying that the virus is present in that state in Nigeria as well. In December [2018], there were Lassa fever cases in Benin that were imported from Nigeria as well as infections that were locally acquired in Benin, so the Lassa fever cases cross the border in both directions. The source of the infecting virus for any of these cases is not mentioned. - ProMED Mod.TY

[HealthMap/ProMED-mail maps:
Kwara state, Nigeria: <http://healthmap.org/promed/p/19690>]
Date: Wed 26 Dec 2018
Source: Quotidein Le Matinal [in French, trans. ProMED Corr.SB, edited]

Minister of health Benjamin Hounkpatin confirmed on Wednesday [26 Dec 2018] 4 new cases of Lassa haemorrhagic fever in Benin, including one in Cotonou. This occurred in the period from 15-26 Dec 2018.

In the case of Cotonou, a 28-year-old (has been infected). His case was detected on 24 Dec [2018], but his illness commenced the previous week. He had a fever, a cough, a cold, and fatigue. Due to the persistence of the cough and cold, and with the appearance of traces of blood in nasal discharge on 24 Dec 2018, the alert was given.

The patient was placed in isolation on [Tue 25 Dec 2018], and on the morning of Wed 26 Dec 2018, his result from the laboratory came back positive [for Lassa fever]. Subsequently, the patient was isolated and put on treatment.

According to the details provided by Hounkpatin, there is no indication of travel [by the patient] to an epidemic locality of Lassa fever. According to the patient's statements, there is no known contact with rodents.

Taking advantage of this opportunity, the minister reassured the public that public health measures are underway. He also reminded people of the behaviours that will help avoid becoming infected. This involves washing hands regularly with soap and water; avoiding contact with stool, sperm, urine, saliva, vomit, and contaminated objects from a person suspected to be ill or dead from Lassa; and protecting food and keeping it in a safe place, out of reach of rodents.

It should be recalled that 7 cases have been recorded since the beginning of the epidemic to date, including 5 positive cases.
=======================
[One case is located in Cotonou on the Benin coast and apparently was locally acquired, perhaps from contact with the rodent host or its excrement. The location of the other 3 cases is not mentioned, but a 13 Dec 2018 report indicated that there were 3 cases in the municipality of Parakou in Borgou Department, in the northern part of Benin. Perhaps these 3 cases, which came from the village Taberou (in Nigeria), located 5 km [3.1 mi] from Tandou in the commune of Tchaourou, are the ones mentioned in this report.

The previous Lassa fever cases in Benin this year [2018] occurred in January and also involved case importation from Nigeria. A previous WHO report stated that Lassa fever is endemic in bordering Nigeria, and, given the frequent population movements between Nigeria and Benin, the occurrence of additional cases is not unexpected. Strengthening of cross-border collaboration and information exchange between the 2 countries is, therefore, needed. - ProMED Mod.TY]

[Images of the rodent reservoirs of Lassa fever virus can be seen as follows:
For _Mastomys natalensis_, see
For _M. erythroleucus_ and _Hylomycus pamfi_, see

HealthMap/ProMED-mail maps:
Date: Fri, 29 Jun 2018 13:37:32 +0200

Cotonou, June 29, 2018 (AFP) - Benin's Constitutional Court has banned the right to strike by workers in the country's defence, security, justice and health sectors, sparking concern among union officials and legal observers.   The ruling, issued late on Thursday, came after months of wrangling between the government and the court, which had previously said the measure was unconstitutional.

"Civil servants, public security forces and equivalents should fulfil their duties in all circumstances and not exercise their right to strike," the court said in its new ruling.   "There should be no disruption to the duties of public sector defence, security, justice and health workers."   The decision was taken "in the public interest" and for "the protection of citizens", it said.

Speaking on Friday, one senior union leader, who asked to remain anonymous, described the ruling as shocking and a "hammer blow".   And Benin legal affairs expert Albert Medagbe told AFP the decision was a "worrying sudden legal U-turn".   Earlier this month, a close ally of President Patrice Talon, Joseph Djogbenou, was elected to lead the Constitutional Court during a vote held behind closed doors.   Djogbenou is Talon's former personal lawyer and was previously  Benin's attorney general.

Until his arrival, the court had strained relations with Talon, and had criticised the government for misunderstanding and failing to respect the constitution.   The small West African nation was last year hit by a wave of public sector strikes, which brought the education, health and justice system to a near halt.   The industrial action was sparked by Talon's attempts to introduce free-market reforms.
Date: Wed, 21 Feb 2018 17:31:52 +0100

Cotonou, Feb 21, 2018 (AFP) - Nine people appeared in a Benin court Wednesday on charges of selling fake drugs at the start of a landmark trial in a regional campaign against illicit medicines.   The suspects, who include executives from major pharmaceutical companies operating in the West African nation, were remanded in custody until March 6 on technical grounds.   They are accused of "the sale of falsified medicines, (and) display, possession with a view to selling, commercialisation or sale of falsified medical substances."   A tenth defendant, the head of the Directorate for Pharmacies, Medications and Diagnostic Evaluation (DPMED) under the control of the ministry of health, was not in court on the trial's opening day.   He is accused of failing to prevent the offences.

Benin launched the crackdown last year after mounting alarm about the scale of the trafficking of expired and counterfeit drugs in West Africa.   Fake medicines are drugs that are bogus or below regulatory standards but often are outwardly indistinguishable from the genuine product.   Taking them may do nothing to tackle an illness or -- in the case of antibiotics -- worsen the problem of microbial resistance.   According to an investigation by the Paris-based International Institute of Research Against Counterfeit Medicines (IRACM), West African markets are awash with fake drugs made in China and India.

In 2015, the American Society of Tropical Medicine and Hygiene estimated that 122,000 children under five died due to taking poor-quality antimalarial drugs in sub-Saharan Africa.   A 15-nation regional body, the Economic Community of West African States (ECOWAS), last April announced an investigation into the fake drugs business.   A lawyer for the civilian plaintiffs told AFP that the trial in Benin was adjourned until March 6 at their request "in order to incorporate another case, of illegal pharmaceutical practice".
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Eritrea

Eritrea US Consular Information Sheet
November 26, 2008
COUNTRY DESCRIPTION:
Eritrea is a poor but developing East African country, the capital of which is Asmara. Formerly a province of Ethiopia, Eritrea became an independent country on M
y 24, 1993, following a 30-year struggle that culminated in an overwhelming referendum vote for independence. Tourism facilities are very limited. Read the Department of State Background Notes on Eritrea for additional information.

