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Netherlands Antilles

Netherland Antilles US Consular Information Sheet
May 12, 2008
COUNTRY DESCRIPTION:
The five islands of Bonaire, Curaçao, Saba, St. Eustatius (or “Statia”) and St. Maarten (Dutch side) comprise the Netherlands Antilles, an autonomous
art of the Kingdom of the Netherlands. Tourist facilities are widely available. Read the Department of State Background Notes on the Netherlands Antilles for additional information.
ENTRY/EXIT REQUIREMENTS: All Americans traveling by air outside 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 document compliant with the Western Hemisphere Travel Initiative, 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. Based on current projections, we expect to begin production of the passport card in June 2008 and be in full production in 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 is available at http://travel.state.gov/passport/ppt_card/ppt_card_3926.html and upcoming changes to U.S. passport policy can be found on the Bureau of Consular Affairs web site at http://travel.state.gov/travel/cbpmc/cbpmc_2223.html. We strongly encourage all American citizen travelers to apply for a U.S. passport well in advance of anticipated travel. American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.
The U.S. Consulate recommends traveling in the Netherlands Antilles with a valid U.S. passport to avoid delays or misunderstandings. A lost or stolen passport is also easier to replace when outside the United States than other evidence of citizenship. Visitors to the Netherlands Antilles may be asked to show onward/return tickets or proof of sufficient funds for their stay. Length of stay is granted for two weeks and may be extended for 90 days by the head office of immigration. For further information, travelers may contact the Royal Netherlands Embassy, 4200 Linnean Avenue, N.W., Washington, D.C. 20008, telephone (202) 244-5300, or the Dutch Consulate in Los Angeles, Chicago, New York, Houston or Miami. Visit the web site for the Embassy of the Netherlands at http://www.netherlands-embassy.org/homepage.asp for the most current visa information.

We have more information pertaining to dual nationality and international child abduction. Please refer to our customs information to learn more about customs regulations.

