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Armenia

Armenia US Consular Information Sheet
January 05, 2009
COUNTRY DESCRIPTION:
Armenia is a constitutional republic with a developing economy. Tourist facilities, especially outside Yerevan, the capital, are not highly developed, and many of
he goods and services taken for granted in other countries may be difficult to obtain. Read the Department of State’s Background Notes on Armenia for additional information.
ENTRY/EXIT REQUIREMENTS: A passport and visa are required. U.S. citizens may purchase visas in advance for a stay of up to 120 days online at http://www.armeniaforeignministry.am/ for the fee of USD 60; however, this visa is valid only for entry at Zvartnots airport in Yerevan. At this time a visa valid for 120 days may also be obtained upon arrival at the port of entry for the fee of 15,000 Armenian Drams (approx. USD 50). Visas for up to 120 days may be purchased at the Armenian Embassy in Washington, D.C. or the Consulate General in Los Angeles for the fee of USD 69. For further information on entry requirements, contact the Armenian Embassy at 2225 R Street NW, Washington, DC 20008, tel. (202) 319-1976 and (202) 319-2983; the Armenian Consulate General in Los Angeles at 50 N. La Cienega Blvd., Suite 210, Beverly Hills, CA 90211, tel. (310) 657-7320, or visit the Armenian Embassy’s web site at http://www.armeniaemb.org for the most current visa information.

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

SAFETY AND SECURITY:
A cease-fire has been in effect since 1994 around the self-proclaimed “Republic of Nagorno-Karabakh,” an unrecognized ethnic Armenian enclave within Azerbaijan. However, intermittent gunfire along the cease-fire line and along the border with Azerbaijan continues. Because of the existing state of hostilities, consular services are not available to Americans in Nagorno-Karabakh. Travelers should exercise caution near the Armenia-Azerbaijan border and consult the Country Specific Information for Azerbaijan if considering travel to Nagorno-Karabakh from Armenian territory. Armenia's land borders with Turkey, Azerbaijan, and the Nakhichevan Autonomous Republic of Azerbaijan remain closed and continue to be patrolled by armed troops who stop all people attempting to cross. There are still land mines in numerous areas in and near the conflict zones.

Political rallies in the aftermath of the February 2008 presidential elections turned violent. Clashes between government security forces and opposition demonstrators resulted in dozens of casualties, including 10 fatalities, in early March 2008. While the opposition continued to hold periodic protests over the summer and early fall, there have been no violent confrontations since the March events.
Americans should be mindful that even demonstrations intended to be peaceful could turn confrontational and possibly escalate into violence. American citizens are urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations.

Armenia is an earthquake- and landslide-prone country. In addition to these natural disasters, there exists the possibility of chlorine gas spills and radiation poisoning due to industrial accidents.
The Soviet-era Armenia Nuclear Power plant is located in Metsamor, approximately 30 kilometers southwest of Yerevan.
Armenia is currently under international pressure to close the plant permanently, due to safety concerns.

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada or for 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: Crime against foreigners is relatively rare in Armenia. Break-ins, particularly of vehicles, and theft are the most common crimes, but there have been instances of violent crime as well.
While the incidence of violent crime remains lower than in most U.S. cities, American citizens are urged to exercise caution and to avoid traveling alone after dark in Yerevan. Several American investors have also reported being involved in disputes over property ownership, and have had to seek legal recourse through a long, and in the majority of cases, unsuccessful court proceeding.
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 U.S. Embassy. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy for assistance. The Embassy staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. For information on assistance in the U.S. including possible compensation, see our Victims of Crime.
The local equivalents to the “911” emergency line in Armenia are: 101 - fire emergency; 102 - police emergency; 103 - medical emergency; and 104 - gas leak.
MEDICAL FACILITIES AND HEALTH INFORMATION: Though there are many competent physicians in Armenia, medical care facilities are limited, especially outside the major cities. The U.S. Embassy maintains a list of English-speaking physicians in the area. Most prescription medications are available, but the quality varies. Elderly travelers and those with existing health problems may be at risk due to inadequate medical facilities.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Armenia.

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 Armenia is provided for general reference only and may not be totally accurate in a particular location or circumstance.
Travel in Armenia requires caution. Public transportation, while very inexpensive, may be unreliable and uncomfortable. Travel at night is not recommended, and winter travel can be extremely hazardous in mountain areas and higher elevations.
Travelers should avoid the old highway between the towns of Ljevan and Noyemberyan in the Tavush region, as well as the main highway between the towns of Kirants and Baghanis/Voskevan. The U.S. Embassy has designated this portion of the road off-limits to all U.S. Government personnel because of its proximity to the cease-fire line between Armenian and Azerbaijani forces, a line which has seen numerous cease-fire violations over the years.

On weekends, there are an increased number of intoxicated drivers on Armenian roads. American citizens are urged to exercise particular vigilance while traveling on the main highway from Yerevan to the resort areas of Tsaghkadzor and Sevan. Traffic police will attempt to stop individuals driving erratically and dangerously, but police presence outside of Yerevan is limited.

Armenia does have emergency police and medical services, but they may take time to reach remote regions.
With the exception of a few major arteries, primary roads are frequently in poor repair, with sporadic stretches of missing pavement and large potholes. Some roads shown as primary roads on maps are unpaved and can narrow to one lane in width, while some newer road connections have not yet been marked on recently produced maps.
Secondary roads are normally in poor condition and are often unpaved and washed out in certain areas. Street and road signs are poor to nonexistent. Truck traffic is not heavy except on the main roads linking Yerevan to Iran and Georgia, i.e. the roads virtually all travelers need to use when traveling overland to those countries. Minibuses are considered more dangerous than other forms of public transportation. Travelers who choose to ride minibuses should exercise caution because these vehicles are often overcrowded and poorly maintained, commonly lack safety measures including seatbelts, and are frequently involved in accidents.

People driving in Armenia should be aware that “road rage” is becoming a serious and dangerous problem on Armenian streets and highways.
For safety reasons drivers are encouraged to yield to aggressive drivers.
Incidents of physical aggression against drivers and pedestrians have occurred

Though crime along roadways is rare, the police sometimes seek bribes during traffic stops. Drivers in Armenia frequently ignore traffic laws, making roadways unsafe for unsuspecting travelers.
Pedestrians often fail to take safety precautions and those driving in towns at night should be especially cautious. In cities, a pedestrian dressed in black crossing an unlit street in the middle of the block is a common occurrence.

The quality of gasoline in Armenia ranges from good at some of the more reliable stations in cities to very poor. The gasoline and other fuels sold out of jars, barrels, and trucks by independent roadside merchants should be considered very unreliable.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Armenia, the U.S. Federal Aviation Administration (FAA) has not assessed Armenia’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.
Travelers on Armavia International Airways may experience prolonged delays and sudden cancellations of flights. Air travel to Armenia via European carriers is typically more reliable. Ticketed passengers on flights leaving Yerevan should reconfirm their reservations 24 hours prior to departure.
SPECIAL CIRCUMSTANCES:
Armenia remains largely a cash-only economy. Credit cards are accepted at some businesses, including major hotels and restaurants in Yerevan, but rarely outside of the capital. Limited facilities exist for cashing traveler's checks and wiring money into the country. There are a number of ATMs in the center of Yerevan. Dollars are readily exchanged at market rates. Travelers may experience problems with local officials seeking bribes to perform basic duties.

Armenian customs authorities may enforce strict regulations concerning temporary importation into or export from Armenia of items such as firearms, pornographic materials, medication, and communications equipment. For export of antiquities and other items that could have historical value, such as paintings, carpets, old books, or other artisan goods, a special authorization is required in advance from the Armenian Ministry of Culture. It is advisable to contact the Embassy of Armenia in Washington, DC or Consulate General in Los Angeles for specific information regarding customs requirements.

Please see our Customs Information.

Dual Nationals: Changes to Armenian legislation now permit Armenian citizens to hold dual citizenship. This means that U.S. citizens who emigrated from Armenia to the U.S. and subsequently acquired U.S. citizenship without explicitly giving up their Armenian citizenship may be able to (re)acquire Armenian citizenship along with all the associated rights and duties, e.g. the right to vote in Armenian elections and/or the duty for certain males to perform military service. The new law also means that dual citizens need to enter and leave Armenia on their Armenian passport, i.e. they would no longer need an Armenian visa. U.S. citizens interested in obtaining Armenian citizenship must register their dual citizenship with Passport and Visa Department of the Police of the Republic of Armenia (formerly OVIR) by simply presenting proof of their other citizenship (e.g. passport). For more information, please consult with Passport and Visa Department of the Police (tel.: +37410-501439) and/or http://www.armeniaforeignministry.am.

Compulsory Military Service: In addition to being subject to all Armenian laws affecting U.S. citizens, dual nationals are also subject to other laws that impose special obligations on Armenian citizens. Male U.S. citizens over the age of 18 who are also considered to be Armenian citizens may be subject to conscription and compulsory military service upon arrival, and to other aspects of Armenian law while in Armenia.
Armenian authorities have regularly detained U.S. citizens on these grounds upon their arrival in or departure from Armenia. In most cases, ethnic Armenian travelers who are accused of evading Armenian military service obligations are immediately detained and later found guilty of draft evasion. Penalties for those convicted are stiff and include jail time or a substantial fine. Those who may be affected are strongly advised to consult with Armenian officials and inquire at an Armenian embassy or consulate to their status before traveling. For additional information on dual nationality, see our dual nationality flyer.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offences. Persons violating Armenian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Armenia 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 Armenia 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 Armenia. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. The American Citizen Services section of the U.S. Embassy in Yerevan maintains a computer terminal in the consular waiting room available to U.S. citizens for registration. The U.S. Embassy provides Internet access to the general public through the American Corners program and through the U.S. Embassy's Information Resource Center. American Corners are located in Yerevan (2 Amiryan Street, tel. +374-10-56-13-83), Gyumri (68 Shirakatsi Street, tel. +374-312-22153), Vanadzor (25, Vardanants Street, tel. +374-322-21672), and Kapan (6, Shahumyan Street, tel. +374-285-22151). By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy in Yerevan is located at 1 American Avenue, tel. +374-10-46-47-00 and fax: +374-10-46-47-42. The Consular Section is open from 9:00 a.m. until 5:00 p.m., with time reserved for American citizen services from 1:30 p.m. until 4:30 p.m., Monday through Friday, except for official U.S. Embassy holidays. For more information, see the Embassy's web site at http://yerevan.usembassy.gov/
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This replaces the Country Specific Information dated June 9, 2008 to update sections on Entry and Exit Requirements, Safety and Security, Traffic Safety and Road Conditions, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Fri 7 Feb 2020
Source: Armenian Press [edited]

Influenza A virus subtype H1N1 (swine flu) cases have been recorded among students of the A Pushkin public school in Yerevan, principal Natalia Stepanyan told Armenpress. She said so far 10 parents have submitted sick leaves on their children having H1N1. The headmaster said 552 out of the total 1800 students did not show up to classes on 7 Feb [2020].

"We have 2 shifts: 1500 students study at 1st shift, and 452 of them are absent, while 100 are absent from the 300-student 2nd shift. We still don't know how many of those absent are sick with the flu since not all parents take their children to hospitals and not all bring sick leaves," Stepanyan said.

School doctors are carrying out regular monitoring among the children, and in the event of suspected cases, parents are asked to take their children to hospitals for check-ups.

Earlier on 6 Feb 2020, the healthcare ministry said cases of respiratory infections are increasing in the country. Out of 740 sample tests during the season, 18.5% were confirmed to be influenza A virus subtype H1N1, 5.5% were subtype B, and 24.7% were other viruses (rhinovirus, adenovirus, etc).  [byline: Stepan Kocharyan, editor and translator]
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: Fri 8 Mar 2019
Source: Nouvelles Armeni Magazine [in French, trans. ProMED Corr SB, abridged, edited]

A 2nd case of measles infection was reported in Armenia on Wednesday [6 Mar 2019], the country's Ministry of Health press office reported. A person infected with this disease arrived on 20 Feb [2019] in Armenia through the territory of Georgia. Clinical symptoms became visible on 25 and 26 Feb [2019], which was initially explained as drug intolerance, but later, on 6 Mar [2019], a laboratory test diagnosed measles disease.

According to the Ministry of Health, the 1st measles infection was reportedly found in Armenia by a Ukrainian citizen who arrived in Yerevan by plane from Kiev on 24 Feb [2019].

The 2 infected people had contact with many people, particularly those in the airport lobby and at the hospital.
17th February 2019

- National. 14 Feb 2019. 57 cases of dengue in Armenia [have been] recorded to date; the figure increased in 2019 compared to the year 2018. The increase in records so far in 2019 is 25.
Date: Sun, 29 Jul 2018 12:23:52 +0200
By Mariam HARUTYUNYAN

Arinj, Armenia, July 29, 2018 (AFP) - When Tosya Gharibyan asked her husband to dig a basement under their house to store potatoes, she had little idea the underground labyrinth he would eventually produce would prove to be one of Armenia's major tourist draws.   Their one-storey house in the village of Arinj outside the capital Yerevan may not look like much but today it brings in visitors from all over the globe after a 23-year labour of love by Tosya's late husband, Levon Arakelyan.   They come to see a twisting network of subterranean caves and tunnels known as "Levon's divine underground."

In the cold and quiet, Tosya leads tourists through corridors that connect seven chambers adorned with Romanesque columns and ornaments like those on the facades of mediaeval Armenian churches.   "Once he started digging, it was impossible to stop him," she said of the project that began in 1995. "I wrangled with him a lot, but he became obsessed with his plan."   A builder by training, Levon would toil for 18 hours a day -- only pausing to take a quick nap and then rush back to the cave, confident that he was being guided "by heaven".   "He never drew up plans and used to tell us that he sees in his dreams what to do next," his widow told AFP.

Over more than two decades he hammered out the 280-square-metre (3,000 square-foot) space, 21 metres deep into strata of volcanic rocks -- only using hand tools.   "My primary childhood recollection is the loud knock of my father's hammer heard at night from the cave," said his 44-year-old daughter Araksya.   At the start he had to break through a surface layer of black basalt, but at the depth of a few metres Levon reached much softer tufa stone and the work progressed.   He pulled out 600 truckloads of rocks and earth, using only hand-held buckets.   Levon died in 2008 at the age of 67 from a heart attack after destroying the last wall that separated two tunnels.

- 'Amazing place' -
A decade on from the project's completion, Tosya also runs a small museum commemorating her husband's work in the village of some 6,000 people.   The underground complex has several analogues in the world.   An eccentric man named William Henry "Burro" Schmidt spent more than three decades digging a half-a-mile tunnel to transport gold through a granite mountain in California, beginning his work in the early 1900s during the state's gold rush.

In Ethiopia a man named Aba Defar began carving churches on a mountainside after claiming divine inspiration from years of dreams.   Today the Armenian cave features prominently in travel brochures, regularly drawing busloads of visitors.   Milad, a 29-year-old Iranian tourist, called the maze an "amazing place".   He said it made him realise just "how boundless the spiritual and physical capabilities of a person can be".
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Bermuda

Bermuda US Consular Information Sheet
March 10, 2009
COUNTRY DESCRIPTION:
Bermuda is a highly developed British overseas territory with a stable democracy and modern economy. Tourist facilities are widely available. Read the Department of
tate Background Notes on Bermuda for additional information.

ENTRY/EXIT REQUIREMENTS:
Travelers may contact the British Consulate in New York, telephone (212) 745-0273/3206/0281, or the British Consulate in Atlanta, Boston, Chicago, Dallas, Los Angeles, or San Francisco or the Bermuda Department of Immigration.

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

Applications for the new U.S. Passport Card are now being accepted and have been in full production since July 2008.
The card may not be used to travel by air and is available only to U.S. citizens. Further information on the passport card and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site.
We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel.
American citizens can visit our web site or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

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

CRIME:
Bermuda has a moderate but growing crime rate. Recent crime statistics can be viewed at the official web site of the Bermuda Police Service.
Examples of common crimes include theft of unattended baggage and items from rental motorbikes, purse snatching (often perpetrated against pedestrians by thieves riding motorbikes), mugging, and theft from hotel rooms. Valuables left in hotel rooms (occupied and unoccupied) or left unattended in public areas are vulnerable to theft. The Consulate regularly receives reports of thefts of money, valuables, and passports and advises that travelers keep their hotel windows and doors locked at all times. Criminals often target transportation systems and popular tourist attractions.

Travelers should exercise caution when walking after dark or visiting out-of-the-way places on the island, as they can be vulnerable to theft and sexual assault, and because narrow and dark roadways can contribute to accidents.
In the past, there have been incidents of sexual assault and acquaintance rape; the use of “date rape” drugs such as Rohypnol has been reported in the media and confirmed by local authorities. Travelers should also note an increase in gang presence in Bermuda and should take regular precautions to avoid confrontation. The back streets of Hamilton are often the setting for nighttime assaults, particularly after the bars close.

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.

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 Bermuda laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Bermuda are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

SPECIAL CIRCUMSTANCES:
The Department of State warns U.S. citizens against taking any type of firearm or ammunition into Bermuda.
Entering Bermuda with a firearm, some kinds of knives or even a single round of ammunition is illegal, even if the weapon or ammunition is taken into the country unintentionally.
The Bermudian government strictly enforces its laws restricting the entry of firearms and ammunition.
Permission to import or own a gun in Bermuda must be sought in advance from the Bermuda Police Service. Any privately owned firearms must be secured at Bermuda Police Headquarters. Violations may result in arrests, convictions, and long prison sentences.

ATMs are widely available in Bermuda. Local banks may not accept checks drawn on U.S. accounts, but some Front Street stores catering to the tourist trade will accept U.S. checks as payment. The local American Express office will cash U.S. checks up to $500.00 for a three-percent fee. Credit cards are widely accepted at all establishments.
U.S. citizens who are taking prescription medication must inform Bermuda customs officials at the point of entry. Medicines must be in labeled containers. Travelers should carry a copy of the written prescription and a letter from the physician or pharmacist confirming the reason the medicine is prescribed.

Bermuda customs authorities may enforce strict regulations concerning temporary importation into or export from Bermuda of items such as animals, arms, ammunition and explosives, building sand, crushed rock, gravel, peat and synthetic potting media, foodstuffs (animal origin), fumigating substances, gaming machines, historic articles (relating to Bermuda), lottery advertisements and material, motorcycles, motor vehicles, obscene publications, organotin anti-fouling paint, plants, plant material, fruits and vegetables (living or dead, including seeds), pesticides, prescription drugs, prohibited publications, seditious publications, soil, VHF radios, radar and citizens band (CB) radios. For additional information on temporary admission, export and customs regulations and tariffs, please contact Bermuda Customs at telephone 1-441-295-4816, by email, or visit the Bermuda Customs web site.

The emergency number in Bermuda for police, fire, and medical assistance is 911.
Please see our Customs Information.

MEDICAL FACILITIES AND HEALTH INFORMATION:. Good medical care is available, though extremely expensive. The hospital performs general surgery and has an intensive care unit. Serious or complex medical problems will likely require medical evacuation to the United States. Most Bermudian health care providers (including the local hospitals) do not accept overseas insurance and will expect payment at the time of service.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Bermuda.
However, visitors with visible indicators of any communicable disease can be refused entry into Bermuda.
Foreign residents who test positive for TB are required to submit x-rays before approval is granted for them to reside in Bermuda.

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

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

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

Traffic in Bermuda moves on the left side of the road and the roads are very narrow, often with no defined shoulder. The maximum speed limit in the city of Hamilton is 25 kph (15 mph) and 35 kph (21 mph) on the rest of the island. Under Bermudian law, non-residents are not allowed to own, rent, or drive four-wheeled vehicles. Non-residents must rely on taxis, the excellent local bus system, or motor scooters. Traffic is moderate, but road accidents - particularly involving motorbikes - are common and often result in serious injuries or death.