ENTRY/EXIT REQUIREMENTS:
All travelers should have a passport and valid visa prior to arrival; visas are not available at the airport unless specifically pre-authorized by the Eritrean government.
Travelers visiting Eritrea using a foreign passport do not need an exit visa, provided they leave before their entrance visa expiration date.
Persons staying beyond their entrance visa expiration date may be subject to fines or imprisonment, or be required to remain in Eritrea for an extended period while their case is reviewed in court.
All long-term residents, regardless of citizenship, must obtain an exit visa 30 days prior to departure, unless they hold a difficult-to-obtain multiple entry visa.
Upon entry and exit, visitors must declare all foreign currency, and may be asked to declare electronic equipment such as cameras, computers and video equipment.
Visitors must save all receipts for foreign exchange and present these upon departure to account for all foreign currency spent in Eritrea.
Failure to report foreign currency or meet customs requirements usually results in both a fine and imprisonment.
There is also a $20 airport departure tax.
Information about the airport tax and entry/exit requirements is available from the Embassy of Eritrea, 1708 New Hampshire Avenue NW, Washington, DC 20009; telephone (202) 319-1991; fax (202) 319-1304.
Overseas, inquiries may be made at the nearest Eritrean embassy or consulate.

U.S. citizens born in Eritrea, to Eritrean parents, or who in any other way appear to have Eritrean origins, are required to register with the Immigration and Nationality office in Asmara within seven business days of their entry into the country.
The Eritrean government sometimes subjects U.S. citizens of Eritrean heritage to the same entry/exit requirements as Eritrean citizens.
See the “Special Circumstances” section below for more information about dual nationality.

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:
Eritrea and Ethiopia fought a border war from 1998-2000.
United Nations peacekeepers patrolled the border until March 2008, when Government of Eritrea diesel fuel restrictions resulted in the peacekeepers’ withdrawal.
Both Eritrea and Ethiopia maintain large military presences along the border and currently all border crossings into Ethiopia from Eritrea remain closed.
U.S. citizens are strongly advised to avoid travel near the Eritrean-Ethiopian border and to register their presence in Eritrea with the U.S. Embassy in Asmara.

Since April 2008, large numbers of Eritrean troops have been deployed along the northeastern border of Djibouti.
U.S. citizens are strongly advised to avoid non-essential travel to the Southern Red Sea region of Eritrea, including the port of Assab.

Landmines and unexploded ordnance remain a serious problem throughout the country.
There are reports of accidents and numerous incidents where vehicles and people occasionally detonate mines.
Many detonations occurred on relatively well-traveled roads in and near the Gash Barka region of western Eritrea; subsequent investigations indicated that several mines had been recently laid.
Vast areas of the country still have not been certified free of mines and unexploded ordnance left over from both the 30-year war for independence and the subsequent 1998-2000 conflict with Ethiopia.
Americans should avoid walking alone and hiking in riverbeds or areas that local government officials have not certified as safe.

Although Eritrea and Sudan have diplomatic relations, the procedures for crossing their common border are not clear and subject to change.
Overland travel between the two countries is dangerous and ill advised.
Travelers crossing from Eritrea to Sudan north and west of the Keren-Barentu road risk becoming victims of banditry or Islamic extremist insurgent activity.
Several incidents were reported in 2007, apparently involving insurgents or criminals in this area.
The U.S. Embassy also received reports of sporadic bombings of vehicles and government facilities in the Gash Barka region near Sudan in 2007 and 2008.
If travel near the Eritrean-Sudanese border is essential, travelers should consult both the Eritrean authorities and the U.S. Embassy in advance.
Foreign travelers who wish to visit any area outside of Asmara must apply at least ten days in advance for a travel permit from the Eritrean government.

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

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphletA Safe Trip Abroad.
CRIME:
Although still a safe city by many measures, Asmara reported significant increases of street crime, such as theft, robbery, and assault in 2008.
Travelers should exercise vigilance in their personal security and safety precautions regarding what valuables they carry and which areas they visit.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Eritrea are extremely limited.
Travelers must carry their own supplies of prescription drugs and preventative medicines because pharmaceuticals are in short supply.
Food and water-borne illnesses are very common among travelers, so drink only bottled or purified water and eat foods that are cooked or peeled.
Malaria is a serious risk to travelers in the lowlands of Eritrea, but Asmara is generally considered free of the disease.

There is no HIV testing requirement for temporary or permanent entry into Eritrea.
Please verify this information with the Embassy of Eritrea before you travel.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s website at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website 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 Eritrea is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

The roads between major cities (Asmara, Massawa, Mendefera, Dekemhare, Barentu, and Keren) are paved and in relatively good condition.
However, secondary roads and those in remote areas are usually unpaved and in poor condition.
U.S. citizens should avoid traveling on these roads, especially at night.
Bad weather can also make the condition of poor roads worse.
If you must take unpaved roads, check first with local government and village officials as new minefields continue to be discovered.

Landmines and unexploded ordnance litter the countryside in many areas, occasionally causing injuries and deaths.
Although the UN conducted de-mining efforts until late 2007, evidence of new mines has been reported, particularly in areas near the Ethiopian border.
All areas that are not well traveled are potentially dangerous due to live mines, especially north and west of Keren.
There are also minefields near Massawa, Ghinda, Agordat, Barentu, south of Tessenae, Nakfa, Adi Keih, Arezza, Dekemhare, and in a roughly 40-kilometer wide region just west of the Eritrean-Ethiopian border between the Setit and Mereb Rivers.

Many Eritreans use inexpensive public transportation, especially bus service.
Travelers should avoid taking buses due to extreme over-crowding.
Taxis are plentiful and inexpensive in Asmara, but usually carry multiple passengers along pre-defined routes.
If an empty taxi is available, a customer may request a "contract" taxi, which accepts no additional passengers, for a significantly higher fixed price.
Drivers should be aware of heavy and erratic pedestrian and bicycle traffic obstructing vehicle flow.
Occasionally horse-drawn carts, cattle, or goats add to the obstacles.
Other hazards are children and the elderly, who sometimes wander into the path of moving traffic, as well as small, slow, motorized carts.
Elderly or disabled people usually drive these carts and do not always yield to faster moving traffic.
When parallel parking on city streets, watch for pedestrians as you back into the space.
Please refer to our Road Safetypage for more information.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Eritrea, the U.S. Federal Aviation Administration (FAA) has not assessed Eritrea’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:
Due to Eritrean government restrictions impacting Embassy operations, the consular section of the U.S. Embassy in Asmara does not provide routine services to American citizens in Eritrea, including reports of birth, passports, and notaries.
Americans traveling or residing in Eritrea who require such services must travel to a U.S. Embassy or Consulate outside Eritrea, and should plan accordingly.

American citizens should also be aware that U.S. diplomatic personnel are subject to travel restrictions.
The Government of Eritrea requires resident diplomats to apply 10 days in advance for travel outside of Asmara city limits; often travel permission is not given.
This restriction can delay or prevent U.S. Embassy emergency assistance to American citizens outside of Asmara.

The consular section of the U.S. Embassy in Asmara has been closed for visa services since January 2007.
Eritrea has complicated citizenship laws and does not recognize renunciation of Eritrean citizenship.
Dual nationals who enter the country on Eritrean documents are treated as Eritrean citizens, regardless of their other citizenship.
U.S. citizens born in Eritrea, or who otherwise are considered to have acquired Eritrean citizenship, may be subject to certain obligations, including being drafted into national service, regardless of the documents they present at entry.
(National service is approximately six months of military training, followed by an often unspecified number of years in military or other government service.)

