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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: 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".
Date: Fri 18 May 2018
Source: Armenpress [edited]

The investigation into a foodborne incident in Armenia's Armavir province continues. The suspected cause -- food poisoning -- has been confirmed through lab tests. Salmonellosis has been discovered in all victims.

63 from the overall 88 victims of the food poisoning have already been treated and discharged. The healthcare ministry says they confirm that the cause was food poisoning. Earlier, the state service for food safety has dispatched agents to Armavir province to probe the suspected food poisoning incident in the plant of Tierras de Armenia, a viticulture and winemaker known for its Karas wines. Earlier, doctors said they suspected the cause of the poisoning to be a lunchtime snack, which all of the employees consumed in the cafeteria of the plant.

Agents have taken samples from the facility and sent them for laboratory analysis. Food safety agents also ceased the operation of a businesswoman's food supply business in relation to the incident as a precaution. The businesswoman, Alvina Melkonyan, supplied Tierras de Armenia with lunch-time food on the day when the incident happened. A company, who in turn is supplying Melkonyan, is also under investigation. All patients are in satisfactory states, doctors say.

The likely cause of the mass poisoning in Armavir province is thought to be lunch-time snacks containing chicken, cheese and potatoes, which the victims have consumed in the cafeteria of the plant, a doctor of the Armavir medical center told Armenpress. Earlier, it was unclear whether the poisoning was food-related.
======================
[The specific food is not yet stated, but chicken is a common vehicle, either undercooked or cross-contaminated after cooking. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Armavir Province, Armenia: <http://healthmap.org/promed/p/46276>]
More ...

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, 21 Jul 2019 00:04:32 +0200

San José, July 20, 2019 (AFP) - Alcohol tainted with potentially toxic levels of methanol has killed 19 people in Costa Rica, where authorities issued an alert against drinking some half-dozen brands.   The Ministry of Health issued the national warning Friday while also updating the death toll.   Of 34 people who have been poisoned, 14 men and five women, age 32 to 72, have died since the first week of June, the ministry said.   Authorities warned that it was not known how much alcohol had been adulterated, but have confiscated some 30,000 bottles and are carrying out a countrywide investigation.

The doctored alcohol contained between 30 to 50 percent methanol, according to Donald Corella, head of emergency services at Calderon Guardia Hospital in San Jose, who was quoted in the daily La Nacion.   He said six people who were treated at his hospital had died, while four others survived but suffered "very serious after-effects" ranging from irreversible total blindness to brain lesions that cause tremors similar to Parkinson's disease.   If ingested in large quantities, methanol can cause blindness, liver damage and death.   According to authorities, the majority of the 19 deaths occurred among homeless and alcoholic individuals.
Date: Wed, 26 Jun 2019 10:01:43 +0200

San José, June 26, 2019 (AFP) - A 6.2 magnitude earthquake hit the Panama-Costa Rica border around midnight on Tuesday, the US Geological Survey said, revising earlier warnings of "significant damage", as the tremor cut power supplies near the epicentre.   The quake struck at a depth of 26 kilometres (16 miles), about two kilometres from the nearest town of Progreso in Panama, USGS said, updating a previous alert that estimated the depth at 10 kilometres.

There were no immediate reports of casualties, and USGS said "the impact should be relatively localized", reversing an earlier advisory that "past events with this alert level have required a regional or national level response."   "Estimated economic losses are less than 1 percent of GDP of Panama," the website said.   According to the National Seismological Network (RSN) in Costa Rica, the quake struck at 0523 GMT Wednesday (11.23 pm Tuesday) with its epicentre located 11 kilometres east of the Panamanian border town of Puerto Armuelles.

The tremor was felt in Costa Rica's capital San Jose and in many parts of the Central American country, according to initial reports, but the national tsunami warning system said there was no risk of a tsunami.   Villagers in the south of Costa Rica fled their homes, fearing aftershocks. Two houses in the region were damaged by the quake, said Alexander Solis, president of the country's National Emergency Commission.

Costa Rica's President Carlos Alvarado said there were power cuts in several communities in the southwest of the country, near the epicentre.   In November 2017 a 6.5-magnitude quake on the Pacific coast of Costa Rica caused buildings to sway in San Jose and contributed to the deaths of two people who had heart attacks.   Further north, two months earlier a 7.1-magnitude earthquake killed more than 300 people in Mexico.
Date: Mon 20 Jan 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/costa-rica-health-officials-investigate-hepatitis-surge-puntarenas-28003/>

Health officials in Costa Rica continue to investigate the hepatitis A outbreak reported in the province of Puntarenas where 33 cases have been reported during the 1st 11 days of 2019, according to the [health ministry] (computer translated). Cases have been primarily reported in the following districts: Barranca (10), Oak (8), and Chacarita (7). Officials announced last week [week of 14 Jan 2019] that contaminated water has been ruled out by laboratory analysis and the epidemiologists now aim to confirm as a source of contamination the poor hygiene in the preparation of food products and the presence of faecal coliforms (faeces) in the food.

After confirmation of the cases, the Ministry of Health issued a health alert to intervene and activate the health protocols in the active surveillance of new cases, both in the health services and in the population close to the suspects. In addition, urgent actions are taken in health services, protection of water sources for consumption, and dissemination of prevention measures for the population. The Regional Directorates of the CCSS [Caja Costarricense de Seguro Social/Costa Rican Social Security Fund] and the Ministry of Health intensified health promotion and prevention activities, using all local means of communication to inform the population about the disease, existing cases, hygiene measures in preparation and handling of food, and personal hygiene measures for the prevention of Hepatitis A.

The Director of Health Surveillance, Dr Rodrigo Mara­n, vehemently calls the people of Barranca, Chacarita, and El Roble to take measures to prevent and avoid new cases: "Self-care and food safety are the more effective measures to combat hepatitis A. Self-care refers, in this case, to proper personal hygiene practices such as proper and regular hand washing," said Mara­n.
=====================
[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 less children are infected and therefore still susceptible to HAV as adults. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Costa Rica: <http://healthmap.org/promed/p/43112>]
Date: Wed, 5 Dec 2018 18:04:53 +0100

San José, Dec 5, 2018 (AFP) - A fingerprint test has confirmed the murder of a Venezuelan-born American tourist who had been missing for over a week, police said Wednesday.   The body found in the mountainous area of San Antonio de Escazu, southwest of the capital, where the tourist was staying, "is that of Carla Lucia Stefaniak, 36, who had been reported missing," the Judicial Investigation Agency (OIJ) said.   The body, exhibiting stab wounds and a severe blow to the head, was found on Monday near Stefaniak's hotel, OIJ chief Walter Espinoza said.   Her identity was confirmed after the US Federal Bureau of Investigation sent fingerprints that were compared to those of the body.

Nicaraguan national Bismarck Espinoza Martinez, 32, was arrested as a suspect in the homicide. He will be held in preventive detention for three months while the case is being investigated, prosecutors said.    "Words cannot express the devastation within her family and friends. We want the world to know that we will never forget Carla," the victim's family said on a dedicated Facebook page, "Finding Carla."    "We will never forget the joy she brought into our lives, how much she made us laugh. We will always be with her and we know she will always be with us."   Stefaniak's father, Carlos Caicedo, was able to view the body late Tuesday, when he identified it as his daughter's.   The murder was a fresh blow to Costa Rica's image as a tourist destination, after a Mexican tourist and one from Spain were killed in separate incidents in August.
Costa Rica - human Date: 15 Nov 2018
Source: Q Costa Rica [edited]
<http://qcostarica.com/biologist-infected-with-rabies-died/>

A 43 year old biologist infected with the rabies virus died on Wed 14 Nov 2018 the Ministry of Health has confirmed. His admission to the medical centre occurred 2 months after the biologist entered a cave during a family outing on 15 Aug 2018 in Copey de Dota and had contact with bats, suffering a bite on one of his arms. He began to manifest symptoms [numbness and paralysis, difficulties swallowing, and behavioural disorders] on 11 Oct 2018, when he finally decided to obtain medical help. The patient was admitted to the intensive care unit of San Juan de Dios Hospital in San Jose on 21 Oct 2018, where he remained on life support but died of cardiorespiratory failure according to Daniel Salas Peraza, director of health surveillance, in the Ministry of Health.

The rabies virus is typically transmitted through the bite of an infected host. The bite transmits infected saliva, passing the virus to a previously uninfected animal. In humans, rabies is fatal unless treated before severe symptoms occur. If untreated, the virus spreads through the central nervous system, reaching the brain and ultimately leading to death. All travellers should exercise caution when in close proximity to animals, including wild animals and strays. Street dogs are common in Costa Rica. For adventure travellers, particularly cavers who may find themselves in close proximity to infected bats, and long-term travellers, including expats, who may be spending extended periods of time in high-risk areas, vaccination may be recommended.

If travelling with children, tell them not to pet wild or domestic animals (especially when unsupervised). Children might not report scratches or bites, making them particularly vulnerable. If bitten by a potentially rabid animal, you should 1st wash the wound thoroughly with soap and water. You should then seek medical attention immediately. According to the Centers for Disease Control and Prevention (CDC): "The 1st symptoms of rabies may be very similar to those of the flu, including general weakness or discomfort, fever, or a headache." These symptoms can last for days, often accompanied by an itching sensation at the site of the bite. As the disease progresses, symptoms such as agitation, hallucinations, and delirium start to appear.
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[HealthMap/ProMED map of Costa Rica available at <http://healthmap.org/promed/p/17>]
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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: 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>]
Date: Wed 12 Jun 2019
Source: New York Times [edited]
<https://www.nytimes.com/2019/06/12/travel/dominican-republic-deaths.html>

More than two million Americans visit the Dominican Republic every year, making up about a third of the country's tourists. Six have died in the last year during their visits. Because of the seeming similarities among their deaths, their family members have suggested that they are connected and have raised suspicions about the resorts where they died. Here's what we know, and don't know, about the circumstances.

Who has died, and how?
Yvette Monique Sport, 51, died in June 2018 of a heart attack. Her sister, Felecia Nieves, has said that Ms. Sport had a drink from the minibar in her room at a Bahia Pri­ncipe resort, one of a number on the island, then went to sleep and never woke up.

In July 2018, David Harrison, 45, died at the Hard Rock Hotel & Casino Punta Cana. Mr. Harrison died of a heart attack and The Washington Post reported that his death certificate also listed "pulmonary oedema, an accumulation of fluid in the lungs that can cause respiratory failure, and atherosclerosis" as causes of death. He and his wife were in the Dominican Republic for their wedding anniversary with their son.

In April of this year, Robert Wallace became sick at the Hard Rock Hotel & Casino Punta Cana, where he was attending a wedding and died. The 67 year old's family said that he became ill after drinking scotch from the minibar in the hotel. Miranda Schaup-Werner, 41, of Allentown, Pa., was celebrating her 10th wedding anniversary when she died at the Luxury Bahia Pri­ncipe Bouganville, on May 25 of this year of a heart attack. She had been at the resort for less than 24 hours.

A few days later, Nathaniel Edward Holmes 63, and Cynthia Ann Day, 49, from Prince George's County, Md., were found dead in their room at the Grand Bahia Pri­ncipe La Romana. The two had recently become engaged. An autopsy found that the couple had respiratory failure and pulmonary oedema.

Are the hotels connected?
Four of the dead were staying at Bahia Pri­ncipe resorts, which are part of a group of 14 hotels in the Dominican Republic that are popular among tourists because they are all-inclusive. The Luxury Bahia Pri­ncipe Bouganville, where Ms. Schaup-Werner died, is less than a five-minute walk away from the Grand Bahia Pri­ncipe La Romana, where Mr. Holmes and Ms. Day died. Both are near the town of San Pedro De Macoris.

The Hard Rock is across the island from the other two hotels in Punta Cana. It is not known which Bahia Principe resort Ms. Sport was staying in.