Rental motor scooters are readily available, and the required helmet is provided. However, visitors should carefully consider whether or not it is worth the risk to ride a scooter. Motor scooters provide the greatest road peril in Bermuda; local operators tend to abuse the speed limit more than other drivers, and they will often pass on the left or right with no warning. Those unfamiliar with driving on the left are likely to find the roundabouts and regulations for yielding at junctions confusing and dangerous. In addition, vehicles often stop on the side of the road, blocking one lane of traffic. Main roads, while generally in good condition, are extremely narrow and tend to be bordered by heavy vegetation or low stone walls. Travelers who rent scooters should be aware that scooter accidents involving visitors are relatively common, and they can be fatal or involve serious injuries.

Taxis are readily available. The local bus system, which is excellent and relatively inexpensive, services the length of the island and stops close to most beaches, hotels, the downtown shopping area, and other points of interest. In addition, water ferry service to a variety of stops around the island is available seven days a week, and is a very safe and enjoyable mode of transportation.

For specific information concerning Bermuda driver's permits, vehicle inspection, road tax and mandatory insurance, please contact the Bermuda Department of Tourism offices at 310 Madison Avenue, Suite 201, New York, NY, telephone (212) 818-9800.

Please refer to our Road Safety page for more information.
You may also visit Bermuda’s Ministry of Tourism and Transportation online.

Emergency services may be called at 911, and response time is generally good.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Bermuda’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Bermuda’s air carrier operations.

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 Bermuda are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Bermuda.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Consulate General is located at Crown Hill, 16 Middle Road, Devonshire DV03, and telephone 1-441-295-1342. Office hours for American Citizens Services are 1:30-3:30 Monday-Wednesday and 8:30-10:30 on Thursdays, except Bermudian and U.S. holidays. American citizens in need of after-hours emergency assistance may call the duty officer at telephone 1-441-335-3828. The Consulate General’s American Citizen Services office provides routine information online.
* * *
This replaces the Country Specific Information for Bermuda dated 23 June 2008, to update sections on entry/exit requirements, crime, information for victims of crime, special circumstances and medical facilities & health information.

Travel News Headlines WORLD NEWS

Date: Wed, 18 Sep 2019 03:56:31 +0200 (METDST)

Washington, Sept 18, 2019 (AFP) - Hurricane Humberto strengthened to a major Category 3 storm on Tuesday and was expected to pass near Bermuda, threatening it with dangerous waves and heavy rain, the US National Hurricane Center said.   "Hurricane conditions are expected to reach Bermuda by Wednesday night and continue into early Thursday morning," the Miami-based NHC said.   "Some fluctuations in intensity are likely during the next day or so, but Humberto should remain a powerful hurricane through Thursday," it said.   As of 8:00 pm (0000 GMT), the storm had maximum sustained winds of 115 miles per hour (185 kilometers per hour) and was moving east-northeast at 12 miles per hour.
Date: Thu, 16 Oct 2014 15:04:20 +0200 (METDST)

WASHINGTON, Oct 16, 2014 (AFP) - Hurricane Gonzalo gained strength overnight into Thursday as it barrelled in the Atlantic toward Bermuda, which was bracing for a hit from the powerful Category Four storm.   Gonzalo's winds were whirling at 140 miles (220 kilometres) per hour, taking it back up a notch on the five-point Saffir-Simpson scale, The US National Hurricane Center said.    It was expected to pass Friday near Bermuda, which could see flooding along the coast. A hurricane warning was in effect for the British overseas territory.

At 1200 GMT, it was located about 525 miles (225 kilometres) south-southwest of the Bermudian archipelago. It was moving north at nine miles per hour, according to the Miami-based NHC.   "This general motion is expected to continue today," the NHC said.   "A turn toward the north-northeast and an increase in forward speed are expected tonight and Friday."   But the forecasters stressed that major hurricanes like Gonzalo tend to fluctuate in strength.    The storm could weaken later Thursday and on Friday, but Gonzalo is on track to be a "dangerous hurricane" when it moves near Bermuda, the NHC said.

The NHC noted that elevated and hilly terrain could face especially strong winds, since wind speeds atop and on the windward sides can often be up to 30 percent stronger than at the surface.   "A dangerous storm surge is expected to produce significant coastal flooding in Bermuda," the NHC said.   "Near the coast, the surge will be accompanied by large and destructive waves."   Up to six inches (15 centimetres) of rain were expected over Bermuda.   Large swells triggered by Gonzalo were already affecting parts of the Virgin Islands, the northern coast of Puerto Rico and the Dominican Republic, as well as portions of the Bahamas.

Swells were expected to reach much of the US East Coast and Bermuda later Thursday.   "These swells are likely to cause life-threatening surf and rip current conditions," the NHC said.   Three people were reported missing in the islands of St Martin and St Barthelemy after the storm passed, and French authorities expressed concern about four other people they were trying to contact.   The storm caused property damage on both islands, which were battered by strong winds and heavy rains.

- Seventh storm of the season -
Gonzalo is the seventh storm of the Atlantic season -- which stretches from June to November -- and the third hurricane to slam the Caribbean this year.    Hurricane Cristobal left at least four people dead in late August when it trashed the Bahamas, Turks and Caicos Islands and Dominican Republic with heavy rains causing serious flooding.     The NHC predicted that storm activity will be lower than average this year.
Date: Wed, 27 Aug 2014 01:09:20 +0200 (METDST)

MIAMI, Aug 26, 2014 (AFP) - Strengthening Hurricane Cristobal killed at least four people in the Caribbean and then trained its deadly sights Tuesday on the holiday paradise of Bermuda, officials and meteorologists said.   The storm dumped torrential rain on the Bahamas, Turks and Caicos Islands and Dominican Republic, triggering flooding and killing four people, authorities there said.

Cristobal was packing maximum sustained winds of 75 miles (120 kilometres) per hour, the Miami-based National Hurricane Center (NHC) said in its latest forecast, at 2100 GMT.   It was moving north towards Bermuda at 10 miles per hour, the NHC said, warning its impact was also being felt in the United States.   "The centre of Cristobal is expected to pass northwest of Bermuda on Wednesday and Wednesday night," the NHC said.   It added: "Swells generated by Cristobal are affecting portions of the United States coast from central Florida northward to North Carolina and will spread northwards later this week."

A tropical storm watch was already in effect for Bermuda, forecasters said, meaning inclement conditions were possible in the next 24 hours.   Cristobal, a category one hurricane, is the third hurricane of the Atlantic storm season.   It comes hot on the heels of Hurricane Marie, which briefly reached the highest possible category five destructive power but was weakening in the Pacific off Mexico.   Marie's crashing waves over the weekend caused a fishing vessel to capsize, with three of its occupants still missing and presumed dead.
Date: Tue, 26 Aug 2014 10:34:53 +0200 (METDST)

WASHINGTON, Aug 26, 2014 (AFP) - Hurricane Cristobal churned slowly toward Bermuda on Tuesday after dumping rain on the Bahamas and the Turks and Caicos Islands, US forecasters said.   The storm was due to pass west and north of Bermuda on Wednesday, the US National Hurricane Center said.   Cristobal was packing maximum sustained winds of 75 miles (120 kilometre) per hour as it whirled some 655 miles southwest of Bermuda.

A turn to the northeast with a gradual increase in forward speed is forecast to occur over the next 48 hours, an NHC bulletin said.   A tropical storm watch was in effect for Bermuda.   Meanwhile, Hurricane Marie was pounding heavy waves into Mexico's Pacific coast, where three fishermen went missing after their boat capsized.   An estimated 10,000 families were affected by the storm as it flooded homes, damaged roads and caused rivers to overflow their banks.   The storm weakened to a category three hurricane on the five-point Saffir-Simpson scale late Monday.   No coastal watches or warnings were in effect.
Date: Wed, 11 Sep 2013 00:14:11 +0200 (METDST)

MIAMI, Florida, Sept 10, 2013 (AFP) - Bermuda braced Tuesday for Tropical Storm Gabrielle, as US forecasters warned it was strengthening and on track to hit or closely pass by the popular vacation spot.   Meanwhile, fellow Tropical Storm Humberto, churning far off land in the Atlantic, appeared on the cusp of becoming a hurricane.

Packing maximum sustained winds near 70 miles per hour (110 kilometers per hour), Humberto was about 245 miles (400 kilometers) west of the southernmost Cape Verde Islands, the National Hurricane Center said.   "Humberto (is) almost a hurricane," it said in a 2100 GMT advisory, adding the storm could surge to hurricane force either later Tuesday or Wednesday.   However, no coastal watches or warnings were in effect.

Gabrielle, with maximum sustained winds near 60 miles per hour (96 km/h), was some 55 miles (88.5 km) south of Bermuda, according to a separate 2100 GMT advisory from the Miami-based center.   "Gabrielle is expected to pass over or near Bermuda in the next few hours," the forecasters said.   Winds have already picked up on Bermuda as Gabrielle -- which could strengthen further over the next 48 hours -- approaches, they added.    A tropical storm warning was in effect for the tourist haven, which could see up to six inches (15 centimeters) of rainfall and storm surges of two to three feet (0.6 to 0.9 meters) above normal.
More ...

Costa Rica

Costa Rica - US Consular Information Sheet
June 05, 2008
COUNTRY DESCRIPTION:
Costa Rica is a middle-income, developing country with a strong democratic tradition.
Tourist facilities are extensive and generally adequate.
The capi
al is San Jose.
English is a second language for many Costa Ricans.
Read the Department of State Background Notes on Costa Rica for additional information.

ENTRY/EXIT REQUIREMENTS:
For entry into Costa Rica, U.S. citizens must present valid passports that will not expire for at least thirty days after arrival, and a roundtrip/outbound ticket.
Some U.S. airlines may not permit passengers to board flights to Costa Rica without such a ticket.
Passports should be in good condition; Costa Rican immigration will deny entry if the passport is damaged in any way.
Costa Rican authorities generally permit U.S. citizens to stay up to ninety days; to stay beyond the period granted, travelers must submit an application for an extension to the Office of Temporary Permits in the Costa Rican Department of Immigration.
Tourist visas are usually not extended except under special circumstances, and extension requests are evaluated on a case-by-case basis.
There is a departure tax for short-term visitors.
Tourists who stay over ninety days may experience a delay at the airport when departing.
Persons who overstayed previously may be denied entry to Costa Rica.
Persons traveling to Costa Rica from some countries in South America and Sub-Saharan Africa must provide evidence of a valid yellow fever vaccination prior to entry.
The South American countries include Bolivia, Brazil, Colombia, Ecuador and Venezuela.
See “SPECIAL CIRCUMSTANCES” for information on requirements to carry documentation within Costa Rica and on travel by dual national minors.


The most authoritative and up-to-date information on Costa Rican entry and exit requirements may be obtained from the Consular Section of the Embassy of Costa Rica at 2114 “S” Street NW, Washington, DC 20008, telephone (202) 234-2945/46 , fax (202) 265-4795 , e-mail consulate@costarica-embassy.org, web site http://www.costarica-embassy.org, or from the Costa Rican consulates in Atlanta, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, San Juan (Puerto Rico), San Francisco, and Tampa.
The Costa Rican immigration agency web site is http://www.migracion.go.cr.
It is advisable to contact the Embassy of Costa Rica in Washington or one of Costa Rica's consulates in the United States for specific information regarding customs requirements before shipping any items.
Visit the Embassy of Costa Rica web site at http://www.costarica-embassy.org for the most current visa information.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
There have been no recent acts of terrorism in Costa Rica.
Visitors to Costa Rica may experience the effects of civil disturbances such as work stoppages and strikes.
Although infrequent, these acts can create inconveniences for visitors.
On both the Caribbean and Pacific coasts, currents are swift and dangerous, and there are few lifeguards or signs warning of dangerous beaches.
Every year eight to twelve American citizens drown in Costa Rica due to riptides or sudden drop-offs while in shallow water.
Extreme caution is advised.

Adventure tourism is popular in Costa Rica, and many companies offer white-water rafting, bungee jumping, jungle canopy tours, deep sea diving, and other outdoor attractions.
Americans are urged to use caution in selecting adventure tourism companies.
The government of Costa Rica regulates and monitors the safety of adventure tourism companies; enforcement of safety laws is overseen by the Ministry of Health.
Registered tourism companies with operating permits must meet safety standards and have insurance coverage.
The safety regulations enforced in Costa Rica are not the same as safety regulations enforced in the United States.

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:
Over one and a half million foreign tourists, the majority American, visit Costa Rica annually.
All are potential targets for criminals, primarily thieves looking for cash, jewelry, credit cards, electronic items and passports.
U.S. citizens are encouraged to exercise the same level of caution they would in major cities or tourist areas throughout the world.
Local law enforcement agencies have limited capabilities and do not act according to U.S. standards.
Travelers should minimize driving at night, especially outside urban areas.

Americans should avoid areas with high concentrations of bars and nightclubs, especially at night, and steer clear of deserted properties or undeveloped land.
For safety reasons, the Embassy does not place its official visitors in hotels in the San Jose city center, but instead puts them at the larger hotels in the outlying suburbs.
Americans should walk or exercise with a companion, bearing in mind that crowded tourist attractions and resort areas popular with foreign tourists are common venues for criminal activities.
Travelers should ignore any verbal harassment, and avoid carrying passports, large amounts of cash, jewelry or expensive photographic equipment.
Tourists are encouraged to carry photocopies of the passport data page and Costa Rican entry stamp on their persons, and leave the original passport in a hotel safe or other secure place.
Costa Rican immigration authorities conduct routine immigration checks at locations, such as bars in downtown San Jose and beach communities, frequented by illegal immigrants.
American citizens detained during one of these checks who have only a copy of the passport will be required to provide the original passport with appropriate stamps.



Travelers should purchase an adequate level of locally valid theft insurance when renting vehicles, park in secured lots whenever possible, and never leave valuables in the vehicle.
The U.S. Embassy receives several reports daily of valuables, identity documents, and other items stolen from locked vehicles, primarily rental cars.
Thefts from parked cars occur in downtown San Jose, at beaches, in the airport and bus station parking lots, and at national parks and other tourist attractions.
Travelers should use licensed taxis, which are red with medallions (yellow triangles containing numbers) painted on the side.
Licensed taxis at the airport are painted orange.
All licensed taxis should have working door handles, locks, seatbelts and meters (called "marias"); passengers are required to use seatbelts.
When traveling by bus, avoid putting bags or other personal belongings in the storage bins.
At all times have your belongings in your line of sight or in your possession.

Thieves usually work in groups of two to four.
A common scam has one person drop change in a crowded area, such as on a bus, and when the victim tries to assist, a wallet or other item is taken.
The most prevalent
scam involves the surreptitious puncturing of tires of rental cars, often near restaurants, tourist attractions, airports, or close to the car rental agencies themselves.
When the travelers pull over, "good Samaritans" quickly appear to change the tire - and just as quickly remove valuables from the car, sometimes brandishing weapons.
Drivers with flat tires are advised to drive, if at all possible, to the nearest service station or other public area, and change the tire themselves, watching valuables at all times.
In late 2006, the government of Costa Rica established a Tourist Police force, and units were established in popular tourist areas throughout the country.
The Tourist Police can assist with the reporting of a crime, which can be difficult for victims due to language barriers and the requirement that only investigative police can accept crime reports.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care in San Jose is adequate, but is limited in areas outside of San Jose.
Most prescription and over-the-counter medications are available throughout Costa Rica.
Doctors and hospitals often expect immediate cash payment for health services, and U.S. medical insurance is not always valid outside the United States.
A list of local doctors and medical facilities can be found at the website of the U.S. Embassy in San Jose, at http://sanjose.usembassy.gov.
An ambulance may be summoned by calling 911.
Most ambulances provide transportation but little or no medical assistance.
The best-equipped ambulances are called “unidad avanzada.”
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

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

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

Costa Rica has one of the highest vehicle accident rates in the world.
The fatality rate for pedestrians and those riding bicycles and motorcycles is disproportionately high.
Traffic laws and speed limits are often ignored, turns across one or two lanes of traffic are common, turn signals are rarely used, passing on dangerous stretches of highway is common, and pedestrians are not given the right of way.
Roads are often in poor condition, and large potholes with the potential to cause significant damage to vehicles are common.
Pedestrians, cyclists, and farm animals may use the main roads.
Traffic signs, even on major highways, are inadequate and few roads are lined.
Shoulders are narrow or consist of drainage ditches.
All of the above, in addition to poor visibility due to heavy fog or rain, makes driving at night especially treacherous.
Landslides are common in the rainy season.
All types of motor vehicles are appropriate for the main highways and principal roads in the major cities.
However, some roads to beaches and other rural locations are not paved, and many destinations are accessible only with high clearance, rugged suspension four-wheel drive vehicles.
Travelers are advised to call ahead to their hotels to ask about the current status of access roads.
Costa Rica has a 911 system for reporting emergencies.
In the event of a traffic accident, vehicles must/must be left where they are.
Both the Transito (Traffic Police) and the Insurance Investigator must make accident reports before the vehicles are moved.

Please refer to our Road Safety page for more information.
Visit the website of Costa Rica’s national tourist office and national authority responsible for road safety at http://www.mopt.go.cr and www.visitecostarica.com.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Costa Rica’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Costa Rica’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Land Ownership and Shoreline Property: U.S. citizens are urged to use caution when making real estate purchases, and consult reputable legal counsel and investigate thoroughly all aspects before entering into a contract.
Coastal land within fifty meters of the high tide line is open to the public and therefore closed to development, and construction on the next one hundred fifty meters inland is possible only with the approval of the local municipality.

Squatters: Organized squatter groups have invaded properties in various parts of the country.
These squatter groups, often supported by politically active persons and non-governmental organizations, take advantage of legal provisions that allow people without land to gain title to unused agricultural property.
Local courts may show considerable sympathy for the squatters.
Victims of squatters have reported threats, harassment, and violence.
Documentation Requirements: Visitors are required to carry appropriate documentation at all times.
However, due to the high incidence of passport theft, tourists are permitted and encouraged to carry photocopies of the datapage and entry stamp from the passport, leaving the passport in a hotel safe or other secure place.
However, as noted under CRIME, Costa Rican immigration authorities conduct routine checks for illegal immigrants, especially in bars located in downtown San Jose and in beach communities.
An American citizen detained during one of these checks and carrying only the copy of the passport will be required to produce the original passport.
Tourists should consider carrying their passports when traveling overnight or a considerable distance from their hotel.
Tourists who carry passports are urged to place them securely in an inside pocket.

Exit Procedures for Costa Rican Citizens: Costa Rican children may only depart the country upon presentation of an exit permit issued by immigration authorities.
This policy, designed to prevent international child abduction, applies to dual national U.S./Costa Rican citizens.
Parents of minors who obtained Costa Rican citizenship through a parent or through birth in Costa Rica are advised to consult with appropriate Costa Rican authorities prior to travel to Costa Rica, especially if one (or both) parent(s) is not accompanying the child.



Disaster Preparedness: Costa Rica is located in an earthquake and volcanic zone.
Serious flooding occurs annually on the Caribbean side near the port city of Limon, but flooding occurs in other parts of Costa Rica as well, depending on the time of year and rainfall.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.