U.S.-Eritrean dual nationals who enter the country on an Eritrean passport or national ID card must obtain an exit visa prior to departure.
Exit visa applications can significantly delay travel plans or be denied, even for persons who entered Eritrea legally.
Eritrean dual nationals are also required to pay a 2% income tax on overseas earnings to the Eritrean Government prior to being granted an exit visa.
Additionally, Eritrean authorities sometimes to not allow Eritreans who left the country after 1993 to depart Eritrea after visiting the country, even if they have a U.S. passport and a valid Eritrean visa.

The government of Eritrea does not inform the U.S. Embassy of the detention of American citizens, and does not allow Embassy officials to visit incarcerated Americans.

Visitors are advised to exercise caution when taking photographs in Eritrea.
Foreigners in Asmara have been harassed and detained by local police and plain clothes security officials for taking photographs of street scenes in the city.
No law has been cited, but the arresting officials' justifications have been that (unmarked) government buildings are in the background and/or that the pictures are being taken (illegally) for commercial reasons.

All foreign nationals in Eritrea are required to apply for permits to travel outside of Asmara.
Travel permits must be presented at all checkpoints.
Checkpoints are found on major roads through Eritrea, but locations may change without notice.
Applications for travel permits are available at the Ministry of Tourism located on Harnet Avenue.
There is a high risk of earthquakes in Eritrea.
General information about natural disaster preparedness is available on the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.
Please see our information on Customs Regulations.

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 Eritrean laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Eritrea 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 Eritrea 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 Eritrea.
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 179 Alaa Street, PO Box 211, Asmara; telephone (291-1) 12-00-04; fax (291-1) 124-255 and (291-1) 127-584; the Embassy’s web site is located at http://eritrea.usembassy.gov/
*

*

*
This replaces the Country Specific Information for Eritrea dated April 28, 2008, to update sections on Entry/Exit Requirements, Safety and Security, Crime,
Medical Facilities and Health Information, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Sat 10 Sep 2016
Source: Asmarino Independent [edited]

Activists have reported a serious cholera outbreak in the Upper Gash-Barka Region of Eritrea, which is proving difficult to control. The outbreak was 1st observed at Barentu Referral Hospital 2 weeks ago when people who had travelled from the upper Gash region were reported to be suffering from an illness that was not diagnosed easily. However, as a result of the extended time taken for accurate diagnosis of cholera due to a severe shortage of expertise and infrastructure, the outbreak spread widely, affecting areas of the Gash-Barka Region.

It has now been a week since the Ministry of Health acknowledged the outbreak as being a potential national epidemic and has briefed health professionals in the region to that effect.

So far, the effort to curb the spread is proving futile, and the impact of the outbreak is being felt across the region. Markets were deserted as a result of the spread, and even cattle markets in small villages outside Barentu have been cordoned off to prevent the spread. An expert at the Ministry of Health's public health section for preventing such epidemics stated: "There is currently no national emergency response team to prevent and control such outbreaks; we are, therefore, prone to such epidemics, as it always takes time to pull such a team together to both control the outbreak and treat victims."

Already, the current epidemic is said to have spread from the Upper Gash Region to the Southern Region and particularly to the area of Mai Dima, where an epidemic control team has been dispatched.

According to health experts in the region, when such an outbreak occurs, even able-bodied adults find it impossible to cope with the acute loss of bodily fluids. Without appropriate medical assistance, it is impossible for patients to recover, and the situation is considerably worse for pregnant women and children.

Given the lack of public health awareness, Arbi Harnet calls on the people to take preventive actions by strictly adhering to personal and public hygiene practices.
======================
[A HealthMap/ProMED-mail map showing Eritrea is available at
Date: Sat, 23 Jan 2016 12:14:06 +0100

Nairobi, Jan 23, 2016 (AFP) - Eritrean President Isaias Afwerki on Saturday dismissed fears the Horn of African nation faces a food crisis, despite sweeping drought across the wider region leaving millions in need of aid.   Floods and failed rains caused by the El Nino weather phenomenon have sparked a dramatic rise in the number of people going hungry in east Africa.

But authoritarian and isolated Eritrea has long rejected UN food aid in favour of a policy of self reliance, and Isaias said he was not worried.    "In view of the harvest shortfall that has affected the whole Horn of Africa region, President Isaias stated that the country will not face any crisis in spite of reduced agricultural output," the information ministry said, after he was interviewed by state-run media.   Isaias praised the government's "judicious policy and approaches of bolstering its strategic food reserves."

In November, the UN warned that Eritrea was among the countries at risk, like all the other nations in the wider region. "The current El Nino pattern, being the strongest ever recorded, has caused severe drought in the Horn of Africa nation, resulting in crop reduction by 50 to 90 percent; even failure in some regions," the United Nations said earlier this month.   In Ethiopia, over 10 million people need food aid, it added.    In Eritrea, few if any major foreign aid agencies are allowed operate, while the UN has limited access across the country, and most assessments are dependent on government reports.

Thousands of Eritreans flee the county each month, saying they are escaping conscription and rampant rights abuses.   Refugees from the repressive Red Sea state make up the third-largest number of people risking the dangerous journey to Europe after Syrians and Afghans, running a gauntlet of ruthless people smugglers to make the treacherous Mediterranean crossing.
Date: Thu 30 Jul 2015
Source: Eurosurveillance edition 2015; 20(30) [edited]

Louse-borne relapsing fever (_Borrelia recurrentis_) in asylum seekers from Eritrea, the Netherlands, July 2015
----------------------------------------------------------------------
[Authors: Wilting KR, Stienstra Y, Sinha B, Braks M, Cornish D, Grundmann H]

Two patients from Eritrea, recently arrived in the Netherlands, presented with fever and were investigated for malaria. Bloodfilms showed spirochetes but no blood parasites. Louse-borne relapsing fever caused by _Borrelia recurrentis_ was diagnosed. Treatment was complicated by severe Jarisch-Herxheimer reactions [inflammatory reaction observed after antimicrobial treatment of several infectious diseases] in both patients. Physicians should be aware of the possibility of _B. recurrentis_ infection in migrant populations who travel under crowded conditions, especially after passing through endemic areas such as Ethiopia and neighbouring countries.

_Borrelia recurrentis_ has for many centuries caused infections of often epidemic proportions known as relapsing fever. Since the infection is exclusively transmitted by body lice and humans are their only host, large scale outbreaks are only expected under circumstances conducive to louse infestation. We here report the 1st introduction of louse-borne relapsing fever into the Netherlands after World War II.

