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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: Tue 21 Jan 2020
Source: Ahora Noticias, Costa Rica [in Spanish, machine trans., edited]
<https://www.ahoranoticiascr.com/2020/01/21/autoridades-cerraron-pizzeria-debido-a-casos-de-hepatitis-a-en-san-ramon/>

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[HealthMap/ProMED-mail map:
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.
More ...

Macedonia

Macedonia US Consular Information Sheet
August 15, 2008
COUNTRY DESCRIPTION:
Macedonia is a parliamentary democracy that is steadily transforming its economy. Tourist facilities are available in the capital, Skopje, and other major towns.
In tourist centers, such as Skopje and Ohrid, European-standard hotels and other travel amenities are available, while the standard of facilities throughout the rest of the country varies considerably. Read the Department of State Background Notes on Macedonia for additional information.

ENTRY/EXIT REQUIREMENTS:
Short trip for business or tourism:
A valid passport is required for travel to Macedonia.
A visa is not required for U.S. passport holders for tourist and business trips up to 90 days during a six-month period.
Entry stamps are issued at airports or land border crossing points, which grant permission to remain 90 days.
All foreign citizens must register with local police within 24 hours of arrival.
Those staying in private accommodation or renting an apartment should register in person at the police station nearest his/her place of residence, and should be accompanied to the station by the owner or landlord of the apartment.
Hotels are responsible for the registration of foreign guests.
If the foreigner changes address in Macedonia, he or she should notify the police station where s/he initially registered and reregister with the police station closest to the new place of residence.

An unaccompanied minor U.S. citizen who enters Macedonia should be in possession of a parental or guardian statement of consent to enter and stay in the country.
The statement of consent must be certified by a competent authority of the country from which s/he arrives or by a diplomatic or consular mission of the Republic of Macedonia abroad.

NOTE:
A U.S. citizen who possesses more than one passport is required to leave the country with the travel document used for entry into the country.

Temporary residence:
Individuals intending to work, study or remain longer then 90 (ninety) days in Macedonia, must obtain an entry visa prior to their arrival in Macedonia.
The practice of switching from tourist status to long-term status when already in Macedonia is no longer allowed.
Those wanting to do so must leave Macedonia and apply for a long-term visa at a Macedonian Embassy of Consulate.
Macedonian visas, as opposed to entry stamps, can only be issued at a Macedonian Embassy or Consulate in a foreign country.

American citizens resident in the United States may apply at:
Macedonian Embassy in Washington D.C.2129 Wyoming Avenue, NW, Washington, D.C. 20008, Tel: (202) 667-0501; Fax: (202) 667-2131;
E-mail: washington@mfa.gov.mk; usoffice@macedonianembassy.org, Website: http://www.macedonianembassy.org.

The passport should be valid for at least three months longer than the validity of the visa.
For additional information about the conditions and procedures for visa issuance, the applicant should contact the Embassy or Consulate of the Republic of Macedonia.
Using the list of diplomatic and consular missions of the Republic of Macedonia abroad (which can be found at the Ministry of Foreign Affairs’ website at www.mfa.gov.mk), a visa applicant can choose the most convenient Embassy/Consulate to the submit the visa application.

Travelers should be aware that all
border areas apart from designated border crossings are restricted zones. Presence in these zones is forbidden without prior official permission.

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: The security situation in Macedonia is stable, although occasional criminal violence does occur. Americans should avoid areas with demonstrations, strikes, or roadblocks where large crowds are gathered, particularly those involving political causes or striking workers.

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

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME: Crime in Macedonia is low by U.S. standards, and violent crime against Americans is rare. Pickpocketing, theft, and other petty street crimes do occur, however, particularly in areas where tourists and foreigners congregate. American travelers are advised to take the same precautions against becoming crime victims as they would in any U.S. city. Valuables, including cell phones and electronic items, should not be left in plain view in unattended vehicles. Windows and doors should be securely locked when residences are not occupied. Organized crime is present in Macedonia; organized criminal activity occasionally results in violent confrontations between members of rival organizations. ATM use is safe, as long as standard safety precautions are taken.
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 a victim of a crime while overseas, in addition to reporting to the 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, to 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 find an attorney if needed.

The local equivalent to the “911” emergency line in Macedonia is:
police 192 and ambulance 194
If you are outside the city of Skopje you need to dial 02 first.

For additional assistance see our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Although many Macedonian physicians are trained to a high standard, and a number of well-equipped private clinics are available especially in Skopje, most public hospitals and clinics are not equipped and maintained at U.S. or Western European standards. Basic medical supplies are usually available, but specialized treatment may not be obtainable. Travelers with previously diagnosed medical conditions may wish to consult their physician before travel.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of [country]. 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 Macedonia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Driving safely in Macedonia requires excellent defensive driving skills. Many drivers routinely ignore speed limits and other traffic regulations, such as stopping for red lights and stop signs. Drivers may make illegal left turns from the far right lane, or drive into oncoming lanes of traffic. The combination of speeding, unsafe driving practices, poor vehicle maintenance, the mixture of new and old vehicles on the roads, and poor lighting contributes to unsafe driving conditions. Pedestrians should exercise extreme caution when crossing the street, even when using crosswalks, as local drivers rarely slow down or stop for pedestrians.