SAFETY AND SECURITY:
Drug-related organized crime exists within the Netherlands Antilles but has not directly affected tourists in the past.
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, 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., 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: In recent years, street crime has increased, especially in St. Maarten. Valuables, including passports, left unattended on beaches, in cars and hotel lobbies are easy targets for theft, and visitors should leave valuables and personal papers secured in their hotel. Burglary and break-ins are increasingly common at resorts, beach houses and hotels. Armed robbery occasionally occurs. The American boating community has reported a handful of incidents in the past, and visitors are urged to exercise reasonable caution in securing boats and belongings. Car theft, especially of rental vehicles for joy riding and stripping, can occur. Incidents of break-ins to rental cars to steal personal items have been reported by American tourists. Vehicle leases or rentals may not be fully covered by local insurance when a vehicle is stolen. Be sure you are sufficiently insured when renting vehicles and jet skis.
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, 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 to find an attorney if needed.
Please see our information for American Victims of Crime Overseas.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is generally good in Curaçao and St. Maarten, but may be limited on the other three islands. Hospitals have three classes of services i.e.: First Class: one patient to a room, air conditioning etc.; Second Class: two to six patients to a room, no air conditioning; Third Class: 15 to 30 people in one hall. Patients are accommodated according to their level of insurance.
Bonaire: The San Francisco hospital is a medical center (35 beds) with decompression facilities. The hospital has an air ambulance service to Curaçao and Aruba.
Curaçao: St. Elizabeth hospital is a public hospital that may be compared to midrange facilities in the United States. St. Elizabeth's hospital has a decompression chamber and qualified staff to assist scuba divers suffering from decompression sickness. Several private clinics provide good to excellent medical service.
St. Maarten: St. Maarten Medical Center (79 beds) is a relatively small hospital where general surgery is performed. Complex cases are sent to Curaçao.
Statia: Queen Beatrix Medical Center (20 beds) is a medical facility well equipped for first aid. Surgery cases are sent to St. Maarten.
Saba: Saba Clinic (14 beds) is a well-equipped first aid facility. Surgery cases are sent to St. Maarten. The Saba Marine Park has a decompression chamber and qualified staff to assist scuba divers suffering from decompression sickness.
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 the Netherlands Antilles is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving in the Netherlands Antilles is on the right hand side. Right turns on red are prohibited, and traffic conditions require somewhat defensive driving. Local laws require drivers and passengers to wear seat belts and motorcyclists to wear helmets. Children under 4 years of age should be in child safety seats; children under 12 should ride in the back seat.
Nonexistent or hidden and poorly maintained street signs are the major road hazard in the Netherlands Antilles. Therefore, drivers should proceed through intersections with caution. Roads in the Netherlands Antilles are extremely slippery during rainfall. Night driving is reasonably safe in the Netherlands Antilles as long as drivers are familiar with the route and road conditions. Most streets are poorly lit or not lit at all. In Curacao, drivers should be aware of herds of goats that may cross the street unexpectedly. In Bonaire, wild donkeys may also cross the road.
Taxis are the easiest, yet most expensive form of transportation on the islands. As there are no meters, passengers should verify the price before entering the taxi. Fares quoted in U.S. dollars may be significantly higher than those quoted in the local currency. Vans are inexpensive and run non-stop during daytime with no fixed schedule. Each van has a specific route displayed in the front of the windshield. Buses, which run on the hour, have limited routes. The road conditions on the main thoroughfares are good to fair.
See road safety information at the following sites; http://www.curacao.com, http://www.statiatourism.com, http://www.sabatourism.com, http://www.infobonaire.com, http://www.st-maarten.com/.
Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of the Netherlands Antilles’ Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of the Netherlands Antilles’ 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:
Dutch law in principle does not permit dual nationality. However, there are several exceptions. For example, American citizens who are married to Dutch citizens are exempt from the requirement to abandon their American nationality when they apply to become a Dutch citizen by naturalization. For detailed and specific information on this subject, contact the Embassy of the Netherlands in Washington or one of the Dutch consulates in the U.S. In addition to being subject to all Dutch laws affecting U.S. citizens, dual nationals may also be subject to other laws that impose special obligations on Dutch citizens.
Time-share buyers are cautioned about contracts that do not have a "non-disturbance or perpetuity protective clause" incorporated into the purchase agreement. Such a clause gives the time-share owner perpetuity of ownership should the facility be sold. Americans sometimes complain that the timeshare units are not adequately maintained, despite generally high annual maintenance fees. Because of the large number of complaints about misuse of maintenance fees, particularly in St. Maarten, prospective timeshare owners are advised to review the profit and loss statement for maintenance fees. Investors should note that a reputable accounting firm should audit profit and loss statements.
Potential investors should be aware that failed land development schemes involving time-share investments could result in financial losses. Interested investors may wish to seek professional advice regarding investments involving land development projects. Real estate investment problems that reach local courts are rarely settled in favor of foreign investors.
An unusually competitive fee to rent vehicles or equipment could indicate that the dealer is unlicensed or uninsured. The renter is often fully responsible for replacement costs and fees associated with any damages that occur during the rental period. Visitors may be required to pay these fees in full before leaving the Netherlands Antilles and may be subject to civil or criminal penalties if they cannot or will not make payment.
Netherlands Antilles customs authorities may enforce strict regulations concerning temporary importation into or export from the Netherlands Antilles. For example, it is strictly prohibited to export pieces of coral and/or seashells. Please see our information on customs regulations.
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 the laws of the Netherlands Antilles, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the Netherlands Antilles are severe, and convicted offenders can expect long jail sentences and heavy fines. The Netherlands Antilles has strict gun control laws; even a stray bullet in a suitcase can trigger a fine or time in jail. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties.
CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children’s Issues web site.
REGISTRATION / EMBASSY LOCATION:
American citizens residing or traveling in the Netherlands Antilles are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within the Netherlands Antilles. 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 J.B. Gorsiraweg #1, Willemstad, Curaçao, telephone (599-9) 461-3066; fax (599-9) 461-6489; e-mail address: acscuracao@state.gov.
* * *
This replaces the Country Specific Information dated May 7, 2007, to update the Entry/Exit, Crime, Traffic Safety and Road Conditions, and Registry / Embassy Location sections.

Travel News Headlines WORLD NEWS

Date: 4 Jul 2017
From: Harry Vennema <harry.vennema@rivm.nl> [edited]

On several of the Caribbean islands, epidemics of viral conjunctivitis are ongoing. Recently, general practitioners in the overseas territories of the Netherlands reported an increased incidence of this syndrome.

As of 26 May 2017, an outbreak of conjunctivitis occurred in a nursing home on Bonaire. In total, 14 patients and 13 healthcare workers presented with conjunctivitis. Patients were between 71 to 94 years of age. The number of new cases peaked in week 20 through 22. After week 22, a significant reduction was seen (1-3 new cases per week). Initially, conjunctival swabs from 5 patients were tested for the presence of adenovirus by PCR; all 5 were negative.