Case descriptions
-----------------
Patient 1
On 4 Jul 2015, a young adult from Eritrea was referred from the National Reception Centre for Asylum Seekers (Asielzoekercentrum, AZC) to a regional hospital in the northern Netherlands with a 5-day history of headache, dizziness, right upper quadrant pain, myalgia, and fever (39.3 deg C [102.7 deg F]). Malaria was suspected. The patient had been in the Netherlands for only 2 days after arriving in Europe 14 days earlier. En route to Europe, they travelled through Ethiopia, Sudan, and Libya. Previously, they had noticed chills while sheltering in an unofficial street camp in Rome where they stayed with a small group of fellow Eritreans before travelling to the Netherlands.

Thick and thin bloodfilms did not show malaria parasites and commercial malaria antigen tests were negative. However, filamentous unidentified structures were reported in the thick film by the laboratory of the peripheral hospital. The patient received empirical treatment with a single dose of ceftriaxone (2000 mg intravenously) for suspected bacterial septicaemia. After administration, their condition deteriorated and the patient was transferred within the next 2 hours to the University Medical Center Groningen (UMCG) where they arrived at the emergency department with headache, peripheral hypothermia (35.3 deg C [95.5 deg F]), hypotension (systolic/diastolic blood pressure 78/52 mmHg, heart rate of 106 beats per minute), abdominal pain but no hepatosplenomegaly, and shortness of breath (respiratory rate 23 breaths/min). Laboratory analysis showed leucocytopenia (leucocytes: 1.6 x 10(9)/L, norm: 4.5-10 x 10(9)/L), anaemia (haemoglobin: 6.5mmol/L, norm: 8.6-11.2 mmol/L) and thrombocytopenia (thrombocytes: 16x10(9)/L, norm: 150-450x10(9)/L). C-reactive protein (CRP) was 254 mg/L (norm: less than 1 mg/L). Kidney function was normal. The patient's liver function tests showed mildly elevated transaminases (alanine transaminase: 58 U/L, norm: 7-56 U/L; aspartate transaminase: 108 U/L, norm: 10-40 U/L; alkaline phosphatase: 124 U/L, norm 20-140 U/L; gamma-glutamyl transferase: 93 U/L, norm 0-51 U/L) and total bilirubin levels of 38 micromole/L (norm: less than 26 micromol/L) and direct bilirubin 35 micromol/L (norm: less than 7 micromol/L). Oxygen saturation was 91 percent (norm: 95-100 percent). Giemsa-stained thick and thin films revealed spirochetes in large numbers (Figure 1 [available at the source URL]) and no malaria parasites.

Given the patient's travel history, louse-borne relapsing fever was suspected. The clinical deterioration was provoked by the ceftriaxone administration leading to a severe Jarisch-Herxheimer reaction [1]. Treatment was switched to doxycyline 200 mg per day intravenously intravenously to reduce the risk of relapse [2]. The patient was transferred to the intensive care unit (ICU) for fluid resuscitation, cardiac support with noradrenalin, and supportive oxygen delivery via high flow nose mask.

_B. recurrentis_ was confirmed by 16S rDNA PCR and sequencing directly from blood 2 days later. The patient stayed at the ICU for 2 days, made a full recovery and was discharged after 6 days. The body louse _Pediculus humanus humanus_ was recovered from [the patient's clothing (Figure 2 [available at the source URL]).

Patient 2
In 9 Jul 2015, a 2nd young adult from Eritrea was directly referred by the responsible physician at the AZC to the UMCG. On arrival, the patient presented with general malaise, headache, fever (38.5 deg C [101.3 deg F]) and cough. Blood tests showed elevated inflammatory parameters (leucocytes: leucocytes: 12.7 x 10(9)/L, CRP: 320 mg/L), normal kidney function and slightly elevated transaminases, but the blood sample was haemolytic. Thick and thin films showed spirochetes and treatment was started with doxycyline 200 mg orally. 2 hours later the patient developed a severe Jarisch-Herxheimer reaction [that] required admission to intensive care where they received fluid resuscitation, inotropic treatment with noradrenalin, and oxygen via a face-mask. _B. recurrentis_ was confirmed by 16S rDNA sequencing.

The patient reported symptoms of chills and fever 2 weeks before presentation at our hospital. Their journey through North Africa followed the same route as that of Patient 1, but Patient 2 had arrived in Europe a week earlier. Patient 2 had camped out in the streets for 5 days in Rome (as had Patient 1). Patient 2 arrived in the Netherlands 2 weeks before presenting at our hospitals after travelling through Austria and Germany. The patient made a full recovery and was discharged after 5 days. Lice could not be recovered from the clothing.

Discussion
----------
_B. recurrentis_ should be suspected in patients presenting with fever and a recent history of migration from or through endemic countries (Ethiopia, Sudan, Eritrea, and Somalia). The infection is transmitted through body lice (_P. humanus humanus_, formally known as _P. humanus corporis_), which typically lives and breeds in the seams of clothes but can occasionally also be found in bed linens. Immigrants may share their clothing and that can pose an additional risk of transmission. The incubation period for relapsing fever is usually 4 to 8 days with a range of 2 to 15 days [3]. It should be noted that head lice (_P. humanus capitis_), which are not uncommon in Northern Europe, are incompetent vectors and cannot transmit _B. recurrentis_. The spirochetes are easily visible under a microscope in a Giemsa-stained thick or thin blood film as used for the diagnosis of _Plasmodium_ spp [4]. In our patients, the diagnosis was confirmed in both cases by 16S rDNA PCR and sequencing from blood.

Published evidence supports a single dose of tetracycline 500 mg intravenously as the conventional treatment, but considering the limited availability of this drug, doxycycline 200 mg can be used as an effective alternative [2,5]. In young children, pregnant women, or patients with a tetracycline allergy, erythromycin 500 mg can be used instead [6].

Both patients had travelled independently along a similar route before arriving in the Netherlands. Given the incubation period, it cannot be ruled out that the infection was acquired within Europe. Crucial information about risk factors such as exact travel history, recollection of louse infestation or bites and onset of symptoms was, however, impossible to obtain from our patients. Apart from being very sick and the fact that communication required an interpreter versed in Tigre our patients appeared to be traumatised and intimidated and not eager to volunteer information for fear of legal consequences.

Both patients developed a severe Jarisch-Herxheimer reaction after starting antibiotic treatment. _B. recurrentis_ evades host immune defences, resulting in very high bacterial loads (10(6)-10(8)/microl), and effective antibiotic therapy is followed by severe reactions characterised by sudden rigors, fever, and hypotension in virtually all treated patients [3]. Clinical symptoms are associated with increased plasma concentrations of tumour necrosis factor alpha (TNF-alpha), interleukin-6 and interleukin-8 [7]. Treating physicians should be aware of this complication and the chances that ICU admission may be warranted. It is advised that patients receive 2 well-placed intravenous lines for rapid fluid resuscitation. Treatment of Jarisch-Herxheimer reaction consists mainly of supportive care. Corticosteroids seem to have limited beneficial effect but studies suggests that TNF-alpha blockers may be useful [8].