A valid U.S. driver’s license in conjunction with an International Driving Permit is required for Americans driving in Macedonia. Driving is on the right side of the road. Speed limits are generally posted. Most major highways are in good repair, but many secondary urban and rural roads are poorly maintained and lit. Horse-drawn carts, livestock, dead animals, rocks, or other objects are sometimes found in the roadway. Some vehicles are old and lack standard front or rear lights. Secondary mountain roads can be narrow and poorly marked, lack guardrails, and quickly become dangerous in inclement weather. Overall, public transportation in Macedonia is dilapidated. Roadside emergency services are limited.
In case of emergency, drivers may contact the police at telephone 192, the Ambulance Service at telephone 194, and Roadside Assistance at telephone 196.

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 Macedonia, the U.S. Federal Aviation Administration (FAA) has not assessed Macedonia’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://faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: Macedonian customs authorities may enforce strict regulations concerning temporary importation to or exportation from Macedonia of certain items, including items deemed to be of historical value or significance. Taking photographs of anything that could be perceived as being of military or security interest may result in problems with authorities. Visitors should always observe “no photographing” signs. If in doubt, please ask permission before taking photographs.

The local currency is the denar. While credit cards are accepted in larger stores and restaurants, cash in local currency is advised for purchases in small establishments.

Upon entry into Macedonia, every foreigner must declare all cash amounts of foreign currency greater than EUR 2,000 at the Customs Control Office. Failure to report funds in excess of this amount may result in the confiscation of the entire amount by the customs service. After going through the court system, an individual is normally required to pay a fine and the National Bank will also keep a certain percentage of the undeclared amount before it is released.
Please also 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 Macedonian laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Macedonia 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. Prostitution is illegal in Macedonia. 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 Macedonia 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 Macedonia. 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 in Skopje is located at Ilindenska bb, 1000 Skopje, tel. (389) (2) 311-6180, fax (389) (2) 321-3767, email: consularskopje@state.gov; web site: http://macedonia.usembassy.gov
* * *
This replaces the Country Specific Information for Macedonia dated March 05, 2008 to update the section on Entry/Exit Requirements.

Travel News Headlines WORLD NEWS

Date: Mon 29 Jul 2019
Source: Institute of Public Health of Republic of North Macedonia [abridged, edited]

Information on the situation of measles in the Republic of North Macedonia in 2018-2019, 25 Jul 2019
--------------------------------------------------------------------------------
In the period from 20 Jul-25 Jul 2019, a total of 5 cases of measles were reported. From the total number of newly reported cases, 4 cases are from Skopje, while one is from Kumanovo.

In total, since the onset of the epidemic in December 2018 as of 25 Jul 2019, 1870 cases of measles have been registered in the Republic of North Macedonia with a disease rate of 90.4 per 100,000 inhabitants.

Due to the epidemiological criteria, a measles epidemic is ongoing in the entire territory of the Republic of North Macedonia.

According to the place of permanent living, measles cases are registered in 24 towns, of which 979 cases are from Skopje, Kumanovo 231, Tetovo 194, Struga 112, Kicevo 59, Veles 53, Gostivar 69, Ohrid 35, Gevgelija 19, Debar 22, Prilep 11, Stip 40, and in other cities less than 10 cases were registered (Chart 1). The highest incidence is registered in Skopje (158.5/100 000, Struga (165.1/100 000, Kumanovo 161.9/100 000)

According to the vaccine status, 1501 or 80.3% of diseased people are unvaccinated, incompletely vaccinated or with unknown vaccine status. >From the non-vaccinated persons, 320 (21.3%) are under the age of 12 months and are not subject to vaccination, according to the Immunization Calendar.

According to the results obtained from the samples sent to Luxembourg's reference measles laboratory, the B3 Dublin genotype circulates in the country, which is circulating also in the neighbouring countries.
 
The total number of immunized people aged 14 years with MRP [morbilli, rubella, and parotitis epidemica/MMR measles, mumps, rubella] vaccine since the start of the epidemic in the republic is 33,729.  From the beginning of the epidemic to present date, in the Centers for Public Health, a total of 6032 people have been vaccinated, of which more than 60% are health workers, students, and pupils in secondary medical schools, the rest are persons over 14 years of age.

[Available at the source URL:]
Chart 1. Geographic distribution of measles in N. Macedonia, December 2018-July 2019
----------------------------------------------
Communicated by:
Aleksandar Jovicic
==========================
[HealthMap/ProMED-mail map of Republic of North Macedonia:
Date: Fri 29 Mar 2019
Source: Institute of Public Health of Republic of Macedonia [abridged, edited]

Information on the situation of measles in the Republic of North Macedonia in 2018-2019, 29 Mar 2019
-------------------

In the period 23 Mar-29 Mar 2019, a total of 109 cases of measles (laboratory confirmed or related to the epidemiological link) were reported.

Out of the total number of newly reported cases, 49 cases are from Skopje, with 89.8% of them incomplete vaccinated, unvaccinated, or with unknown vaccine status. The remaining 60 patients are from 11 other cities in North Macedonia:

- From Kumanovo and Struga, 30 cases (15 cases in each) were reported, of which 90% were unvaccinated, incomplete vaccinated, or with unknown vaccine status;
- From Tetovo and Debar: in 7 cases from Tetovo, 6 were unvaccinated, incomplete vaccinated, or with unknown vaccine status; from Debar, one case was unvaccinated and one with unknown vaccine status;
- From Gostivar, there are 6 cases, of which 5 are unvaccinated, incomplete vaccinated, or with unknown vaccine status;
- 4 cases were reported from Kicevo, with 2 of them unvaccinated and incomplete vaccinated;
- From Veles, 2 cases, with 1 unvaccinated and 1 incomplete vaccinated;
- 1 new case each was reported from Stip (unknown vaccine status), Ohrid (incomplete vaccinated), Radovis (not vaccinated), and Prilep (completely vaccinated).