What are the hotels saying?
In a statement on Friday, Bahia Principe said reports of the deaths had been inaccurate and that the hotel was committed to "collaborating completely with the authorities and hope for a prompt resolution of their inquiries and actions." Hard Rock Hotels & Casinos said in a statement on Tuesday evening that it is waiting for official reports about the deaths and is, "Deeply saddened by these two unfortunate incidents, and we extend our sincerest sympathy to the families of Mr. Harrison and Mr. Wallace."

What are Dominican officials doing?
The Dominican Attorney General's office and the national police are investigating the deaths, but tourism officials have been downplaying them. The tourism minister, Francisco Javier Garci­a, said last week that in the last five years, more than 30 million tourists have visited the country, and that these deaths are "isolated incidents" and the island is safe for tourists. "These are situations that can occur in any country, in any hotel in the world," he said. "It's regrettable but sometimes it happens." The tourism ministry said last week that hotels had 60 days to install security cameras. What are U.S. officials saying?

In a statement issued Tuesday evening, the U.S. State Department said that "Dominican authorities have asked for F.B.I. assistance for further toxicology analysis," and it could take up to a month to receive the results. A spokeswoman for the Centers for Disease Control said that the organization had not received a request for assistance from the Dominican Republic relating to these deaths. Are there any theories as to what might be causing the deaths? Tom Inglesby, director of the Johns Hopkins Center for Health Security, said in a phone interview that the symptoms that have been reported, like pulmonary oedema, bleeding and vomiting blood, are "consistent with poisoning," perhaps accidental.

But until toxicology reports are available, he said, it is difficult and too soon to definitively say what caused the visitors' deaths. "It's rare for travellers to die of unknown causes like this, and to have a high number of them in a relatively short period of time is alarming, shocking, sad," Dr. Inglesby said. "It's something that investigators should be able to get to the bottom of." The fact that toxicology reports have not been released or completed is "unconscionable and inexplicable," he said. Have there been other incidents? Two couples have come forward to say they fell ill while staying at one of the Bahia Pri­ncipe resorts where tourists have died. In January 2018, Doug Hand, 40, and his wife Susie Lauterborn, 38, were staying at the Grand Bahia Pri­ncipe La Romana when, he said in a phone interview, they got sick with fevers, nausea, cold sweats, diarrhoea and fatigue. Mr. Hand said that he didn't drink alcohol on the trip, but he did notice a "mouldy, mildew smell like the A.C. or filter hadn't been cleaned."

When Mr. Hand told an employee in the hotel's lobby that his wife was sick, the employee gave him directions to a doctor, but seemed more focused on ensuring the couple attended a meeting about buying time shares, Mr. Hand said. Kaylynn Knull, 29, and Tom Schwander, 33, are suing the resort chain for $1 million, their lawyer told The Times, because the Colorado-based couple became violently ill during their stay at the Grand Bahia Pri­ncipe La Romana last summer. Ms. Knull got a persistent headache and was sweating and drooling profusely, the lawyer, David Columna, said. She also had blurry vision, nausea and diarrhoea, she told CNN, and family doctors determined the couple had been exposed to organophosphates, a class of insecticides. "The hotel did nothing," said Mr. Columna, who is representing Ms. Knull and Mr. Schwander in the Dominican Republic. The couple, he said, "spent the night inhaling the chemical and they are still having side effects of the intoxication and the hotel hasn't given us any idea of what happened." [Byline: Elisabeth Malkin, Tariro Mzezewa]
Date: 6 Jun 2019
Source: Washington Post [edited]

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

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

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

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

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

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

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

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

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

Dominican authorities initially did not run toxicology tests for MSW because there were no signs of violence, said Ramon Brito, a spokesman for the National Police's special tourism unit. After the Maryland couple was found, investigators ordered a set of tests to determine whether anything the 3 Americans consumed may have led to their deaths, Brito said.  [Byline: Arelis R. Hernandez]
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 10 Jul 2018
Source: MSN [edited]

Samoa has issued an immediate recall of the vaccine for mumps, measles and rubella (MMR) following the deaths of 2 infants who reportedly passed away just hours after receiving their shots. The 2 children, a boy and a girl, were both aged about 12 months. They were not related, came from different communities and were vaccinated on [Fri 6 Jul 2018] using the same batch of the MMR vaccine.

Australian forensic experts will fly into the country tonight to help investigate the incident, which happened at the Safotu District Hospital on the island of Savai'i.

In a statement, Samoan Prime Minister Tuilaepa Sailele expressed condolences to the children's families and called for a full inquiry."There are already processes that will determine if negligence is a factor," Mr. Tuilaepa said. "And if so, rest assured those processes will be implemented to the letter to ensure that such a tragedy will not be repeated and those responsible will be made to answer."

Health officials said testing was underway to see if the vaccine was responsible, and it has been recalled nationwide as a precautionary measure. The Government has called on the World Health Organisation (WHO) for assistance. Rasul Baghirov, the WHO's Samoa Representative, told the ABC's Pacific Beat program the situation was serious, but it was too early to determine exactly what caused the deaths.

"These deaths are a tragedy and the Government is committed to understanding exactly what happened, for the families of those children, but also to ensure the ongoing safety of the immunisation program," Dr Baghirov said.

He said the investigation would examine the vaccine itself, the injecting equipment and the storage arrangements for the vaccine. The training and conduct of staff would also be looked at, as well as the medical history of the infants' families. An autopsy team from the Victorian Institute of Forensic Medicine in Melbourne will arrive in Samoa tonight to assist the investigation.

Severe vaccine reaction 'very, very rare'. Dr Baghirov said there have been no other reported cases of children dying after being vaccinated using the batch supplied to Samoa.

The vaccines were from India, were safety checked by the WHO and supplied by the United Nations Children's Fund (UNICEF).

"The MMR immunisation is the best way to reduce a child's risk of getting these highly infectious diseases," Dr Baghirov said. "It has been used around the world for many years, providing more than 2 billion children with protection against these diseases. The severe reaction following the administration of MMR vaccine is very, very rare -- that's why we want to really investigate and find out what caused the deaths here in Samoa."

UNICEF's Pacific Representative Sheldon Yett said it was important for people concerned by the case to remember that vaccines are safe.  "Stopping immunisation would be a disaster for children in the South Pacific and around the world," he said. "It does make sense to pause, and do a complete investigation to know what specifically happened here. "But stopping immunisation of course would be a very wrong approach to pursue here."  [Byline: Catherine Graue & Michael Walsh]
======================
[The very unfortunate death of these 2 infants should be investigated immediately, but it is a mistake to completely stop vaccination, which would result in more morbidity and possibly mortality. All vaccines carry a minimal risk, which generally is mild and only very rarely severe. It is not clear whether there were underlying conditions such as a weakened immune system or allergies in these 2 infants that led to complications from the MMR vaccine, or even whether the vaccine was truly the cause of death. The enquiry will look into the vaccine itself, equipment, storage of the vaccine and its administration. It is important to monitor the safety of this very commonly used vaccine, as appears to have been done by WHO in this case. Only a strong monitoring program will reassure the public.

According to CNN report (<https://www.cnn.com/2018/07/10/health/samoa-mmr-baby-deaths-intl/index.html>), "Vaccines prevent almost 6 million deaths worldwide every year, according to the World Health Organization. In countries that widely use vaccines, diseases such as measles have been nearly eradicated, with a 99 percent reduction in cases."

Typically given in 2 doses in early childhood, the MMR vaccine protects against 3 diseases: measles, mumps, and rubella.

One dose is about 93 percent effective at preventing measles if the person is exposed to the virus, while 2 doses are about 97 percent effective, according to the US Centers for Disease Control and Prevention (CDC).

Dr. Sanjay Gupta: Benefits of vaccines are a matter of fact.

"Most children in the world receive this vaccine or similar vaccines to this," Helen Petousis-Harris, a vaccinologist at the University of Auckland, told CNN. "We have safety data on the vaccine, we understand the effects really well. This type of case is exceedingly rare."

Furthermore, she said, child mortality has gone down in many countries that use these vaccines.

"Every country has a vaccine program that has been demonstrated to be very safe," she added. "At the moment we need to understand what's happened so we can work out strategies to ensure it doesn't happen again. There's a lot we don't know about (the deaths)." - ProMED Mod.LK]

[HealthMap/ProMED map available at:
Date: Thu, 12 Jul 2018 03:45:09 +0200

Wellington, July 12, 2018 (AFP) - International health experts launched an investigation Thursday into why two Samoan infants died shortly after receiving childhood vaccination injections in a tragedy that has rocked the close-knit Pacific nation.

The tiny country has suspended its vaccination programme and seized all doses for testing after the deaths at the Safotu District Hospital last Friday.   The health department said two one-year-old babies, a boy and a girl, died soon after being administered a vaccine for measles, mumps and rubella (MMR).   A World Health Organisation expert has arrived to investigate and a specialist from UNICEF was also en route, along with a forensic pathologist to carry out autopsies, it added.

"We will investigate the cause and will take the appropriate actions to ensure that the lives of Samoan children will not be compromised in the future," the director-general of health Take Naseri said.   Samoa Prime Minister Tuilaepa Sailele Malielegaoi expressed his condolences at the deaths, which have rattled the nation of 195,000 people.   Malielegaoi, who almost lost his grandson several years ago under similar circumstances, said an inquiry would look at whether negligence was a factor.

Medical experts say the cause of the deaths remains unknown and have warned the tragedy should not be exploited by anti-vaccination activists.   "The message is -- please understand vaccination is very safe, it's very appropriate and everyone should still continue with their appointments as currently planned," Australian Medical Association president Tony Bartone told Sky News.

University of Auckland vaccinologist Helen Petousis-Harris said almost every child in the world received an MMR vaccine or a similar jab and deaths were extremely rare.   "There are two main reasons why something like this might happen," she said.   "Medical error, where the vaccine is prepared for injection incorrectly and the wrong substance is injected, (or) contamination of the vaccine due to leaving it at room temperature for a long period of time."

WHO data shows measles kills about 134,000 children a year and rubella causes some 100,000 children to be born with birth defects such as deafness.   Concerns about the MMR vaccine surfaced in 1998 when a British study, since discredited, linked it with autism.   While the study was found to be a fraud and the autism link debunked, vaccination rates have dropped in some countries as parents prevent children receiving their shots.
Monday 16th April 2018

- Samoa. 9 Apr 2018. Serotype 2 Outbreak in Samoa, 2017/2018. The cumulative total as of 18 Mar 2018 is 3255, with a national attack rate of 16.6 per 1000 population. Dengue fever continues to spread geographically, mostly in the Apia Urban and North West Upolu regions. A majority of those affected are 5-9-year-old children, which make up 31 percent of the total cases. There have not been any dengue related deaths reported, hence the total dengue-related mortality remains at 5.
Date: Mon 15 Dec 2014
Source: Radio New Zealand [edited]

The number of people infected with chikungunya in Samoa has reached more than 3000.

Ministry of Health figures up until the last week of November [2014] show 3135 cases of the mosquitoborne virus. The ministry says 333 people reported to hospitals that week, the most number of people showing symptoms of the disease in one week since the initial outbreak in July [2014].

The latest numbers mean that 1.7 per cent of Samoa's population has contracted "chik", whose symptoms include fever, sore joints, and a rash. The ministry says the largest clusters of chikungunya are within the Faleata and Vaimauga districts and more women than men have been affected.

There have been no deaths from chikungunya in Samoa. In French Polynesia, 5 people have died and more than 35 000 people have been affected by the disease.
=================
[The chikungunya outbreak continues to grow in Samoa, from 269 cases reported on 25 Aug 2014, to 626 cases on 20 Sep 2014, to an estimated 2500 on 24 Nov 2014, and now to 3135 cases, with cases reported throughout Samoa. Vigilance alone will not halt the outbreak. The Ministry of Health and the public will need to cooperate in the elimination of the breeding sites of the vector mosquitoes.

A map showing the location of Samoa in the Pacific Ocean can be accessed at
a HealthMap/ProMED-mail map can be accessed at
Date: Wed 10 Dec 2014
Source: Outbreak News Today [edited]

The chikungunya outbreak in the Pacific Islands continue to balloon, particularly in French Polynesia, where health authorities report seeing an estimated 9000 new cases during the past week.