An ad hoc survey at the AZC on [16 Jul 2015] found body lice on 2 newly arrived Eritreans. Since then, all asylum seekers arriving from endemic countries to the AZC have been segregated into a different compound, where they turn over all of their personal clothes in exchange for disposable overalls. Personal clothes are then washed and returned on the next day. Used overalls and bed linen are subsequently destroyed. In addition to delousing, all arrivals receive a single dose of ivermectin as pre-emptive treatment against scabies and Eritreans who arrive with clinically manifest scabies (about 80 percent of all new arrivals) receive a 2nd dose a week later. No new cases of _B. recurrentis_ infection have been identified since mandatory delousing was implemented.

Conclusion
----------
Because infections with _B. recurrentis_ pose a significant health risk to other migrants, aid workers, healthcare personnel, and arguably to the general population, screening and delousing should be considered for arriving migrants already at ports of entry into the European Union. Our patients may have acquired body lice before arriving in Europe but transmission of infected lice between migrants after arrival in Europe cannot be ruled out and could pose an additional public health challenge.

[Figures and references are available at the source URL above.]
======================
[Relapsing fever is a bacterial infection caused certain species of the spirochete _Borrelia_. These organisms are able to periodically change their surface protein molecules to evade the host's immune response, thus causing a relapsing illness. Following an incubation period of about 7 days, the illness is characterized by recurring episodes of high fever, headache, muscle and joint pain, nausea and vomiting, each episode lasting several days, followed by a several-day asymptomatic interval. There may be up to 3-4 recurrences. Complications may include involvement of the lungs (ARDS; acute respiratory distress syndrome), central nervous system, spinal cord, eyes, heart, and liver. The bacteremia is intense (more than 10,000 organisms per ml of blood) during febrile episodes, which allows detection of organisms on a Wright-Giemsa stained blood smear. Thick blood smears are more sensitive than thin smears.

There are 2 types of relapsing fever: Tick-borne relapsing fever (TBRF) and louse-borne relapsing fever (LBRF). LBRF is more severe than TBRF, with case-fatality rates without antimicrobial treatment of 30 to 70 percent in outbreaks. TBRF occurs in the Western hemisphere, Africa, Asia, the Mediterranean region and the Middle East. In the western United States, TBRF is usually associated with sleeping in rustic, rodent-infested cabins in mountainous areas. In the United States, 3 species, _Borrelia hermsii_, _B. parkerii_, and _B. turicatae_, transmitted by the bite of soft-bodied ticks (genus _Ornithodoros_) cause TBRF. A recently discovered _Borrelia_ species, _Borrelia miyamotoi_, has been found in hard-bodied ticks (_Ixodes_) in regions where Lyme disease is endemic.

LBRF is caused by a single species, _Borrelia recurrentis_, transmitted through abraded skin when the body louse is crushed during scratching. LBRF is endemic in Ethiopia, Sudan, Eritrea, and Somalia. Outbreaks are found in developing regions affected by war and in refugee camps characterized by overcrowding and poor personal hygiene. While mammals and reptiles may serve as a reservoir for tick-borne _Borrelia_ species, humans are the only host of _B. recurrentis_.

Treatment of relapsing fever consists of either a tetracycline (such as, doxycycline), a macrolide (such as, erythromycin), penicillin, or other beta-lactam antibiotics (such as, ceftriaxone). LBRF can be treated effectively with a single dose of the antibiotic (<http://jid.oxfordjournals.org/content/137/5/573.abstract>), whereas treatment of TBRF requires 7-10 days to prevent relapse. When initiating antibiotic therapy, all patients should be observed for a Jarisch-Herxheimer reaction. The reaction, caused by massive release of tumor necrosis factor alpha (TNF-alpha), interleukin-6, interleukin-8, and other cytokines, is manifest by a worsening of symptoms with rigors, tachycardia, sweating, hypotension, and high ever, occurs in over 50 percent of cases. The Jarisch-Herxheimer reaction can be fatal. Pretreatment with anti TNF-alpha antibody has been found to suppress Jarisch-Herxheimer reactions (<http://www.nejm.org/doi/full/10.1056/NEJM199608013350503>).

Corticosteroids and antipyretic agents have little or no effect (<http://jid.oxfordjournals.org/content/137/5/573.abstract> and <http://www.ncbi.nlm.nih.gov/pubmed/6132178?dopt=Abstract>), whereas meptazinol, an opioid agonist-antagonist, has been reported to reduce the severity of the reaction (<http://www.ncbi.nlm.nih.gov/pubmed/6132178?dopt=Abstract>). Treatment with intravenous fluids and vasopressors to maintain adequate blood pressure may be required. - ProMed Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Fri, 20 Jan 2012 13:40:00 +0100 (MET)

ADDIS ABABA, Jan 20, 2012 (AFP) - Addis Ababa said Friday that two Germans kidnapped during a deadly attack by unidentified gunmen on a group of tourists in northern Ethiopia had been taken to neighbouring Ethiopia. Germany said it was still investigating the pair's whereabouts. "There is news that they are in Eritrea by now," foreign ministry spokesman Dina Mufti told AFP.

The Germans are believed to have been abducted when gunmen attacked a group of tourists in Ethiopia's remote Afar region earlier this week. Five people were killed in the attack: two Germans, two Hungarians and one Austrian. The German foreign ministry said three members of Germany's Federal Crime Agency were dispatched to Ethiopia to assist search efforts.  "The Federal Crime Agency (has) sent staff to Ethiopia in order to support the Embassy," a spokeswoman for Germany's foreign ministry told AFP from Berlin.  "They are trying to investigate where the two missing Germans could be." Six other Germans were among twelve survivors, some of them wounded, who were flown back to Addis Ababa on Wednesday. A Belgian citizen with gunshot wounds remains in hospital in Mekele in northern Ethiopia. The five bodies have been flown to the capital.

The attack took place near the famed Erte Ale volcano in Ethiopia's sparsely populated Danakil desert, close to the tense Ethiopia-Eritrea border.  The area, which boasts spectacular moon-like landscapes and is famed to be the hottest place on earth, is popular among travellers.  No group has claimed responsibility for the killings, but Ethiopia blamed arch-foe Eritrea for carrying out the attack. Eritrea vehemently denied being behind the incident, calling Ethiopia's claim "ludicrous" and a "smear campaign." The two Horn of Africa countries fought a bloody border war from 1998 to 2000 which killed 70,000 people. The border remains contested, with Ethiopian troops occupying land that international courts say belongs to Eritrea.
Date: Tue, 30 Aug 2011 12:41:08 +0200 (METDST)
by Jenny Vaughan

Shire, Ethiopia, Aug 30, 2011 (AFP) - In Ethiopias Endabaguna refugee camp, rows of gaunt Eritreans clad in rubber sandals give vent to their exasperation after days of trekking and dodging soldiers in an attempt to escape failed crops, hunger and an autocratic government. Over 12 million people across the Horn of Africa are struggling from the region's worst drought in decades, but secretive Eritrea is the only country to deny it has been affected by the crisis. "This year I farmed, but there was lack of rain. I dont know whats going to happen, only God knows," said Mehreteab, a refugee. He escaped from the army, risking death or jail if caught crossing the heavily militarized border, leaving his wife and three children behind. "There is no food and no grain in the home," he said. "I dont have any idea whats going to happen to them." Camps in northern Ethiopia receive about 900 refugees every month from Eritrea, one of the regions most isolated countries. A former colony of Italy and then part of Ethiopia, Eritrea fought a 30-year war with Ethiopia and only gained independence in 1991. A subsequent border conflict with Ethiopia from 1998-2000 still simmers.  Former rebel leader Issaias Afewoki, who has been in power since 1991 without elections, has cracked down on all dissidents and severely restricted press and religious freedom.