In total, since the onset of the epidemic in Skopje in December 2018, as of 29 Mar 2019, 767 measles cases were registered in the Republic of North Macedonia, of which 575 were epidemiologically related and reported in the epidemic in Skopje.

According to the place of permanent living, measles cases were registered in 20 towns in Macedonia, of which 521 were from Skopje, 63 from Tetovo, 61 from Kumanovo, 27 from Struga, 18 cases from Gevgelija and Debar, 15 from Gostivar, 12 from Veles, 11 from Kicevo, 4 from Kocani and Shtip, and in sporadic cases in the other 9 cities. The highest incidence per 100 000 inhabitants is registered in Struga (97.3), Skopje (84.4), Debar (64.9), Kumanovo (42.8), and Gevgelija (41.8).

The largest number of cases are from the age group over 30 years, with 305 or 39.8% of the total. A high percentage of patients is also registered in the age group of 0-4 years, with 37.9% of the total number of cases (n = 291).

Out of 150 children aged 1-4 years, 137 or 91.3% were unvaccinated or with unknown vaccine status; from 412 patients in persons over 20 years of age, 69.2% (n = 285) were unvaccinated, incomplete vaccinated, or with unknown vaccine status.

Out of the total number of 767 registered cases of measles, the highest number and percentage, 369 or 48.1%, are laboratory confirmed, 193 or 25.2% are epidemiologically linked, while 205 cases (26.7%) are measles with clinical features.

>From the beginning of the epidemic in Skopje, the total number of vaccinated people under 14 years of age who are subject to 1st or 2nd vaccination is 11 475 children. In the rest of the republic, from the beginning of the epidemic, the total number of vaccinated people up to 14 years of age with a 1st or 2nd dose is 6776 children.

The total number of immunized people aged 14 years with the MRI vaccine since the beginning of the epidemic is 18,251.  Submitted by: Aleksandar Jovicic.
=========================
[HealthMap/ProMED map of North Macedonia
http://healthmap.org/promed/p/55666. - ProMED Mod.MPP]
Date: Fri 8 Mar 2019
Source: IPH (Institute of Public Health of Republic of Macedonia) [abridged, edited]

This week [week of Mon 4 Mar 2019], a total of 81 cases of measles have been reported (laboratory confirmed or with an epidemiological link). A total of 45 cases of measles have been reported from Skopje (of whom 73.3% were incompletely vaccinated, unvaccinated, or with unknown vaccine status) while the other 36 are from 9 other cities in Macedonia.

From Gevgelija, 7 cases were reported, 6 of them unvaccinated. From Kumanovo, 8 cases were reported, 7 unvaccinated. From Tetovo, 7 new cases were reported, 6 of which were not vaccinated, with incomplete vaccine status. From Struga, 5 cases were reported, of which 3 were incompletely vaccinated with unknown vaccine status. Three new cases have been reported from [each of] Debar and Veles; [of these,] 5 persons have been incomplete vaccinated or with unknown vaccine status. Also, one new case from [each of] Kriva Palanka (not vaccinated), Kicevo (unknown vaccine status), and Kocani (completely vaccinated) [were reported].

A total of 493 cases of measles have been registered in Macedonia since the beginning of the epidemic in Skopje since December 2018, of which 410 have been linked to the epidemic in Skopje.

According to the place of permanent living, measles cases were registered in 17 towns in Macedonia, of which 366 cases were from Skopje, 39 from Tetovo, 25 from Kumanovo, 16 from Gevgelija, 9 from Debar, 7 from Struga, 6 from Gostivar, 6 from Veles, 5 from Kichevo, and 4 from Kocani, and the other 7 cities are sporadic cases.

The largest number of cases are from the age group 0-4 years: 220, or 44.6% of the total. A high percentage of patients is also registered in elderly groups. Persons older than 30 years account for 36.9% (n = 182) and persons from 20-29 years for 10.3% (n = 51).

Out of a total of 122 cases of children aged 1-4 years, 105 (86%) were unvaccinated, and out of 233 cases in people over 20 years of age, 70.8% (n = 165) were unvaccinated, incompletely vaccinated, or had unknown vaccine status.

From the total number of registered 493 cases of measles, the highest number and percentage -- 278 (56.4%) -- are laboratory confirmed; 117 (23.7%) are epidemiologically related, while 98 cases (19.9%) are measles [presumably this means clinically diagnosed but not laboratory confirmed. - ProMED Mod.SH].

Since the onset of the epidemic, in Skopje, total of 9958 children under 14 years of age have been vaccinated as part of the response to the outbreak with a 1st or 2nd dose. In the rest of the republic, since the epidemic began, a total of 5193 children up to 14 years have been vaccinated with a 1st or 2nd dose. The total number of those aged 14 years [and under] who have received MRP vaccine since the start of the epidemic in the Republic of Macedonia is 15 151.
Date: Sat 9 Feb 2019
Source: China.org.cn, a Xinhua report [edited]

The Macedonian Health Minister Venko Filipce confirmed on [Fri 8 Feb 2019] the death of a 6-month-old baby related to measles. According to Filipce, the baby was under treatment for lung complications and was not vaccinated.