According to numbers released by the Auckland Regional Public Health Service in New Zealand, as of [1 Dec 2014], the following island countries are battling an on-going chikungunya outbreak: French Polynesia: 18,352 cases, American Samoa: 1148 cases, Samoa: more than 2500 suspected cases and Tokelau: 159 suspected cases.

Radio New Zealand reported more up-to-date numbers today [10 Dec 2014] showing the French Polynesia outbreak is actually up to 27,000 cases and 5 deaths.

Chikungunya is a viral disease transmitted by the bite of infected mosquitoes such as _Aedes aegypti_ and _Aedes albopictus_, the same mosquito vector that transmits dengue fever. It can cause high fever, joint and muscle pain, and headache.

Chikungunya does not often result in death, but the joint pain may last for months or years and may become a cause of chronic pain and disability. There is no specific treatment for chikungunya infection, nor any vaccine to prevent it.  [Byline: Robert Herriman]
======================
[Pending the development of a new vaccine, the only effective means of prevention is to protect individuals against mosquito bites.

The chikungunya outbreak in the Pacific islands, especially in French Polynesia, continues with increasing numbers of cases. So far, attempts to halt transmission through mosquito vector control have not prevented the increase in case numbers. There is a dengue outbreak in French Polynesia as well, and those viruses are transmitted by the same mosquito vector. In the absence of available vaccines, mosquito vector control and avoidance of mosquitoes bites are the only preventive measures available. These measures would require active public collaboration through education.

A HealthMap/ProMED-mail map showing the location of the islands in French Polynesia can be accessed at <http://healthmap.org/promed/p/31048>; maps showing the location of American Samoa and Samoa can be accessed at <http://www.worldatlas.com/webimage/countrys/oceania/wsnewz.gif> and <http://healthmap.org/promed/p/2>; maps of Tokelau, a New Zealand territory, can be accessed at <http://www.worldatlas.com/webimage/countrys/oceania/tk.htm> and <http://healthmap.org/promed/p/6767>. - ProMED Mod.TY]
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Mozambique

Mozambique US Consular Information Sheet
July 15, 2008
COUNTRY DESCRIPTION:
Mozambique is a developing country in southern Africa which has steadily rebuilt its economy and civic institutions since ending a 16-year civil war in 1992.
he country stabilized following Mozambique's first multi-party elections in October 1994, and a new president was elected in December 2004.
Despite high economic growth rates in recent years, Mozambique remains among the world's poorest countries.
Facilities for tourism in Maputo, the capital city, are steadily improving but remain limited in other areas as many of the goods and services taken for granted in other countries are not yet available.
The official language is Portuguese, although English is spoken in many tourist areas, and in some rural areas only local languages are widely spoken.
Read the Department of State Background Notes on Mozambique for additional information.
ENTRY/EXIT REQUIREMENTS:
A visa is required for entry into Mozambique.
It is recommended that travelers acquire the appropriate visa prior to departing for Mozambique, although a one-entry visa can be obtained at country points of entry, including airports.
Foreigners in Mozambique without a valid visa can expect to pay a substantial fine for each day they are in Mozambique illegally.
The fine can be assessed upon departure or if caught while in Mozambique by authorities.
The passports of all travelers who wish to enter Mozambique must be valid for six months upon arrival and must contain at least three clean (unstamped) visa pages each time entry is sought.
The Mozambican Embassy and Consulates in South Africa charge up to five times the amount charged in the U.S. or at border crossing points for a tourist visa to Mozambique.
In September 2007 the Mozambican Interior and Health Ministries decreed that all travelers entering Mozambique, having previously visited a country where yellow fever is present, must present a valid certification of vaccination against yellow fever.
We recommend all travelers be vaccinated to avoid complications at the border.
Any passenger who cannot present such a certificate at the port of entry will be vaccinated at a cost of $50 US dollars or the equivalent in metical.
Additionally, all travelers entering Mozambique must carry their yellow vaccination book.
For further information on entry requirements, contact the Embassy of Mozambique located at 1525 New Hampshire Avenue NW, Washington, DC 20036, telephone: (202) 293-7146, email: embamoc@aol.com, fax: (202) 835 0245, or the nearest Mozambican embassy or consulate. Visit the Embassy of Mozambique web site at http://www.embamoc-usa.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:
Overland travel after dark is extremely dangerous due to poor road conditions, lack of emergency services, and the increased potential for vehicle hijacking.
Visitors should be particularly vigilant when driving on the main thoroughfares connecting Mozambique and South Africa as incidents of vehicle theft, including assault and robbery, have been reported.
Official Americans serving in Mozambique are prohibited from overland travel outside Maputo city limits after dark and are encouraged to travel in convoys of two or more vehicles when outside of the city during daylight hours.
Accidents involving pedestrians are increasingly common, and some reports suggest pedestrians purposely throw themselves in front of vehicles driven by foreigners in order to extort reparation payment.
Due to residual landmines, overland travelers are advised to remain on well-traveled roads or seek local information before going off-road outside of Maputo and other provincial capitals.
Drivers should obey police signals to stop at checkpoints, which are common throughout Mozambique.
Foreigners in Mozambique for more than 90 days are required to have an International Driver’s License or to obtain a Mozambican driver’s license. Although demonstrations do occur in Mozambique, they are infrequent and there have been no recent demonstrations against U.S. interests.
If any demonstrations do occur, they should be avoided.
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:
Although the vast majority of visitors complete their travels in Mozambique without incident, the most serious threat facing U.S. citizens visiting Mozambique is crime.
Street crimes, including mugging, purse snatching and pick-pocketing are common, both in Maputo and in secondary cities.
Carjacking is increasingly common in Maputo.
Visitors must be vigilant when out in public areas and should not display jewelry or other expensive items.
Isolated areas should be avoided.
Joggers and pedestrians have frequently been mugged, even during daylight hours.
Visitors should take caution when walking at night, even in well-known tourist areas.

Mozambican police are not at the standard U.S. citizens are accustomed to in the United States and visitors should not expect the same level of police service.

Many airline trips from Mozambique to the U.S., Europe, or African destinations transit Johannesburg, South Africa.
Baggage pilferage is an ongoing problem at Johannesburg's Oliver Tambo International Airport.
Travelers are encouraged to secure their luggage, use an airport plastic wrapping service, and avoid placing currency, electronics, jewelry, cameras, cosmetics, running shoes, or other valuables in checked luggage.
Having a complete inventory of items placed in checked baggage can aid in processing a claim if theft does occur.

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.
There is no local equivalent to the “911” emergency line in Mozambique.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are rudimentary, and most medical providers do not speak fluent English.
Medicines are not always consistently available.
There are both public and private medical facilities in the city of Maputo and most provincial capitals.
All health care institutions and providers require payment at the time of service, and may even require payment before service is given.
While some private clinics accept credit cards, many medical facilities do not.
Doctors and hospitals outside Maputo generally expect immediate cash payment for health services.
Outside of Maputo, available medical care ranges from very basic to non-existent.

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

Tuberculosis is an increasingly serious health concern in Mozambique.
For further information, please consult the CDC's Travel Notice on TB
http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.
MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Mozambique is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
The main north-south thoroughfare is passable until the city of Caia (Sofala province), where vehicle passengers must disembark and cross the Zambezi River by ferryboat.
On the north side of the river, the road continues to the Northern provinces.
The road network connecting provincial capitals is in fair condition, but can be riddled with potholes and other obstacles.

The EN4 toll road between Maputo and South Africa is well-maintained.
Official Americans are prohibited from traveling outside cities after dark because of the increased risk of banditry, poor road conditions in some areas, poor maintenance of many vehicles in the country (e.g., no headlights or rear lights), as well as the threat imposed by livestock that graze on roadsides.
Travel outside Maputo often requires a four-wheel drive vehicle, which creates an additional security risk since these vehicles are high-theft items.
Public transportation is limited and often has poor safety standards.
Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office at http://www.turismomocambique.co.mz/.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Mozambique, the U.S. Federal Aviation Administration (FAA) has not assessed Mozambique’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Mozambican law requires that all persons carry an identity document, such as a passport, when out in public, and produce it if requested by police.
Notarized copies of both the biographic page of a passport and a valid Mozambican visa are acceptable forms of identification, although police will occasionally demand original documents.
There are certain areas in Mozambique where pedestrian traffic is prohibited and the ban is strictly enforced.
These areas include the front of the presidential offices located north of the Hotel Polana on the seaside of Avenida Julius Nyerere and the Praça dos Herois on Avenida Acordos de Lusaka near the airport, both in Maputo.

It is against the law to destroy Mozambican currency; offenders can expect a jail sentence or fine.
The limit for an undeclared amount of U.S. dollars one can take out of the country is $5,000.
The limit on local currency is 500 metical, which is approximately 20 U.S. dollars.
Some American travelers have reported having difficulties cashing traveler’s checks and have relied instead on ATMs and credit cards for money withdrawals in Mozambique.
Outside of the major hotels and restaurants, credit cards are not widely accepted in Mozambique.
The South African rand and U.S. dollar are sometimes accepted as legal tender, although this is more common in the southern part of the country or in tourist areas; all transactions must have a local currency (metical) payment option. 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 Mozambique’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Mozambique 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 Mozambique 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 Mozambique.
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 Maputo at 193 Avenida Kenneth Kaunda, telephone (258) 21 49 2797.
The after-hours telephone number for use in emergencies is (258) 21 49 0723.
The Consular Section's fax number is (258) 21 49 0448.
The Consular Section's e-mail address is consularmaputo@state.gov.
The Embassy's web site is http://maputo.usembassy.gov/
*

*

*
This replaces the Country Specific Information for Mozambique dated January 14, 2008, to update sections on Entry/Exit requirements, Information for Victims of Crime, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Sat, 3 Aug 2019 12:59:45 +0200 (METDST)

Maputo, Aug 3, 2019 (AFP) - Mozambique on Saturday set up disease checkpoints along its border with Malawi as a precaution against any spreading of a deadly Ebola outbreak, a senior health ministry official said.   More than 1,800 people have died in eastern Democratic Republic of Congo since Ebola broke out there in August last year.   Mozambique has yet to report an Ebola case, but DRC's regional neighbours have been on high alert while the World Health Organization (WHO) has elevated the crisis to a global health emergency.

Checkpoints began operating in the Milage and Morrumbala districts in the Zambezia province and controls are expected to widen to other provinces of Mozambique that share borders with Malawi, according to a ministry of health official.   "Setting up Ebola checkpoints is a guideline given by decision of the Ministry of Health and World Health Organization to prevent the spread of the disease to other countries" Zambezia province health director, Hidayate Kassim told reporters.   "The checkpoints aim to track all people entering Mozambique having fevers or if they have had contact with anyone who has been in Congo," he said.   "Depending on this control we will determine whether there is a risk or not in our province," Kassim added.   Authorities characterised the screening of people entering Mozambique as a preventive control measure to prepare, prevent, detect and treat any Ebola case that could develop in the country.

The deadliest epidemic of Ebola broke out in West Africa in December 2013 and lasted more than two years, killing more than 11,300 of the 29,000 infected people recorded.   The current one-year old epidemic has left 1,823 dead, according to the DR Congo health ministry, making it second only to the 2013-2016 crisis.   Rwanda on Thursday shuttered its border with DRC after a third case of the deadly virus was detected in the border city of Goma.
Date: Fri 3 May 2019
Source: France24, Agence France-Presse (AFP) [edited]

Provincial authorities said Fri 3 May 2019 that 14 cholera cases have been confirmed in northern Mozambique following floods caused by a powerful cyclone that battered the country last week. The city of Pemba registered 11 cases of the disease while the neighbouring district of Mecufi had 3. "We were already prepared for that -- the healthcare sector has been on the alert since Cyclone Kenneth started," the provincial health director, Anastacia Lidimo, told reporters.

Cyclone Kenneth made landfall in northern Cabo Delgado province on 25 Apr 2019, packing winds up to 220 kilometres (137 miles) per hour -- hitting a region that has not experienced a tropical cyclone in the modern era.