Subsequently, swabs from 4 patients were analyzed for the presence of enterovirus by RT-PCR, and all 4 were positive. The enterovirus from 3 samples was further characterized by partial VP1 sequence analysis. In all 3 samples, the enterovirus was characterized as Coxsackievirus A24, which belongs to Enterovirus C. Coxsackievirus A24 has been identified frequently as the causative agent of epidemic viral conjunctivitis. The strain from Bonaire is at least 5 percent different from any of the previously isolated and sequenced CV-A24 strains available in Genbank in a 330nt VP1 fragment. The strain involved in the most recent outbreak of CV-A24 conjunctivitis on La Reunion in 2015 is 6 percent different from the Bonaire 2017 strain.

[Andert Rosingh, Yingbin Celestijn-Wu, Fundashon Mariadal Hospital, Clinical Microbiology, Kralendijk, Bonaire, Caribbean Netherlands Annelies Riezebos, University Medical Centre Utrecht, Medical Microbiology, Utrecht, Netherlands Harry Vennema, Kim Benschop, Johan Reimerink, Hans van den Kerkhof, National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, Netherlands]
--------------------------------------------
Harry Vennema
National Institute for Public Health and the Environment
Centre for Infectious Disease Control
Bilthoven, Netherlands
=========================
[ProMED thanks Harry Vennema and colleagues for this report.  Acute hemorrhagic conjunctivitis (AHC) is characterized by sudden onset of painful, swollen, red eyes with subconjunctival haemorrhages and excessive tearing. Most cases are self-limited but highly contagious, with the potential for causing considerable illness. Adenoviruses and picornaviruses can cause AHC outbreaks (1). Among picornaviruses, enterovirus 70 and coxsackievirus A24 variant (CA24v) have caused large outbreaks of AHC[2].

Coxsackieviruses are transmitted primarily via the fecal-oral route and respiratory aerosols, although transmission via fomites is possible. The viruses initially replicate in the upper respiratory tract and the distal small bowel. They have been found in the respiratory tract up to 3 weeks after initial infection and in feces up to 8 weeks after initial infection[3]. The potential for exponential spread is, therefore, quite considerable.

It is important to understand that sequential outbreaks of AHC due to CA24v might occur in the same location after a considerable period, and public health precautions are necessary to control these outbreaks.

References:
1. Hierholzer JC, Hatch MH. Acute hemorrhagic conjunctivitis. In: Darrell RW, editor. Viral diseases of the eye. Philadelphia: Lea & Febiger; 1985. p. 165-96.
2. Kono R. Apollo 11 disease or acute hemorrhagic conjunctivitis: a pandemic of a new enterovirus infection of the eyes. Am J Epidemiol. 1975;101:383-90.

[A HealthMap/ProMED-mail map can be accessed at:
Date: Published ahead of print 7 Dec 2015
Source: American Journal of Tropical Medicine & Hygiene Published on line doi:10.4269/ajtmh.15-0308 [edited]

Noellie Gay, Dominique Rousset, Patricia Huc, Severine Matheus, Martine Ledrans, Jacques Rosine, Sylvie Cassadou, and Harold Noel. Seroprevalence of Asian Lineage Chikungunya Virus Infection on Saint Martin Island, 7 Months After the 2013 Emergence.

Abstract
--------
At the end of 2013, chikungunya virus (CHIKV) emerged in Saint Martin Island, Caribbean. The Asian lineage was identified. 7 months after this introduction, the seroprevalence was 16.9 percent in the population of Saint Martin and 39.0 percent of infections remained asymptomatic. This moderate attack rate and the apparent limited size of the outbreak in Saint Martin could be explained by control measures involved to lower the exposure of the inhabitants. Other drivers such as climatic factors and population genetic factors should be explored. The substantial rate of asymptomatic infections recorded points to a potential source of infection that can both spread in new geographic areas and maintain an inconspicuous endemic circulation in the Americas.
--------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
===================
[Asymptomatic or very mild infections may be an important source of infectious blood meals for vector mosquitoes. These infections should not be overlooked in epidemiological assessments of chikungunya virus outbreaks and implementation of control measures in the field. - ProMed Mod.TY]
Date: Wed, 26 Aug 2015 16:43:59 +0200 (METDST)

Miami, Aug 26, 2015 (AFP) - Tropical storm Erika took aim at the Lesser Antilles Wednesday as storm warnings went up there and in Puerto Rico in anticipation of heavy rains, US forecasters said.   With winds of 75 kilometres (45 miles) per hour, Erika was 540 kilometres (335 miles) east of Antigua at 1200 GMT, the Miami-based National Hurricane Center reported.