The minister said vaccination in Macedonia should continue in order to strengthen the immunity of the population after the significant drop on vaccination coverage in 2014.  Filipce also confirmed that 2 children are treated for lung complications but are not in life-threatening conditions. The minister made the remarks after his visit at the Neurology Clinic in Skopje. On [2 Jan 2019], the Health Ministry in Macedonia declared the outbreak of measles in the capital of Skopje.
Date: Wed 2 Jan 2019
Source: Outbreak News Today [abridged, edited]

Health officials in Macedonia are reporting a measles outbreak in the capital city of Skopje. Minister of Health Assoc. Dr. Venko Filipce announced the outbreak declaration today [2 Jan 2019].

In addition to the 7 cases that appeared in the Skopje settlement Radishani 10 days ago, there are now 12 new cases from almost all municipalities in Skopje, of which 6 are officially laboratory confirmed and 6 have a clear clinical picture and are awaiting official laboratory confirmation. The outbreak has affected both children and adults, all of whom were unvaccinated.

"Of the 15 000 unvaccinated children with vaccine calls, only 310 were vaccinated, which is a small figure. It is a good circumstance that schools [were closed] because of the holidays.

"But, of course, we have the situation under control. This is an extremely serious disease that, unfortunately, is sometimes fatal to the lives of children. Any disregard for the recommendations is an additional risk for the health of the whole population," said Minister Filipche (computer translated).  [Byline: Robert Herriman]
=========================
[A total of 310 children vaccinated of 15 000 is only 2% of the children immunized. This is an unacceptably high risk for the children. - ProMED Mod.LK]

[HealthMap/ProMED-mail map:
Skopje, Macedonia (FYROM): <http://healthmap.org/promed/p/1999>]
More ...

Guam

No Profile is available at present

Travel News Headlines WORLD NEWS

Date: Tue 19 Mar 2019
Source: Daily Post [edited]

The Department of Public Health and Social Services is monitoring an outbreak of shigellosis on Guam. Shigellosis is an infectious disease caused by a group of bacteria called _Shigella_. Most who are infected with _Shigella_ develop diarrhoea, fever, and stomach cramps starting a day or 2 after they are exposed to the bacteria.

So far in 2019, a total of 10 cases have been reported, 9 have been confirmed. In 2018, a total of 29 cases of shigellosis were reported; 23 were confirmed.

Shigellosis usually resolves in 5 to 7 days. However some people who are infected may have no symptoms at all, but may still pass the _Shigella_ bacterium to others. The spread of shigellosis can be stopped by frequent and careful hand washing with soap and taking other hygiene measures.
=========================
[_Shigella_ was discovered more than 100 years ago by the Japanese microbiologist Kiyoshi Shiga, for whom the genus is named. There are 4 species: _S. boydii_, _S. dysenteriae_, _S. flexneri_, and _S. sonnei_. _Shigella_ organisms can survive transit through the stomach because they are less susceptible to acid than other bacteria; for this reason, as few as 10 to 100 organisms can cause disease. Ingested bacteria pass into the small intestine where they multiply; large numbers of bacteria then pass into the colon, where they enter the colonic cells. Given its relatively low infectious dose, transmission can occur via contaminated food and water or via direct person-to-person spread, including sexual practices more common in MSM (men who have sex with men). Humans are the only natural reservoir for the disease.

The bacterium is the classical cause of bacterial dysentery (formerly known as flux or the bloody flux) is an inflammatory disorder of the colon, which results in severe diarrhoea containing mucus and/or blood in the faeces with fever, abdominal pain, and rectal tenesmus (pain while passing the diarrhoea).

Guam (<https://en.wikipedia.org/wiki/Guam>) is an unincorporated and organized territory of the United States in Micronesia in the western Pacific Ocean. It is the easternmost point and territory of the USA, along with the Northern Mariana Islands. The inhabitants of Guam are called Guamanians, and they are American citizens by birth. Indigenous Guamanians are the Chamorros, who are related to other Austronesian natives of Eastern Indonesia and Philippines and Taiwan.  - ProMED Mod. LL]

[HealthMap/ProMED map available at:
Date: Wed, 23 Aug 2017 10:40:35 +0200

Tokyo, Aug 23, 2017 (AFP) - Guam's number two politican Wednesday rolled out the welcome mat to tourists, promising his sun-kissed tropical island is safe -- despite North Korea's threat to launch missiles toward the Pacific US territory.   Lieutenant Governor Raymond Tenorio made the comments in Tokyo where he was joined by Guam's tourism boss Jon Nathan Denight, amid fears that Pyongyang's sabre-rattling will hammer the key tourism industry.

Last year, Japanese tourists made up about half of the 1.5 million visitors to the island, which is about a four-hour flight from Tokyo.   "We're one of the most protected and safe islands you'll find in the world," Tenorio told reporters at the Foreign Correspondents' Club of Japan.   He added there was a big US military presence on Guam, a strategic outpost in the Pacific with its own missile defence system.

Added Denight: "Guam's brand image was built as a very safe and family-friendly destination. I want to reassure people of Japan that there has been no change and Guam is safe for travel."   The unusual appeal to tourists comes several weeks after Pyongyang said it was considering firing a salvo of missiles toward the island -- prompting an angry reaction from US President Donald Trump.