According to the UN humanitarian agency OCHA, Pemba, a city of 200,000 people and the capital of Cabo Delgado province, is in one of the most cholera-endemic regions in Mozambique. In Beira, the impoverished and aid-dependent country administered nearly 900 000 doses of oral cholera vaccines after Cyclone Idai [4-9 Mar 2019] to avert an epidemic.
====================
[Maps of Mozambique:
Date: Fri, 3 May 2019 12:08:16 +0200

Maputo, May 3, 2019 (AFP) - Fourteen  cholera cases have been confirmed in northern Mozambique following floods caused by a powerful cyclone that battered the country last week, provincial authorities said Friday.   The city of Pemba registered 11 cases of the disease while the neighbouring district of Mecufi had three.   "We were already prepared for that - the health care sector has been on the alert since Cyclone Kenneth started," the provincial health director, Anastacia Lidimo, told reporters.

Cyclone Kenneth made landfall in northern Cabo Delgado province on April 25, packing winds up to 220 kilometres (137 miles) per hour -- hitting a region that has not experienced a tropical cyclone in the modern era.   It killed at least 41 people, with some 226,000 affected, destroyed thousands of homes and wrecked water supply systems.   It was the second massive storm to hit Mozambique in six weeks after Cyclone Idai devastated the port city of Beira 1,000 kilometres (600 miles) to the south, causing huge floods and more than 600 deaths.    Cholera is transmitted through contaminated drinking water or food and causes acute diarrhoea.

According to the UN humanitarian agency OCHA, Pemba, a city of 200,000 people and the capital of Cabo Delgado province, is in one of the most cholera-endemic regions in Mozambique.   In Beira, the impoverished and aid-dependent country administered nearly 900,000 doses of oral cholera vaccines after Cyclone Idai to avert an epidemic.    At least four deaths from cholera were recorded in Beira and surrounding districts out of 4,979 cases.
Date: Wed, 24 Apr 2019 19:23:46 +0200

Moroni, Comoros, April 24, 2019 (AFP) - Violent winds caused landslides and flooding and cut off roads in Comoros in the vanguard of tropical storm Kenneth, set to hit Wednesday evening before heading to recently cyclone-ravaged Mozambique, officials said.   As the storm neared, schools were closed and inter-island hopper flight suspended.    Chief of the Comoros Centre for Relief and Civil Protection Centre (COSEP) Mouigni Daho said the arrival of the cyclone on the island was preceded by strong winds and floods.    There have been no reports of injuries.   Comoros Interior Minister Mohamed "Kiki" Daoudou urged citizens Wednesday to "stay calm and follow the instructions."

After Comoros, Kenneth is expected to reach the far north of Mozambique late Thursday or early Friday, if it stays on its current course.   This comes a month after cyclone Idai ravaged the country and neighbouring Zimbabwe, claiming some 1,000 lives and causing about $2 billion in damage, according to the World Bank.   The Mozambique National Meteorology Institute (INAM) warned in a statement that the storm system was intensifying.    "The severe tropical storm has intensified in the past few hours into a Category Three tropical cyclone, and forecasts project that the cyclone could intensify to a Category Four on April 25," it said.

Heavy rains and winds of up to 140 kilometres per hour (87 miles per hour) would follow, it added.   Mozambique's National Institute of Disaster Management (INGC) cautioned Wednesday that 692,000 people could be affected.    The INGC said it would relocate rescue equipment, including boats and helicopters previously reserved in Sofala province for victims of Idai, to Cabo Delgado where Kenneth is expected.   "We have water, we have a generator, we are prepared. We've done everything we were told to," said a hotel owner in the small town of Mucojo which is projected to be close to the eye of the cyclone.

- 'Concerned' -
"We've learned with Idai that it's a good strategy to allocate the rescue means before the cyclone..." Augusto Maita, general director of INGC told AFP.   The province of Cabo Delgado, bordering Tanzania, is also dealing since 2017 with a wave of deadly violence attributed to a jihadist group that advocates the application of Islamic law.   Volunteers of the Red Cross and Red Crescent, who had assisted in cyclone Idai rescue efforts, said teams were already "on alert".   "We are concerned about the impact that this storm could have across the three countries," regional director for Africa for the International Federation of Red Cross and Red Crescent Societies (IFC), Dr Fatoumata Nafo-Traore said.   "We are especially concerned about its possible impact in Mozambique where communities are still recovering from the devastation of Cyclone Idai," she said.   In Mozambique alone, Idai killed more than 600 people and affected 1.85 million, while over 340 died in Zimbabwe.   "Typically cyclones occur in the rainy season which is already over. This cyclone at the end of April is unusual," Comoros environment ministry expert Youssouf Hamadi told AFP.   "It confirms the increasing intensity and frequency of cyclones in the Indian Ocean" -- a phenomenon some blame on global warming.
Date: Tue, 23 Apr 2019 17:10:55 +0200

Maputo, April 23, 2019 (AFP) - A tropical system off Mozambique threatens to unleash a cyclone on the northern Cabo Delgado province just weeks after the country's central parts were ravaged by a powerful storm, meteorologists warned Tuesday.   The poor southern African country is still reeling from the impact of deadly cyclone Idai -- the most powerful storm to hit the region in recent decades -- which left about 1,000 dead in Mozambique and Zimbabwe.   The storm is forecast to make landfall late this week in Cabo Delgado province, reeling from violence at the hands of Islamists who have been terrorising villagers in remote communities for the past 18 months.   "The (weather) system we are talking about was a low pressure and today evolved into tropical depression," Aniceto Tembe, spokesman for the Mozambique Meteorology Institute told AFP in the capital Maputo.

The depression was north of Madagascar island Tuesday, approaching the Mozambique Channel where warm conditions are conducive for it to grow into a cyclone.    "We are projecting that a severe tropical cyclone may arrive and if the conditions allow it can even reach Category 3 tropical cyclone" strength -- with winds of between 140 and 160 kilometres (87 to 99 miles) per hour, he added.   "The projections indicate that the system will approach the coast of Mozambique... mainly the northern part of Cabo Delgado and the southern part of Tanzania," Tembe told AFP.   In a statement Monday, the public works ministry issued a warning of strong winds and heavy rains that could cause flooding and destruction of property in the province of Cabo Delgado and its southern neighbouring province of Nampula.   It said 80,000 people were at risk.

The centre for disaster management issued a warning Tuesday of a tropical storm with wind speeds of between 80 and 120 kilometres per hour, expected to make landfall Friday in the gas-rich district of Palma, the nerve centre of Mozambique's nascent gas industry.   Hardline Islamists have launched several deadly attacks in the Muslim-majority, oil and gas-rich Cabo Delgado province in the past year, killing about 200 people, beheading some of them, and forcing thousands from their homes.   Last month Cyclone Idai cut a path of destruction through Mozambique, Malawi and Zimbabwe on the night of March 14-15, causing damage worth about $2 billion, according to the World Bank.   In Mozambique alone, more than 600 people died among the 1.85 million affected, while over 340 died in Zimbabwe.
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Uganda

Uganda - US Consular Information Sheet
March 02, 2009
COUNTRY DESCRIPTION:
Uganda is a landlocked, developing country in central eastern Africa. Infrastructure is adequate in Kampala, the capital, but is limited in other areas.
Read t
e Department of State Background Notes on Uganda for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport valid for three months beyond the date of entry, visa and evidence of yellow fever vaccination are required.
Visas are available at Entebbe Airport upon arrival or may be obtained from the Embassy of the Republic of Uganda.
The current fee for a three month tourist visa obtained upon arrival at Entebbe Airport is $50.00.
Travelers should be aware that a visa does not determine how long a person may remain in Uganda.
The Ugandan immigration officer at the port of entry will determine the length of authorized stay, which is generally from one to three months as a tourist.
Extensions of duration of stay may be requested at Ugandan immigration headquarters on Jinja Road in Kampala.
Airline companies may also require travelers to have a visa before boarding.
Travelers should obtain the latest information and details from the Embassy of the Republic of Uganda at 5911 16th Street, NW, Washington, DC
20011; telephone (202) 726-7100.
The Ugandan Embassy may also be contacted by email.
Travelers may also contact the Ugandan Permanent Mission to the United Nations, telephone (212) 949-0110. Overseas, inquiries may be made at the nearest Ugandan embassy or consulate.

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

SAFETY AND SECURITY:
U.S. citizens residing in or planning to visit Uganda should be aware of threats to their safety posed by insurgent groups operating in the Democratic Republic of the Congo and southern Sudan, and the potential of cross border attacks carried out by these armed groups.
In addition, U.S. citizens traveling to the area commonly known as Karamoja in northeastern Uganda should also be aware of ongoing conflict and armed banditry in this region.

Northern Uganda:
After years of conflict, relative stability has returned to northern Uganda with the departure of the Lord’s Resistance Army (LRA) insurgent group in 2006.
Recent LRA activity has been restricted to the remote region of Garamba National Park in the Democratic Republic of the Congo (DRC), where LRA insurgents have continued to attack and terrorize civilian populations.
LRA attacks have also occurred in the neighboring Central African Republic and southern Sudan.
The Governments of Uganda, the DRC, and southern Sudan initiated joint military operations against LRA bases in Garamba National Park on December 14, 2008, after LRA leader Joseph Kony refused to sign a peace agreement following two years of negotiations.
These military operations continue and in order to deter an LRA return to Uganda, the Uganda Peoples Defense Force (UPDF) maintains a significant presence in the northern districts.
Given the continued threat to regional security posed by the LRA, American citizens should exercise caution when traveling in those districts of northwestern Uganda that border the DRC and southern Sudan and which could potentially be subject to LRA incursions.
The Ugandan Government also continues to expand and improve the capacity of the civilian police force in northern Uganda by deploying additional personnel and concentrating resources to further recovery and re-development activities throughout the north.

American citizens traveling to northern Uganda are advised to ensure that they have made appropriate travel, lodging, and communication arrangements with their sponsoring organization before visiting the region.
Local officials in northern Uganda have expressed concern for the safety and security of foreigners visiting the area to assist with relief efforts, but without any specific arrangements with a sponsoring organization.
Foreign citizens who travel to the region without a sponsoring organization may not find secure lodging or safe transport, and may become more susceptible to crime.
They may also find that local officials are unable to provide assistance in the event of an emergency.
There is a general lack of infrastructure throughout northern Uganda, and services such as emergency medical care are nonexistent.
Given crime and other security concerns in northern Uganda, American citizens are advised to restrict travel to primary roads and during daylight hours only.

Cattle rustling, armed banditry, and attacks on vehicles are very common in the Karamoja region of northeastern Uganda, and the UPDF continues to implement a program to disarm Karamojong warriors.
Past incidents have included ambushes of UPDF troops, and attacks on vehicles, residences, and towns that resulted in multiple deaths.
Most of the violence occurred in the districts of Kaabong, Kotido, and Abim, although some violent incidents also occurred in Moroto and Nakapiripirit Districts.
American citizens are advised to avoid travel to the Karamoja region given the frequent insecurity.
Any travel to Karamoja (excluding charter flights to Kidepo National Park) by U.S. Embassy personnel must first be authorized by the Chief of Mission.

Southwestern Uganda:
American citizens traveling in southwestern Uganda should also exercise caution given the ongoing conflict in the districts of North and South Kivu in the DRC, and the close proximity of fighting to the Ugandan border.
During spikes in the conflict, refugee flows across the border number in the thousands and there is also a risk of incursions by armed combatants.
American citizens should review the Travel Warning for the Democratic Republic of the Congo for the most up-to-date information regarding the conflict in the DRC.