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 Costa Rica’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Costa Rica 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 Costa Rica are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Costa Rica.
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 in Pavas, San Jose, and may be reached at (506) 2519-2000; the extension for the Consular Section is 2453.
The Embassy is open Monday through Friday, and is closed on Costa Rican and U.S. holidays.
Those seeking information are strongly encouraged to utilize the embassy web site http://sanjose.usembassy.gov/, and can email consularsanjose@state.gov with any questions/concerns.
For emergencies arising outside normal business hours, U.S. citizens may call (506) 2220-3127 and ask for the duty officer.
*

*

*
This replaces the Country Specific Information for Costa Rica dated August 15, 2007, to update sections on Registration/Embassy Location and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Sun 23 Feb 2020
Source: Q Costa Rica News [edited]
<https://qcostarica.com/costa-rica-is-the-first-country-in-america-where-very-resistant-antibiotic-bacteria-for-meningitis-is-isolated/>

A 50-year-old man and a senior became the 1st 2 people in Costa Rica -- and in the Americas -- found to be infected with the bacteria most resistant to antibiotics used in the treatment of meningitis and meningococcal septicaemia that cause serious brain damage and even death. The Centro Nacional de Referencia en Bacteriolog­a (CNRB) -- National Center of Reference in Bacteriology, of the Instituto Costarricense de Investigacian y Enseaanza en Nutricin y Salud (Inciensa) -- Costa Rican Institute for Research and Education in Nutrition and Health (Incense), issued an alert, in early February [2020], after documenting the circulation of _Neisseria meningitidis_ (_N. meningitidis_) serogroup Y, resistant to penicillin and not sensitive to cefotaxime [and ceftriaxone?], two 3rd generation antibiotics, reports La Nation.
====================
[Invasive meningococcal disease (meningococcaemia and meningitis) is a life-threatening infection caused by _Neisseria meningitidis_ that evolves rapidly, often even when appropriate treatment has been started promptly. Because antimicrobial treatment for invasive meningococcal disease with a 3rd-generation cephalosporin (cefotaxime and ceftriaxone) is the widely accepted standard recommendation (<https://academic.oup.com/cid/article/39/9/1267/402080>), resistance of _N. meningitidis_ to cefotaxime and ceftriaxone is very worrisome.

The news report above says that 2 patients in Costa Rica were infected with _N. meningitidis_ serogroup Y resistant to penicillin and 2 3rd generation cephalosporins, one of which was cefotaxime. The other 3rd generation cephalosporin is not specified, but is perhaps ceftriaxone, the other 3rd generation cephalosporin usually used to treat this disease. We are also not told in the news report above if the 2 patients were epidemiologically linked, nor are we told the extent (that is, MICs [minimum inhibitory concentration] of penicillin or cefotaxime), the mechanisms of resistance, or resistance to any of the other antimicrobial drugs used to prevent or treat this disease.

More information would be appreciated from knowledgeable sources. Reduced susceptibility of _N. meningitidis_ to penicillin has been reported in the past in many countries, including the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>), usually due to decreased affinity of target penicillin-binding proteins for penicillin and less commonly to beta-lactamase production (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC89938/>, <https://pubmed.ncbi.nlm.nih.gov/3134848-relative-penicillin-g-resistance-in-neisseria-meningitidis-and-reduced-affinity-of-penicillin-binding-protein-3/>, and <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC162989/pdf/392577.pdf>).

Meningococcal isolates with reduced susceptibility to penicillin G usually were reported susceptible to 3rd-generation cephalosporins (cefotaxime and ceftriaxone). For example, despite the decrease in susceptibility to penicillin G in 33% of 2888 isolates of _N. meningitidis_, all isolates were susceptible to ceftriaxone in Brazil from 2009 to 2016 (<https://pubmed.ncbi.nlm.nih.gov/29717974-surveillance-of-antimicrobial-resistance-in-neisseria-meningitidis-strains-isolated-from-invasive-cases-in-brazil-from-2009-to-2016/>). Similar data have been reported for the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>).

However, one previous study reported 8 clinical isolates _N. meningitidis_ in Delhi, India in 2006 that were resistant to ceftriaxone and cefotaxime, with most also resistant to penicillin, ciprofloxacin, and chloramphenicol (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698303/>). All of the isolates were identified as serogroup A _N. meningitidis_, but no further details concerning these isolates were given in this report (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1865813/>).

Resistance to other antimicrobial agents that may be used for therapy of meningococcal infections or for prophylaxis of case contacts has been reported in several countries. This includes resistance to chloramphenicol, fluoroquinolones, and rifampin. Horizontal exchange of genes that encode resistance for penicillin, rifampin, and the fluoroquinolones from other _Neisseria_ species that share a common ecological niche with _N. meningitidis_ in the nasopharynx has been proposed as one possible mechanism of acquisition of meningococcal antibiotic resistance (<http://jac.oxfordjournals.org/cgi/content/full/49/3/545>). - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Costa Rica: <http://healthmap.org/promed/p/17>]
Date: Tue 21 Jan 2020
Source: Ahora Noticias, Costa Rica [in Spanish, machine trans., edited]
<https://www.ahoranoticiascr.com/2020/01/21/autoridades-cerraron-pizzeria-debido-a-casos-de-hepatitis-a-en-san-ramon/>

As many as 22 people suffered from hepatitis A infection in San Ramon de Alajuela, and consequently the Health authorities closed a pizzeria in the area. A source close to this media confirmed the existence of the cases which were detected since 13 Jan 2020.

The cases were thought to be related to food consumption in that establishment 4 of patients were employees of the pizzeria. In statements to the media La Nación, Azalea Espinoza of the Directorate of Surveillance of the Ministry of Health, said they intervened in the business, issued a closing health order, and proceeded to cleaning and disinfecting it. [Byline: Carlos Miranda]
========================
[Although the eating establishment was identified as a pizzeria, pizza itself is not likely to be the vehicle of transmission as it is cooked before serving unless ingredients are added after the cooking process. It is unclear if the pizzeria employees were the source of, or just part of, the outbreak.

With an incubation period averaging 28 but up to 45 days, more cases may occur. The cases are not broken down in regard to age. In children, most cases of HAV infection are subclinical so it is likely that the cases reported were in adults. In the developing world, HAV is not reported much in adults as most children have been infected, and therefore immune to subsequent infection, by the age of 10. That outbreaks are occurring in the area suggests improvement in potable water so fewer children are infected and therefore still susceptible to HAV as adults. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Costa Rica:
<http://healthmap.org/promed/p/17>]
Date: Wed, 8 Jan 2020 02:28:38 +0100 (MET)

San José, Jan 8, 2020 (AFP) - Costa Rica on Tuesday vehemently objected to the US government's decision to raise the alert level for tourists visiting the Central American country due to the risk of crime.   "We express energetic protest on the part of the Costa Rican government for the decision to change the recommendation level for American tourists," said foreign minister Manuel Ventura.

Ventura's statement came shortly after the US government issued a new travel advisory for visitors to Costa Rica.   According to the alert, "petty crime is the predominant threat for tourists in Costa Rica."   But the advisory warns that "armed robbery, homicide and sexual assault" could also occur.   Costa Rica also rose from Level 1, the lowest level, to Level 2 on he US State Department's travel alert scale. The highest is Level 4, which recommends no visiting.

The Central American country, known for its natural resources and beaches, attracts 1.2 million US tourists each year, according to official figures. In 2019, a total of more than 3 million foreign tourists visited.   "The change is surprising, because it puts Costa Rica -- which ended 2019 with a rate of 11 homicides per 100,000 inhabitants -- on par with countries on the continent that are among the most violent in the world," the Costa Rican foreign ministry said in a statement.

Data from the Ministry of Public Service indicates that there were 688 cases of theft of mobile phones, passports and money from tourists in 2019 -- only 0.02 percent of visitors to Costa Rica.   Tourism in Costa Rica has been shaken in recent years by several murders of female tourists, as well as sexual violence, including a Venezuelan-American woman who was killed near her hotel outside of the capital San Jose.
Date: Thu 8 Jan 2020
Source: Outbreak News Today [edited]

The Costa Rica Ministry of Health reported [Tue 7 Jan 2019] (computer translated) on the 2nd ever _Naegleria fowleri_, or "brain-eating amoeba" infection in their history.

The case is a 15-year-old who is presenting with a clinical picture of primary amebic meningoencephalitis (PAM) remains in a serious state at the Liberia Hospital. The investigation into the case shows the young man acquired the amoeba by inhaling water in the thermal springs of Guayabo de Bagaces.

The 1st case of primary amebic meningoencephalitis in the history of Costa Rica was recorded in 2014 in an American child who later died.

_Naegleria fowleri_ is a microscopic amoeba which is a single-celled living organism. It can cause a rare and devastating infection of the brain called primary amebic meningoencephalitis (PAM). The amoeba is commonly found in warm freshwater such as lakes, rivers, ponds and canals.

Infections can happen when contaminated water enters the body through the nose. Once the amoeba enters the nose, it travels to the brain where it causes PAM (which destroys brain tissue) and is usually fatal. Infections usually occur when it is hot for prolonged periods of time, which results in higher water temperatures and lower water levels.  _Naegleria fowleri_ infections are rare. Most infections occur from exposure to contaminated recreational water. Cases due to the use of neti pots and the practice of ablution have been documented.

[Byline: Robert Herriman]
=======================
[Amoebic meningoencephalitis is rare but is found worldwide and the reservoir is fresh water sources like lakes and rivers. It has been discussed if it is found in household water supplies, but so far cases have not been linked to tap water although it is possible in theory. - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Date: Fri 25 Oct 2019
From: Donald J. Brightsmith <dbrightsmith@cvm.tamu.edu> [edited]

There have been 37 cases of autochthonous transmission of malaria in 2019 as reported by the Costa Rican Ministry of Health (<https://www.ministeriodesalud.go.cr/index.php/vigilancia-de-la-salud/analisis-de-situacion-de-salud>). The ministry also reports 39 cases of malaria in country that were likely contracted in foreign countries, mostly in Nicaragua.

The autochthonous cases came mostly from the northern part of the country in the district of Crucitas, but cases were also reported from other areas of the country.
---------------------------------------------------
Donald J. Brightsmith
University College of Veterinary Medicine & Biomedical Sciences
Texas A&M University
College Station, TX
=============================
[ProMed thanks Dr. Donald J. Brightsmith for communicating this to us.

This is a comment from the WHO website, "Costa Rica: 'Ripe' for malaria elimination?"

"Costa Rica is one of 21 countries identified by WHO as having the potential to eliminate malaria by 2020. Its success in bringing down cases of indigenous malaria -- that is, transmission of the malaria parasite within a country's own borders -- has been commendable, so much so that it has received an award from the Pan American Health Organization in recognition of the strides made. Notably, no one has died from malaria since 2009.

"However, after recording 3 consecutive years of zero indigenous cases between 2013 and 2015, local transmission of the disease has slowly been creeping upwards: 4 cases in 2016 and 12 in 2017. Of equal concern is imported malaria: To date, 21 such cases have been detected in 2018, up from 5 for all of 2017.

"In June 2018, the Costa Rican Ministry of Health issued a public health alert following the reporting of 10 imported malaria cases in just one week in the country's northern region bordering malaria-endemic Nicaragua. The Ministry is working to quickly identify and treat imported cases to prevent onward transmission to local communities in high-risk zones of the country. The areas of concern are mainly agricultural sites, like banana plantations.

"One such area is the canton of Matina, home to some of Costa Rica's largest plantations that grow the yellow fruit. Situated next to a major port on the Caribbean Sea, the canton's agricultural produce is shipped to markets worldwide, making Matina an important economic hub.

"Although Matina is far from the area of the recent alert, and no cases of malaria have been reported this year, all 4 indigenous cases reported in 2016 originated from the canton, as well as 2 of the 12 indigenous cases in 2017. Health authorities are not taking any chances and are working with the canton's fincas bananeras (banana plantations) to step up malaria surveillance activities, particularly among plantation workers and nearby communities." - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
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Dominican Republic

Dominican Republic US Consular Information Sheet
March 13, 2008
COUNTRY DESCRIPTION: The Dominican Republic covers the eastern two-thirds of the Caribbean island of Hispaniola. The capital city is Santo Domingo, located on the south coast of th
island. Tourist facilities vary according to price and location. Spanish is the official language. Though English is widely spoken in major cities and tourist areas, it is much less common outside these areas. Read the Department of State Background Notes on the Dominican Republic for additional information.

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

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

For information concerning entry and exit requirements, travelers may contact the Embassy of the Dominican Republic at 1715 22nd Street NW, Washington, DC 20008, tel. (202) 332-6280. There are also Dominican consulates in Boston, Chicago (Northfield, IL), Mayaguez, Miami, New Orleans, New York, and San Juan. Visit the Embassy of the Dominican Republic web site at http://www.domrep.org for the most current visa information.

Visas: Visitors who do not obtain a Dominican visa prior to entry must purchase a tourist card upon arrival to enter the country. Tourist cards cost ten U.S. dollars, which must be paid in U.S. currency. Tourist cards may be purchased at the Dominican Embassy in Washington or Dominican Consulates prior to arrival, as well as at Dominican airports at the time of entry. Tourist cards normally permit a legal stay of up to 60 days. Visitors who would like to extend their time in the Dominican Republic should visit the Migration Department in Santo Domingo and request an extension. Failure to request an extension will subject the visitor to a surcharge at the airport upon departure.

Travel of children and EXIT requirements: Strict exit requirements apply to minors under 18 years of age (of any nationality) who are residents in the Dominican Republic. Such children traveling alone, without one parent, or with anyone other than the parent(s), must present written authorization from a parent or legal guardian. This authorization must be in Spanish, and it must be notarized at a Dominican consulate in the United States or notarized and then certified at the Dominican Attorney General’s office (Procuraduria de la Republica) if done in the Dominican Republic. Though not a requirement for non-resident minors (in the Dominican Republic), the U.S. Embassy recommends that any minor traveling to the Dominican Republic without one or both parents have a notarized document from the parent(s). In addition to clarifying the reason for travel, this will facilitate departure from the Dominican Republic.

The specific guidelines on the Dominican regulations governing the travel of children in the Dominican Republic can be found (in Spanish) at http://www.migracion.gov.do.

Visit the Embassy of the Dominican Republic web site at http://www.domrep.org for the most current visa information.

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

SAFETY AND SECURITY:
American citizens should be aware that foreign tourists are often considered attractive targets for criminal activity, and should maintain a low profile to avoid becoming victims of violence or crime. In dealing with local police, U.S. citizens should be aware that the standard of professionalism might vary. Police attempts to solicit bribes have been reported, as have incidents of police using excessive force.

Protests, demonstrations, and general strikes occur periodically. Previous political demonstrations have sometimes turned violent, with participants rioting and erecting roadblocks, and police sometimes using deadly force in response. Political demonstrations do not generally occur in areas frequented by tourists and are generally not targeted at foreigners. However, it is advisable to exercise caution when traveling throughout the country. Street crowds should be avoided. In urban areas, travel should be conducted on main routes whenever possible. Power outages occur frequently throughout the Dominican Republic, and travelers should remain alert during blackout periods, as crime rates often increase during these outages.

U.S. citizens considering overland travel between the Dominican Republic and Haiti should first consult the Country Specific Information Sheet for Haiti as well as the Internet site of the U.S. Embassy in Port-au-Prince for information about travel conditions in Haiti. Santo Domingo and the majority of tourist destinations within the Dominican Republic are located several hours from the Haitian border, and recent events in Haiti have generally not directly affected these areas.

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 Standard Time, Monday through Friday (except U.S. federal holidays).

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

CRIME: Crime continues to be a problem throughout the Dominican Republic. Street crime and petty theft involving U.S. tourists does occur, and precautions should be taken to avoid becoming a target. While pick pocketing and mugging are the most common crimes against tourists, reports of violence against both foreigners and locals are growing. Criminals can be dangerous and visitors walking the streets should always be aware of their surroundings. Valuables left unattended in parked automobiles, on beaches and in other public places are vulnerable to theft, and reports of car theft have increased. Cellular telephones should be carried in a pocket rather than on a belt or in a purse. One common method of street robbery is for at least one person on a moped (often coasting with the engine turned off so as not to draw attention) to approach a pedestrian, grab his or her cell phone, purse or backpack, and then speed away. This type of robbery is particularly dangerous because the motorcyclist reaches the intended victim at 15–20 miles per hour and often knocks the victim to the ground.

Many criminals have weapons and are likely to use them if they meet resistance. Be wary of strangers, especially those who seek you out at celebrations or nightspots. Traveling and moving about in a group is advisable. The dangers present in the Dominican Republic, even in resort areas, are similar to those of many major U.S. cities. Expensive jewelry attracts attention and could prompt a robbery attempt. Limiting the cash and credit cards carried on your person and storing valuables, wallet items, and passports in a safe place is recommended.

Burglaries of private residences continue to be reported as well as crimes of violence. Criminals may also misrepresent themselves in an effort to gain access to your residence or hotel room. In one 2005 homicide, a U.S. citizen was murdered by two men who posed as repairmen to gain access to the apartment. In another, the Dominican police arrested the building’s actual maintenance man and an accomplice for the crime.

The U.S. Embassy continues to receive reports from Americans who have been stopped while driving and asked for “donations” by someone who may appear to be a police officer before they would be allowed to continue on their way. Usually, the person(s) stopping the American drivers had approached from behind on a motorcycle; several of these motorcyclists pulled up alongside the driver's window and indicated that they were carrying a firearm. In some cases, the perpetrators were dressed in the light green uniform of “AMET,” the Dominican traffic police; however, they often seemed too young to be police officers or wore ill-fitting uniforms that might have been stolen. In another incident, individuals dressed in military fatigues told the victim they were police and requested the victim to follow them to the police station prior to robbing him. Such incidents should be reported to the police and the Consular Section. If Dominican police stop an American driver for a traffic violation, the driver should request a traffic ticket rather than paying an on-the-spot fine. The driver also has the right to ask police for identification. New regulations require police to wear a nametag with their last name. While everyone driving in the Dominican Republic should abide by traffic laws and the instructions of legitimate authorities, Americans finding themselves in the aforementioned scenarios should exercise caution. In general, drivers should keep their doors locked and windows closed at all times and leave themselves an escape route when stopping in traffic in the event of an accident or other threat. Incidents involving police may be reported to the Internal Affairs Department of the National Police at 809 688-1777 or 809 688-0777.

In 2006, the U.S. Embassy received reports of Americans and others who were victims of vehicular-armed robberies in the northern provinces of the Dominican Republic. At least three of the reports indicate the victims were intercepted during the morning hours, when there was little other traffic, while driving on rural highways connecting Santiago and Puerto Plata. Drivers should exercise extreme caution when driving at night and use major highways when possible.

Although kidnappings are not common in the Dominican Republic, in 2007, two American citizens were kidnapped and held for ransom, in separate instances.

Many public transportation vehicles are unsafe, especially the route taxis or “carros publicos” in urban areas. These are privately owned vehicles that run along certain routes, can take up to six or more passengers, and are inexpensive. Passengers in “carros publicos” are frequently the victims of pick pocketing, and passengers have on occasion been robbed by “carro publico” drivers. Urban buses (“guaguas”) are only marginally better. The U.S. Embassy is also aware of at least one incident in which the driver of a “motoconcho” (motorcycle taxi) robbed an American passenger. The U.S. Embassy cautions its staff not to use these modes of transportation. As an alternative, some scheduled interurban bus services use modern buses and run on reliable timetables. These are generally the safest means of intercity travel. With respect to taxis, visitors to the Dominican Republic are strongly advised to take only hotel taxis or taxis operated by services whose cabs are arranged in advance by phone and can subsequently be identified and tracked.