Advancing at a speed of 28 kilometres (17 miles) per hour, it was expected to sweep over the Lesser Antilles Wednesday night and then head toward Puerto Rico and the Virgin Islands.   Tropical storm warnings were up in Puerto Rico, the Virgin Islands, Antigua and Barbuda, Guadeloupe, Montserrat, St Kitts and Nevis, Anguilla, Saba, St Eustacia and St Maarten.

A US Air Force hurricane hunter aircraft that flew into the storm found it was slightly increasing in strength.   "Some slow strengthening is forecast during the next 48 hours," the hurricane centre said.   According to the NHC's projections, Erika could become a hurricane by the end of the week, or early next, as it nears Florida.   But "the intensity forecast remains very uncertain," it said.

Erika is arriving on the heels of Danny, the season's first hurricane which petered out before reaching the Caribbean.   Experts said earlier this month that there was a 90 percent chance the 2015 hurricane season in the Atlantic would be less active than usual.
Date: Tue, 9 Jul 2013 09:19:21 +0200 (METDST)

MIAMI, United States, July 09, 2013 (AFP) - Tropical Storm Chantal barrelled toward the Lesser Antilles islands in the Caribbean Sea on Tuesday on its way to the Dominican Republic and Haiti, the US National Hurricane Center reported.  As of 0600 GMT Chantal was located about 250 kilometers (155 miles) east of Barbados packing maximum sustained winds of 85 kilometers (50 miles) per hour, the NHC said.   The storm is moving in a northwesterly direction at 43 kilometers per hour (26 mph).   Chantal's center will sweep through the Lesser Antilles later Tuesday morning and into the eastern Caribbean, and approach the Dominican Republic on Wednesday, the hurricane center said.

Besides Puerto Rico and the southern coast of the Dominican Republic, tropical storm warnings are in effect for the French islands of Martinique and Guadeloupe, as well as for Barbados, Dominica and Santa Lucia, the NHC said.   Chantal is expected to strengthen during the next 48 hours.   It is also expected to dump two to four inches of rain over the Leeward and Windward Islands, Puerto Rico and the US Virgin Islands and parts of the Dominican Republic and Haiti, with maximum amounts of six inches possible, the NHC said.   Poverty-stricken Haiti, which is still recovering from a devastating earthquake in January 2010, is especially prone to landslides triggered by heavy rain.
Date: Fri 15 Jan 2010
Source: Institut de Veille Sanitaire: Le point epidemiologique - N2 [in French, trans. & summ. ProMed Mod.TY, edited]
<http://www.invs.sante.fr/surveillance/dengue/points_sbsm/2009/pe_st_martin_2009_15_dengue.pdf>

Surveillance of cases clinically suggestive of dengue
-----------------------------------------------------
Over the last week (Jan 2010, week 1), we are witnessing a decrease in the number of cases suggestive of dengue seen by general practitioners on the island, with an estimated 100 cases who have consulted [physicians] versus 215 the previous week. However, this number remains very much above the epidemic threshold, and comparable to numbers observed during the 1st 3 weeks of Dec [2009]. Since early Dec 2009, nearly 800 cases clinically suggestive of dengue fever have consulted a general practitioner, averaging over 130 per week. The number of cases clinically suggestive of dengue fever is an estimate, for the entire population Saint Martin, based on the number of people who consulted a general practitioner for a clinical syndrome suggestive of dengue. This estimation is performed using data collected from the network of sentinel physicians.

Monitoring of biologically confirmed cases
------------------------------------------
Since early Dec [2009], the number of laboratory confirmed [dengue] cases has varied from week to week but remained well above the epidemic threshold. During the last week, there were 24 laboratory confirmed dengue cases on the island (incomplete data). A total of 123 of laboratory confirmed cases have been identified since early December [2009].

Positivity rate of requests for laboratory confirmation and [dengue virus, DENV] serotypes circulating
-------------------------------------------------------
The positivity rates of samples taken has been high since the beginning of Dec [2009], every week ranging from 40-55 per cent. In the 1st week of Jan [2010], 24 of the 44 samples tested were positive (55 per cent). Since the beginning of Oct [2009], 3 distinct [dengue virus, DENV] serotypes circulate on the island: DENV-1, DENV-2 and DENV-4. DENV-2 is prevalent (22 samples of 31; 70 per cent); DENV-1 was found 6 times and DENV-4 in 3 patients. Only DENV-3 appears not to be circulating.