Unlike Trump, however, Guam's 162,000-odd residents seem to be taking it all in stride, including Tenorio.   "By and large, 99 percent of our population just go about their lives every single day. Things are normal on Guam," he said.   "I have to admit sometimes it's really hard to do my job in my office. If you look outside...(from) where I'm sitting at my desk many times you'll see dolphins chasing the fish."
Date: Fri, 11 Aug 2017 12:10:33 +0200

Hagatna, Guam, Aug 11, 2017 (AFP) - Tourism-dependent Guam is looking to cash in on its new-found fame as a North Korean missile target, tapping an unlikely promotional opportunity to attract visitors to the idyllic island and prove that all publicity is good publicity.   Pyongyang's threats to launch four missile strikes near the US territory has stirred global curiosity in the remote Pacific destination, with it trending heavily on search engines as social media users wondered, "what is Guam?"

Although Guam hosts two US military installations and 6,000 US soldiers, making it the target of North Korea's wrath, tourism authorities are keen to dispel any impression of danger to the tranquil island and its secluded beaches.   "The circumstances are unfortunate but this is a good opportunity for us to educate the world about Guam and our culture, about where we are, and who we are," said Josh Tyquiengco, marketing director at Guam Visitors Bureau, the official agency for the island.

"Guam is more than a military base. We are a safe family destination. We reassure potential visitors that we continue to be a safe... place to visit," Tyquiengco told AFP.   Despite North Korea's threats to prepare plans within days that would surround Guam with "enveloping fire", fears of a potential attack have not deterred tourists from visiting Guam, he said.   "We heard about a few booking cancellations from South Korea, but it's too minimal to affect the industry," he said. 

Governor Eddie Calvo, in a briefing late Friday, said any attack on Guam "would be met with overwhelming force", pointing out that the biggest threat facing the island was the looming typhoon season.   "With that, everybody should conduct their lives like business as usual. It's the weekend. Go out, have a good time, enjoy the beaches tomorrow and live your lives.   "At this point, there are thousands of tourists coming in on a daily basis... from Japan, (South) Korea, Taiwan and China and other areas. It is our belief that they should enjoy themselves here."

As aircraft after aircraft -- packed with tourists -- landed Friday at Guam's international airport, the latest visitors to the island appeared untroubled by the prospect of missile strikes.   Sun Doojin, who arrived with her husband and two-year-old daughter on a flight from Seoul, responded with an emphatic "no" when asked if she was concerned about an attack during her visit.

- 'A hidden gem' -
The Guam Daily Post, in an editorial, said the spotlight on the territory offered an opportunity to show the world why an island of 162,000 people draws more than 1.5 million tourists a year.    "The beach waters are crystal clear, beaches aren't overrun, and nature hiking trails are very accessible.   "The different cultures that are showcased on the island through food make Guam a hidden gem, a tropical vacation getaway but with the amenities and comforts of some of the small cities stateside."

Guam's history of earthquakes and typhoons mean its infrastructure is built to robust standards and authorities insist that the island is prepared for any emergency, including a North Korean strike.   Homeland Security spokeswoman Jenna Gaminde told the Guam Daily News that in the event of an attack, residents would be immediately notified by sirens from the All-Hazards Alert Warning System located throughout the island.   "If you hear the sirens, tune into local media -- radio, print, television -- for further instructions," she said. 

Pyongyang has said it would take less than 18 minutes for a missile to cross the 3,400-kilometre (2,100-mile) distance to the US territory.   In addition to the US military bases, Guam is also equipped with the sophisticated THAAD weapons system which is capable of destroying intermediate-range missiles in the final phase of flight.

Officials, however, have sought to brush off fears and say there has been no change in the threat level for now.   "I don't think there's anything to worry about. No missile is going to land on Guam," said Carl Peterson, who serves on the Guam Chamber of Commerce's armed forces committee.   "We've got defense mechanisms in place... they have the ability to seek out the missiles with kinetic energy and destroy it."
Date: Thu, 8 Jun 2017 21:02:05 +0200

Miami, June 8, 2017 (AFP) - Five percent of women in the US territories who were infected with the Zika virus while pregnant had fetus or babies with defects, including microcephaly, government health data said Thursday.   The report by the US Centers for Disease Control and Prevention covered the US territories of Guam, American Samoa, the US Virgin Islands, Micronesia, the Republic of Marshall Islands and Puerto Rico.   The report is the first based on data from the US territories and the largest study of its kind to date.

CDC experts said the findings are consistent with previous findings about Zika cases in the mainland United States.   "Women in the US territories and elsewhere who have continued exposure to mosquitoes carrying Zika are at risk of infection," said CDC acting director Anne Schuchat.    "We must remain vigilant and committed to preventing new Zika infections."   The rate of birth defects was slightly higher -- eight percent, or one in 12 -- in women whose infections were confirmed early in the pregnancy, during the first trimester, said the report.

The findings were based on the cases of 2,549 women with possible Zika virus infection who completed their pregnancies.   Among these women, 1,508 had confirmed Zika virus infection from January 1, 2016 to April 25, 2017.   Over 120 pregnancies resulted in Zika-associated birth defects, including infants born with unusually small heads, an irreversible condition known as microcephaly.   Other complications in babies included seizures and problems with movement, coordination, eating and near constant crying.

Zika can be spread by the bite of infected mosquito or via sexual contact.  Pregnant women are urged to avoid areas where Zika is spreading.   Since Zika erupted on a large scale in mid-2015, more than 1.5 million people have been infected, mostly in Brazil and other countries in South America.    Some 70 countries have been impacted.   Zika may lead to an itchy rash and although it is dangerous for pregnant women and their fetuses, it often causes no symptoms in adults.   In November 2016, the World Health Organization announced that the Zika virus outbreak no longer poses a world public health emergency, though it warned the epidemic remains a challenge.
Date: Fri 27 Mar 2015
Source: Outbreak News Today [edited]

Health authorities on the Pacific Island of Guam say the pertussis, or whooping cough outbreak has reached 11 cases to date. This comes after the Department of Public Health and Social Services (DPHSS) received 3 additional laboratory confirmed cases of the vaccine-preventable disease in a 9 month old child, 3 year old child, and 41 year old adult. Investigation into the newest cases show no epidemiological linkage with each other or previous reported cases.  [Byline: Robert Herriman]
=======================
[Guam is an organized, unincorporated territory of the United States in the western Pacific Ocean. A map of the island can be found at <http://www.lib.utexas.edu/maps/islands_oceans_poles/guam.gif>.