Credit card fraud is common and recent reports indicate that its incidence has increased significantly. The U.S. Embassy strongly advises Americans to restrict severely the use of credit/debit cards in the Dominican Republic. The increase in credit card fraud is particularly pronounced in the eastern resort areas of the Dominican Republic. According to reports, store workers, restaurant service staff and hotel employees may conceal devices that can instantly record the credit card information. Often, this device appears to be a normal card reader used by businesses. Credit or debit cards should be carefully protected and never allowed out of the owner’s sight. Stolen cards are often used to the maximum amount before the victims are able to contact the bank. Victims of credit card fraud should contact the bank that issued the credit card immediately. It is advisable to pay close attention to credit card bills following time spent in the Dominican Republic. There have been reports of fraudulent charges appearing months after card usage in the Dominican Republic.

Automated Teller Machines (ATMs) are present throughout Santo Domingo and other major cities. However, as with credit cards, the use of ATMs should be minimized as a means of avoiding theft or misuse. One local ATM fraud scheme involves sticking photographic film or pieces of paper in the card feeder of the ATM so that an inserted card becomes jammed. Once the card owner has concluded the card is irretrievable, the thieves extract both the jamming material and the card, which they then use. There are other ATM scams as well. Exercise caution and be aware of your surroundings when using an ATM card.

The overall level of crime tends to rise during the Christmas season, and visitors to the Dominican Republic should take extra precautions when visiting the country between November and January.

In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm.

Beaches and Resorts: The Embassy occasionally receives reports of individuals who have become victims of crime, and particularly sexual assault, while at the beach. Vigilance is recommended. The numerous “all-inclusive” resorts serve abundant quantities of alcohol, a practice that encourages inattention and may be a factor in crime or sexual assault.

Tourist Police: The Dominican Republic does have police that are specially trained to assist tourists who require assistance. This public institution is called Politur and represents a cooperative effort between the National Police, Secretary of the Armed Forces, and the Secretary of Tourism. Politur typically has personnel in tourist areas to provide first responder type assistance to tourists. If you are the victim of a crime, Politur can help you get to a police station so that you may file a police report and seek further assistance. For more information on Politur and contact information, use the following link: http://www.politur.gov.do/. Politur is located at the corner of 30 de Marzo and Mexico, Bloque D, Governmental Building, Santo Domingo. The general phone number is 809-686-8639.

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 system and to find an attorney if needed.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is limited, especially outside Santo Domingo, and the quality of care varies widely among facilities. There is an emergency 911 service within Santo Domingo, but its reliability is questionable. Outside the capital, emergency services range from extremely limited to nonexistent. Blood supplies at both public and private hospitals are often limited, and not all facilities have blood on hand even for emergencies. Many medical facilities throughout the country do not have staff members who speak or understand English. A private nationwide ambulance service, ProMed, operates in Santo Domingo, Santiago, Puerto Plata and La Romana; Telephone number is 809-548-7200. ProMed expects full payment at the time of transport. The U.S. Embassy maintains a non-comprehensive list of providers of medical care in the Dominican Republic, which can be found at the following link: http://www.usemb.gov.do/Consular/ACS/medical_assistance-e.htm.

Tap water is unsafe to drink and should be avoided. Bottled water and beverages are safe.
Dengue: Dengue is endemic to the Dominican Republic. To reduce the risk of contracting dengue, the U.S. Center for Disease Control (CDC) recommends wearing clothing that exposes as little skin as possible and applying a repellent containing the insecticide DEET (concentration 30 to 35 percent) or Picaridin (concentration 20 percent or greater for tropical travelers). Because of the increased risk of dengue fever and the ongoing risk of malaria in the Dominican Republic (see below), practicing preventative measures is recommended by the CDC. For further information on dengue fever, please visit the CDC web site at http://www.cdc.gov/ncidod/dvbid/dengue.

Malaria: There are occasional reports of cases of malaria in areas frequented by U.S. and European tourists including La Altagracia Province, the easternmost province in which many beach resorts are located. Malaria risk is significantly higher for travelers who go on some of the excursions to the countryside offered by many resorts. Prior to coming to the Dominican Republic, travelers should consult the CDC web site at http://www.cdc.gov/malaria/index.htm for more information and recommendations on malarial prophylaxis.

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

The U.S. Embassy in Santo Domingo and the CDC are aware of several cases in which U.S. citizens experienced serious complications or died following elective (cosmetic) surgery in the Dominican Republic. The CDC’s web site at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5323a4.htm contains a report on patients who suffered postoperative infections following cosmetic surgery in the Dominican Republic. Patients considering travel to the Dominican Republic for cosmetic surgery may also wish to contact the Dominican Society of Plastic Surgeons (tel. 809-688-8451) to verify the training, qualifications, and reputation of specific doctors.

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. Americans traveling in the Dominican Republic should be aware that Dominican hospitals often require payment at the time of service and may take legal measures to prevent patients from departing the country prior to payment. Please see our information on medical insurance overseas.

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

Traffic in the Dominican Republic moves on the right side of the road. Speed limits vary from 25 mph in the city to 50 mph on rural roads, but they are generally not enforced. Drivers are required to carry liability insurance.

If you do drive in the Dominican Republic, you should be aware that the utmost caution and defensive driving are necessary. Traffic laws are similar to those in the United States, but undisciplined driving is common, due to a lack of adequate traffic controls. Many drivers will not use turn indicators. Rather, it is common for a vehicle operator to stick his hand out the window to signal a turn. Drivers can also be aggressive and erratic, often failing to yield the right-of-way even when road signs or signals indicate that they should. Travel at night on intercity highways and in rural areas should be avoided, due to animals on the road, poor road conditions, and other vehicles being driven at excessive speeds, often with malfunctioning headlights or taillights. Blackouts also increase the danger of night travel. Turning right on red lights is permitted, but should be done with caution.

Traffic accidents often result in serious injury or death. This is often the case when heavy vehicles, such as buses or trucks, are involved. Traditionally, vehicles involved in accidents in the Dominican Republic are not moved (even to clear traffic), until authorized by a police officer. Drivers who violate this norm may be held legally liable for the accident.

Dominican law requires that a driver be taken into custody for driving under the influence or being involved in an accident that causes serious injury or death, even if the driver is insured and appears not to have been at fault. The minimum detention period is 48 hours; however, detentions frequently last until a judicial decision is reached (often weeks or months), or until a waiver is signed by the injured party (usually as the result of a cash settlement).

Visitors to the Dominican Republic might want to consider hiring a professional driver during their stay in lieu of driving themselves. Licensed drivers who are familiar with local roads can be hired through local car rental agencies. In case of accidents, only the driver will be taken into custody.

Pedestrians tend to step out into traffic without regard to corners, crosswalks, or traffic signals. Many pedestrians die every year crossing the street (including major, multi-lane highways) at seemingly random locations. Pedestrians do not have the right-of-way, and walking along or crossing busy streets – even at intersections with traffic lights or traffic police present – can be very dangerous.

Seat belts are required by law, and those caught not wearing them will be fined. There are no child car seat laws. The law also requires the use of hands-free cellular devices while driving. Police stop drivers using cell phones without the benefit of these devices. Penalties for those driving under the influence and those involved in accidents resulting in injury or death can be severe.

Motorcycles and motor scooters are common in the Dominican Republic, and they are often driven erratically. Dominican law requires that motorcyclists wear helmets, but local authorities rarely enforce this law. As noted previously in this report, public transportation vehicles such as the route taxis (“carros publicos”) and urban buses (“guaguas”) are unsafe.

Please see the Crime section of this information sheet for more information regarding crimes involving road safety.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the Dominican Republic’s Civil Aviation Authority (CAA) as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the Dominican Republic’s air carrier operations. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Currency Regulations: It is legal to exchange currency at commercial banks, exchange booths in hotels and exchange houses. The exchange rate is set by the Central Bank, based on prevailing market conditions. The market determines the exchange rate. No more than USD $10,000 or its equivalent in another currency, including Dominican pesos, may be taken out of the Dominican Republic at the time of departure.

Real Estate: Real estate investments require a high level of caution, as property rights are irregularly enforced. Investors often encounter problems in receiving clear title to land, and title insurance is not available. Real estate investments by U.S. citizens have been the subject of both legal and physical takeover attempts. Absentee landlords and absentee owners of undeveloped land are particularly vulnerable. Investors should seek solid property title and not just a “carta de constancia,” which is often confused by foreigners with a title. An official land registry measurement (also known as 'deslinde' or 'mensura catastral') is also desirable for the cautious overseas investor. Squatters, sometimes supported by governmental or non-governmental organizations, have invaded properties belonging to U.S. citizens, threatening violence and blocking the owners from entering their property. In at least one instance, the U.S. citizen landowner was physically assaulted. Several U.S. citizens with long-standing expropriation disputes with the Dominican Government have not received compensation.

Gambling: Many Americans have reported losing large amounts of money at Dominican casinos by playing a game (or variations thereof) known as “Super Keno,” “Caribbean Keno,” “Progressive Keno,” or “Progressive Roulette.” Players have complained that the game’s rules are unclear and/or misleading. Any complaints arising from a casino should be directed to the Office of Casinos at the Secretary of Finance. To register a complaint with this office, call 809-687-5131, ext. 2120.

Divorce: In recent years, there have been a number of businesses, primarily on the Internet, which advertise “Quickie Dominican Divorces.” The services of these businesses should be used with caution, as they may misrepresent the process of obtaining a divorce in the Dominican Republic. While it is relatively simple for foreigners to obtain a divorce in the Dominican Republic, such divorces are only valid if specific steps are taken. Those seeking information regarding divorce should first consult with an attorney in their home state. Additional information is available via the U.S. Embassy's flyer on Divorce in the Dominican Republic at http://www.usemb.gov.do/Consular/ACS/divorce_DR-e.htm.

Alien Smuggling: Dominican authorities may prosecute anyone arrested for organizing the smuggling of aliens into or out of the Dominican Republic. This is in addition to any charges individuals may face in the other country involved, including the United States.

Hurricanes: The Dominican Republic is situated in an area of the Caribbean prone to hurricanes. In the event of a hurricane alert, a notice will be posted on the U.S. Embassy in Santo Domingo's web page at http://www.usemb.gov.do/index.htm. Further information can be obtained by visiting the National Weather Service's web site at http://www.nhc.noaa.gov. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency at http://www.fema.gov.

Water Sports: Visitors to the Dominican Republic, including to local resort areas, should carefully assess the potential risk of recreational activities. Some of the swimming areas at popular beaches around the Dominican Republic are subject to dangerous undertows. Many beaches lack life guards and/or warnings of unsafe conditions. Resort managers usually offer current information on local swimming & surf conditions. Americans are cautioned not to swim alone, particularly at isolated beaches.

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 Dominican laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the Dominican Republic are severe, and convicted offenders can expect long jail sentences and heavy fines. For more information on the Dominican judicial system, procedures, and penalties, please visit the Consular Section’s web page at http://www.usemb.gov.do. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.

CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues web pages. The Dominican Republic is a party to the Hague Convention on the Civil Aspects of International Child Abduction. The United States formally accepted the accession of the Dominican Republic on June 1, 2007.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the Dominican Republic are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within the Dominican Republic. 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 Consular Section of the U.S. Embassy is located at the corner of Calle César Nicolás Penson and Avenida Máximo Gómez. The American Citizens Services (ACS) Unit can be reached by telephone at 809-731-4294, or via email at acssantodom@state.gov. ACS Unit office hours are 7:30 a.m. to 4:30 p.m., Monday through Thursday, Friday 7:30-12:15, except on U.S. and Dominican holidays. The Chancery of the U.S. Embassy is located a half-mile away from the Consular Section, at the corner of Calle César Nicolás Penson and Calle Leopoldo Navarro. The telephone number is 809-221-2171.

There is a Consular Agency in the north coast city of Puerto Plata at Calle Villanueva esq. Avenida John F. Kennedy, Edificio Abraxa Libraria, 2nd floor, telephone 809-586-4204, 809-586-8017, 809-586-8023; office hours are 9:00 a.m. to 12:00 p.m., and 2:30 p.m. to 5:00 p.m., Monday through Friday, except holidays.
* * *
This replaces the Country Specific Information dated May 09, 2007 to update Safety and Security, Crime, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Fri, 6 Mar 2020 03:09:21 +0100 (MET)

Santo Domingo, March 6, 2020 (AFP) - A Canadian tourist has the second confirmed case of the new coronavirus in the Dominican Republic, the public health ministry said Thursday.    The 70-year-old woman arrived in the Caribbean country on February 25 with her husband, who is not showing symptoms of COVID-19, the disease caused by the virus that first appeared in China late last year.    The couple has been transferred from their hotel in Bayahibe, in the eastern part of the country, to a hospital isolation centre in the capital Santo Domingo.

The first known case of coronavirus infection in the Dominican Republic was discovered Sunday in a 62-year-old Italian tourist, who was also staying in Bayahibe.    The man was hospitalized and is recovering, according to authorities.    The country established airport and border controls to combat the spread of the virus when the outbreak first took hold in China's Hubei province, and has suspended flights from Milan for 30 days as the virus spreads near the Italian city.    There have been nearly 98,000 infections and some 3,300 deaths in 85 countries and territories throughout the world, according to a count by AFP.
Date: Mon 18 Nov 2019
Source: Pan American Health Organization (PAHO) [abridged, edited]

Between 2005 and 2014, there was an overall decreasing trend in the number of cases of malaria in the Region of the Americas; however, since 2015, there has been an increase in the number of malaria cases reported in the Region.

This overall increase is due to the increase in cases over the last 3 years in the Bolivarian Republic of Venezuela along with increased transmission in endemic areas of countries such as Brazil, Colombia, Guyana, Nicaragua, and Panama, as well as outbreaks in countries that were moving towards elimination (Costa Rica, the Dominican Republic, and Ecuador) (Figure 1 [available at the source URL above]).

Despite this, in 2018, Guatemala and Honduras reported a significant decrease in malaria cases compared to the prior year, which has continued as of November 2019. El Salvador has not reported an autochthonous case in almost 3 years, while Paraguay and Argentina were certified by the Pan American Health Organization/World Health Organization (PAHO/WHO) as malaria-free countries in July 2018 and May 2019, respectively.

In Venezuela, between 1 Jan and week 41 [ending 11 Oct] of 2019, a total of 323,392 malaria cases were reported, representing a slight decrease (1.5%) compared to the same period in 2018 (328,373 cases). In contrast, in 2017, there were 321,358 cases reported during the same period.

In Brazil, the Amazon region is characterized by high endemicity of malaria, accounting for nearly 99% of the cases reported nationally. In this region, there was a 24% overall decrease in the number of cases reported during the 1st semester of 2019 (71,549 cases) compared to the 1st semester of 2018 (93,995 cases).

In Colombia, between 1 Jan and week 42 [ending 18 Oct] of 2019, an outbreak has been occurring with 66,581 malaria cases reported, representing a 28.2% increase compared to the same period in 2018 (51,935 cases).

In Nicaragua, in 2019 as of week 41 [ending 11 Oct] of 2019, there were 9358 cases reported, representing a 15% decrease compared to the same period in 2018 (10,988 cases). This is mainly due to the decrease in cases reported in Puerto Cabezas since mid-2019.
=====================
[The complete PAHO summary can be accessed at the source URL above.  The surge of malaria in Venezuela is well known and is due to an almost entire lack of any vector control activities over the past 10 years. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
Date: 26 Jun 2019
Source: VOX [edited]

Tourist deaths in the Dominican Republic are sparking concern among travellers.  It's not yet clear whether the deaths of 10 Americans over the past year are connected. [Some sources report as many as 13 deaths. - ProMED Mod.TG] Ten known US tourists have died at Dominican Republic resorts, or at the hospital immediately following resort stays -- including 3 within 7 days, and 2 within 3 days -- in just over a year.

Now over a dozen more visitors who fell dangerously ill on vacation in the Dominican Republic are coming forward. Sicknesses reportedly set in quickly, marked by frequently cited symptoms of abdominal pain, nausea, and sweating; guests' descriptions of a "chemical smell" in hotel rooms; and a pattern of minibar liquor consumption before indicators of illness set in.

The Dominican Republic's Ministry of Tourism attributes these deaths to natural causes; local and US federal authorities, however, are investigating the incidents, having left some American travellers uneasy, and the future of the Dominican Republic's robust tourism industry uncertain.  The incidents occurred at a collection of resorts on the island: the Terra Linda Resort in Sousa, the Excellence Resorts in Punta Cana, the Grand Bahia Principe in Punta Cana, the Grand Bahia Principe in La Romana, and the Hard Rock Hotel & Casino in Punta Cana.

At least 3 of the people who died reportedly began experiencing symptoms after having a drink from the minibar in their rooms. The US Embassy in Santo Domingo confirmed earlier this month [June 2019] that the FBI were dispatched to the island to conduct toxicology reports, and the Dominican Republic's Ministry of Health announced samples from the minibar in the guest room of CD and NH of Maryland, who were both found dead on 30 May 2019 in their room at the Grand Bahia Principe La Romana, were undergoing testing. On Monday [24 Jun 2019], the Hard Rock Hotel & Casino announced it'd be removing liquor from minibars in its guest rooms.

As forensic scientist Lawrence Kobilinsky told the "Cut," many of the victims' symptoms might suggest methanol poisoning. Methanol is a toxic, synthetic chemical normally used in antifreeze, also used, illegally, to create counterfeit alcohol. Consuming even a small amount of pure methanol can lead to pulmonary edema, or fluid in the lungs, and respiratory distress, 2 of the official causes of death listed for CD and NH. They're also 2 of the official causes of death listed for SW of Pennsylvania, who also died at Grand Bahia Principe La Romana, after reportedly having a drink from her hotel room minibar, just 5 days before CD and NH's deaths.

The toxicology reports for CD, NH, and SW have not yet been released; the FBI said in mid-June 2019 that answers could be another 30 days coming.

Some recent travellers, however, suspect they were exposed to fumes emitted from the air conditioners in their rooms. CNN reports one Denver couple, KK and TS sued the Grand Bahia Principe La Romana -- the same resort where CD and NH stayed -- earlier this year [2019] for illnesses occurring during a trip last July 2018. KK and TS described a "chemical smell" overtaking their room, an odor similar to paint or industrial cleaner. [Earlier, reports indicated KK and SW described the smell as chemical or pesticide smell. Some of their clinical signs sound like organophosphates. This couple reported earlier a grounds worker was spraying the trees, which reportedly was over the air conditioner. - ProMED Mod.TG] Soon after, they said they experienced excruciating stomach cramps, diarrhoea, bloody stool, incessant sweats and drool, watery eyes, and dizziness. Back home in Denver, their doctors wondered whether they'd been exposed to organophosphates, chemicals most often used in pesticides.

KK said she thought back on what she had seen days earlier: A maintenance person spraying palm plants covering the air conditioning units just outside their room. "I wondered if someone sprayed our unit. They are always constantly out there taking care of the plants. We saw them out there with bug sprayers."

Other tourists told CNN they too became sick after they inhaled what they described as a chemical, or paint-like smell, at the Majestic Elegance Resort in Punta Cana in 2017, and at the Grand Bahia Principe Punta Cana going back to 2016.

As the New York Times reports, poisoning or pesticide exposure is even more likely when more than one person experiences the same outcome on the same timeline, as was the case with CD and NH. Chemicals like organophosphates, adds the Times, can "seep into a vent not adequately sealed, or be sucked inside by a hotel air conditioner." Current scientific literature indicates organophosphate poisoning can lead to respiratory failure in some cases.

Tourism drives much of the Dominican Republic's economy, employing more than 300 000 people and drawing a reported 6.6 million international travellers in 2018. A report on the Dominican Republic's economy from the Canadian Trade Commissioner Service says the Dominican government aims to draw 10 million tourists -- roughly the size of its current population -- by 2020, "generating estimated revenues of US $7.2 billion."