On August 8, 2007, a group of armed assailants entered Uganda from the DRC and raided Butogota, a town in Kanungu District, southwestern Uganda.
Three Ugandans were killed and many others assaulted during the raid.
Ugandan officials believe that the perpetrators of the attack were members of one of the various militia groups operating in the southeastern region of the DRC or possibly remnants of the "Interahamwe," a group that participated in the 1994 genocide in Rwanda and was also responsible for the 1999 attack on Bwindi Impenetrable National Park.
The 1999 Bwindi attack killed four Ugandans and eight foreign tourists.
The 2007 raid on Butogota is in an area transited by tourists traveling to Bwindi, a popular gorilla-trekking destination.
Within Bwindi Impenetrable National Park, armed security personnel accompany tourists on the daily gorilla hikes and the UPDF maintains a military presence.
At Ishasha Camp, another popular tourist destination located in the southern sector of Queen Elizabeth National Park, the UPDF also maintains a small military base near the park headquarters for security purposes.

Eastern Uganda:
In February 2008, an isolated incident occurred in Mount Elgon National Park in eastern Uganda that resulted in the death of a foreign tourist.
A Belgian tourist climbing Mt. Elgon in the company of park rangers was shot and killed.
The attack occurred while the group was camped for the night and assailants fired into the campsite.
The tourist was reportedly struck by gunfire when exiting her tent in the darkness.
Ugandan security and park officials suspected that the attack was perpetrated by smugglers engaged in cattle rustling or other illicit activities that are common in the border area.

Demonstrations:
Demonstrations take place in Kampala and other Ugandan cities from time to time in response to world events or local developments.
In most cases, these demonstrations occur with no warning and demonstrations intended to be peaceful can turn confrontational and possibly violent.
American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if they find themselves in the vicinity of any demonstration.
American citizens should stay current with media coverage of local events and be aware of their surroundings at all times.
Because many demonstrations are spontaneous events, the U.S. Embassy may not always be able to alert American citizens that a demonstration is taking place and to avoid a specific area.
If employed with an institution or other large organization, American citizens may find it helpful to request that local employees notify expatriates when they learn of a demonstration from local radio reports or other sources.
Recent protests have occurred over land disputes involving Kampala market areas, university closures and strikes, opposition political party demonstrations, and protests by taxi drivers over the enforcement of traffic regulations.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State's, 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:
Crimes such as pick pocketing, purse snatching, and thefts from hotels and parked vehicles or vehicles stalled in traffic jams are common.
The Embassy receives frequent reports of theft of items from locked vehicles, even when the stolen items were secured out of sight and the vehicle was parked in an area patrolled by uniformed security personnel.
Pick pocketing and the theft of purses and bags is also very common on public transportation.
Armed robberies of pedestrians also occur, sometimes during daylight hours and in public places.
Although infrequent, the Embassy also receives reports of armed carjackings and highway robbery.
In May 2007, two American citizens reported an attempted robbery when they were traveling near the town of Bugiri in eastern Uganda.
The Americans reported that a second vehicle with at least one armed assailant tried to stop their vehicle by forcing it off the road.
This incident occurred during daylight hours.
On June 27, 2007, two American citizens were robbed and held at gunpoint when the vehicle transporting them to Entebbe Airport was stopped by a group of armed men.
This incident occurred during the early morning hours on Entebbe Road.
Although some of these attacks are violent, victims are generally injured only if they resist.
U.S. Embassy employees are advised against using roads at night, especially in areas outside the limits of cities and large towns. Home burglaries also do occur and sometimes turn violent.
In April 2008, the Ugandan police reported an increase in armed robberies in the Kampala neighborhoods of Bukoto, Kisaasi, Kiwatule, Naalya, Najera, and Ntinda.
Several of these robberies occurred as the victims were arriving at their residences after nightfall and the assailants struck as they were entering their residential compounds.

Women traveling alone are particularly susceptible to crime.
In early 2008, there was an increase in reports of sexual assaults against expatriate females.
In some instances, the victims were walking alone, or were single passengers on one of the common modes of public transport which include "boda boda" motorcycle taxis.
If the victim of a sexual assault, medical assistance should be sought immediately and counseling provided regarding prophylactic treatment to help prevent the transmission of HIV and other sexually transmitted diseases. The U.S. Embassy provides a list of local medical providers for those with medical needs.

American citizens visiting Uganda are advised not to accept food or drink offered from a stranger, even a child, because such food may contain narcotics used to incapacitate a victim and facilitate a robbery or sexual assault.
In addition, patrons of bars, casinos, nightclubs, and other entertainment centers should never leave their drink or food unattended.
When visiting such establishments, it is advisable to remain with a group of friends as single individuals are more likely to be targeted.
Victims have included female patrons who reported they were drugged, and taken to another location and sexually assaulted.
Robberies have been facilitated on public transportation under similar circumstances.
In 2006, an American citizen traveling by bus from Kenya to Uganda was incapacitated and robbed on the bus when the passenger accepted a sealed beverage from a fellow traveler.
Expatriates traveling by bus to the popular tourist destination of Bwindi Impenetrable National Forest in southwest Uganda were also incapacitated and robbed when they accepted snacks from fellow bus passengers.

There has been a recent, marked increase in financial crime, including fraud involving wire transfers, credit cards, checks, and advance fee fraud perpetrated via email.
The U.S. Embassy recommends using money orders for all fund transfers and protecting all bank account and personally identifiable information such as social security numbers and other types of information.

An increasing number of U.S. exporters (primarily vendors of expensive consumer goods such as computers, stereo equipment, and electronics) have been targeted by a sophisticated check fraud scheme.
A fictitious company in Uganda locates a vendor on the Internet, makes e-mail contact to order goods, and pays with a third-party check.
The checks, written on U.S. accounts and made out to entities in Uganda for small amounts, are intercepted, chemically "washed" and presented for payment of the goods with the U.S. vendor as payee and an altered amount.
If the goods are shipped before the check clears, the U.S. shipper will have little recourse, as the goods are picked up at the airport and the company cannot be traced.
American companies receiving orders from Uganda are encouraged to check with the Political - Economic Section of the Embassy to verify the legitimacy of the company.
The Embassy strongly cautions U.S. vendors against accepting third-party checks as payment for any goods to be shipped to Uganda.

Additional information about the most common types of financial fraud can also be found in the State Department Financial Scams brochure.

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

The local equivalent to the "911" emergency line in Uganda is: 999.
Please see our information on Victims of Crime, including possible victim compensation programs in the United States.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Ugandan laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Uganda 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:
Please note that U.S. currency notes in $20 and $50 denominations are exchanged at a lower rate than $100 currency notes.
In addition, travelers often find that they cannot exchange or use U.S. currency printed earlier than the year 2000.
Travelers who find they cannot pay for accommodation or expenses often must request that friends or family wire money to them in Uganda.
There are offices that facilitate Western Union, MoneyGram, and other types of money transfers in Kampala and other cities throughout the country.
ATMs are available in Uganda, particularly in downtown Kampala, but usually only customers who have an account with a specific Ugandan bank may use them.
A few machines function with overseas accounts.

The U.S. Embassy frequently receives requests from American citizens to verify the bona fides of nongovernmental (NGO) and charity organizations operating in Uganda.
The Embassy is unable to provide information regarding the bona fides of these organizations and American citizens traveling to Uganda to work for an organization are encouraged to request that the charity provide references of past volunteers whom they may contact.
American citizens have also reported intimidation and harassment by directors of organizations, when the Americans questioned the organization's activities or use of donated funds.
While the vast majority of NGOs operating in Uganda are legitimate organizations aiding development efforts, there have been reports from concerned Americans regarding the suspected diversion of charity funds for personal gain, etc.

Ugandan Customs authorities may enforce strict regulations concerning the importation of pets.
A Ugandan import permit is required, along with an up-to-date rabies vaccination certificate and a veterinary certificate of health issued by a USDA-approved veterinarian no more than thirty days before arrival.
Travelers are advised to contact the Ugandan Embassy in the United States for specific information regarding customs requirements.
Please see our Customs Information sheet.

Photography in tourist locations is permitted.
However, taking pictures of military/police installations or personnel is prohibited.
Military and police officers have detained tourists for taking photographs of Entebbe Airport and of the area around Owen Falls Dam, near Jinja, although the prohibition on taking photographs is not publicly displayed on signs.

The U.S. Embassy receives frequent inquiries from American citizens wishing to register a nongovernmental organization (NGO) in Uganda.
Information about registering an NGO can be obtained from the Ugandan NGO Board which has offices within the Ministry of Internal Affairs.
The NGO Board can be reached on phone number: 256 414 341 556.
One of the requirements for registering an NGO is that a foreign national employee or volunteer must provide a Certificate of Good Conduct/Criminal Background Check.
The U.S. Embassy Kampala cannot provide a Certificate of Good Conduct or Criminal Background Check, so American citizens intending to travel to Uganda as an employee an NGO or who plan to register an NGO should obtain a Certificate of Good Conduct from their local police or the Federal Bureau of Investigation (FBI) before departing the United States.
More information on how to obtain a Criminal Background Check can be found on the FBI web page about Identification Record Requests.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities in Uganda, including Kampala, are limited and not equipped to handle most emergencies, especially those requiring surgery. Outside Kampala, hospitals are scarce and offer only basic services.
Recently, American citizens involved in automobile accidents required immediate evacuation from Uganda as surgery could not be performed due to insufficient blood supplies at the hospital where they sought treatment.
Equipment and medicines are also often in short supply or unavailable.
Travelers should carry their own supplies of prescription drugs and preventive medicines.
A list of medical providers is available at the U.S. Embassy.

Tuberculosis is an increasingly serious health concern in Uganda.
For further information, please consult the CDC's Travel Notice on TB.

Malaria is prevalent in Uganda.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what antimalarials they have been taking.
For additional information on malaria, including protective measures, see the CDC’s information on malaria.

In January, 2009, the CDC’s Special Pathogens Branch retrospectively diagnosed a case of Marburg hemorrhagic fever in a U.S. traveler, who had returned from Uganda in January, 2008. The patient developed illness four days after returning to the United States.
The Amcit had visited the “python cave” in Queen Elizabeth Park, western Uganda, which is a popular destination among tourists to see the bat-infested cave.
For additional information on Marburg hemorrhagic fever, including protective measures, visit the CDC web site.

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. Uganda has experienced recent outbreaks of Marburg Hemorrhagic Fever, Ebola Hemorrhagic Fever, Pneumonic Plague, Meningitis, and other types of infectious diseases.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Uganda.
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.
American citizens who are seriously injured in vehicle or other types of accidents in Uganda generally seek medical evacuation to Kenya or other destinations for more advanced emergency medical treatment.
These medical evacuations can be very expensive, and in the event the American citizen does not have sufficient insurance coverage, the evacuation is carried out at their personal expense.
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 Uganda is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Most inter-city transportation in Uganda is by small van or large bus.
Many drivers of these vehicles have little training and some are reckless.
Small vans and large buses are often poorly maintained, travel at high speeds, and are the principal vehicles involved in the many deadly single and multi-vehicle accidents along Ugandan roads.
Accident victims have included American citizens traveling in small vans and personal cars, passengers on motorcycle taxis locally known as "boda bodas," and pedestrians.
Large trucks on the highways are often over-loaded, with inadequately secured cargo and poor braking systems.
Alcohol frequently is a contributing factor in road accidents, particularly at night.
Drivers are advised to take extra care when driving.
Nighttime driving and road transportation should be avoided whenever possible.
Pedestrians often walk in the roads and may not be visible to motorists.
Large branches or rocks in the road sometimes indicate an upcoming obstruction or other hazard.
Highway travel at night is particularly dangerous, including the road between Entebbe Airport and Kampala.
The Embassy recommends caution on this road and use of a reliable taxi service to and from the airport.

Traffic accidents draw crowds.
Ugandan law requires that the drivers stop and exchange information and assist any injured persons.
In some cases where serious injury has occurred, there is the possibility of mob anger.
In these instances, Ugandans often do not get out of their cars, but drive to the nearest police station to report the accident.

Please refer to our Road Safety page for more information.
For specific information concerning Ugandan driving permits, vehicle inspection, road tax and mandatory insurance, please contact Tourism Uganda, IPS building, 14, Parliament Avenue, Kampala, Uganda; telephone 256-414-342 196. You may also wish to consult the Tourism Uganda web site or, for information on government agencies, see the My Uganda web site.