There are likely a number of reasons for the upswing of pertussis in the USA and elsewhere, which include the well-recognized normal swings in incidence, the increase in the number of unvaccinated individuals whose parents chose not to vaccinate them, and waning immunity which has caused public health officials to advise boosters for all adults and especially pregnant women. However, research by both Dr Frits R Mooi from the Netherlands (Pertussis - Australia (04): newly emerging clones, discussion 20120322.1078115) and Dr Lyn Gilbert from Australia (Pertussis - Australia (03): newly emerging clones 20120321.1076103) have been previously highlighted in ProMED-mail, reflecting antigenic changes in circulating clones of _Bordetella pertussis_ which may be causing the increased number of pertussis cases throughout the world. These changes may result in a need for modifications of the currently used acellular pertussis vaccines. - ProMED Mod.LL]
More ...

Sweden

Sweden - US Consular Information Sheet
14th October 2008
COUNTRY DESCRIPTION:
Sweden is a highly developed, stable democracy with a modern economy.
Read the Department of State Background Notes on Sweden for additional information.
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ENTRY/EXIT REQUIREMENTS:
Sweden is a party to the Schengen agreement.
As such, U.S. citizens may enter Sweden for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our Schengen Fact Sheet.
Contact the Swedish Embassy at 901 30th Street, NW, Washington, DC
20007, tel: (202) 467-2600 (mailing address 2900 K Street, N.W., Washington, DC), or the Swedish Consulate General in New York at (212) 583-2550. Visit the Sweden Abroad web site at www.swedenabroad.com for the most current visa information.
Sweden’s immigration authorities (Migrationsverket) also maintain a home page at http://www.migrationsverket.se/english.jsp.

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:
Sweden remains largely free of terrorist incidents.
However, like other countries in the Schengen area, Sweden’s open borders with its Western European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

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, including the Worldwide Caution, can be found.

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

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

CRIME:
Sweden has a low crime rate with rare, but increasing, instances of violent crime.
Most crimes involve the theft of personal property from cars or residences or in public areas. Pickpockets and purse-snatchers are becoming more prevalent. Many American citizens fall victim to these highly skilled thieves, especially at the main train stations in Stockholm and Gothenburg and during bus or train transit to and from airports. Do not put any bags containing valuables, such as your passport, down on the ground. Computer bags are particularly desirable.
Pickpockets and purse-snatchers often work in pairs or groups with one distracting the victim while another grabs valuables.
Often they operate in or near major tourist attractions such as Stockholm’s Old Town, restaurants, amusement parks, museums, bars, buses, long distance trains, subway trains, train and bus stations, and airports.
Hotel breakfast rooms and lobbies attract professional, well-dressed thieves who blend in with guests and target purses and briefcases left unguarded by unsuspecting tourists and business travelers.
Valuables should not be left in parked vehicles.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to both 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, contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you in finding appropriate medical care, contacting family members or friends, and explaining how funds can be transferred.
Although the investigation and prosecution of a crime abroad 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.

Sweden has a limited criminal injuries compensation program for victims of violent, personal, and property crime.
Foreign citizens who are victims of crime on Swedish territory are eligible to apply for compensation, but if the victim and offender’s affiliation to Sweden is transitory in nature, compensation may not be awarded even though the crime occurred on Swedish soil.
Application forms in English are available at local police stations and other government agencies as well as on the Internet at
http://www.brottsoffermyndigheten.se/default.asp?id=1345.
Claimants are generally notified of the program’s decision within four months.

The local equivalent to the “911” emergency line in Sweden is 112.
See our information for Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care is comparable to that found in the United States.
The Swedish medical system is a state-run system, so instead of visiting a local private general practitioner, travelers can visit a local medical center or clinic, called an “Akutmottagning” or “Vardcentral.”
Patients should be prepared to present their passports.
In case of a medical emergency, use the emergency telephone number “112” (see above) to contact the appropriate emergency service.

Travelers with special medical needs should consult with their personal physician and take appropriate precautions, including bringing adequate supplies of necessary medication.
Medicines may be brought into the country as long as they are intended for the traveler’s personal use.
Medications categorized as narcotics may only be brought into the country to cover the traveler's personal use for a maximum of five days and must be accompanied by a medical certificate stating why the traveler needs them.
In addition, stringent Swedish customs regulations prohibit travelers from receiving drugs from abroad after having arrived in the country.
Travelers may also find local physicians reluctant to prescribe equivalent quantities or dosages.
Prescriptions are dispensed at state-run pharmacies called “Apotek” in Swedish.
Most pharmacies are open during normal shopping hours but major cities have a 24-hour pharmacy.

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

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


A valid U.S. driver’s license may be used while visiting Sweden, but drivers must be at least 18 years of age.
Driving in Sweden is on the right.
Road signs use standard international symbols and Swedish text.
Many urban streets have traffic lanes reserved for public transportation only.