Preliminary autopsies conducted by Dominican authorities have been released by the resorts for several of the 10 Americans known to have died in the past year. In addition to pulmonary edema and respiratory failure, the causes of death for the tourists have included pneumonia, multiple organ failure, and an exceptionally common one: heart attack. According to Tourism Minister Javier Garcia, 5 of the deaths can be categorized as "natural causes." [While the Tourism Minister may report it as "natural causes," an investigation is necessary, including toxicology reports, to be fully certain of the cause of those individuals' deaths. - ProMED Mod.TG]

The Excellence Resorts in Punta Cana told the family of LC of New York City she died in her room on 10 Jun 2019 of a heart attack. Her son BC remains skeptical, telling WCBS, "I do not believe it was of natural causes."

It's not yet clear what caused this spate of heart attacks, respiratory failures, and food poisoning-like illnesses. And it's also not clear whether these catastrophic events, similar as they are in geographic location, presenting symptoms, and outcome, are connected. Neither the US Embassy nor the Dominican Ministry of Public Health has acknowledged the possibility of a connection; in fact, Garcia has said: "These cases are very regrettable, but isolated" [The deaths are indeed tragic and regrettable, but evidence revealed so far does not seem isolated. - ProMED Mod.TG].

The Dominican Republic's Ministry of Tourism asks the public to look at these recent deaths in context: Many millions of people travel to the Dominican Republic each year and don't fall seriously ill or die. A statement released by the ministry earlier this month [June 2019] references statistics and polls conducted by the Central Bank of the Dominican Republic. The "rate of tourist incidents" in 2018, the ministry says, fell to 1.4 per 100 000 tourists from 1.6 the previous year. It also highlights that 99 percent of American tourists told their survey they'd return to the Dominican Republic for future vacations.

Nevertheless, US travellers are concerned by recent news, to say the least. CNBC cites a survey from the American Society of Travel Advisors revealing that 2/3rds of its members have cancelled trips to the Dominican Republic for clients within one week. CBS News adds flights to the Dominican Republic from the US are down 74.3 percent from this time last year [2018], with cancelled flights up by 51.2 percent in recent weeks, according to data from flight analysis agency. The [US] State Department's most recent Travel Advisory on the Dominican Republic -- from April 2019 -- places the country as a Level 2, with the directive, "Exercise Increased Caution." The rationale: crime.  "Here we are talking about 9 people, but there are countries in the area where 10 times the number of Americans have died there," the Dominican Republic's tourism board reportedly said at a press conference on 21 Jun 2109, as covered by NBC News. (Details on the 10th death, of New York native VC on 17 Jun 2019, hadn't yet been released.) "But all eyes are on us."  [Byline: Stephie Grob Plante]
=====================
[There are several reports of individuals complaining of shortness of breath and an ill feeling after consuming products from the mini bar. There were television reports indicating some drink containers were filled by the hotel, or the pool bar and put back into the mini bar.

This is the 1st article reporting methanol. However, methanol is a common product substituted in alcoholic drinks because it is cheap and easy to make. Frequently, this type of alcohol is associated with blindness. An individual, possibly dehydrated, coming in from the sun who consumes the beverage somewhat quickly may react differently. But pulmonary oedema is certainly associated with methanol consumption.


Airway and lungs:
- Breathing difficulty
- No breathing
Eyes:
- Blindness, complete or partial, sometimes described as "snow
blindness"
- Blurred vision
- Dilation (widening) of the pupils [Organophosphates produce pin
point pupils - Mod.TG]
Heart and blood:
- Low blood pressure
Nervous system:
- Agitated behaviour
- Coma (unresponsiveness)
- Confusion
- Difficulty walking
- Dizziness
- Headache
- Seizures
Skin and nails:
- Bluish-colored lips and fingernails
Stomach and intestines:
- Abdominal pain (severe)
- Diarrhea
- Liver problems, including jaundice (yellow skin) and bleeding
- Nausea
- Pancreatitis (nausea, vomiting, and abdominal pain)
- Vomiting, sometimes bloody
Other:
- Fatigue
- Leg cramps
- Weakness

Compare the clinical signs, as listed by the same source
<https://medlineplus.gov/ency/article/002832.htm> for organophosphate poisoning:

Symptoms of organophosphate or carbamate poisoning:

Heart and Blood
- Slow heart rate
Lungs and Airways
- Breathing difficulty
- Wheezing
Nervous System
- Anxiety
- Coma (decreased level of consciousness and lack of responsiveness)
- Convulsions
- Dizziness
- Headache
- Weakness
Bladder and Kidneys
- Increased urination
Eyes, Ears, Nose, and Throat
- Drooling from increased saliva
- Increased tears in the eyes
- Small pupils
Stomach and Intestines
- Abdominal cramps
- Diarrhea
- Loss of appetite
- Nausea and vomiting
Skin
- Blue-colored lips and fingernails

Note: Serious poisoning can occur if an organophosphate gets on your bare skin or if you don't wash your skin soon after it gets on you. Large amounts of the chemical soak through the skin unless you are protected. Life-threatening paralysis and death can occur very quickly.

While the clinical signs have some differences, it could have been a combination of organophosphates and methanol intoxication. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Dominican Republic: <http://healthmap.org/promed/p/24>]
Date: Thu 27 Jun 2019
Source: USA TODAY on Yahoo News [edited]

A Denver man is the latest American tourist to die in the Dominican Republic this year [2019]. [KA] died on Tuesday [25 Jun 2019], the State Department confirmed to USA TODAY.

Denver's 9 News and Fox 31 report [KA] was on vacation with his daughter [MA] when he fell ill in the Caribbean vacation destination. [MA] told 9 News her father started to complain about a painful bump on his leg just before her flight home on Sunday [23 Jun 2019]. She said they stopped by their hotel's medical clinic, but decided against treatment unless the pain became worse.

[MA] had already returned to Denver when her father's pain worsened the following day [24 Jun 2019]. He booked an earlier return flight but was forced to disembark due to his symptoms.

His sister-in-law [MS] told Fox 31 he was dripping with sweat and vomited in the plane's lavatory. "They transferred him to Santo Domingo and (said) his breathing is really bad and his kidneys were failing," she said. [MS] noted while her brother-in-law had undergone a kidney transplant several years earlier, he was in perfect health when he left Colorado.

[KA]'s relatives said they were not even told he had died; they found out only after [MA] called the hospital repeatedly Wednesday [26 Jun 2019] morning. "It's been hard," she told 9News. "Not being able to get a hold of them, or them miscommunicating, or simply not knowing information."

Authorities are conducting an autopsy and investigation to determine the official cause of death, according to 9 News. (The family said they did not receive any diagnosis.)

Questions about safety have dogged the Dominican Republic since late May [2019], when the 1st of several Americans died in their hotel rooms and a Delaware woman claimed she was attacked there in January [2019].

Last week, tourism minister Francisco Javier Garcia held a press conference to dispel those concerns, stating, "The Dominican Republic is a safe country." Garcia also said the confirmed deaths -- 9 including [KA] -- are not out of the ordinary and the number is actually lower than in some previous years. Garcia said by this point in 2011 and 2015, 15 tourists had died in the Dominican Republic.  [Byline: Sara M. Moniuszko]
=====================
[The Dominican Republic is a small place compared with the USA, Europe, Russia, Australia, Canada, Brazil and others.  While this article says there were 9 deaths, including this victim, other sources and listed names add up to 13, with other victims being severely ill and reporting their illness and having survived to tell about it. This is a lot for a small place and even more so given that most of them are reporting the same clinical signs.

An autopsy alone is insufficient for determining a cause of death in these cases. We have been waiting weeks for the release of the toxicology report from the first 10 or more victims, which allegedly the US officials and CDC toxicologist are involved with.

If the man had no prior illness and suddenly started having these pains, sweating and vomiting, it seems quite out of the ordinary. His kidneys may well have failed from the toxins (allegedly) in his system, but it does not mean the kidney failure was the primary reason for death.

The excessive sweating, complained about by every victim prior to death, and by a few who managed to survive, as well as reports of vomiting roll together to make me think this is not a plain and simple death or a death from kidney failure.

I am still suspicious of organophosphates. I am also suspicious of the pain from a bump on his leg. This article does not address anything about the bump. I wonder if there was a bite or sting there? Or was he injected with something?

While the minister of tourism is saying it is safe, there is no indication of security being increased around the resorts to prevent others with nefarious motives from entering the area. There is no indication of an investigation from the resorts or the minister of tourism to assess what is really happening. - ProMED Mod.TG]

[It is also possible that the "bump" on his leg was an abscess either insect bit related or small entry wound related and the disease process described could also be consistent with sepsis, remembering that the individual had a history of a kidney transplant and was most likely on immunosuppressive drugs to prevent rejection of the transplanted kidney. - ProMED Mod.MPP]

[HealthMap/ProMED-mail map:
Dominican Republic: <http://healthmap.org/promed/p/24>]
Date: Sat 15 Jun 2019, 1:03 PM
Source: New York Post [edited]

A group of Jimmy Buffett-diehards from Oklahoma were incredibly sick in paradise -- the latest in an ever-growing list of tourists to be sickened during a jaunt to the Dominican Republic, a report said.

DF, a travel agent who vacationed to Punta Cana with the Buffett-loving Central Oklahoma Parrothead Association, said 4 days into their April [2019] trip, he and other members came down with a mysterious illness. "I can't even explain how sick I was," DF told Oklahoma's News 4. "I lost 14 pounds during that time and was really sick."

By the end of the vacation, 47 of the 114 Oklahomans reported becoming ill, DF said, with many of them too sick to leave their rooms at the Hotel Riu Palace Macao.

DF said it's unclear what caused the illnesses -- Punta Cana doctors suggested a parasite might be to blame. Everyone who got sick swam in the resort pool equipped with a swim-up bar, DF recalled.

Some of the sick Parrotheads, the nickname for fans of the "Why Don't We Get Drunk" singer [Jimmy Buffet], tested positive for _Salmonella_ spp, according to DF, who said he did not.

The latest report of illness comes amid a spate of unexplained deaths on the island nation since January [2019]. The death count ticked to 8 on [Fri 14 Jun 2019], when the family of a 78-year-old Ohio man revealed he died suddenly after dinner and drinks at the Dreams Punta Cana Resort & Spa. Authorities are eyeing bootleg liquor from hotel minibars as the potential killer, sources have told The Post.  "I will not be going back to the Dominican any time soon," DF said.  [Byline: Sara Dorn]
=====================
[These people may be lucky they were only sick and not dead. However, _Salmonella_ sp most often causes diarrhoea and cramps along with severe dehydration and weakness. While an individual may develop a fever and be sweating, the sweating reported in the fatal cases is extreme sweating.

There is no report of the deceased individuals testing positive for salmonellosis.

Regardless of the cause, salmonellosis, or poisoning by something other than bacteria, the resorts involved in these reports appear to have a problem. The problem may be lack of awareness of chemicals from spraying trees above air conditioning units, to someone tampering with alcohol bottles, or perhaps uncleanliness at some eating/drinking  establishment. This many illness and deaths seems quite out of the ordinary for these resorts. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Dominican Republic: <http://healthmap.org/promed/p/24>]
More ...

Samoa

General:
**********************************
Cuba is an independent island country situated in the Caribbean. It is the largest of the islands and covers 42,000sq miles. The climate is sub tropical throughout the year with most of the rainfall in
the northern parts of the country. Temperatures of between 20C to 35C are fairly standard throughout the year. Generally the winter effects of the American continent only last for short periods.
Safety & Security:
**********************************
The majority of tourists visiting Cuba will have no difficulty but bag snatching and other street crime appears to be increasing. The old Havana area and other major tourist resorts may be particular areas of concern in this regard. On arrival be careful to only use your recognised tour operator. If you are taking a taxi at any stage make sure it is a registered one and not a private vehicle. It is unwise to carry large quantities of money or jewellery away from your hotel and try not to flaunt wealth with your belongings. Pickpockets are too common an occurrence on buses and trains and at train stations so be careful with your essential documents and credit cards. Valuables should not be stored in suitcases when arriving in or departing from Havana as there have been a number of thefts from cases during the time the cases are coming through baggage handling. There is an airport shrink-wrap facility for those departing Havana which reduces the risk of tampering. Remember to carry a photocopy of your main documents (passport, flight tickets etc).
Road Safety:
**********************************
Following a number of serious road accidents involving tourists, you are advised not to use mopeds for travelling around Cuba or in Havana. Also, if you are involved in any accident a police investigation will be required to clear you and this may significantly delay your travel plans. On unlit roads at night there have been a number of accidents associated with roaming cattle (sounds like Ireland!). The traffic moves on the right side of the roads. There is a main highway running the length of the country but many of the country roads are in poor repair.
Local Laws & Customs:
**********************************
When arriving into Cuba make sure you are not carrying any items which could be considered offensive. Any illicit drug offense is treated very seriously and Cuban law allows for the death penalty to be used under these circumstances. If you require personal medication for your health, make sure it is in original packing and carry a letter from your doctor describing the medication. Never agree to carry any item for another individual and always secure your cases once they are packed. Taking photographs of military or police installations or around harbours, rail and airport facilities is strictly forbidden.

Currency:
**********************************
Since 1993 it is now possible to use US dollars for all transactions within Cuba. Remember, there is a 20$ airport departure tax. Certain travellers cheques and credit cards may not be acceptable within Cuba. This is particularly true of American Express cheques and cards but check your situation with the travel operator before departure.
Health Facilities:
**********************************
Generally healthcare facilities outside of Havana are limited and many standard medications may not be available. It is important to carry sufficient quantities of any medications which may be required for the duration of your time in Cuba.
Food & Water:
**********************************
The level of food and water hygiene varies throughout the country and between resorts. On arrival check the hotel cold water supply for the smell of chlorine. If it is not present then use sealed bottled water for both drinking and brushing your teeth throughout your stay. Cans and bottles of drinks are safe but take care to avoid pre-cut fruit. Peel it yourself to make sure it is not contaminated. Food from street vendors should be avoided in most cases. Bivalve shellfish are also a high risk food in many countries and Cuba is no exception in this regard. (Eg Mussels, Oysters, Clams etc)
Malaria & Mosquito Borne Diseases:
***********************************************
Malaria transmission does not occur within Cuba and so prophylaxis is not required. However, a different mosquito borne disease called Dengue has begun to reoccur in the country over the past few years. This viral disease can be very sickening and even progress to death. It is rare for tourists to become infected but avoiding mosquito bites is a wise precaution.
Swimming, Sun & Dehydration:
************************************
The extent of the Cuban sun (particular during the summer months (April to October) can be very excessive so make sure your head and shoulders are covered at all times when exposed. Watch children carefully as they will be a significant risk. Drink plenty of fluids to replace what will be lost through perspiration and, unless there is a reason not to,
take extra salt either on your food or in crisps, peanuts etc. Take care if swimming in the Caribbean to stay with others and to listen to local advice. Never swim after a heavy meal or alcohol.
Rabies Risk in Cuba:
**********************************
This viral disease does occur throughout Cuba and it is essential that you avoid any contact with all warm blooded animals. Dogs, cats and monkeys are the most commonly involved in spreading the disease to humans. Don't pick up a monkey for a photograph! If bitten, wash out the wound, apply an antiseptic and seek urgent medical attention.
Vaccinations for Cuba:
**********************************
There are no essential vaccines for entry / exit if coming from Ireland. However, for your own personal protection travellers are advised to have cover against the following;
*
Tetanus (childhood booster)
*
Typhoid (food & water borne disease)
*
Hepatitis A (food & water borne disease)
For those planning a longer or more rural trip vaccine cover against conditions like Hepatitis B and Rabies may also need to be considered.
Summary:
**********************************
Cuba is becoming a popular destination for tourists and generally most will stay very healthy. However commonsense care against food and water borne disease is essential at all times. Also take care with regard to sun exposure, dehydration and mosquito bites.

Travel News Headlines WORLD NEWS

Date: Tue 4 Feb 2020
Source: Samoa News [abridged, edited]

While there are no new laboratory-confirmed measles cases for American Samoa as of 1 Feb [2020], health officials are awaiting results of one suspected case sent to the Hawaii state lab. This was the latest update provided by the health department and LBJ Medical Center during a cabinet briefing late on Sunday afternoon [2 Feb 2020] on the new coronavirus and measles outbreaks.

Based on data shared by the Samoa Ministry of Health, the department of health [DoH] informed cabinet members that numbers remain the same for measles cases in the independent state since the last briefing on 26 Jan [2020], with 5707 total cases and 83 deaths.

For American Samoa, DoH's Dr Saipale Fuimaono said that as of 2 Feb [2020], the total number of confirmed laboratory cases remain at 15, which is the same from the 26 Jan [2020] briefing. He added that there is one pending case, for which a sample was sent to the Hawaii laboratory for testing.

Data provided by LBJ shows that the suspected case is a female, 24, from Falenui, who was born in American Samoa with no travel history outside of the territory. The person has had the 1st MMR shot. She was seen at the hospital with a rash on her forehead accompanied by a fever and cough. She was treated and released the same day while swabs were taken and sent to Hawaii.

LBJ's Dr Annie Fuavai said if the results come back negative, the person will be given the 2nd MMR shot. As with previous suspected and confirmed cases, DoH carried out the usual contact tracing, checking on those who came in contact with the individual.

DoH also provided the latest update on its MMR overall coverage for both public and private schools as well as day-care centres. As of 1 Feb [2020], a total of 99.7% of children 12 years and older have been given the 1st MMR dose, leaving only 0.3% -- or 44 children -- needing shots.

For students 14 years and older who have received the 2 MMR shots, the percentage has reached 98.4%, leaving 1.6% -- or 208 [students] -- needing the 2nd MMR dose. Of those needing to complete the 2 MMR doses, 83 students are in public elementary schools and 72 attend private elementary schools. For high schools, 34 students in the public education system and 12 in private schools still need to get the 2nd MMR shot.

Education director Dr Ruth Matagi-Tofiga requested that DoH re-check their records for public schools, saying there may be cases of students who have already received both doses but are not properly recorded, as well as students who moved off island.

Governor Lolo Matalasi Moliga reiterated what he had said in previous briefings: ensure all students get their required immunization shots, especially the 44 who are required to get the 1st MMR dose. According to DoH, medical staff will carry out school visits again this week from 8 a.m. to 2 p.m. to update immunization records. DoH this week also continues vaccinations at the same 5 sites as last week.

DoH data on border control for the Pago Pago International Airport shows that 15 passengers were denied entry between 27 Jan and 1 Feb [2020]. There was no explanation on whether the denied entries were passengers from Samoa or Hawaiian Airlines. At the conclusion of the briefing, Lolo said there are no changes to current policies implemented to address both the measles and coronavirus.  [byline: Fili Sagapolutele]
=====================
[This is good news, as the outbreak appears to be basically over, and the vaccination campaign is continuing. - ProMED Mod.LK]
Date: Thu 30 Jan 2020
Source: Kealaka'i [abridged, edited]

Measles continues to spread like wildfire through Samoa, with about 50 cases being reported per day, according to the official Government of Samoa Twitter. The number of dead, as of 14 Dec [2019] is 72, with more than 5200 people sick. Most of the dead are children. BYU-Hawaii professors said much of the problem comes from low vaccination rates, caused by fear and misinformation being spread throughout the Pacific.

Colby Weeks, assistant professor of science, added, "There are thousands of people who are horribly sick and going to the hospitals, putting a massive strain on the healthcare system. This is imminently avoidable because of the healthcare system. Headlines always say deaths, but there is a lot more going on than those individuals. Pick the easiest route and get vaccinated."