The majority of those arriving in the Ethiopian camps are young men escaping conscription, which forces men above 16 to serve in the military for decades on minimal pay. The UN recently called for tighter economic sanctions after releasing a report linking Eritrea to a failed bomb plot at the African Union. According to satellite imagery from the weather monitoring group FEWSNET, rainfall in parts of Eritrea this year has been "below average" - less than 10 percent of normal levels in some areas. Aid workers admit it is nearly impossible to know just how gravely the Eritrea is affected because access to information is so limited in the country where the only media is state-run. "Its been a black hole for us, we dont know whats going on there," said Matthew Conway, spokesman for the UN humanitarian coordination office in Nairobi. "But thats not to say its not happening."

The US ambassador to the United Nations has said she is "deeply concerned" that Eritrea is facing extreme hunger, and urged the government to allow humanitarian access. "The people of Eritrea who most likely are suffering the very same food shortages that were seeing throughout the region are being left to starve," Susan Rice told reporters in New York. And much like other countries in the region, such as Ethiopia and Kenya, Eritrea is vulnerable to increased food prices, exacerbating the crisis. According to the UN agriculture agency, global food prices jumped 33 percent in the last year. "High international prices affected every country in the world, so from that you can assume Eritrea is affected," said Shukri Ahmed, an economist at the Food and Agriculture Organization. Fiercely self-reliant Eritrea stopped sending market information to FAO about three years ago, Ahmed said, so it is impossible to know how much food prices have risen in the country. "Unfortunately, we dont have any information on the ground," he told AFP by phone from Rome.

Over half of Eritrea's food is imported, the FAO estimate, leaving it vulnerable to market fluctuations for staples such as sorghum and maize. Eritrean refugee Berhane, 35, said the cost of food has surged in recent years, though wages have remained the same. Intermittent work as a labourer earned him about $5 per day. But the cost of grain is about $3 per kilo and a sheep is about $170, more than he could make in a month, he told AFP. "How is someone with no money or daily work supposed to buy this?" he asked. "It is too expensive." Facing steep food costs, he relied on a small plot of land to feed his family. But the rains were two months late this year and his harvest failed. "The government doesnt do anything. Nothing. There are no rations," he told AFP.

The Eritrean authorities deny the country is facing food scarcity. "This nonsense about a hidden famine in Eritrea is utterly false," the Eritrea's information ministry said in an online statement last week. Instead, Asmara claims last year's harvest was the best in a decade, while state run media heap praise on government-run food security programs. But refugee Gebrielxavier, 25, said this is not true. He left Eritrea last November because his crop failed, he could not find work and his family went hungry. "We couldnt live. We were famished," he said. "And the government? It did nothing." He is now running a café in the refugee camp, where he earns less than $2 a  day and relies on UN food rations, but says he is still better off. "I got my freedom," he said.
More ...

World Travel News Headlines

Date: Wed, 21 Aug 2019 18:28:15 +0200 (METDST)

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

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

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

Once a worldwide scourge, the number of cases around the globe have fallen by more than 99 per cent since 1988, according to the WHO.   In 2012, Nigeria had 122 polio sufferers, more than half of the 223 victims worldwide.   Despite the progress, aid organisations warned there could be no letup.   "The battle is not over yet," Pernille Ironside, Unicef's deputy representative for Nigeria, said.    "We have to maintain our effort and intensify them to make sure the historic gains are sustained."
Date: Tue, 20 Aug 2019 23:46:29 +0200 (METDST)

Los Angeles, Aug 20, 2019 (AFP) - The jam-band Phish announced Tuesday that plague-infected -- yes, that plague -- prairie dog colonies had forced the cancellation of overnight camping and vending for its annual concert series near Denver.   The band will still play over the Labor Day holiday weekend but said in a statement that health officials overseeing Colorado's Rocky Mountain Arsenal National Wildlife Refuge urged precautionary measures like restricting parking and camping to prevent potential spread of the disease.   "We recognize the tremendous inconvenience this may cause for those who had planned on camping," said Phish, a rock band known for its improvisation and hardcore fan base.   Officials had closed parts of the 15,000-acre refuge starting in July, a statement from the US Fish & Wildlife Service said. Some were re-opened in recent days but several trails remain closed.   Today the plague can be treated with antibiotics but is best known for killing 60 percent of Europe's population during the Black Death of the Middle Ages.

The last epidemic in the United States was in the 1920s in Los Angeles.   Humans can contract the easily spreadable plague from fleas that transmit it from infected rodents, as well as from coming into contact with infected bodily fluids or by inhaling coughed-up bacteria.  

Many dedicated Phish fans had decried the lack of information concerning the August 30-September 1 concerts in the lead-up to Tuesday's announcement: "People are already changing their plans. People are mad," fan Keegan Lauer told a local CNN affiliate of the confusion.   "People are Phish fans and Phish fans that are mad are really mad."
Date: Tue, 20 Aug 2019 23:40:37 +0200 (METDST)

Madrid, Aug 20, 2019 (AFP) - Unions representing Ryanair cabin crew in Spain warned on Tuesday of a 10-day strike in September to protest against the anticipated closing of some airport bases for the low-cast Irish airline.   After meeting with Ryanair representatives for more than seven hours, "which ended without an accord," the unions USO and Sitcpla issued a warning of a strike at 13 Ryanair bases in Spain, the USO said in a statement.   It said the protest was over the possible closing of Ryanair bases at airports on the popular tourist Canary islands of Tenerife and Gran Canaria and also the "future uncertainty" for Girona in northeast Spain.   More meetings between unions and Ryanair management could be held next week, USO said.   Cabin crew are set to observe the strike mainly on Fridays and Sundays in September.

Ryanair had announced last month that it would close some bases because of problems with Boeing's crisis-hit 737 MAX jet, which has been grounded after two fatal accidents.   The Irish no-frills airline said it expected to take delivery of just 30 Boeing 737 MAX 200 jets by the end of May 2020, instead of the 58 that it originally expected, and shortfall would mean it would have to close some bases.   Ryanair also announced in July that it intends to eliminate 900 jobs in its 13,000-strong workforce, and it has faced several protests by employees in Europe.   Pilots in the UK and Ireland warned of strikes in August and September to protest against their working conditions and salaries.
Date: Tue, 20 Aug 2019 15:45:49 +0200 (METDST)

Madrid, Aug 20, 2019 (AFP) - A 90-year-old woman has died and 53 people are in hospital in Spain, including several pregnant women, after eating contaminated meatloaf, officials said Tuesday.   Listeria is a commonly found bacteria and most people who consume foods that contain it do not become ill.  But for elderly people, pregnant women or those with serious conditions like diabetes or cancer, it poses a serious threat.   The outbreak of listeria is affecting mainly the southwestern region of Andalusia where 114 cases have been confirmed, according to the regional health department.