Hospitalized cases
------------------
During the 1st week of January [2010], 4 children with laboratory confirmed dengue were treated in hospital. One of them had a severe form requiring a transfer to the University Hospital of Pointe-a-Pitre, where he is currently hospitalized. The other 3 children had non-severe disease.

Spatial distribution
--------------------
The study of the geographical distribution of laboratory confirmed cases shows a distribution of cases across the island. However, the Concordia neighborhood and the areas between Grand Case to Baie Orientale have been most affected since late Nov [2009].

Situation analysis
------------------
In Saint-Martin, the dengue epidemic continues. Although the number of cases does not seem to increase, there were still hospitalizations during the past week from a severe form [of the disease]. The epidemiological situation is still in Phase 3 of PSAG of the Northern Islands as an epidemic phase.
======================
[It would be of interest to know the current dengue situation on the Netherlands Antilles (Sint Maarten) half of the island.

A map of Saint Martin in the Caribbean can be accessed at
<http://www.worldatlas.com/webimage/countrys/namerica/caribb/stmartin.htm>.

A HealthMap/ProMED-mail interactive map of Saint Martin can be accessed at
<http://healthmap.org/promed/en?v=18.1,-63.1,6>. - ProMed Mod.TY]
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World Travel News Headlines

Date: Thu, 21 Feb 2019 07:52:47 +0100
By Amelie BARON

Port-au-Prince, Feb 21, 2019 (AFP) - With flaming barricades and widespread looting, 10 days of street violence in Haiti have all but buried a tourism industry that managed to resurrect itself after a devastating earthquake in 2010.   Ugly, violent footage beamed around the world has again sent the message that this impoverished Caribbean country is politically unstable and no place to go on vacation.

The final straw was the helicopter evacuation last week of 100-odd Canadian tourists trapped as angry protesters demanded the resignation of the president, whom they accuse of corruption.   "We have been through 12 days of hell. We managed the crisis but today we are suffering from the aftershocks," said Tourism Minister Marie-Christine Stephenson.

- Blacklist -
Beside the direct effects of the demonstrations, the United States delivered another crushing blow on February 14 when it urged its citizens not to travel to Haiti, which thus joined a no-go list with war-torn countries like Syria, Yemen and Afghanistan.

The minister said the US travel alert for Haiti was too harsh, calling the riots something that flared up unexpectedly and are now over.   "OK, they lasted 12 days but I am not sure that other Caribbean countries, which have had riots of their own, have been punished as severely and quickly as we have," said Stephenson.   Overnight, the decision by the US State Department hit the tourism industry hard. Travel web sites simply stopped offering flights to Haiti's two international airports.   Hotels are reporting cancellation of reservations and many empty rooms.

Officials in the industry have yet to tally up the damage but say that for the second time in less than a year, they will have to lay off workers.   In July of last year, three days of riots over a government attempt to raise fuel prices ruined the summer vacation season for Haiti's tourism industry.   It is not just hotels that will suffer again, said Beatrice Nadal-Mevs, president of the Haitian Tourism Association.   "This is going to affect everyday people because these are direct jobs that are going to be lost and supply chains will be threatened: farming, fishing, crafts, transport," Nadal-Mevs said.

- Mardi Gras cancelled -
With the opposition planning more demonstrations to seek the resignation of President Jovenel Moise, the sector got yet more bad news with word that Carnival celebrations have been called off in the Haitian capital, Port-au-Prince.   City Hall said it could not guarantee revelers' safety.   The festivities, which this year were planned for March 3-5, usually draw many Haitians living abroad and fleeing the winter cold in Canada and the eastern US.

Another major Carnival celebration is scheduled to take place in the city of Gonaives, but the government has not said if it will go ahead.   As grim as things are, some foreign tourists have gone ahead with visits to Haiti.   On Wednesday, a group of Australians under police escort visited a square featuring statues of heros of Haiti's independence from France. Days ago, demonstrators at the same plaza were throwing rocks at police, who responded with volleys of tear gas grenades.