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

International airlines offer several weekly flights to Europe and the United Arab Emirates, and Kenya Airways has daily flights between Entebbe Airport and Nairobi.
Other regional airlines operate weekly flights to other destinations in Africa, such as Dar es Salaam, Addis Ababa, Cairo, and Johannesburg.

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 Uganda are encouraged to register with the U.S. Embassy in Kampala through the State Department’s travel registration web site to obtain updated information on travel and security within Uganda.
Americans without Internet access may register directly with the nearest U.S. embassy or consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located at 1577 Ggaba Road, Kampala; telephone 256-414-259-791 or 256 414 306 001; fax 256-414-258-451.
You may contact the Embassy via e-mail.
* * *
This replaces the Country Specific Information dated May 6, 2008, to update sections on Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, Medical Insurance, Traffic Safety and Road Conditions, Special Circumstances, Aviation Safety Oversight, Special Circumstances, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Tue 1 Oct 2019
From: John Frean <johnf@nicd.ac.za> [edited[]

The patient is a 23-year-old male international student, who has been studying in South Africa since late July 2019. Between [6 and 16 Sep 2019] he was on vacation in Uganda.

Places visited in Uganda were:
Entebbe: Jinja music festival for 3 days
Sipi Falls: hiking/waterfalls/homestay
Moroto: visited tribes
Murchison Falls: 2 days
Masindi: 1 day
Entebbe, then back to South Africa.

He did not see any tsetse flies, nor was he aware of any insect bites.

On [Sun 22 Sep 2019] he felt unwell and noticed a lesion on his chin. He was admitted to hospital and on [26 Sep 2019] underwent surgery for a presumed submandibular abscess. No abscess was found but histological examination of tissue removed at surgery showed some areas of necrosis, and evidence of fibrin thrombi compatible with disseminated intravascular coagulopathy. No organisms were seen.

The white cell count was about 3 x 109/L and platelets were 34 x 109/L, then 29 x 109/L, and postoperatively dropped to 4 x 109/L.

Blood films were examined and numerous trypanosomes were seen, estimated density of about 56,000/microlitre. On review of the blood sample from [26 Sep 2019], scanty trypanosomes were seen.

The patient was transferred to the care of an infectious diseases physician on [Sat 28 Sep 2019]. On admission he was very ill with unrelenting fever, tachycardia, periodically hypotensive, dyspnoeic, renal dysfunction (creatinine 300 micromol/L), jaundiced with raised transaminases, and slightly confused. Test dose and 1st dose of suramin were well tolerated, and the 2nd dose was given on [30 Sep 2019]. Clinically the patient is slightly improved today (1 Oct 2019), with a platelet count now 12 x 109/L and creatinine around 200 micromol/L.

According to WHO EAT [East African trypanosomiasis] experts, the infection was most likely acquired at Murchison Falls, where there have been sporadic cases; alternatively at Moroto [both in northern Uganda].

This is the 4th case of EAT evacuated to Johannesburg in 2019. The other cases acquired the infection in Zambia and Malawi.
----------------------------------------------
Lucille Blumberg
John Frean <johnf@nicd.ac.za>
National Institute for Communicable Diseases, GeoSentinel Site,
Johannesburg
Evan Shoul (infectious diseases specialist);
Pieter Ekermans (Ampath Laboratories)

[ProMED-mail thanks Lucille Blumberg, John Frean, Evan Shoul, and Pieter Ekermans for their submission. - Mod.ML]

[Sleeping sickness is endemic in 36 sub-Saharan Africa countries where there are tsetse flies that transmit the disease (WHO Trypanosomiasis fact sheet <https://www.who.int/news-room/fact-sheets/detail/trypanosomiasis-human-african-(sleeping-sickness)>).

Trypanosomiasis is endemic in the national parks in southern Africa, where there are tsetse flies and a reservoir of the trypanosomes in the wildlife. It is important to consider trypanosomiasis in febrile travellers to these national parks with negative tests for malaria. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of South Africa:
Murchison Falls (Uganda):
Date: Thu, 29 Aug 2019 22:36:01 +0200 (METDST)

Kampala, Aug 29, 2019 (AFP) - A nine-year-old girl who had travelled from the Democratic Republic of Congo has been found to have Ebola, authorities in Uganda said on Thursday.   The child, who is of Congolese origin, was diagnosed after exhibiting symptoms at a border crossing in the southwestern Kasese district on Wednesday. She was subsequently isolated and transferred to an Ebola treatment unit.

A rapid response team had been dispatched to Kasese to support local teams, the Ugandan Health Ministry said in a statement.   Earlier this month, Uganda said it had started a trial of an experimental Ebola vaccine that may be used in neighbouring DR Congo where an outbreak of the disease has killed more than 1,900 people.   The trial of the MVA-BN vaccine developed by Johnson & Johnson is expected to last two years.   At present there is no licenced drug to prevent or treat Ebola although a range of experimental drugs are in development.

Uganda has suffered Ebola outbreaks in the past but nothing on the scale of the DR Congo epidemic, which began in August 2018.    It is the second-worst outbreak on record, eclipsed only by the 2013-2016 epidemic in West Africa, which killed more than 11,300 out of 29,000 documented cases.   Uganda has been declared Ebola-free but in June three people from one family died there from the haemorrhagic fever after crossing back from DR Congo.
Date: Tue, 27 Aug 2019 16:19:47 +0200 (METDST)

Kampala, Aug 27, 2019 (AFP) - Uganda on Tuesday re-launched its national airline after two decades with an inaugural flight to Nairobi, becoming the latest East African nation seeking to revive their aviation industry.   "The airline will first fly to seven destinations. Starting with Nairobi, Mogadishu, Juba and Dar es Saalam. And then to Mombasa, Kilimanjaro and Bujumbura," said Prime Minister Ruhakana Rugunda at Entebbe International Airport.

Uganda Airlines is launching into increasingly crowded East African skies, where both Rwanda and Tanzania have in recent years revived their national airlines in a bid to capture a slice of the booming market.   They are taking on regional giants Kenya Airways -- which continues to expand despite struggling with years of losses and management woes -- and Ethiopian Airlines, which largely dominates the skies.    Uganda Airlines is coming to compete in the market alongside other airlines", said Transport Minister Monica Azuba.
 
Uganda Airlines was founded by former Ugandan dictator Idi Amin in 1976 but the carrier was liquidated in 2001 after a failed bid to privatise the floundering company, dogged by corruption and mismanagement.   The country has acquired two new Bombardier CRJ 900 jets, and will take delivery of another two in September, while the addition of two Airbus A330-800 planes in 2020 will allow it to carry out long-haul flights.   "Uganda Airlines will have direct flights from Uganda to China plus other countries, and it will be very important in hitting the four million tourist goal the government has set," said Tourism Minister Ephraim Kamuntu.   Uganda welcomed 1.8 million tourists in 2018, according to official statistics.

Meanwhile, neighbouring Tanzania has invested heavily in reviving its airline, with the purchase of six planes including Bombardiers, Airbus and one Boeing dreamliner since 2016. Air Tanzania launched its first route outside of the continent to Mumbai, India, in July.    Rwanda has massively invested in its national airline Rwandair, with a fleet of 12 jets which now fly 29 routes around the world, with the most recent flight launched to Israel in June.   According to the International Monetary Fund (IMF) Rwanda breached its debt ceiling of $500 million by $87 million due to the lease of new aircrafts in 2018, and is seeking further loans to expand routes and make a profit.   Numerous airlines in Africa have failed to stay afloat, or survive on government bailouts.
Date: Mon, 5 Aug 2019 18:34:26 +0200 (METDST)

Kampala, Aug 5, 2019 (AFP) - Uganda said Monday it had started a trial of an experimental Ebola vaccine that may be used in neighbouring Democratic Republic of Congo, where an outbreak has killed more than 1,800 people.   The trial of the MVA-BN vaccine developed by Johnson&Johnson is expected to last two years, Uganda's Medical Research Council (MRC) said.

The vaccine will be administered to up to 800 health professionals and frontline workers such as cleaners, ambulance personnel and mortuary and burial teams, in the western district of Mbarara, the MRC said in a statement.   MRC spokeswoman Pamela Nabukenya Wairagala said vaccinations had already begun.   The MRC said the trial would be led by Ugandan researchers and supported by the London School of Hygiene and Tropical Medicine.   At present there is no licenced drug to prevent or treat Ebola although a range of experimental drugs are in development.

The Congo outbreak is the first time that a vaccine has been used as a full-scale weapon against the virus.   Health authorities have been issuing the rVSV-ZEBOV vaccine, developed by US pharma group Merck -- a product that has yet to be licenced but has been shown to be safe and effective.   The World Health Organization (WHO) has called for its deployment to be expanded and has recommended the Johnson&Johnson vaccine also be rolled out in order to meet needs.   However, the latter move has been resisted.

Critics have cautioned against introducing a new product in communities where mistrust of Ebola responders is already high.    Congo's former health minister, Oly Ilunga, who stepped down in July, was among the detractors.   The MRC said the Johnson&Johnson vaccine "is safe" and had been tested on more than 6,000 people in Europe, the US and African nations including Uganda.   However, its efficacy is unclear because it has never been assessed in an outbreak scenario.    By comparison, rVSV-ZEBOV was introduced in Guinea towards the end of a 2013-16 epidemic in West Africa, enabling scientists to conclude it was effective.

The trial taking place in Uganda, where there is no Ebola, will look at the response of the immune system to the vaccine -- a key pointer of effectiveness.   It will also look at safety and the attitudes of participants towards the vaccine, the MRC said.   Professor Pontiano Kaleebu, the lead Ugandan researcher in the trial, said developing a reliable vaccine was a key component to controlling Ebola epidemics.   "In this trial we hope to avail more information that will help us work towards having a licenced Ebola vaccine," Kaleebu said in a statement.

Uganda has suffered Ebola outbreaks in the past but nothing on the scale of the Congo epidemic, which began in August 2018.    It is the second-worst outbreak on record, eclipsed only by 2013-2016 epidemic in West Africa, which killed more than 11,300 out of 29,000 documented cases.   Uganda has been declared Ebola-free though in June three people from one family died there from the haemorrhagic fever after crossing back from Congo.
Date: Sat 3 Aug 2019
Source: Daily Monitor [edited]

One person has been confirmed dead and 49 others currently are isolated following an outbreak of Crimean-Congo haemorrhagic fever (CCHF) in Lyantonde District.

According to the Lyantonde District Health Officer, Dr Moses Nkanika, [VB], 42, who was a businessman dealing in cattle, succumbed to the deadly disease on [Wed 31 Jul 2019].

"The blood samples we got from the deceased in Kasagama Sub County have tested positive for CCHF, not Ebola as earlier suspected," Dr Nkanika told Daily Monitor in an interview on Saturday morning [3 Aug 2019].

He said 49 residents who got in close contact with the deceased are currently isolated to avoid contacts with other people as health workers continue to monitor their health conditions.

"These people are expected to remain in isolation for 40 days until they are cleared by ministry of health," he said. He advised residents to be on alert and report any emergencies to the nearby health centres.

Mr Emmanuel Ainebyoona, the Ministry of Health spokesperson said he was not aware of the outbreak, but promised to crosscheck with other responsible authorities to confirm.  [Byline: Paul Ssekandi]
==========================
[CCHF has occurred sporadically in Uganda over recent years and is endemic there. It causes a viral hemorrhagic fever and the virus is transmitted by ticks. ProMED Mod.UBA has indicated that, "Uganda lies between countries that have frequent outbreaks of RVF [Rift Valley fever] and in which CCHF is endemic: Kenya, Somalia, Tanzania, and Sudan. A recent Food and Agriculture Organization risk analysis identified Uganda as at very high risk of amplification in some districts of the cattle corridor, which covers 52 districts cutting across the central part of the country from the southwest in Ankole-Kigezi to the northeastern region in Karamoja.