Line Kruse, a special instructor, explained the situation is occurring all across Oceania, but it is worst in Samoa. "There is an epidemic in Samoa. There have also been measles reported by the World Health Organization and UNICEF in New Zealand, Australia, Tonga, and Fiji.

"It has been declared a state of emergency in the Kingdom of Tonga, the Republic of the Fiji Islands, and Samoa. Samoa, however, is the only country in Oceania, as of this entire year [2019], that has this many reported deaths."

Akanoa shared the death toll is so high in Samoa because their vaccination rate is much lower than the other Pacific Islands. "This is due to a lack of understanding with parents about how important it is to vaccinate your children. There are still people out there who don't believe in vaccination. With this outbreak, we know it is the only solution."

According to one NPR article, the vaccination rate dropped from 58% in 2018 to 31% in 2019. The situation has become urgent, and unvaccinated homes are being marked with red flags as part of a mass door-to-door vaccination campaign by the government.

"People also rely heavily on their faith," shared Akanoa. "When things like this happen, they have this really great faith Heavenly Father will not let anything worse happen. When children started dying, they finally realize that maybe God wants them to do something about it."

Kruse said, "The government of Samoa has gone through several series of responses to the measles epidemic. They started to mandate vaccinations, but as of 5 and 6 Dec [2019], they have shut down the government. They have shut down roads. They have shut down public gatherings."

One purpose of the government shutdown, said Akanoa, is because "all the government workers in the public sector are going out to help with vaccinations and to assist families."

The biggest argument of anti-vaccination supporters in Oceania, or anti-vaxxers, according to Kruse, is that vaccinations made in India, which is where most Oceanic countries get their vaccinations, are lower quality than European-made vaccines.

"The anti-vaxxers are trying to create this false narrative that [vaccines] from India are bad for you, which is very Eurocentric and downright racist ... It is reckless because there are no scientific journals that validate any deaths attributed to manufacture vaccines from India," she explained.

One anti-vaxxer on Twitter wrote, "Talking with friends. Most are pro-vax, but none of them want to harm their children with this Indian vaccine. People are really going to be hiding their children in the attic to protect them from the government." He attached a screenshot of a text saying, "I'd rather infect my kids with measles than inject them with those cheap Indian vaccines."

The anti-vaccination sentiment came right on the heels of a tragic mix-up in vaccines in Samoa in 2018, said both Akanoa and Kruse. The vaccine, which is supposed to be mixed with water, was combined with muscle relaxer by 2 nurses in Samoa, explained Kruse. Two young children were killed.

"Parents were afraid to take their kids to get the vaccination," shared Akanoa. "[Parents] hear horror stories and freak out."

According to Kruse, another unfortunate side effect of disasters like this is that charlatans, or people who use deception to obtain money from people, begin to appear. One such man, Fritz Alai'asa, showed up during the measles epidemic.

"A man has come into Samoa and set up shop," she shared. "Kangen water is what he had said is going to cure them. 'Pay me 10 tala [WST 10 / USD 3.68]. Bring your family,' he says. So, the family comes, and hegets this Kangen water, this alkaline water, and he sprinkles it on them."  [Byline: Haeley van der Werf]
Date: Tue 7 Jan 2020
Source: Xinhuanet [abridged, edited]

Samoa's Ministry of Health confirmed on Tuesday [7 Jan 2020] 2 more deaths in the island nation's measles epidemic, bringing the death toll to 83 since the measles outbreak in mid-October [2019]. The Samoan Ministry of Health said that the 2 fatalities, an infant and [an] adult, died between 29 Dec last year [2019] and 5 Jan this year [2020].

A total of 5697 measles cases have been reported to the Disease Surveillance Team so far, with 30 new cases recorded during the same period. A total of 16 people with measles are currently hospitalized in the island nation, including 4 critically ill children.

Currently, there are no travel restrictions or vaccination requirement for those travelling to Samoa.

With the latest measles case, the reopening of day-care centres in Samoa has now been delayed until next week, but public schools will resume on Tuesday [7 Jan 2020] as planned. Death may occur in up to 5-10% of infected young children in developing countries.
Date: Thu, 5 Dec 2019 00:51:07 +0100 (MET)
By Neil SANDS

Wellington, Dec 4, 2019 (AFP) - Samoa entered a two-day lockdown Thursday as authorities launched an unprecedented mass vaccination campaign to contain a deadly measles outbreak that has devastated the Pacific island nation.   Officials ordered all businesses and non-essential government services to close, shut down inter-island ferry services and told private cars to keep off the roads.

Residents were advised to stay in their homes and display a red flag if they were not yet immunised as hundreds of vaccination teams fanned out across the nation of 200,000 in the early hours of the morning.   The operation, carried out under emergency powers invoked as the epidemic took hold last month, is a desperate bid to halt an inexorably rising death toll that reached 62 on Thursday, most of them young children.   "I've seen mass mobilisation campaigns before, but not over an entire country like this," UNICEF's Pacific island chief Sheldon Yett told AFP.   "That's what we're doing right now. This entire country is being vaccinated."

Immunisation rates in Samoa were about 30 percent before the outbreak and have risen to more than 55 percent since a compulsory mass vaccination campaign began a fortnight ago.   Yett said the aim of this week's two-day drive was to push the rate above 90 percent, which should help curb the current outbreak and stop future epidemics.   He said the normally busy streets of the capital Apia were almost deserted early Thursday.   "It's very, very quiet out here. I can just hear a few barking dogs. The streets are empty. There are no cars," he said.   "People are staying at home waiting for the vaccination campaign. The teams are getting their supplies together and getting ready to go out."   Even Prime Minister Tuilaepa Sailele Malielegaoi's residence had a red flag fluttering outside it, with the leader saying his nephew had recently arrived from Australia and needed a measles shot.

Malielegaoi said he was angered by anecdotal reports that some parents were encouraging their children to hide from the vaccination teams to avoid the mandatory immunisation injection.    "The message is that we have vaccinated a lot of people and they are OK," he told reporters.   "The only cure for this is vaccination... having your children vaccinated is the only way."   Children are the most vulnerable to measles, which typically causes a rash and fever but can also lead to brain damage and death.

The latest figures show that 54 of the 62 dead were aged four or less and infants account for most of the 4,217 cases recorded since the outbreak began in mid-October.   There have also been measles epidemics in neighbouring Fiji and Tonga, but higher immunisation rates mean they have been more easily contained, with no fatalities.
Date: Tue, 3 Dec 2019 06:07:45 +0100 (MET)

Wellington, Dec 3, 2019 (AFP) - The World Health Organisation warned of a "slide back" in global efforts to eliminate measles Tuesday, as the death toll from an outbreak that has killed dozens of children in Samoa continued to climb.   A total of 55 people have died since the epidemic began in mid-October, 50 of them children aged four or under, officials in the Pacific nation said Tuesday.   Another 18 infants are critically ill in hospital and the crisis shows no sign of slowing, with 153 new cases in the past 24 hours, taking the national total to 3,881 in a population of 200,000.   Emergency measures including compulsory mass immunisations and school closures have so far done little to stop the virus spreading in a country that was particularly vulnerable to measles due to low vaccination rates of about 31 percent.

World Health Organisation (WHO) medical officer for the western Pacific, Jose Hagan, said it was a grim reminder of the danger posed by "probably the most infectious disease that we know of".   "Unfortunately the case (to) fatality rate of measles is much higher than people realise," he told Radio New Zealand.   "This is quite a severe disease and we just aren't used to seeing it, so it comes as quite a surprise when we see how fatal it can be."   He said the fatality rate in Samoa was less than two percent but had been known to reach five percent in developing countries.

Hagen said increased access to measles vaccines was estimated to have saved 21 million lives over the past 20 years.   "But we are starting to have a slide back and there are outbreaks happening all over the world in all WHO regions and it's leading to the virus being exported through international travel," he said.   Cases have skyrocketed in Europe, leading to Britain, Greece, the Czech Republic and Albania all losing their measles-free status in August.   The United States narrowly maintained its "measles eliminated" status a few months later, despite experiencing its worst outbreak since 1992.   The WHO has pointed to various reasons for declining immunisation rates including lack of access to healthcare and complacency about the need to vaccinate.

Another major factor, which has been cited by the WHO as a reason for the severity of the Samoa outbreak, is misinformation about immunisation from anti-vaccine campaigners.   Prime Minister Tuilaepa Sailele Malielegaoi this week said vaccination was the only answer to the epidemic.   He has ordered the government to cease non-essential operations on Thursday and Friday so public servants can help a mandatory vaccination campaign that aims to give anti-measles jabs to everyone aged below 60.
More ...

Austria

Austria - US Consular Information Sheet
July 29, 2008
COUNTRY DESCRIPTION:
Austria is a highly developed, stable democracy with a modern economy.
Tourism is an important pillar of the Austrian economy and facilities are widely availab
e.
Read the Department of State Background Notes on Austria for additional information, or see the information at the Austrian National Tourist Office web site, http://www.austria.info.
ENTRY/EXIT REQUIREMENTS:
A valid passport is required. U.S. citizens can stay without a visa for tourist/business for up to 90 days in each six-month period. That 90-day period begins when you enter any of the Schengen countries: Austria, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, and Sweden.
Note:
Although European Union regulations require that non-EU visitors obtain a stamp in their passports upon initial entry to a Schengen country, many borders are not staffed with officers carrying out this function.
If an American citizen wishes to ensure that his or her entry is properly documented, it may be necessary to request a stamp at an official point of entry.
Under local law, travelers without a stamp in their passports may be questioned and asked to document the length of their stay in Schengen countries at the time of departure or at any other point during their visit, and could face possible fines or other repercussions if unable to do so.
There are no vaccination requirements for international travelers.
Visit the Embassy of Austria web site at http://www.austria.org/ for the most current visa information. There are four Austrian Consulates General in the United States. As each one serves clients from a particular region, please contact the appropriate office for assistance. If you reside outside the U.S. please contact the responsible Austrian Embassy or Consulate in your country of residence.
A list of Austrian Embassies/Consulates is available at http://www.bmeia.gv.at/aussenministerium/buergerservice/oesterreichische-vertretungen.html.
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:
Austria remains largely free of terrorist incidents. However, like other countries in the Schengen area, Austria’s open borders with its Western European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity. Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

Austrian intelligence experts have registered increased radicalization of immigrant Muslim individuals and of small conspiratorial groups, as well as intensified use of the Internet as a propaganda and communications platform. Despite some terrorism-related incidents in 2007 directed against individual Austrian nationals or the Government of Austria, authorities overall believe the likelihood of terrorist attacks in Austria remains relatively low; the State Department rates Austria as a “Medium” threat for transnational terrorism.

Every year, a number of avalanche deaths occur in Austria's alpine regions. Many occur when skiers/snowboarders stray from the designated ski slopes. Leaving the designated slopes to ski off-piste may pose serious risks and may delay rescue attempts in case of emergency. Skiers/snowboarders should monitor weather and terrain conditions, and use the available avalanche rescue equipment. Avalanche beepers (transceivers) are the most common rescue devices and, when properly used, provide the fastest way of locating an avalanche victim, usually enabling authorities to begin rescue operations within minutes.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State’s, 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:
Austria has one of the lowest crime rates in Europe, and violent crime is rare. However, crimes involving theft of personal property have increased in recent years.
As such, most crimes involving Americans are crimes of opportunity involving theft of personal belongings. Travelers are also targets of pickpockets who operate where tourists tend to gather. Some of the spots where such crimes are most frequently reported include Vienna’s two largest train stations, the plaza around St. Stephan’s Cathedral and the nearby pedestrian shopping areas (in Vienna’s First District).

There has been an increase in thefts and pick-pocketing on public transportation lines, especially on those lines coming into and out from the city center. U.S. citizens are advised to secure personal belongings and always take precautions while on public transportation and in public places such as cafes and tourist areas. Many citizens have had to disrupt travel plans while awaiting replacements for lost and stolen passports since emergency passports are generally only authorized in rare circumstances such as critical medical emergencies.
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.
Information on the Austrian crime victim compensation program can be found on the U.S. Embassy web site at http://vienna.usembassy.gov/en/embassy/cons/compens.htm.
The local equivalent to the 911 emergency line in Austria is 133.See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
There are an adequate number of hospitals available in Austria. Local hospitals will not settle their accounts directly with American insurance companies. The patient is obliged to pay the bill to the local hospital and later claim a refund from his/her insurance carrier in the United States. MEDICARE payments are not available outside the United States.

The Austrian Medicine Import Act generally prohibits the import of prescription drugs into Austria, with two exceptions:
A) Travelers residing outside the European Union are allowed to carry with them (as part of their personal luggage) drugs and medicines, but only the quantity that an individual having a health problem might normally carry; and,
B) Travelers while staying in Austria may receive drugs and medicines for their personal use by mail. The quantity is limited to the length of their stay in Austria and must never exceed three packages.
Generally, it is recommended that travelers have either a prescription or written statement from their personal physician that the medicines are being used under a doctor's direction and are necessary for their physical wellbeing while traveling.
Public health conditions in Austria are excellent. The level of community sanitation in Vienna meets or exceeds that of most large American cities. Disease incidence and type are similar to that seen in the major cities of Western Europe and the United States. At the present time, air pollution is not a major health problem in Vienna.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Austria.

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.

Any person, regardless of citizenship, who wants to take up residence in Austria, must be covered by some health insurance plan that covers full medical treatment in Austria. American citizens interested in joining the health insurance plan under the Austrian system should apply to the Health Insurance Agency (Gebietskrankenkasse) in the province (Bundesland) where they reside.
Further information may be obtained from the appropriate “Gebietskrankenkasse” http://www.sozialversicherung.at/portal/index.html?ctrl:cmd=render&ctrl:window=esvportal.channel_content.cmsWindow&p_menuid=955&p_tabid=6&p_pubid=687.
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 Austria is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Road conditions in Austria are generally excellent. During the winter, however, roads in alpine areas may become dangerous due to snowfall, ice, or avalanches. Some mountain roads may be closed for extended periods and tire chains are often required. Drivers should exercise caution during the heavily traveled vacation periods (December-February, Easter, July-August). Extra caution is recommended when driving through autobahn construction zones, particularly on the A-1 East/West Autobahn. Reduced lanes and two-way traffic in these zones have resulted in several deadly accidents in recent years. Traffic information and road conditions are broadcast on the English language channel fm4, located between 91 and 105 FM depending on the locale.

A U.S. driver’s license alone is not sufficient to drive in Austria. The U.S. driver’s license must be accompanied by an international driver’s permit (obtainable in the U.S. from American Automobile Association and the American Automobile Touring Alliance) or by an official translation of the U.S. driver’s license, which can be obtained at one of the Austrian automobile clubs (OEAMTC or ARBOE). This arrangement is only acceptable for the first six months of driving in Austria, after which all drivers must obtain an Austrian license.

Austria requires all vehicles using the autobahn to display an “Autobahn Vignette” highway tax sticker on the inside of the vehicle’s windshield. The sticker may be purchased at border crossings, gas stations in Austria, and small “Tabak” shops located in Austrian towns. Fines for failing to display a valid autobahn vignette on the windshield of your car are usually around $120.

Austrian autobahns have a maximum speed limit of 130 km/hr, although drivers often drive much faster and pass aggressively. The use of hand-held cell phones while driving is prohibited. Turning right on red is also prohibited throughout Austria. The legal limit for blood alcohol content in Austria is .05 percent and penalties for driving under the influence tend to be stricter than in many U.S. states.

Tourists driving rented vehicles should pay close attention to the provisions of their rental contract. Many contracts prohibit drivers from taking rented vehicles into eastern European countries. Drivers attempting to enter countries listed as “prohibited” on the car rental contract may be arrested, fined, and/or charged with attempted auto theft. Austrian police are authorized to hold the rented vehicle for the car rental company.
Emergency roadside help and information may be reached by dialing 123 or 120 for vehicle assistance and towing services (Austrian automobile clubs), 122 for the fire department, 133 for police, and 144 for ambulance.
The European emergency line is 112.
Austrian Federal Railroads (Österreichische Bundesbahnen) offer excellent railroad service to all major towns of the country and also direct connections with all major cities in Europe. Trains are well maintained and fares are reasonable. There is also an extensive network of bus lines operated by the Austrian Postal Service (Österreichische Post). All major cities also offer excellent public transportation services.
Please refer to our Road Safety page for more information. Visit the web-site of Austria’s national tourist office (Österreich Werbung) at http://www.austria.info and the national authority responsible for road safety (Kuratorium für Verkehrssicherheit) at http://www.kfv.at/.

AVIATION SAFETY OVERSIGHT The U.S. Federal Aviation Administration (FAA) has assessed the Government of Austria’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Austria’s air carrier operations.
For more information, travelers may visit the FAA’s web site at: http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Travelers using U.S. issued debit cards in Austrian Automatic Teller Machines (ATMs) may encounter problems. If the request for cash is rejected, travelers should check their accounts immediately to see whether the money was in fact debited from their account. If this is the case, they should notify their banking institution immediately. Prompt action may result in a refund of the debited amount. Receipts should always be requested and kept for verification with your home bank.
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 Austrian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Austria 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 Austria are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Austria.
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 Consular Section of the U.S. Embassy is located at Parkring 12a, tel. +43- 1-31339-7535, fax: +43-1-5125835, web site: http://vienna.usembassy.gov/en/index.html
*

*

*
This replaces the Country Specific Information sheet for Austria dated January 23, 2008, without substantive changes.

Travel News Headlines WORLD NEWS

Date: Thu, 19 Mar 2020 17:34:25 +0100 (MET)

Vienna, March 19, 2020 (AFP) - Austria said Thursday it was placing all arrivals to the country by air in mandatory quarantine after recording more than 2,000 coronavirus cases to date.   A decree published on the health ministry website stated "Austrian and foreign citizens are obliged to enter home quarantine immediately for 14 days on arrival by plane in Austria," adding they would be required to provide a written commitment to that effect.   Transit passengers, medical professionals and staff from international organisations are exempt from the measure.
Date: Tue, 10 Mar 2020 12:05:30 +0100 (MET)

Vienna, March 10, 2020 (AFP) - Chancellor Sebastian Kurz on Tuesday said Austria was restricting travel from Italy, which has been hard hit by the coronavirus.   "We are putting in place an entry ban for people from Italy to Austria, unless they have a doctor's certificate," Kurz told reporters.   Austrians in Italy will be allowed to return as long as they agree to a two-week home quarantine, he added.
Date: Sun, 8 Mar 2020 15:48:15 +0100 (MET)

Vienna, March 8, 2020 (AFP) - Avalanches killed six people in Austria Sunday in two separate incidents, police said.   At least five people were swept away Sunday morning by a large avalanche on a mountain in Upper Austria, part of a group walking in snow shoes on the Dachstein range.   Local police said five bodies had been recovered from the avalanche, which began 2,800 metres (9,200 feet) up. The victims were thought to be from the Czech Republic, they added.