A woman named Carole, who did not want to give her last name, said, "I trust the company we're traveling with. They not only want to take us but they want to bring us back."   Kevin McCue, another of the people in the group of 20, said he was glad that their tour operator had not opted for Plan B, which would have meant skipping Haiti and spending the whole week in the neighboring Dominican Republic.   "Tourism is alive and well here. People should come. The more they come, the better they spread some money among people who need it and the better for Haiti," said McCue.
Date: Thu, 21 Feb 2019 07:20:54 +0100
By Shafiqul ALAM

Dhaka, Feb 21, 2019 (AFP) - At least 70 people were killed when fire tore through crumbling apartment blocks in a historic part of Dhaka, setting off a chain of explosions and a wall of flames down nearby streets, officials said Thursday.    It started in one building where chemicals for deodorants and other household uses were illegally stored and spread at lightning speed to four nearby buildings, the fire service said.    People became trapped by the flames at a nearby bridal party and a restaurant. TV images showed the gates to one building were chained up so residents were unable to escape.

Traffic jams in the clogged narrow streets held up the rescue operation.   Bangladesh fire chief Ali Ahmed said at least 70 people were killed but that the toll would likely rise.    "The number of bodies may increase. The search is still going on," he told AFP.   Doctors said at least 10 of the scores of injured were in critical condition.   Firefighters who took almost 12 hours to bring the fire under control, went through the blackened floors of the building, littered with spray cans, looking for bodies.

The fire started at about 10.40pm (1640 GMT) on Wednesday at Chawkbazar in the old Mughal part of the capital.   Ahmed said it may have been started by a gas cylinder and quickly spread through the building where chemicals were stored in rooms alongside the apartments.   Chemicals used for household products were also stored in the nearby buildings. They exploded as the fire spread, witnesses said.     "There was a traffic jam when the fire broke out. It spread so quickly that people could not escape," the fire chief said.   Another fire official told reporters the blaze was under control but was not extinguished despite the efforts of more than 200 firefighters.   "It will take time. This is not like any other fire," he said, adding that the inferno had been made more devastating by the "highly combustible" chemicals.   Fire trucks had struggled in the narrow streets to reach the scene and there was also a lack of water for the battle, officials said.   The main gate of one five storey building was chained up, trapping residents inside, according to images shown on Bangladesh television.

- 'Flames were everywhere' -
Members of a bridal party in a nearby community centre were also caught in the fire and many were injured. Others were caught in small restaurants.   Dhaka deputy police commissioner Ibrahim Khan said at least two cars and 10 cycle rickshaws were burned in the fire.   "The victims included passersby, some people who were eating food at a restaurants and some members of the bridal party," he told AFP.   "I saw the charred body of a woman who was holding her daughter in her lap as their rickshaw was caught in the fire," said one witness.

Haji Abdul Kader, whose shop was destroyed, said he only survived the blaze as as he had left to go to a pharmacy.   "When I was at the pharmacy, I heard a big bang. I turned back and saw the whole street, which was jam packed with cars and rickshaws, in flames. Flames were everywhere," he told AFP.   "I got burned and rushed to hospital," he said.

Doctors at Dhaka Medical College Hospital said at least 55 people were injured, including 10 in a critical condition.   Hundreds of people rushed to the hospital looking for missing relatives.  However, most of the bodies of the dead were charred beyond recognition.    Sohag Hossain, one of the injured, told the Daily Star that he and two friends were working at a plastic factory in one of the buildings at the time of the fire.    They heard an explosion and could not escape the flames.

A similar blaze in 2010 in an old Dhaka building, which was also used as a chemical warehouse, killed more than 120 people in one of the worst fire disasters in the city of 20 million people.      Dhaka authorities launched a crackdown on chemical warehouses in residential areas following the blaze, but efforts to rein in the practice have waned.   Many buildings in Bangladesh lack adequate fire safety measures and the enforcement of fire regulations in factories and apartment buildings is lax.  
Date: Wed 20 Feb 2019, 2:13 PM CET
Source: El Pais in English [edited]
<https://elpais.com/elpais/2019/02/20/inenglish/1550655774_604104.html>

An investigation has been opened to determine the cause of death of a 46-year-old woman, who became ill after eating at a one-star Michelin restaurant called RiFF in Valencia. A total of 23 other patrons, including the victim's husband and 12-year-old son, also fell sick after the meal but their symptoms were mild and they have reportedly all recovered. The case was confirmed by regional health chief Ana Barcela, who expressed her condolences to the family and said that an investigation was already underway. "We've conducted a primary inspection of the establishment and everything appears to be normal," she said. "Analytical tests will now be carried out on the food products."