Swedish roads are comparable to those in the U.S., though secondary roads may be less heavily traveled.
These secondary routes often narrow to two lanes with a wider shoulder.
Slower vehicles are expected to move onto the shoulder to allow faster moving vehicles to pass.
All vehicles must have headlights lit when on the road, no matter what time of day.
The use of snow tires is mandatory between December 1 and March 31 and, experience in driving on ice and snow is recommended before navigating Sweden’s winter roads.

Public transport in Sweden is of good quality and is the recommended method of travel.
Passenger trains, intercity buses, and plane flights provide regular service over longer distances.
Public transportation in urban centers includes buses, subways, trams, suburban trains, and taxis.
Taxis are more expensive than in major U.S. cities.
Most local residents use public transport in Stockholm as parking can be hard to find and expensive.
The bus, train, and subway systems are relatively safe.

Use of seat belts is mandatory for drivers and all passengers, and children under the age of seven must be seated in approved child or booster seats.
The maximum speed limit is 110 kilometers per hour.
Driving under the influence of alcohol or drugs, including prescription drugs, is considered a very serious offense.
The rules are stringently enforced and fines can be severe.
Violations can result in severe fines and possible jail sentences.

Emergency services for traffic accidents can be reached by calling 112 (the equivalent to 911 in the U.S.).
Please refer to our Road Safety page for more information.
Visit the website of the country’s national tourist office and national authority responsible for road safety at www.visitsweden.se and at http://www.vv.se/templates/page2_2____13172.aspx?epslanguage=EN
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Sweden’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Sweden’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:
Please see our information on Customs Information and the Swedish web site www.tullverket.se/en for customs information specific to Sweden.
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 Sweden’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Sweden are severe, and convicted offenders can expect long jail sentences and heavy fines.
There is no bail system in Sweden and non-resident Americans who are arrested may be held in custody until the trial is complete.
Engaging in illicit 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 Sweden are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, https://travelregistration.state.gov, so that they can obtain updated information on travel and security within Sweden.
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
Dag Hammarskjoldsvag 31, telephone: (46) (8) 783-5300, fax:
(46) (8) 783-5480, and after-hours telephone: (46) (8) 783-5310.
The Embassy’s web site is http://stockholm.usembassy.gov/
* * *
This replaces the Consular Information Sheet dated March 4, 2008 to update the sections on Entry Requirements, Information for Victims of Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Sun 1 Dec 2019
Source: Outbreak News Today [edited]

In a follow-up on a previous report on the _Cryptosporidium_ outbreak in Sweden, the Public Health Authority, or Folkhalsomyndigheten, reports more than 300 cases of cryptosporidiosis in October and November [2019].

The good news is while the number of cases is still unusually high, the number of reported cases has decreased.

Adults have been the most affected age group and most cases have been reported from Stockholm, Ostergotland, Halland, Uppsala, Jonkoping, and Vastra Gotaland.

Health officials say of the 140 samples analyzed so far, 73 have been shown to belong to the same subtype (A ) of _Cryptosporidium parvum_. In addition to this subtype, a number of different subtypes have been detected, of which 35 cases with subtype B.

As part of the investigation, cases are interviewed about what they ate and drank before they became ill. The analysis shows that it was much more common among the cases with subtype A to drink pre-purchased freshly pressed fruit and vegetable drinks compared to the cases with subtype B.

Such beverages have not been heat-treated and can, therefore, contain harmful microorganisms. The investigation indicates that it is the spinach in the beverage, delivered in October [2019], which is the source of infection for the cases with subtype A. Since spinach is a fresh product, the contaminated beverage is no longer in store.

However, it is still unknown what the cases with subtype B have been infected with, so far the investigation indicates that it is a different source of infection than for subtype A.
======================
[The case-control investigation confirms that the outbreak is food-related stating that "that it was much more common among the cases with subtype A to drink pre-purchased freshly pressed fruit and vegetable drinks." The source of subtype B still has to be defined. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Sweden:
Date: Wed 13 Nov 2019
Source: Swedish Public Health Agency [in Swedish, trans. ProMED Mod.EP, edited]

The Public Health Agency of Sweden is investigating an increase in notified cases of infection with _Cryptosporidium_.

During the autumn and in particular during weeks 44 and 45 [28 Oct-8 Nov 2019], an increase in the number of reported cases of cryptosporidiosis, infected in Sweden, was noted. Half of the regions in Sweden have reported cases in all age groups but mostly in adults. Most cases have been seen in the Stockholm region.

The Agency has initiated an outbreak investigation in collaboration with regional authorities and the Swedish Food Agency to identify a possible common source. The investigation will focus on food and water consumption in cases and controls and samples will be analysed by the agency.
=====================
[The graph in the article (see source URL above] shows that approximately 85 cases were recorded in week 45, compared to 20 to 30 cases weekly from week 32 (5-11 Aug 2019]. All cases were infected in Sweden.

Infection with _Cryptosporidium_ spp. is a zoonosis with a natural reservoir in ruminants from which surface water such as in lakes and rivers, is contaminated.

This outbreak is observed in half of the regions in Sweden, which strongly suggests that the infection is foodborne and not related to contaminated drinking water. The concentration of cases in Stockholm most probably reflects the distribution of the population between the regions. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Sweden:
Date: 10 Oct 2019
Source: Food Safety News [edited]

Livsmedelsverket has warned people to correctly soak and cook dried legumes such as beans, peas and lentils after they were linked to a large food poisoning outbreak at a school.