The RVF virus has been isolated frequently in domestic animals in all affected areas. In addition, the practice of eating "sanga meat" (meat harvested from sick animals) in some districts heightens the risk of zoonotic transmission of both VHFs [viral haemorrhagic fevers, CCHF and Rift Valley fever]. At present, there is inadequate community engagement and social mobilization around the risks posed by these practices. Most of the 52 districts in the cattle corridor lack such engagement  (<http://apps.who.int/iris/bitstream/handle/10665/273497/OEW30-2127072018.pdf>)."

CCHF can cause serious disease in humans, with a case fatality rate of 10-40%. It can be responsible for severe outbreaks in humans, but it is not pathogenic for ruminants, their amplifying hosts. WHO states that the onset of symptoms in humans is sudden, with fever, myalgia, (muscle ache), dizziness, neck pain and stiffness, backache, headache, sore eyes and photophobia (sensitivity to light). There may be nausea, vomiting, diarrhoea, abdominal pain, and sore throat early on, followed by sharp mood swings and confusion.

After 2-4 days, the agitation may be replaced by sleepiness, depression, and lassitude, and the abdominal pain may localize to the upper right quadrant, with detectable hepatomegaly (liver enlargement). Other clinical signs include tachycardia (fast heart rate), lymphadenopathy (enlarged lymph nodes), and a petechial rash (a rash caused by bleeding into the skin) on internal mucosal surfaces, such as in the mouth and throat, and on the skin.

Public education, especially among individuals in contact with livestock or their products, is needed to prevent cases of CCHF infection. A One Health approach is needed for effective surveillance, with effective communication between animal health and human health professionals. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Uganda:
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World Travel News Headlines

Date: Wed, 16 Oct 2019 18:45:39 +0200 (METDST)

Manila, Oct 16, 2019 (AFP) - A child was killed in a strong 6.4-magnitude quake that hit the southern Philippines on Wednesday, a local mayor said, as houses collapsed, power was knocked out and a shopping mall burst into flames.   Residents evacuated homes and buildings across the Mindanao region including a mall that caught fire in the city of General Santos shortly after the quake struck in the evening, officials said.   The child died in a house collapse in the town of Datu Paglas, while four residents of nearby Tulunan town were injured when at least two other houses fell down, Tulunan Mayor Reuel Limbungan told AFP.   "The child was crushed by a collapsed house wall" and pronounced dead in hospital, Limbungan said, adding that he had visited the medical facility and spoken to its director.

Rescue and local officials said there were no immediate reports of deaths elsewhere in Mindanao, and rescue official Anthony Allada told local television that 20 people were treated for injuries in the town of Magsaysay, near the epicentre.   Three other people were hurt in the town of M'lang, added its vice-mayor, Joselito Pinol.   The quake was 14 kilometres (8.7 miles) deep and was followed by at least two aftershocks, according to the United States Geological Survey (USGS).   "It was the most powerful earthquake I have ever experienced," Sara Duterte, mayor of the largest Mindanao city of Davao, and daughter of President Rodrigo Duterte, told local television.

- Falling debris -
The Philippines is part of the Pacific "Ring of Fire", an arc of intense seismic activity that stretches from Japan through Southeast Asia and across the Pacific basin.   An elderly man was treated for injuries after being struck by a falling object during the evacuation of a Davao mall, local TV reported.   Jerome Barranco, civil defence officer for the region, said several people were also injured in the city of Kidapawan "as a result of falling debris".   In General Santos, television footage showed firemen battling a blaze that engulfed the three-storey Gaisano shopping mall.   It was not known if there were still people inside the building, which was evacuated as the quake struck.   The blaze was still raging more than three hours later despite the efforts of nearly 100 firemen, fire officer Redentor Batulan told AFP.

Coastal residents of Davao fled their homes in fear of a tsunami, but rescue workers were trying to convince them to return as no warning was issued, city civil defence chief Rodrigo Bustillo told local television.   "Our volunteers are out to calm the people and tell them there is no tsunami," Bustillo added.   Chief Philippine government seismologist Renato Solidum said there was no risk of a tsunami because the quake occurred inland, but he advised residents to check their homes for possible damage.   "We ran out of the police station, and we also let the inmates at the municipal jail out," patrolwoman Celina Sarte told AFP by telephone from the town of Bansalan.   She said the 10 prisoners were put in handcuffs outside moments later.
Date: Tue, 15 Oct 2019 20:35:37 +0200 (METDST)

Addis Ababa, Oct 15, 2019 (AFP) - Rescue workers on Tuesday used excavators to dig out bodies after a landslide in southern Ethiopia washed away homes and killed more than 20 people, a local official said.    The landslide in the remote district of Konta occurred Sunday following 10 hours of heavy rains, said the official, Takele Tesfu.   "There are 22 people dead and we have only been able to dig up 17 using manpower and machine power," Takele told AFP.   "So far, we cannot get the others, so tomorrow we will continue to dig."     He said the victims included nine women and six children.

While the district -- located in Ethiopia's Southern Nations, Nationalities, and Peoples' Region -- sees landslides with some regularity, Takele said this was the deadliest he could remember.    "The area where this occurred is very mountainous, and this means the landslide was very dangerous," he said.    Ethiopia is nearing the end of its rainy season, but security forces are nonetheless relocating some families for fear that more rain in the coming days could lead to similar disasters, Takele said.
Date: Tue, 15 Oct 2019 10:00:23 +0200 (METDST)

New Delhi, Oct 15, 2019 (AFP) - New Delhi banned the use of diesel generators on Tuesday as pollution levels in the Indian capital exceeded safe limits by more than four times.   Every winter, New Delhi is enveloped in a noxious blanket of smog of car fumes, industrial emissions and smoke from stubble burning at farms outside the megacity of 20 million people.   The ban on generators is part of the Graded Response Action Plan (GRAP) that entered into force on Tuesday.   Other measures that will come into effect as smog levels rise, particularly following the Diwali festival in late October, include banning trucks and setting up a "war room".

From November 4-15, a road-rationing scheme will come into force, meaning cars with odd and even plates would be allowed on alternate days in that period.   "We will hand out anti-pollution masks to schoolchildren next week but the date is yet to be decided," the official told AFP.   Indian authorities have also sought to reduce the burning of stubble by farmers in areas surrounding Delhi.   According to government data, concentrations of particles measuring less than 2.5 microns across -- which can penetrate the lung barrier and enter the blood -- hit 108 icrograms per cubic metre on Tuesday.   This was more than four times the recommended World Health Organization safe daily maximum of 25. In previous years, the level has regularly exceeded 400.   Last year, a UN report found 14 of the world's 15 most polluted cities were in India, with one US study saying it kills a million people prematurely every year.
Date: Tue, 15 Oct 2019 09:50:21 +0200 (METDST)
By Kyoko HASEGAWA

Tokyo, Oct 15, 2019 (AFP) - Rescuers in Japan were working around the clock Tuesday in an increasingly desperate search for survivors of a powerful weekend typhoon that killed nearly 70 people and caused widespread destruction.   Hagibis slammed into Japan on Saturday night, unleashing fierce winds and unprecedented rain that triggered landslides and caused dozens of rivers to burst their banks.   By Tuesday afternoon, local media put the toll at nearly 70, with around a dozen people missing. The government's tally was lower, but it said it was still updating information.   Prime Minister Shinzo Abe said there was no plan to slow rescue operations, with around 110,000 police, coast guard, firefighters and military troops involved.   "Currently in damaged areas rescue work and searches for the missing are continuing around the clock," Abe told parliament.   "Where rivers flooded, work is ongoing to fix spots where banks broke, and water is being pumped out where floods occurred," he added.   The prime minister's office said more than 3,000 people have been rescued in the wake of the disaster, which affected 36 of the country's 47 prefectures.   The defence ministry has called up several hundred reserve troops in addition to active duty soldiers for the first time since the 2011 earthquake and tsunami.

- Rain prompts new warnings -
Government officials warned that more rain was expected throughout the day Tuesday in several parts of the country affected by the typhoon.   "We ask people not to drop their guard and to remain fully alert," chief cabinet secretary Yoshihide Suga. told reporters.   Hagibis crashed into land packing gusts up to 216 kilometres (134 miles) per hour, but it was the storm's heavy rain that caused the most damage.   At least 176 rivers burst their banks, including in central Nagano, where a levee breach sent water from the Chikuma river gushing into residential neighbourhoods and submerging bullet trains in a depot up to their windows.   Deaths were reported across many prefectures and included a man whose apartment was flooded, a municipal worker whose car was caught in rising waters and at least seven crew aboard a cargo ship that sank in Tokyo bay on Saturday night.   By Tuesday morning, some 34,000 households were still without power, and 133,000 homes had no water.   Tens of thousands of people spent Monday night in government shelters, with many unsure when they would be able to return home.   "My frightened daughter can't stop shaking. We want to go home quickly," Rie Nishioka, 39, told Kyodo News agency in Miyagi prefecture.

- Government pledges aid -
The government pledged financial support to affected regions without specifying how much aid it would set aside.   "Support for the victims of the disaster is an urgent task," Abe said.   "There are concerns that the impact on daily life and economic activities may be long-lasting."   Another area affected by the storm was Fukushima, where several bags containing soil and plants collected during nuclear decontamination efforts were washed away.   "Ten bags out of 2,667 were swept into a river during the typhoon, but six of them were recovered yesterday," environment ministry official Keisuke Takagi told AFP, adding that the remaining four bags had been found and would be collected soon.   "Residents must be worried about the environment, but there are no reports that the bags were broken, so there will be nothing to worry about once they have been recovered safely," he said.   Hagibis caused transport chaos over a holiday weekend in Japan, grounding flights and halting train services.   By Tuesday, things were largely back to normal, though some flights were cancelled and train services partially disrupted where tracks or train stock were damaged by the storm.   The typhoon also caused disruption to sporting events, delaying Japanese Grand Prix qualifiers and forcing Rugby World Cup organisers to cancel three matches.   A crunch fixture pitting the hosts against Scotland went ahead on Sunday night, with Japan winning its first-ever quarter final spot.
Date: Mon, 14 Oct 2019 17:55:47 +0200 (METDST)

Harare, Oct 14, 2019 (AFP) - Striking Zimbabwe doctors on Monday defied a court order to return to work, saying a pay rise offered by the government failed to meet everyday costs.   Doctors remained home for a 43rd consecutive day, striking for better pay after their salaries were eroded by the country's spiralling inflation.   Zimbabwe's labour court ruled the action "unlawful" on Friday and ordered the medics back to their wards within 48 hours.

The Zimbabwe Hospital Doctors Association (ZHDA) announced Sunday it would appeal to the Supreme Court.    "We noted the court order but unfortunately we don't have the means by which to comply," said ZHDA spokesman Masimba Ndoro on Monday.   "We remain incapacitated... There is nothing we can do when we don't have the means to go to work and to meet our basic needs," he told AFP.   The doctors say the value of their pay shrank 15-fold over the past year -- a legacy of hyperinflation caused by economic mismanagement under ex-president Robert Mugabe.   His successor Emmerson Mnangagwa has so far failed to redress the situation.    Fuel prices have increased by more than 400 percent since the start of the year, and the ZHDA said that doctors had to use their savings just to show up to hospital each morning.

Negotiations with the government have been deadlocked since the ZHDA rejected a 60-percent salary rise offer.   With pay slips worth less than the equivalent of $100 (91 euros) in some cases, they are demanding doctors' salaries be pegged to the US dollar and have appealed to international bodies to supplement their wages.   "While doctors would want nothing more than to return to work in service of their patients, they continue to be incapacitated and lack the resources to comply with the Labour Court judgement," the ZHDA said in a statement on Sunday.   Nurses joined in the action last week.   "We have reduced the number of days we are coming to work initially to three days a week now we are down to two days," Zimbabwe Nurses Association spokesman Enoch Dongo told AFP.   "If the issue of salaries is not urgently addressed we will soon have a situation where nurses will no longer be able to come to work," he said, adding that nurses were "taking turns" in coming to hospital.      Rural teachers also embarked on strike action on Monday with a stay-at-home protest "against underpayment".   "We urge the government to respect our right to engage in job actions and peacefully protest demanding a living wage," the Amalgamated Rural Teachers Union of Zimbabwe posted on Twitter.
Date: Mon, 14 Oct 2019 16:33:26 +0200 (METDST)
By Daniel BOSQUE

Barcelona, Oct 14, 2019 (AFP) - "I feel fury and a sense of powerlessness," said Joan Guich, a 19-year-old student protesting in Barcelona after Spain's Supreme Court jailed nine Catalan leaders jailed over a failed independence bid.   "They have been convicted for an ideology which I agree with."   Within minutes of the ruling demonstrators had poured onto the streets of the Catalan capital, waving flags and blocking traffic over the conviction of the separatist leaders who organised a 2017 referendum banned by Madrid.   "We have to mobilise and stick up for them ... in a way that has an impact, closing airports, stations, but always avoiding violence," Guich said. "Or at least, it won't be us that provokes it."