Outside Andalusia, only one case has so far been confirmed in the neighbouring region of Extremadura, Spain's Health Minister Maria Luisa Carcedo told Cadena Ser radio.   A 90-year-old patient affected by the outbreak died overnight at a hospital in Seville, the capital of Andalusia, the regional government said in a statement.   It said another 53 people are in hospital including 18 pregnant women and two new-borns.

Spanish consumer group Facua said two pregnant women who ate meatloaf, suspected of being contaminated with listeria, "lost their babies" in Seville.   An investigation has been opened because there appears to be a link to the outbreak of listeria, the health ministry said.   The regional government of Andalusia warned last Thursday that meatloaf sold under the commercial name "la Mecha" made by Seville-based company Magrudis was the source of a listeria outbreak.   The factory was closed and all of its meatloaves were recalled from shops, the health ministry said.   Listeriosis begins with flu-like symptoms including chills, fever and muscle aches. It can take up to six weeks after consuming contaminated foods for symptoms to occur.
Date: Tue 20 Aug 2019
Source: WTOP [edited]

Health authorities in Spain are on high alert after a 90 year old woman died amid a listeria outbreak in the southern region of Andalusia that has affected more than 110 people.

Jose Miguel Cisneros, director of the infectious disease department at Seville's Virgen del Rocio Hospital, on Tuesday [20 Aug 2019] announced the 1st casualty since the outbreak was declared on 15 Aug [2019]. Authorities have closed the pork meat supplier's plant and recalled all of its products. Cisneros said roughly half of the 114 people affected by the bacteria remain hospitalized.

Health minister Maria Luisa Carcedo said an investigation is looking into how the meat evaded what she called "strict food safety controls".

Listeria is a bacteria that usually causes mild illness in healthy people but can be dangerous to pregnant women and those with weakened immune systems.
======================
[The listeriosis outbreak, which was previously reported to have affected 44 people mainly in the cities of Huelva and Seville (ProMED-mail post Listeriosis - Europe (06): (Spain) meat, recall, alert http://promedmail.org/post/20190817.6627473), is now said to involve 114 people.

Huelva, with a population of 144,258 residents, is a city located along the Gulf of Cadiz coast in south western Spain in the autonomous community of Andalusia (<https://en.wikipedia.org/wiki/Huelva>). Seville, with a metropolitan population of about 1.5 million, is the capital and largest city of the autonomous community of Andalusia, located about 80 km (50 mi) inland from the Gulf of Cadiz coast (<https://en.wikipedia.org/wiki/Seville>).

A map showing the location of Huelva and Seville can be found at

We still have not been told the characteristics of the meat product involved in this listeriosis outbreak. Adequate cooking of the meat before eating should have markedly reduced the risk for listeriosis. However, refrigerated ready-to-eat cold cut meats are well-recognized sources for listeriosis. Even if initial contamination added only a few listeria organisms to the food, the contamination can be significant for refrigerated foods because _Listeria monocytogenes_ can subsequently multiply at refrigerator temperatures to sufficient number to cause disease. Refrigerated ready-to-eat meat products should not be served to people who are likely to be at increased risk for listeriosis, such as pregnant women, adults aged 65 years or older, and people with weakened immune systems.

The meat ("La Mecha" made by the Magrudis company, based in Seville) suspected to be the source has been recalled, but because it can take up to 70 days after exposure to listeria for symptoms of listeriosis to develop, more cases can be expected.

In the USA and Europe, clusters of related cases are identified based on clinical isolates of _L. monocytogenes_ that have similar genotypes. Food is confirmed to be the source if listeria isolated from it has a genotype that matches the genotype of the clinical outbreak strain. We await further developments in the investigation of this outbreak. - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Spain:
Date: Mon 19 Aug 2019
Source: ARY News [edited]

One more case of Congo virus [has been] reported in Karachi as a young boy was diagnosed with the disease after being admitted at a hospital in Nazimabad area, ARY News reported on Sunday [18 Aug 2019]. Doctors confirmed that the 17 year old boy, named as [QS] who is [a] resident of Sohrab Goth and worked at a dairy farm, was diagnosed with Congo virus during the initial medical examination tests.

It is pertinent to mention here that the 1st case of Congo virus was reported on [11 Feb 2019] in the metropolis as a woman, [TF], [who] had been brought to Jinnah Hospital in critical condition.

In 2018, at least 16 deaths were reported in Karachi from the life-threatening virus, and 41 patients -- mainly from Quetta, Balochistan -- were diagnosed with it.

Earlier on [25 Jul 2019], a Congo virus alert had been issued for the metropolis, stipulating precautionary instructions for all those people who visit cattle farms. The alert was issued by Karachi Metropolitan Corporation (KMC) to hospitals, directing the management to adopt special precautions for a Congo-affected patient. The letter of the KMC further asked hospitals to establish special wards for Congo patients, and run awareness campaigns about the virus through banners and posters.

The disease is caused when a tick attaches itself to the skin of cattle, and when that infected tick or animal comes in contact with people, the highly contagious virus is transmitted into the human body and the person falls ill. This disease has a 40% to 50% mortality rate. The initial symptoms of Congo fever include headache, high fever, rashes, back pain, joint pain, stomach pain and vomiting.

Precautions: people should wear light-coloured and airy clothes while going to cattle farms. Use of mask and gloves is also recommended while touching animals.
Date: Wed 21 Aug 2019
Source: The Canberra Times [edited]

Australian Capital Territory (ACT) health officials are investigating a cluster of hepatitis A cases in Canberra's South Korean community. There have been 8 cases of the virus in the ACT and Sydney since June 2019. The cluster of cases comes as South Korea experiences a large outbreak of the virus, with more than 11,000 cases reported in the country in 2019.

ACT Health said it was working with its counterparts in New South Wales to investigate the cause of the outbreak. An ACT Health spokesman said most of the people affected by hepatitis A in recent weeks in Canberra had not reported travelling overseas recently. "Australia has a low incidence of hepatitis A, and when outbreaks occur, they are linked to consumption of contaminated food products or person-to-person spread," the spokesperson said. "However, at this stage of the investigation, no specific food has been connected to the outbreak."

Symptoms of the virus may include nausea, vomiting, fever and yellowing of the skin, dark urine and pale stools.

"The ACT Health directorate is reminding the South Korean community in Canberra and anyone travelling to South Korea, of the importance of vaccination prior to travel and practicing good hand hygiene to reduce the risk of spread," the spokesman said. Health officials have recommended at least one dose of a hepatitis A vaccination before travel. Two doses prevent an infection.