Dried legumes naturally contain lectins which can cause nausea, vomiting and diarrhea around 1-7 hours after consumption.

Illness occurred in the canteen at lunchtime in early September 2019 at Baldergymnasiet school in Skelleftea, a city in Vasterbotten County. Swedish media reported that almost 280 people were affected, and samples were sent to a laboratory in the United Kingdom.

Sandra Wallstrom, a food inspector at Skelleftea municipality, said it was thought to be the 1st time elevated levels of lectin have been shown to have caused food poisoning in Sweden.

Follow-up checks will be made at the school to ensure the handling of beans and similar foods is safe in the future.

Swedish officials urged people to follow instructions on the packaging and in recipes. They should be soaked for at least 12 hours, rinsed and cooked for at least half an hour. Canned beans are already cooked and can be eaten directly without soaking and boiling.  [Byline: Joe Whitworth]
=======================
["Lectins are proteins selectively binding carbohydrates and, importantly, the carbohydrate moieties of the glycoproteins decorating the surface of most animal [and mammal] cells. They are found in a wide range of vegetables (29 out of 88 tested; [1]). Plant lectins not efficiently degraded by digestive enzymes, and that have an affinity for the surface of gut epithelial cells, such as those present in the Leguminosae family, can be poisonous [2]. Acute symptoms following ingestion include nausea, vomiting and diarrhea.

"Ingestion of the lectins present in certain improperly cooked vegetables [especially beans and lentils] can result in acute gastrointestinal (GI) tract distress, but the mechanism of toxicity is unknown. _In vivo_, gut epithelial cells are constantly exposed to mechanical and other stresses and consequently individual cells frequently experience plasma membrane disruptions. Repair of these cell surface disruptions allows the wounded cell to survive: failure results in necrotic cell death. Plasma membrane repair is mediated, in part, by an exocytotic event that adds a patch of internal membrane to the defect site. Lectins are known to inhibit exocytosis.

"Repair of plasma membrane disruptions and exocytosis of mucus was assessed after treatment of cultured cell models and excised segments of the GI tract with lectins. Plasma membrane disruptions were produced by focal irradiation of individual cells, using a microscope-based laser, or by mechanical abrasion of multiple cells, using a syringe needle. Repair was then assessed by monitoring the cytosolic penetration of dyes incapable of crossing the intact plasma membrane. We found cell surface-bound lectins potently inhibited plasma membrane repair, and the exocytosis of mucus normally accompanies the repair response."

1. Nachbar MS, Oppenheim JD. Lectins in the United States diet: a survey of lectins in commonly consumed foods and a review of the literature. Am J Clin Nutr. 1980;33:2338-2345.
2. Vasconcelos IM, Oliveira JT. Antinutritional properties of plant lectins. Toxicon. 2004;44:385-403.

The full article may be found at:

One note: Be sure to discard the water the lentils or beans were soaked in. Fresh water should be added for cooking the lentils/beans. The taste of soaked vs. unsoaked beans may not vary much, but apparently the effect on the GI tract is much different. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
Date: Wed 25 Sep 2019
Source: Food Safety News [edited]

Authorities in Sweden are investigating a national outbreak of monophasic _Salmonella_ Typhimurium, which has affected almost 40 people.

Folkhalsomyndigheten (Public Health Agency of Sweden) reported that the source of the infections is still unknown. During September [2019], there was an increase in the number of cases of salmonellosis. The outbreak was identified, thanks to Folkhalsomyndigheten's microbial surveillance program. The latest date of illness onset is 6 Sep [2019].

To date, 36 illnesses from 10 counties have been linked by whole-genome sequencing. Most patients live in Vastra Gotaland, Jonkoping, Halland, and Dalarna. Those ill come from all age groups, including children and the elderly. More women, 22, than men, 14, have become ill.

Local authorities, Livsmedelsverket (Swedish Food Agency) and Folkhalsomyndigheten are investigating the outbreak to identify the source of infection that is suspected to be a food widely distributed in Sweden. People are being interviewed about what they ate the week before illness, with the aim of identifying common suspect foods.

The outbreak strain has multilocus variable-number tandem-repeat analysis (MLVA) pattern 3-12-11-N-211.

In 2018, isolates from 864 _Salmonella_ infections were typed; 91% were infected in Sweden, and 18% had been infected abroad. Among cases infected in Sweden, Enteritidis, Typhimurium, and monophasic Typhimurium were the most common serotypes.  [Byline: Joe Whitworth]
==========================
[The source of this outbreak is as yet unknown. By monophasic, it is meant that the organism does not have the complete set of flagellar serotypes. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Fri 6 Sep 2019
Source: Rikard Dryselius rikard.dryselius@folkhalsomyndigheten.se
[edited] [re: ProMED-mail Tularemia - Sweden (04): further increase, RFI
http://promedmail.org/post/20190905.6659382]
--------------------------------------------------------------------------------
According to clinical reports, a majority (over 70%) of the reported cases during the ongoing outbreak of tularemia in Sweden appear to have contracted the infection through insect bites, mainly mosquito bites. For about 1/4 of the disease cases no path of infection is indicated, while mainly animal contact and in some cases drinking water is indicated as route of infection for the remaining cases. -- Rikard Dryselius Folkhalsomyndigheten rikard.dryselius@folkhalsomyndigheten.se
=====================
[ProMED thanks Rikard Dryselius for this clinical information. - ProMED Mod.LL]
 
[HealthMap/ProMED-mail map of Sweden: <http://healthmap.org/promed/p/108>]
More ...

World Travel News Headlines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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