Barcela explained that the regional public health department will be in charge of the investigation and for determining the causes behind the woman's death. According to sources from the regional health department, the food poisoning outbreak was reported on [Sun 17 Feb 2019], after the 3 family members fell ill. They began to show symptoms of food poisoning - vomiting and diarrhoea - on [Sat 16 Feb 2019]. According to Europa Press, the father and son recovered but the woman's symptoms were more severe, and she died in her home early on the following morning. The investigation into the death revealed that a total of 9 patrons had experienced illness, mainly vomiting, after eating at the same restaurant.

Subsequently, it emerged that a further 14 people had also suffered light symptoms. "17 people have been interviewed, of whom 14 stated that they had some kind of mild symptoms," explained regional health chief Ana Barceló today, [Wed 20 Feb 2019]. "The samples that have been collected over the last few days have been sent to the National Toxicology Institute to be analyzed." Public health officials inspected the restaurant on [Mon 18 Feb 2019], but did not find any problems that could have contributed to the food poisoning. Investigators also collected samples of ingredients and raw food products that were part of the menu, and are currently analyzing them.

Barcela added that at this point she could not confirm whether the sickness had been caused by morel mushrooms that were on the restaurant's menu. "We will have to wait for the autopsy to be carried out on the woman before we can determine whether it was the ingestion of a food that directly caused her death, or whether it prompted a state that led to this fatal outcome, or if she had an existing condition," she explained on [Wed 20 Feb 2019].

Forensic teams are working to determine whether she could have been poisoned by something she ate, or whether she may have choked on her own vomit. In a statement, the owner of RiFF, Bernd H. Knaller, announced that the restaurant will remain closed until the cause of the food poisoning outbreak is determined and "activities can resume with full assurances for the staff and the patrons." The owner said he has been cooperating with the regional health department on the investigation and pointed out that the inspection "showed that the restaurant complies with all sanitary regulations." He added: "Regardless of what caused the situation, I want to convey my deep regret for what happened, and I hope all of the facts will be clarified shortly." [Byline: Cristina Vazquez]
Date: Mon 18 Feb 2019
Source: The News International [edited]

An elderly man died due to complications of the Crimean-Congo haemorrhagic fever (CCHF), commonly known as Congo virus, at the Jinnah Postgraduate Medical Centre (JPMC) on early [Sun 17 Feb 2019] morning, becoming the 2nd victim of the deadly tick-borne disease in the city [Karachi] in 2019.

"MUY, an elderly person of 75 years of age, died due to CCHF complications at JPMC on early [Sun 17 Feb 2019] morning," said JPMC Executive Director Dr. Seemin Jamali while taking to The News. She added that the deceased had earlier been taken to a private hospital from where he was shifted to Jinnah hospital.

It is the 2nd death in the city caused by the CCHF within a week as earlier on [Tue 12 Feb 2019] morning, a 35-year old woman from Orangi Town had died of Congo virus at an isolated ward of the JPMC.

CCHF is a tick-borne viral disease, which is caused when a person comes in contact with an animal infected with the Congo virus due to the presence of the parasite on its skin. Mostly butchers, sheep and animal herders and those who are associated with cattle farming become victims of the CCHF, which has a 40 to 50% mortality rate.

Dr. Jamali said both the woman from Orangi Town and the latest CCHF victim, who lived in the Landhi area of the city, were brought to the JPMC from Liaquat National Hospital where they had tested positive for the lethal disease.

She said the 2nd victim had a history of dealing with cattle and was in a serious condition when brought to the JPMC. He was suffering from high grade fever as well as internal and external bleeding, low platelets count and other comorbidities.

"We had moved both the patients to an isolation ward where they were given antiviral drugs, mega units [blood/platelets?] and other symptomatic treatment, but they could not survive due to the complications of the lethal ailment. All precautionary measures had also been adopted to prevent other patients and the medical staff from contracting the viral infection," she said.

"There were many people who contracted this disease in Karachi during their interaction with cattle, but they survived due to their strong immunity and the medical care they received at hospitals, including the JPMC. People should take precautionary measures while dealing with cattle and livestock," Dr. Jamali said. She added that in case the symptoms of red spots on the body, high-grade fever and blood oozing from mouth and nose are found in any patient, they should be rushed to a major hospital.

According to Dr. Kamran Rizvi, district officer (preventive) of Karachi Metropolitan Corporation, around 16 people died at various hospitals in Karachi last year [2018] due to CCHF, a majority of whom were residents of different areas of Balochistan, including Quetta, as people from the province are now regularly brought to Karachi for treatment.