Workers rallied outside their offices, university students walked out of classes and regional lawmakers demonstrated inside Catalonia's parliament, where most of the defendants had held a senior role.   "Today is going to be historic, you can feel it in the atmosphere. Serious things are happening, we can't stay home," said Oscar Quiles, a 47-year-old real estate entrepreneur.   News of the verdict reached him as he arrived at the office and he immediately called his mother to join him at a protest in Plaza Cataluna in the centre of Barcelona.   By noon the square was packed with thousands of demonstrators, many waving yellow, red and blue Catalan separatist flags or banners reading "We would do it again" and "Freedom for political prisoners".   The protesters then set off walking towards Barcelona's airport, Spain's second busiest, in the hope of blocking it, just as pro-democracy activists have done recently in Hong Kong.

- 'Weeks of mobilisation' -
Tension gripped Barcelona on Monday morning ahead of the ruling, with a heavy police presence outside the courts, the airport and the city's main train station, as a helicopter flew overhead.    Democratic Tsunami, a group advocating more active forms of civil disobedience, had urged demonstrators to hit the streets as soon as the verdicts were announced.   "Tomorrow everyone ready! When the verdict is out, the response will be immediate," said the group in a message to its roughly 150,000 followers on mobile messaging service Telegram.   Juli Cuellar, a 44-year-old office worker, said he believed the verdict was politically motivated.    "Now all we have left is a life of civil and institutional disobedience," he told AFP, predicting "weeks of mobilisation".   The Catalan National Assembly (ANC) and Omnium Cultural, the region's two biggest grassroots pro-independence groups, have also called supporters to attend an evening rally. They have organised some of the largest separatist protests in recent years.   Several more protests are scheduled over the next few days across Catalonia, as well as a general strike on Friday.

- 'Felt like crying' -
Democratic Tsunami, the group that called the gathering in Plaza Cataluna, only emerged in recent weeks. It says it does not depend on Catalan separatist parties or civil associations for support.   Its leaders remain unknown, keeping in touch with each other through encrypted messaging apps such as Wire.   But supporters tend to be kept in the dark until the last minute.   "We don't know exactly what we have to do," said Arnau Font, a 22-year-old shop assistant who took the week off to protest.   "We have to get involved. Right now I feel really powerless in light of the verdicts," he told AFP.    "When I found out, I felt like crying."   The uncertainty was over a few minutes later when a Telegram message arrived urging everyone to "go to the airport", a 15-kilometre (nine-mile) walk from the city centre.    "The time has come to make our voice felt around the world. The goal: stop the activity of Barcelona's airport," it said.   Spain's airport operator Aena said no flights were disrupted, but many passengers got stuck in traffic jams leading to the airport.
Date: Mon, 14 Oct 2019 14:09:03 +0200 (METDST)

Frankfurt am Main, Oct 14, 2019 (AFP) - German cabin crew union UFO urged members Monday to walk off their jobs at airline giant Lufthansa on October 20, although the carrier contests its right to represent workers.   "We call on all cabin crew... not to show up to work" between six and eleven am (0400 to 0900 GMT) at Germany's two busiest hubs Frankfurt and Munich, Ufo chairman Daniel Flohr said in a video message to staff.   At least five of the Lufthansa group's airlines -- Lufthansa, Eurowings, Germanwings, Cityline and Sunexpress -- would be hit by strikes for higher pay in the coming weeks, Flohr added.

Lufthansa told AFP it would "maintain its entire timetable", calling UFO's call to strike "illegal".   Bosses at the airline group believe UFO may no longer have the legal right to speak for workers and have challenged its status in court.   Internal disputes at the union have cost it members and support among cabin crew, some of whom have now turned to other representative organisations.   Berlin daily Tagesspiegel on Monday called UFO a "half-dead" outfit.   "UFO is battling for its life," agreed business daily Handelsblatt.   "With its far-reaching call for strikes, it wants to show members it remains capable of acting and is representing cabin crew interests."   Lufthansa could also contest before a court whether UFO has the right to initiate a strike -- potentially leaving the worker representatives on the hook for any resulting costs.
Date: Mon, 14 Oct 2019 11:08:10 +0200 (METDST)

Manila, Oct 14, 2019 (AFP) - Parents lined up from sunrise holding sleeping infants as the Philippines launched a campaign on Monday to vaccinate millions of children against polio, which has re-emerged nearly two decades after the nation's last cases.   Years of falling vaccination rates, made worse by the botched rollout of a dengue vaccine, culminated in an outbreak of the preventable disease in September.   "This is for the welfare of my child," Ruth Miranda told AFP after the vaccine was squirted into her child's mouth at the Manila slum they call home.

Miranda's child is among scores who are unprotected in the capital of about 13 million people, where vaccination rates of young children plunged from 77 percent in 2016 to a mere 24 percent in June.   The atmosphere at the event in Manila was festive -- with ice cream vendors and music -- but the stakes for the campaign are high.

Polio, which can cause paralysis and can be fatal in rare cases, has no cure and can only be prevented with several doses of oral and injectable vaccines.   Two cases were detected in September, the first polio infections in the Philippines since 2001, adding to the woes of a country already hit by deadly measles and dengue epidemic.   The risk of the disease spreading within the Philippines is high, according to World Health Organization, due to low immunisation coverage partly blamed to a dengue vaccine scandal.

The Philippines was the first nation to use Dengvaxia in a mass programme in 2016, but a botched rollout led to claims that children had died after being vaccinated.   A dramatic drop in vaccine confidence followed, with trust plunging from 93 percent in 2015 to 32 percent in 2018, according to a study led by the London School of Hygiene and Tropical Medicine.   The Philippines polio outbreak has been traced back to the weakened form of the virus used in vaccines, which is excreted by people for a time after they receive it.   According to the WHO, that form can mutate and spread in the surrounding community when immunisation rates get too low.
Date: Mon, 14 Oct 2019 10:25:38 +0200 (METDST)
By Shingo ITO, Sara HUSSEIN

Tokyo, Oct 14, 2019 (AFP) - Tens of thousands of rescue workers in Japan battled on Monday to find survivors of a powerful typhoon that killed at least 43 people, as fresh rain threatened to hamper efforts.   Typhoon Hagibis crashed into the country on Saturday night, unleashing high winds and torrential rain across 36 of the country's 47 prefectures, and triggering landslides and catastrophic flooding.   "Even now, many people are still unaccounted for in the disaster-hit area," Prime Minister Shinzo Abe told an emergency disaster meeting on Monday.   "Units are trying their best to search for and rescue them, working day and night," Abe said.

But even as rescuers, including troops, combed through debris, the country's weather agency forecast rain in central and eastern Japan that it warned could cause further flooding and new landslides.   "I would like to ask people to stay fully vigilant and continue watching for landslides and river flooding," Chief Cabinet Secretary Yoshihide Suga told a news conference.   In Nagano, one of the worst-hit regions, rain was already falling and was expect to intensify.   "We are concerned about the impact of the latest rain on rescue and recovery efforts," local official Hiroki Yamaguchi told AFP.   "We will continue operations while watching out for secondary disasters due to the current rain."

- 43 dead, 16 missing: NHK -
By late Monday afternoon, national broadcaster NHK said the toll had risen to 43 dead, with 16 others missing and over 200 people injured. The government gave lower figures but was continuing to update its information.   The dead included a municipal worker whose car was overcome by floodwaters and at least seven crew from a cargo ship that sank in Tokyo Bay on Saturday night, a coast guard spokesman said.   Four others, from China, Myanmar and Vietnam, were rescued when the boat sank and the coast guard was still searching for a last crew member.   While Hagibis, one of the most powerful storms to hit the Tokyo area in decades, packed wind gusts of up to 216 kilometres (134 miles) per hour, it was the heavy rains that caused most damage.

A total of 142 rivers flooded, mainly in eastern and northern Japan, with river banks collapsing in two dozen places, local media said.   In central Nagano, a levee breach sent water from the Chikuma river gushing into residential neighbourhoods, flooding homes up to the second floor.   As water slowly receded Monday, television footage showed patients being transferred by ambulance from a Nagano hospital where some 200 people had been cut off by flooding.   Elsewhere, rescuers used helicopters to winch survivors from roofs and balconies, or steered boats through muddy waters to reach those trapped.

- Japan dedicates rugby win to victims -
By Monday afternoon, some 75,900 households remained without power, with 120,000 experiencing water outages.   The disaster left tens of thousands of people in shelters, with many unsure when they would be able to return home.   "Everything from my house was washed away before my eyes, I wasn't sure if it was a dream or real," a woman in Nagano told NHK.   "I feel lucky I'm still alive."   The storm brought travel chaos over the holiday weekend, grounding flights and halting commuter and bullet train services.

By Monday, most subway trains had resumed service, along with many bullet train lines, and flights had also restarted.   The storm also brought havoc to the sporting world, forcing the delay of Japanese Grand Prix qualifiers and the cancellation of three Rugby World Cup matches.   But a crucial decider pitting Japan against Scotland went ahead, with the hosts dedicating their stunning 28-21 win to the victims of the disaster.   "To everyone that's suffering from the typhoon, this game was for you guys," said Japan captain Michael Leitch.
Date: Sun, 13 Oct 2019 23:31:57 +0200 (METDST)

Kinshasa, Oct 13, 2019 (AFP) - Doctors will use a second Ebola vaccine from November in three eastern provinces in the Democratic Republic of Congo to fight the deadly virus, medical officials said Sunday.   "It's time to use the new Ad26-ZEBOV-GP vaccine, manufactured by Johnson & Johnson's Belgian subsidiary," said Dr. Jean-Jacques Muyembe, who leads the national anti-Ebola operation in the DRC.    It will arrive in the eastern city of Goma, in North Kivu province, on October 18 and be used from the beginning of next month, he added.   DRC's latest Ebola epidemic, which began in August 2018, has killed 2,144 people, making it the second deadliest outbreak of the virus, after the West Africa pandemic of 2014-2016.

Muyembe said the communes of Majingo and Kahembe had been selected to receive the vaccine as they were considered the epicentres of the epidemic.   "We will extend this vaccination to our small traders who often go to Rwanda to protect our neighbours," he added.   "If it works well, we will expand vaccination in South Kivu and Ituri."   DR Congo's eastern provinces of Ituri, North Kivu and South Kivu sit on the borders with Uganda, Rwanda and Burundi.   The Belgian laboratory will send a batch of 200,000 doses to neighbouring Rwanda and 500,000 doses in the DRC, Muyembe said.   More than 237,000 people living in active Ebola transmission zones have received a vaccination produced by the pharma company Merck Sharpe and Dohme since August 8, 2018. 

The J&J vaccine had been rejected by DRC's former health minister Oly Ilunga, who cited the risks of introducing a new product in communities where mistrust of Ebola responders is already high.   But Ilunga's resignation in July appears to have paved the way for approval of the second vaccine. He currently faces charges that he embezzled funds intended for the fight against Ebola.   In his letter of resignation Ilunga said "actors who have demonstrated a lack of ethics" want to introduce a second vaccine, but did not elaborate.    Muyembe, who took over the Ebola fight in the DRC in July, said "The Johnson & Johnson vaccine has the most science-based data."