Handwashing in soap and water for at least 15 seconds has also been recommended by health officials to help prevent the spread of the virus.
===================
[Since no travel was involved, it is not clear if the cases were from imported food, food contaminated by an infected food handler or from transmission from an asymptomatic person. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Australia:
Date: Tue 20 Aug 2019, 4:29 PM
Source: Arka News Agency [edited]

Anthrax cases have been reported in Geghhovit community of Armenia's Gegharkunik province, the press office of Armenia's health ministry reported on [Tue 20 Aug 2019]. According to the ministry's press release, 2 residents of the community came to a medical centre in Martuni with sores on their fingers. The patients told doctors that they had taken part in butchering a cow of a fellow villager.

The health ministry has dispatched its experts to the community. As a result of joint efforts with local medical centres' workers, 6 other infected people have been found. All the patients are being treated now, and the community is under medical control now. The Armenian Food Safety Agency has been informed.
===================
[Gegharkunik province is on the eastern border of Armenia and pokes into Azerbaijan; see:
<http://legacy.lib.utexas.edu/maps/commonwealth/armenia_pol_2002.jpg>

Geghhovit is south of Sevana Lich (lake); see:

When the dust settled there were 2 initial cutaneous cases subsequent to them butchering a neighbour's cow, which would have been sick or dead. The first report suggests that they might have butchered a number of "cattle" carcasses, though the 2nd report has a single cow. And in due course another 6 villagers came down with cutaneous anthrax as they were sent to the local hospital merely for diagnostic confirmation.

Anthrax is sporadic in Armenia and thus the risks of butchering sick and dead animals are only realised after the onset of human anthrax lesions. And the number of human cases can exceed the indirectly reported livestock cases. - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Date: Mon 19 Aug 2019
Source: Centers for Disease Control and Prevention (CDC) [edited]

Viral hepatitis, outbreaks, hepatitis A outbreaks
-------------------------------------------------
Since March 2017, CDC's Division of Viral Hepatitis (DVH) has been assisting multiple state and local health departments with hepatitis A outbreaks, spread through person-to-person contact.

The hepatitis A vaccine is the best way to prevent HAV infection.

The following groups are at highest risk for acquiring HAV infection or developing serious complications from HAV infection in these outbreaks and should be offered the hepatitis A vaccine in order to prevent or control an outbreak:
- people who use drugs (injection or non-injection);
- people experiencing unstable housing or homelessness;
- men who have sex with men (MSM);
- people who are currently or were recently incarcerated; and
- people with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C.

One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% seroprotection in healthy individuals for up to 11 years.

Pre-vaccination serologic testing is not required to administer hepatitis A vaccine. Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable.
[further information available at URL above]
=============================
[Overall, the top 4 states for HAV cases remain Kentucky, Ohio, Florida and West Virginia.

As the numbers of cases continue to raise in a number of states, and news of smaller (so far) outbreaks occur in others, the question at the end of ProMED-mail post http://promedmail.org/post/20190104.6241686 by a Kentucky official -- "This is a disease of developing countries. One has to ask: Why are we seeing it in the USA?" -- is more and more relevant. We are seeing these outbreaks because of the inability to deal with marginalized populations among our midst. The dramatic cutbacks in public health infrastructure in some of these states clearly feed the fire of these outbreaks. They must be addressed by bolstering public health resources and education and directly addressing the needs of these marginalized populations. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Fri 16 Aug 2019
Source: Fox News [edited]

A 7 year old girl from Mt Vernon, Ohio has been infected with a rare mosquito borne virus that, in severe cases, can cause encephalitis, or an inflammation of the brain. The girl, who was not identified, has been confirmed to have La Crosse virus (LACV), local news outlet Knox Pages reported, citing the Knox County Health Department. It wasn't immediately clear where or when the girl was infected.

La Crosse virus is typically caused by a bite from an infected eastern tree-hole mosquito [_Aedes triseriatus_], which "lays its eggs in tree holes and man-made containers" and "typically bites during the day", according to the Centers for Disease Control and Prevention (CDC).

A rare disease -- there is an average of 70 cases in the United States each year, according to the federal health agency -- LACV can make a person feel ill with fever, headache, nausea, vomiting, and fatigue. Most people begin to notice symptoms 5 to 15 days after they are bitten. In severe cases, however, LACV can lead to encephalitis -- though this is commoner in children under 16 "and is often accompanied by seizures," says CDC. "Coma and paralysis occur in some cases," it added.

The disease is diagnosed through blood and spinal fluid tests. There's no specific treatment for the mosquitoborne ailment. "Antibiotics are not effective against viruses, and no effective anti-viral drugs have been discovered. Severe illnesses are treated by supportive therapy which may include hospitalization, respiratory support, IV fluids, and prevention of other infections," CDC added, noting that most people infected make a full recovery.

People are most at risk for LACV if they live in wooded areas. Most cases in the US have occurred in upper Midwestern, mid-Atlantic and southwestern [sic. southeastern] states. Ohio, specifically, sees about 20 cases of the disease each year, according to the Knox Pages.

The best way to prevent LACV and other mosquitoborne ailments is by draining standing water -- like in birdbaths, buckets or on pool covers -- which can serve as a breeding ground for these insects. Other preventative measures include covering skin with long-sleeved pants and shirts while outside and using insect repellent containing DEET or another EPA-recognized ingredient.  [byline: Madeline Farber]
=======================
[The previous case of La Crosse virus encephalitis in Ohio was in a boy, also 7 years old. Severe neurological cases of La Crosse virus encephalitis mainly occur in pre-school age children. They are seldom fatal, but prolonged hospitalization and sequelae including personality changes, may occur.

As noted earlier, La Crosse encephalitis virus (LACV) is a member of the California serogroup of arboviruses. A map of the distribution of California virus serogroup neuroinvasive disease cases (mainly LACV cases) shows 3 major focal geographic areas: (1) in the unglaciated areas of south eastern Minnesota/south western Wisconsin/north western Illinois, (2) Ohio, where this case occurred, and (3) the central Appalachian Mountain areas of Virginia/West Virginia and North Carolina/Tennessee, (see the CDC map at <http://www.cdc.gov/lac/tech/epi.html>).

Cases may occur earlier in the summer season than other arthropod-borne viruses because the virus can be transovarially transmitted by the infected female to her eggs, so that emerging adults may already be infected and ready to transmit the virus without the need to take an infectious blood meal from an infected forest mammal. It is wise to eliminate fresh water catchments, which are breeding sites of _Aedes triseriatus_, the La Crosse virus vector mosquito. The Asian tiger mosquito _Aedes albopictus_ can also transmit the virus.

The CDC has a good summary of LACV, its epidemiology, geographic distribution, and clinical characteristics at

An image of _Aedes triseriatus_ can be seen at

[HealthMap/ProMED map available at:
Ohio, United States: <http://healthmap.org/promed/p/237>]