Although they did not think there were other victims, mountain rescue workers were searching the site, team leader Christoph Preimesberger told the Austrian Press Agency (APA).   In January 2019, about 60 residents in the town of Ramsau-am-Dachstein, which also lies in the Dachstein range, escaped another large avalanche which caused significant damage but no casualties.   Elsewhere Sunday, a 33-year-old police officer died in an avalanche in the southern Carinthia region on the Grossglockner peak.   Local police said he died while taking part in a training exercise.
Date: Mon, 18 Nov 2019 16:10:29 +0100 (MET)

Vienna, Nov 18, 2019 (AFP) - A man died on Monday in a landslide that destroyed much of his home in southern Austria, which has been hit by heavy rainfall and snow affecting transport and electricity.   The retiree was behind his house in Carinthia state when part of the hill above it slid off, killing the 79-year-old, police said.   Earlier Monday, two women were rescued from the rubble of two houses after another landslide, this one in the spa town of Bad Gastein in Salzburg state.   Salzburg, Tyrol and Carinthia states have all seen heavy rain and snowfall since last week, leading to power cuts in thousands of homes.   Many roads and railway lines have also been cut, and several schools in these areas remained closed on Monday.
Date: Tue, 27 Aug 2019 13:51:00 +0200 (METDST)

Vienna, Aug 27, 2019 (AFP) - An Austrian court has ruled that a German hiker who was trampled to death by cows was partly to blame for the accident in a case which has sparked national debate.   A lower court ordered the cows' owner in February to pay the woman's family 180,000 euros ($200,000) plus a monthly pension of 1,500 euros.

The verdict was seen as potentially harmful for agriculture and tourism in the Alpine country known for its picturesque mountains and cows grazing freely on their slopes in the summer.   A higher court however ruled that the 45-year-old who was hiking with her dog bore 50 percent of the blame as she needed to be aware of the risks cows, especially those with calves, posed when confronted by dogs, a court official said Tuesday.   She also did not heed warning signs to keep a distance from the herd. The farmer in turn had known his cows with calves to be aggressive and should have fenced off part of his pasture, the official said.   The decision means the compensation will also be cut by half. Both parties can appeal the verdict.

The incident took place in July 2014 in the Pinnistal Valley in Tyrol when a herd of cows suddenly surrounded the hiker and trampled her. She died of her injuries at the scene.   Her husband and son had accused the farmer of negligence, while the farmer insisted he had put up warning signs on the pasture.   The February ruling led to Tyrol's farmers describing it as a threat to their livelihood and threating to close off their lands to hikers.   Following the outcry, the government published a "code of conduct" for hikers.   The guidelines include keeping a distance from cows and walking dogs on a short lead but unleashing them in case of attack.
More ...

Serbia

General:
**********************************
Cuba is an independent island country situated in the Caribbean. It is the largest of the islands and covers 42,000sq miles. The climate is sub tropical throughout the year with most of the rainfall in
the northern parts of the country. Temperatures of between 20C to 35C are fairly standard throughout the year. Generally the winter effects of the American continent only last for short periods.
Safety & Security:
**********************************
The majority of tourists visiting Cuba will have no difficulty but bag snatching and other street crime appears to be increasing. The old Havana area and other major tourist resorts may be particular areas of concern in this regard. On arrival be careful to only use your recognised tour operator. If you are taking a taxi at any stage make sure it is a registered one and not a private vehicle. It is unwise to carry large quantities of money or jewellery away from your hotel and try not to flaunt wealth with your belongings. Pickpockets are too common an occurrence on buses and trains and at train stations so be careful with your essential documents and credit cards. Valuables should not be stored in suitcases when arriving in or departing from Havana as there have been a number of thefts from cases during the time the cases are coming through baggage handling. There is an airport shrink-wrap facility for those departing Havana which reduces the risk of tampering. Remember to carry a photocopy of your main documents (passport, flight tickets etc).
Road Safety:
**********************************
Following a number of serious road accidents involving tourists, you are advised not to use mopeds for travelling around Cuba or in Havana. Also, if you are involved in any accident a police investigation will be required to clear you and this may significantly delay your travel plans. On unlit roads at night there have been a number of accidents associated with roaming cattle (sounds like Ireland!). The traffic moves on the right side of the roads. There is a main highway running the length of the country but many of the country roads are in poor repair.
Local Laws & Customs:
**********************************
When arriving into Cuba make sure you are not carrying any items which could be considered offensive. Any illicit drug offense is treated very seriously and Cuban law allows for the death penalty to be used under these circumstances. If you require personal medication for your health, make sure it is in original packing and carry a letter from your doctor describing the medication. Never agree to carry any item for another individual and always secure your cases once they are packed. Taking photographs of military or police installations or around harbours, rail and airport facilities is strictly forbidden.

Currency:
**********************************
Since 1993 it is now possible to use US dollars for all transactions within Cuba. Remember, there is a 20$ airport departure tax. Certain travellers cheques and credit cards may not be acceptable within Cuba. This is particularly true of American Express cheques and cards but check your situation with the travel operator before departure.
Health Facilities:
**********************************
Generally healthcare facilities outside of Havana are limited and many standard medications may not be available. It is important to carry sufficient quantities of any medications which may be required for the duration of your time in Cuba.
Food & Water:
**********************************
The level of food and water hygiene varies throughout the country and between resorts. On arrival check the hotel cold water supply for the smell of chlorine. If it is not present then use sealed bottled water for both drinking and brushing your teeth throughout your stay. Cans and bottles of drinks are safe but take care to avoid pre-cut fruit. Peel it yourself to make sure it is not contaminated. Food from street vendors should be avoided in most cases. Bivalve shellfish are also a high risk food in many countries and Cuba is no exception in this regard. (Eg Mussels, Oysters, Clams etc)
Malaria & Mosquito Borne Diseases:
***********************************************
Malaria transmission does not occur within Cuba and so prophylaxis is not required. However, a different mosquito borne disease called Dengue has begun to reoccur in the country over the past few years. This viral disease can be very sickening and even progress to death. It is rare for tourists to become infected but avoiding mosquito bites is a wise precaution.
Swimming, Sun & Dehydration:
************************************
The extent of the Cuban sun (particular during the summer months (April to October) can be very excessive so make sure your head and shoulders are covered at all times when exposed. Watch children carefully as they will be a significant risk. Drink plenty of fluids to replace what will be lost through perspiration and, unless there is a reason not to,
take extra salt either on your food or in crisps, peanuts etc. Take care if swimming in the Caribbean to stay with others and to listen to local advice. Never swim after a heavy meal or alcohol.
Rabies Risk in Cuba:
**********************************
This viral disease does occur throughout Cuba and it is essential that you avoid any contact with all warm blooded animals. Dogs, cats and monkeys are the most commonly involved in spreading the disease to humans. Don't pick up a monkey for a photograph! If bitten, wash out the wound, apply an antiseptic and seek urgent medical attention.
Vaccinations for Cuba:
**********************************
There are no essential vaccines for entry / exit if coming from Ireland. However, for your own personal protection travellers are advised to have cover against the following;
*
Tetanus (childhood booster)
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Typhoid (food & water borne disease)
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Hepatitis A (food & water borne disease)
For those planning a longer or more rural trip vaccine cover against conditions like Hepatitis B and Rabies may also need to be considered.
Summary:
**********************************
Cuba is becoming a popular destination for tourists and generally most will stay very healthy. However commonsense care against food and water borne disease is essential at all times. Also take care with regard to sun exposure, dehydration and mosquito bites.

Travel News Headlines WORLD NEWS

Date: Fri, 24 Jan 2020 03:33:13 +0100 (MET)
By Rusmir SMAJILHODZIC with Emmy VARLEY in Belgrade

Sarajevo, Jan 24, 2020 (AFP) - As winter grips the Balkans, the poor are caught in a cruel bind, being forced to light fires at home for heating while fuelling a pollution crisis smothering the region.   In recent weeks, Balkan capitals from Belgrade and Sarajevo to Skopje and Pristina have been ranked among the world's top 10 most polluted major cities, according to the monitoring application AirVisual.

While these are small cities compared to leading Asian polluters like New Delhi and Dhaka, a combination of coal-fired power plants, old cars and fires to heat homes are pumping the air with toxins.   "I know it is polluting. I am not an idiot but my only other choice would be to heat this home with electricity and that is damn expensive," said Trajan Nestorovski, who like many in his working-class Skopje neighbourhood burns wood to stay warm in winter.   His wife Vera added: "There are a couple of factories near our neighbourhood that are burning God knows what in the evenings".

Thanks to the rise of mobile phone apps that measure air quality, like the local Moj Vozduh (My Air) created by a Macedonian developer, citizens are finally grasping the full extent of the crisis.    "Serbia is suffocating, has anyone seen the minister of the environment?", said a recent headline in Belgrade's local Blic newspaper, speaking of the fog and dirty air enveloping the city.   Protests have been erupting around the region in recent days.

In Skopje, the capital of North Macedonia, young people have taken inspiration from Swedish activist Greta Thunberg by holding a spate of protests on Fridays.    "Greta inspired all of us," said 17-year-old Iskra Ilieska.   "In winter, half of my school class is absent because of lung problems. That is not normal," she said.

In neighbouring Bosnia, several hundred people wearing face masks gathered in the city of Tuzla to demand a plan from authorities to tackle pollution and phase out coal-fired plants in the next five years.   "The only recommended measures are that we stay shut up at home... when you go out on the streets, in the playgrounds, you won't see children anywhere," said Alisa Kasumovic, a mother in her forties.

- Silent killer -
According to a recent UN environment report, air pollution causes nearly 20 percent of premature deaths in 19 Western Balkan cities.   The main sources of the dust, soot and smoke are low-grade coal plants and household heating, the report said.    More than 60 percent of people in the region rely on coal and firewood to heat their homes, the report said. Only 12 percent of buildings are connected to district heating systems.

Governments need to make "clean energy more accessible", ban old polluting vehicles and tighten regulations on industry emissions and power plants, the UN urged.    Many people cannot afford cleaner heating options at home in countries where average wages are around 500 euros or less.   Sali Ademi, a 78-year-old in Kosovo's capital Pristina, uses coal.     "There's no worse thing, but what can you do?" he said in a city whose air is already poisoned by two nearby coal-fired power plants running on outdated technology.

- Cable car escape -
Those who warm their homes with fires also bear the brunt of health risks, according to experts.   "Some of the emissions from these stoves stay in the house and poison them," warned Anes Podic, president of an environmental group in Bosnia who has called on the government to replace inefficient wood stoves in the country.

In cities like Sarajevo and Skopje, a circle of mountains helps trap the hazardous air in the valleys where residents live.   Sakiba Sahman, 60, is a Sarajevan taking advantage of a recent reduction on ticket prices for a cable car that rides to the top of the 1,160-metre-high (3,800-foot-high) Mount Trebevic, which peaks above the smog over the Bosnian capital.   "We've come to spend a few hours to ventilate the lungs," she told AFP.   Down below, "the pollution is enormous, there are a lot of cars, everything is dirty, grey and depressing."
Date: 29 Aug 2018
Source: DW [edited]

Health officials in Serbia have reported new deaths from West Nile virus, where over 200 people are confirmed to be infected. The disease has also claimed lives in several EU countries.

Serbian authorities announced on Wednesday [29 Aug 2018] that 6 people have died after being infected by the West Nile virus last week, bringing the current death toll to 21. Serbia, with 213 infected cases, is the European country worst-hit by the disease.

At the same time, Greece reported 5 deaths due to the West Nile virus during the past week. The overall toll now stands at 16, with 130 registered cases of infection.

At least 9 people have died from the disease in Italy and another 6 people in Romania. Two fatalities have also been reported in Kosovo.

The exact number of cases is likely much larger, as humans infected with the mosquito-borne virus typically show no signs of disease and require no treatment. Only about 20 percent of those infected exhibit symptoms similar to influenza, such as fever, headaches, fatigue and swelling of the lymph nodes. Less than one percent of patients develop encephalitis or meningitis, which could potentially lead to death.

The virus has been present in Serbia since 2012, according to infectious disease specialist Dragan Delic, as cited by the Serbian daily Blic. He warned that global warming is likely to boost the spread of other tropical diseases into new areas, including "malaria and dengue fever."

Health experts believe the West Nile virus expanded its foothold in Europe through migratory birds. While there is no vaccine for it, doctors say the risk of infection can be managed by using protection from mosquito bites.
========================
[WNV activity has been higher than in previous years, with cases reported from many countries, and Serbia has reported 213 cases to date according to the ECDC update in section [1] above.

Vector control and community mobilization, awareness, and support are the key steps to controlling disease transmission for WNV, as with other vector borne diseases such as dengue and chikungunya - ProMED Mod.UBA]

[HealthMap/ProMED maps available at:
Date: Mon, 18 Jun 2018 05:25:56 +0200
By Katarina SUBASIC

Belgrade, June 18, 2018 (AFP) - "Join us comrade!" tourists are warmly greeted, as they climb into a vintage car that is no longer produced for a visit back in time to a country that no longer exists.   As a symbol of the former Yugoslavia, the Yugo car is back in vogue on Belgrade's streets.  Like in other places once stranded behind the detested Iron Curtain, the Serbian capital has found a unique way to cater for a surge in interest and even nostalgia for life under communism.

On a three-hour tour, visitors see some of Yugoslavia's most significant sites, seated in one of the once ubiquitous Yugos, ending up at the Museum of History of Yugoslavia which holds dictator Josip Broz Tito's mausoleum.   "People come to experience rides in an iconic car and it is something they cannot experience anywhere else in the world actually," Jovana Stojiljkovic, who manages the Yugotour travel agency, told AFP.   The last Yugo cars were produced a decade ago, but, says Stojiljkovic, they are still a hit among tourists for the "Rise and Fall of a Nation" tour, on which most clients are foreigners.   "It's something similar to a Trabant (East German car) tour in Berlin," she says.

- Made in Yugoslavia -
For vintage car aficionados, Belgrade has a lot to offer, with sightings of American Chryslers or Ford limousines not uncommon.   And for the handful of "Made in Yugoslavia" makes of car, thousands still rumble around on Balkans roads more than 25 years after Yugoslavia's collapse.   As well as the Yugo, the small Fica and Zastava 101, all produced at the Zastava plant in the central town of Kragujevac, were the pride of communist Yugoslavia.

They were highly popular due to their low price.   But the Yugo car was also often the butt of jokes over its design and unreliability.   It even appeared in the 1995 Hollywood blockbuster "Die Hard With a Vengeance" with Bruce Willis and Samuel L. Jackson.   Now it is tourists from all over the world climbing into the Yugos, which in their heyday were exported from Yugoslavia to 74 countries, including Egypt, India and even the United States.   Described by the communist authorities as the "deal of the century" for the US market, the Yugo had only limited success there, however.

- 'View of history' -
When Stojiljkovic was born in 1992, Yugoslavia had already fallen apart in a series of bloody wars and most of its republics were already independent states.   But by the age of 25, she had launched a career in preserving the memory of the Socialist Federal Republic of Yugoslavia (SFRJ) and telling its story, coinciding with a wave of "Yugonostalgia" among some for a period viewed as having enjoyed peace and relative prosperity before the onset of the conflicts.   Dennis Bertelsen, a 38-year-old Dane on a weekend visit to the city, was among the hundreds of thousands of tourists descending on Belgrade -- it hosted one million last year, 835,000 of whom were from abroad, according to
official figures.

With his three friends, he said he took the tour "to get a view of the history and what actually had been the development and downfall of Yugoslavia".   The itinerary includes passing by the famous Hotel Jugoslavija on the Danube river bank, one of the country's most luxurious at the time.   Guests included US presidents Richard Nixon and Jimmy Carter as well as Britain's Queen Elizabeth II.   The hotel has been out of service since it was hit in a 1999 NATO bombing campaign to force the then Serbian strongman Slobodan Milosevic to withdraw his troops from Kosovo but the building still has a mythical status.

- 'Commercialisation' -
Polish student Dominik Wojciechowski came across the tour while researching the Fica car for his photo-art project on so-called Yugonostalgia, a feeling still present in all the countries that emerged after Yugoslavia's collapse, although much less in Croatia where a national sense of being Croat is ultra dominant.

"I am interested in this process of commercialisation of Yugonostalgia and how people today are trying to preserve knowledge of Yugoslavia, while the older generation even (attempts) to return to these times," the 25-year-old said.   For him, the most impressive part of the tour was a 30-floor twin tower called Genex, or Western Gates of Belgrade, still among the tallest in the city.   "You stand below it and look up how big it is and feel this grandiosity of Yugoslavia and how powerful it was," he said.   Most tourists know very little about Yugoslavia, its 22 million people and dictator Tito who led it from the end of World War II until his death in 1980.

A decade later, the federation comprising six republics -- Bosnia, Croatia, Macedonia, Montenegro, Serbia and Slovenia -- collapsed in a series of wars that claimed more than 130,000 lives.   Although Stojiljkovic never lived in Yugoslavia she said she nevertheless knows a lot about it.   "I have heard all the stories from my parents, their friends and the rest of my family, so based on their experience it was a really nice time, they had a good time," she said.   And she herself is now the proud owner of two Fica cars, which, she said, was "to show to the rest of the world what they meant to us".
Date: Tue, 20 Mar 2018 18:47:46 +0100

Belgrade, March 20, 2018 (AFP) - Serbian authorities said Tuesday they have launched an initial investigation of some public opponents of vaccination after 12 people, including two children, have died in an outbreak of measles.   "The prosecutor's office for high-tech crime is looking into whether there is criminal accountability by a number of public persons, opponents of vaccination of children," the Serbian prosecutors's office said in a statement.

The probe came about after a group of 270 parents last month accused 43 people of "causing panic", including a famous folk singer Jelena Krleusa, a writer and even a doctor who have publicly spoken against vaccination, local media has reported.   The prosecutor did not reveal the names of those being investigated.    According to Serbia's Institute of Public Health, more than 3,800 cases of measles, including a 15-day-old baby, have been recorded since the beginning of the outbreak in October.   The 12 people who died of the disease included two children, aged two and four, the Institute said on its web site.

Earlier this month Serbian Health Minister Zlatibor Loncar urged parents to vaccinate their children, saying "the outbreak of measles would have never happened  if they had listened to doctors and not celebrities."   The vaccination, including against measles, is mandatory for children in Serbia, but courts have rarely issued fines that are 30,000 to 150,000 dinars (250 to 1,250 euros/$300 to $1,550).   Measles has also struck in neighbouring Romania as well as Italy, France, Germany and Greece.
Date: Wed 27 Dec 2017, 10:41 AM
Source: B92 [edited]

A 20-year-old man from Belgrade has died in a hospital's intensive care unit from complications caused by measles, RTS is reporting. He is the first victim of measles in Serbia. The patient had not been inoculated against the infectious disease.

Since October [2017], a total of 630 persons in central Serbia and in Serb-majority areas in Kosovo and Metohija contracted the disease, the Public Health Institute Batut announced on [Tue 26 Dec 2017].

A total of 91 percent of those have either not been vaccinated against the disease, or have incomplete or uncertain vaccination status.

Since the measles epidemic was reported in late October [2017], there had been 259 cases in Serb and non-Albanian municipalities in Kosovo.

In early November [2017], an epidemic of the disease was also reported in central Serbia.
=================
[Measles can be a serious illness in all age groups. However, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications. Some people may suffer from pneumonia (infection of the lungs) and encephalitis (swelling of the brain). They may need to be hospitalized and can die.

According to the CDC:
As many as 1 out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children. About 1 child out of every 1000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability. For every 1000 children who get measles, 1 or 2 will die from it.

Measles may cause pregnant woman to give birth prematurely, or have a low-birth-weight baby.

(Excerpted/edited from

A Healthmap/ProMED of Serbia may be found at
More ...

World Travel News Headlines

Date: Mon, 30 Mar 2020 12:35:06 +0200 (METDST)

Brussels, March 30, 2020 (AFP) - Belgium's death toll from the novel coronavirus passed the 500 mark Monday, with almost 12,000 cases detected since the start of the epidemic.   Health authorities in the country of 11.4 million said 513 COVID-19 deaths had been recorded and 11,899 cases confirmed by laboratory tests.

But officials said the rise in admissions to hospital and to intensive care units had slowed slightly over the previous 24 hours.   "We're not at the peak, but at what we call the inflection point -- that means the force of the epidemic is beginning to diminish thanks to the efforts we have all made over the last two weeks," said Emmanuel Andre, spokesman for government's epidemic team.   "It is extremely important to keep up these efforts -- just because the curve is softening slightly today, it doesn't mean it won't get worse if we let up our efforts."

On Friday, Belgium extended lockdown measures by two weeks to April 18 to slow the spread of the virus.   Schools, restaurants and most shops are closed, entry to supermarkets is restricted to allow room for social distancing and people have been told to work from home.

Outdoor sports activities and walks outside are still allowed, but only in small groups, with a friend or with family members living under the same roof.    Prime Minister Sophie Wilmes said the lockdown could be extended by another two weeks to May 3 if the spread of the virus demanded it.
Date: Mon, 30 Mar 2020 12:16:41 +0200 (METDST)

Madrid, March 30, 2020 (AFP) - Spain confirmed another 812 deaths in 24 hours from the coronavirus on Monday, bringing the total number of deaths to 7,340, according to health ministry figures.   It is the first decline in the number of deaths in a 24-hour period since Thursday in Spain, which has the world's second most deadly outbreak after Italy. Spain recorded 838 virus deaths on Sunday.   The number of confirmed cases in Spain has now reached 85,195 -- after the one-day increase of 8.0 percent.

However, officials have pointed to a slower growth rate for both deaths and confirmed cases and expressed hope that the peak of the outbreak was approaching.   The percentage increase in the number of deaths on Monday over the previous day was of 12.4 percent, less than half the increase of 27 percent recorded on Wednesday.

Spain imposed a near-total nationwide lockdown on March 14 to try to curb the spread of the virus, banning people from leaving their homes except to go to work, buy food and medicine or care for a sick relative.   Prime Minister Pedro Sanchez on Saturday announced even stricter lockdown measures which will force all non-essential workers in the nation of around 47 million residents to stay home for the next two weeks.
Date: Mon, 30 Mar 2020 11:21:42 +0200 (METDST)

Harare, March 30, 2020 (AFP) - Zimbabwean authorities on Monday began enforcing a three-week lockdown in its fight against the spread of coronavirus after the disease left one person dead and infected six others.   President Emmerson Mnangagwa declared a 21-day "total" lockdown from Monday curtailing movement within the country, shutting most shops and suspending flights in and out of Zimbabwe.    Police mounted checkpoints on routes leading to Harare's central business district, stopping cars and turning away pedestrians who had no authorisation to be in the area.

Elsewhere truckloads of metropolitan and national police armed with batons were on patrol, ordering people back to their homes.   "We don't want to see people here on the streets. We don't want to see people who have no business in town just loitering," a policewoman said through a loud hailer. "Everyone to their homes."   Her colleagues, in riot gear, dispersed people standing in small groups at the Copacabana minibus terminus, which is usually abuzz with people including foreign currency dealers.    In the township of Mbare, the usually bustling  terminus for long-distance buses was deserted with only municipal street cleaners sweeping the empty bus ranks.   A traditionally busy downtown area of Harare referred to as "The Third World" resembled a ghost town with few people on the streets. Most shops had their shutters down.

For many of the country's 16 million people, who are already suffering a grim economic recession, the lockdown means even tougher hardship.   With unemployment rate estimated at around 90 percent, most Zimbabweans have informal jobs to eke out a living and few have substantial savings.   Some were trying to leave the city for rural villages.   "We would rather spend the 21 days at our rural home, where we don't have to buy everything. I can't afford to feed my family here when I am not working," said Most Jawure.   "We have been waiting here for more than two hours but there are no buses," Jawure told AFP while standing with his wife and daughter beside a bulging suitcase.
Date: Mon, 30 Mar 2020 09:48:42 +0200 (METDST)

Moscow, March 30, 2020 (AFP) - Moscow on Monday imposed a lockdown in a bid to slow the spread of the coronavirus as Russian Prime Minister Mikhail Mishustin asked regional authorities to make similar preparations.    The enforcement of the tough new rules, which were suddenly announced by Moscow Mayor Sergei Sobyanin late Sunday, coincide with the beginning of a "non-working" week declared by President Vladimir Putin last week.   Europe's largest city announced the strict new isolation measures after many Muscovites refused to heed official recommendations and self-isolate at the weekend and instead went to parks for barbecues.

On Monday, the streets of Moscow were deserted following the closure of all non-essential shops, including restaurants and cafes, but traffic was still seen on the roads in the city centre.   "I ask regional heads to work on the introduction of quarantines similar to the one introduced in Moscow," Mishustin said at a government meeting.   In a rare televised address last Wednesday, Putin announced that Russians would not be required to go to work this week, but would still get paid.   The country has so far reported 1,534 cases of coronavirus and eight deaths, with more than one thousand infections in the capital.   The new restrictions apply to all of the city's residents, regardless of age.

Muscovites will only be allowed to leave their homes in cases of a medical emergency, to travel to jobs judged essential, and to shop for food or medicines.   People will be allowed to take out trash and walk their dogs within a 100-metre (330-foot) radius of their homes.   The new isolation rules, which will be policed by a vast system of facial-recognition cameras in Moscow, come into force as Russia closes its borders as part of increasingly stringent measures to stop the spread of COVID-19.
Date: Mon, 30 Mar 2020 08:20:07 +0200 (METDST)

Shanghai, March 30, 2020 (AFP) - A passenger train derailed after striking debris from a landslide in central China on Monday, injuring a number of passengers and staff, officials said.   The accident happened around midday in a rural part of Hunan province and came after recent heavy rains triggered landslides in the area, the state-run railway system said.   The statement said one car caught fire and five derailed. An unspecified number of staff and passengers were sent to hospital for treatment.

There were no immediate reports of deaths.   Unverified video posted on Chinese social media sites showed at least three cars lying on their side and smoke rising from a fire in the distance.   The train was travelling from the eastern city of Jinan to Guangzhou in the nation's south.   Parts of southern, eastern and central China have been soaked by steady rains beginning last week.
Date: Mon, 30 Mar 2020 08:10:11 +0200 (METDST)

Mogadishu, March 30, 2020 (AFP) - A governor in Somalia's Puntland has been killed in a suicide bombing claimed by the al-Shabaab jihadist group, police and hospital sources said Monday.   Abdisalan Hassan Hersi, governor of Nugaal region, succumbed to his injuries after being rushed to hospital in Garowe, the capital of Puntland where the blast occurred Sunday.   "The doctors tried to save the governor's life but unfortunately he died from his injuries," Mohamed Weli, a police officer in Puntland, told AFP by phone.   "He was in a critical condition when he was admitted to hospital."   A source at the hospital, who did not wish to be identified, said the governor died less than an hour after being admitted to the intensive care ward.   "He was badly wounded in the blast and he had little chance of surviving such serious injuries," the source told AFP.

A former police commander and a civilian also wounded in the blast were being treated at hospital, officials said Monday.   Several witnesses described the attacker running at the governor's vehicle before detonating a suicide vest, triggering an explosion.   Al-Shabaab, an Islamist militant group waging a deadly insurgency in Somalia, claimed responsibility for the attack in a statement.   The Al-Qaeda affiliate was driven out of Mogadishu in 2011 and lost most of their strongholds, but still control vast swathes of the countryside.   They have vowed to overthrow the internationally-backed government in Mogadishu and have carried out many attacks in the capital.
Date: Sun, 29 Mar 2020 20:06:11 +0200 (METDST)

Luanda, March 29, 2020 (AFP) - Angola has recorded its first two deaths from coronavirus, out of the seven confirmed cases in the southwestern African country, health minister said Sunday.   "We now have seven confirmed cases and unfortunately two people lost their lives between last night and this morning," Health Minister Silvia Lutucuta told a news conference.   The fatalities were both Angolan citizens -- a 59-year-old, who was regularly resident in Portugal,but returned home on March 12 and a 37-year-old who had returned home from Lisbon the following day.
Date: Sun, 29 Mar 2020 11:48:20 +0200 (METDST)

Montevideo, March 29, 2020 (AFP) - Uruguay reported its first death linked to the novel coronavirus on Saturday, a former minister and ally of the ruling party, the government said.   "With deep sadness we announce the first death due to coronavirus in Uruguay," Secretary of the Presidency Alvaro Delgado told a press conference, naming the victim as Rodolfo Gonzalez Rissotto.

Gonzalez Rissotto was one of nine patients with the coronavirus who were in intensive care, Delgado said, adding his death was "all the more reason to reinforce the request to everyone to take care of themselves and stay home."   President Luis Lacalle Pou paid tribute in a tweet.   "A big hug for the family and friends of Rodolfo Gonzalez Risotto. Friend and counselor. RIP."   Uruguay has reported 304 confirmed cases of the virus.
Date: Fri 27 Mar 2020
Source: AP News [edited]

Standing over the still body of an intubated 5-year-old boy wearing nothing but a plastic diaper, an Iranian healthcare worker in a hazmat suit and mask begged the public for just one thing: Stop drinking industrial alcohol [methanol, the most common industrial alcohol] over fears about the new coronavirus.

The boy, now blind after his parents gave him toxic methanol in the mistaken belief it protects against the virus, is just one of hundreds of victims of an epidemic inside the pandemic now gripping Iran.

Iranian media report nearly 300 people have been killed and more than 1000 sickened so far by ingesting methanol across the Islamic Republic, where drinking alcohol [ethanol] is banned and where those who do rely on bootleggers. An Iranian doctor helping the country's Health Ministry told the Associated Press on Friday [27 Mar 2020] the problem was even greater, giving a death toll of around 480 with 2850 people sickened. [Apparently all from methanol intoxication. - ProMed Mod.TG]

The poisonings come as fake remedies spread across social media in Iran, where people remain deeply suspicious of the government after it downplayed the crisis for days before it overwhelmed the country.

"Other countries have only one problem, which is the new coronavirus pandemic. But we are fighting on 2 fronts here," said Dr. Hossein Hassanian, an adviser to Iran's Health Ministry, who gave the higher figures to the AP. "We have to both cure the people with alcohol [methanol] poisoning and also fight the coronavirus."

For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough, clearing up in 2-3 weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, or death.

The pandemic has swept across the world, overwhelming hospitals, crippling economies, and forcing governments to restrict the movements of billions of people. Particularly hard hit has been Iran, home to 80 million people.

As of now, there is no known cure for COVID-19, the illness caused by the virus. Scientists and doctors continue to study the virus and search for effective medicines and a vaccine.

But in messages forwarded and forwarded again, Iranian social media accounts in Farsi falsely suggested a British schoolteacher and others cured themselves of the coronavirus with whiskey and honey, based on a tabloid story from early February [2020]. Mixed with messages about the use of alcohol-based hand sanitizers, some wrongly believed drinking high-proof alcohol would kill the virus in their bodies.

The Islamic Republic has reported over 29 000 confirmed cases [of COVID-19] and more than 2200 deaths from the virus, the highest toll of any country in the Middle East. International experts also fear Iran may be under-reporting its cases, as officials for days played down the virus ahead of a parliamentary election.

That fear of the virus, coupled with poor education and internet rumours, saw dozens sickened by drinking bootleg alcohol containing methanol in Iran's southwestern Khuzestan province and its southern city of Shiraz. Videos aired by Iranian media showed patients with IVs stuck in their arms, lying on beds otherwise needed for the fight against the coronavirus, including the intubated 5-year-old boy. Iranian media also reported cases in the cities of Karaj and Yazd.

In Iran, the government mandates manufacturers of toxic methanol add an artificial color to their products so the public can tell it apart from ethanol, the kind used in cleaning wounds. Ethanol is also the kind of alcohol found in alcoholic beverages, though its production is illegal in Iran.

Some bootleggers in Iran use methanol, adding a splash of bleach to mask the added color before selling it as drinkable. Sometimes it is mixed with consumable alcohol to stretch supply, and other times it comes as methanol, falsely advertised as drinkable. Methanol also can contaminate traditionally fermented alcohol.

Methanol cannot be smelled or tasted in drinks. It causes delayed organ and brain damage. Symptoms include chest pain, nausea, hyperventilation, blindness, and even coma.

Hassanian said his figures included reports from coroner's offices around Iran also counting those who died outside of hospitals from the poisonings.

"Unfortunately, in some provinces, including Khuzestan and Fars, deaths from drinking methanol has exceeded the number of deaths from the new coronavirus," he said.

Dr. Knut Erik Hovda, a clinical toxicologist in Oslo, said to expect more methanol poisoning victims.

"The virus is spreading, and people are just dying off, and I think they are even less aware of the fact there are other dangers around," Hovda said. "When they keep drinking this [methanol], there's going to be more people poisoned."

Even before the outbreak, methanol poisoning had taken a toll in Iran. One academic study found methanol poisoning sickened 768 people in Iran between September and October 2018 alone, killing 76.

Other Muslim nations banning their citizens from drinking also see such methanol poisoning, although Iran appears to be the only one in the pandemic so far to turn toward it as a fake cure. In Buddhist Cambodia, police said they seized 4200 liters (1100 gallons) of methanol from a man who unwittingly planned to make toxic hand sanitizer because of the virus outbreak.

Muslim drinkers in Iran can be punished with cash fines and 80 lashes. However, minority Christians, Jews, and Zoroastrians can drink alcoholic beverages in private.

While police occasionally announce alcohol busts, the trade in nontoxic alcohol also continues. Locally made Iranian arak from fermented raisins, known as Aragh sagi, sells for USD 10 for a 1.5 l [1.6 qt] bottle. Imported vodka sells for USD 40 a bottle.

"Every year during Nowruz, or the Persian New Year holidays beginning 21 Mar 2020, my customers double," said Rafik, an Iranian-Armenian who makes vodka in the basement of his Tehran home. He spoke on the condition only his 1st name be used for fear of arrest. "This year [2020], because of coronavirus, it jumped up by 4- or 5-fold."

Farhad, a self-described heavy drinker who lives in central Tehran, said alcohol remains easy to find for those looking for it. "Even you can find it offered when you are walking down the street, " he said.

Since 1979, Iran's 40 alcohol factories have seen their production changed to pharmaceutical needs and sanitizers. Others had been left idle, like the abandoned Shams alcohol factory east of Tehran.

But now, in a time when even some mosques in Iran hand out high-proof alcohol as a sanitizer, officials plan to start work again at Shams to produce 22 000 l [23 247 qt] of 99% alcohol a day. [This alcohol is not for internal consumption but can be used in hand sanitizers. - ProMed Mod.TG]  [Byline: Nasser Karimi and Jon Gambrell]
====================
[Methanol toxicity initially lacks severe toxic manifestations. Its pathophysiology represents a classic example of lethal synthesis in which toxic metabolites cause fatality after a characteristic latent period. In other words, these people may not realize they are sick or ill until sometime after consumption.

Methanol is sometimes used as an ethanol substitute for alcohol. Foods such as fresh fruits and vegetables, fruit juices, fermented beverages, and diet soft drinks containing aspartame are the primary sources of methanol in the human body, but [they contain] minute quantities.

Wood alcohol is also known as methanol. It is a commonly used toxic organic solvent causing metabolic acidosis, neurologic issues, and death when ingested. It is a part of many commercial industrial solvents and of adulterated alcoholic beverages or is mistaken as being the same as alcohol for ingestion. Methanol toxicity remains a common problem in many parts of the developing world, especially among members of lower socioeconomic classes.

Neurological complications are recognized more frequently due to advanced technologies and because of early recognition of the toxicity and advances in supportive care. Hemodialysis and better management of acid-base disturbances remain the most important therapeutic improvements.

Serum methanol levels of greater than 20 mg/dL correlate with ocular injury. Funduscopic changes are notable within only a few hours after methanol ingestion. The mechanism by which the methanol causes toxicity to the visual system is not well understood. Formic acid, the toxic metabolite of methanol, is regarded as being responsible for ocular toxicity, and blindness can occur in humans.

The prognosis in methanol poisoning correlates with the amount of methanol consumed and the subsequent degree of metabolic acidosis; more severe acidosis confers a poorer prognosis. Methanol has a relatively low toxicity. The adverse effects are thought to be from the accumulation of formic acid, a metabolite of methanol metabolism. The prognosis is further dependent on the amount of formic acid that has accumulated in the blood, with a direct correlation existing between the formic acid concentration and morbidity and mortality. Little long-term improvement can be expected in patients with neurologic complications.

The minimal lethal dose of methanol in adults is believed to be 1 mg/kg of body weight. The exact rates of morbidity and mortality from methanol intoxication are not available.

Rapid, early treatment is necessary for survival, but sequelae such as blindness may be permanent.

Metabolic acidosis in methanol poisoning may necessitate the administration of bicarbonate and assisted ventilation. Bicarbonate potentially may reverse visual deficits. In addition, bicarbonate may help to decrease the amount of active formic acid.

Antidote therapy, often using ethanol or fomepizole, is directed towards delaying methanol metabolism until the methanol is eliminated from the patient's system either naturally or via dialysis. Like methanol, ethanol is metabolized by ADH [alcohol dehydrogenase], but the enzyme's affinity for ethanol is 10-20 times higher than it is for methanol. Fomepizole is also metabolized by ADH; however, its use is limited because of high cost and lack of availability.

Hemodialysis can easily remove methanol and formic acid. Indications for this procedure include (1) greater than 30 mL [1 oz] of methanol ingested, (2) serum methanol level greater than 20 mg/dL, (3) observation of visual complications, and (4) no improvement in acidosis despite repeated sodium bicarbonate infusions.

Intravenous administration of ethanol in a 10% dextrose solution may be helpful. As ethanol prolongs the elimination half-life of methanol, the treatment may take several days, and the patient should be hospitalized. Dialysis may be necessary to prevent kidney failure as well. Hemodialysis remains an effective treatment.

Portions of this comment were extracted from

This tragic development is another example of the broader deleterious impact of a pandemic on other aspects of public health.  Anecdotal reports of other potentially harmful "home remedies" for COVID-19 being hawked on the internet reminds us that education of the general public and responsible messaging are more important now than ever. - ProMed Mod.LXL]

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Date: Fri, 27 Mar 2020 22:49:49 +0100 (MET)

Dublin, March 27, 2020 (AFP) - Ireland is to impose a lockdown in a bid to stem the spread of the coronavirus, Prime Minister Leo Varadkar said on Friday.   "Everybody must stay at home, in all circumstances," he said of the new measures to come into force at midnight (0000 GMT) on Saturday and last until 12 April.   Exceptions will be made for essential workers, medical appointments and the purchase of food.   Travel for "vital family reasons", for farming and exercise within two kilometres (one mile) of homes will also be allowed.

All public or private gatherings "of any number of people" outside a single household are also prohibited.   "These are radical actions aimed at saving as many people's lives as possible," said Varadkar at a press conference.   "I'm asking us for a time to forego our personal liberties and freedoms for a greater cause."   There have been 22 COVID-19 related deaths and 2,121 confirmed cases of the virus in Ireland, according to department of health figures released earlier Friday.   Earlier this month the Irish government ordered schools, universities and pubs to close nationwide.   Swathes of non-essential businesses were also ordered shut earlier this week as Ireland braced for an uptick of COVID-19 cases within its borders.

Emergency coronavirus legislation passed through the final stages of Irish parliament and was signed into law by president Michael D. Higgins earlier Friday.   The bill enacts a rent freeze and a moratorium on evictions for the duration of the crisis.   It also streamlines the registration of healthcare and defence forces staff returning to the workforce, and enables the Irish government's financial supports to those laid off as a result of COVID-19 business closures.   "The legislation is emergency legislation for a time of crisis," said Higgins in a statement.   "These are difficult times, but our difficulties will come to an end."