He said a total of 41 Congo virus patients were brought to different hospitals in Karachi last year [2018], of whom 16, mostly males, could not survive while the others were successfully cured.
=====================
[The CCHF virus is now endemic in both rural and urban parts of the country, and he best safeguard on the human side is to inform the public regarding the risks and provide education on the use of appropriate practices and protection measures.

Persons working in close contact with animals are at risk for CCHF due to presence of ticks that can transmit the virus through bites or crushing during removal through skin cuts, etc. The animals do not show clinical disease during viraemia and the virus can be transferred in butchering, handling of meat and hides, etc.  The veterinary aspect of the problem requires establishment of animal screening with measures for tick control. Collaborative work by health and veterinary sectors with support of entomologists for setting up CCHF surveillance can help plan prevention and control programs - ProMED Mod.UBA]
[HealthMap/ProMED map available at:
Date: Tue 19 Feb 2019, 1:32 PM
Source: KCRG-TV9 [edited]

TV9 has learned the Johnson County Public Health Department and the Iowa Department of Public Health are investigating reports of food poisoning following an event in Swisher, Iowa.

The illnesses have been linked to the Swisher Men's Club's Game Feast Dinner this past weekend [16-17 Feb 2019]. The group's Facebook page says the fundraiser has been going on for 15 years and features dishes that include meat from animals that are often hunted. The health departments are looking for anyone who may have attended the meal to try to track down the source of the illnesses. It's asking attendees to email <diana.vonstein@idph.iowa.gov> with their contact information.

Johnson County Public Health Director Dave Koch tells TV9 part of their investigative efforts have included taking part in a conference call with officials from the Iowa Department of Public Health on [Tue 19 Feb 2019]. Koch says part of the investigation will also include testing samples of the food that was served along with conducting tests on any individuals who think they may have contracted an illness.

It is unclear how many people may be claiming to be sick however the club posted the following message to their Facebook page which reads in part: "The Swisher Men's Club is aware of a number of illnesses as a result of our Game Feast Dinner. We are actively working with the county and state health departments to determine the cause of these illnesses."

TV9 has reached out to the Swisher Men's Club for comment. President Mike Brown, Jr. referred back to the statement provided on Facebook. Brown declined TV9's offer for an on-camera interview, but did say they are relaying all necessary information to the Iowa Department of Public Health.  [Byline: Josh Scheinblum & Aaron Scheinblum]
Date: January 2019
Source: Nigeria CDC: Nigeria monkeypox monthly situation report

Nigeria monkeypox -- monthly situation report
---------------------------------------------
Key indicators / Numbers
New suspected cases reported / 6
New confirmed cases / 3
Total deaths / 0
Healthcare worker infection / 0

Epidemiological summary
- Nigeria continues to report sporadic cases of monkeypox after the index case reported in September 2017.
- In the reporting month (January 2019), 6 new suspected monkeypox cases were reported in 4 states (Bayelsa - 2; Rivers - 1; Bauchi - 1; Lagos - 1; Borno - 1; Delta - 1) out of which 3 confirmed cases were recorded in 2 states (Rivers - 1, Bayelsa - 2). - No death recorded.
- All reported cases (suspected and confirmed) are males.
- The confirmed cases are all between 32-39 years of age.
- The South-South region of the country has the highest burden of monkeypox.
- Since the beginning of the outbreak in September 2017, 311 suspected cases and 7 deaths have been reported in 26 states. Of this, 132 were confirmed in 17 states (Rivers, Bayelsa, Cross River, Imo, Akwa Ibom, Lagos, Delta, Edo, FCT [Federal Capital Territory], Abia, Oyo, Enugu, Ekiti, Nasarawa, Benue, Plateau, Anambra)
- Results of animal surveillance carried out in 2 states are awaited.

[Available at the source URL above]:
Figure 1 [graph]: weekly trend of Nigeria monkeypox cases as at 31 Jan 2019
Figure 2 [graph]: line graph of Nigeria monkeypox cases weeks 31-52, 2017; 1-52, 2018 and 1-2, 2019
Figure 2 [map]: map of Nigeria showing distribution of monkeypox cases by LGA [local government area], September 2017-January 2019
=======================
[The number of monkeypox cases in Nigeria continues to increase slowly but steadily, with 6 new suspected and 3 new confirmed cases in January 2019. Interestingly, all cases are male individuals. Monkeypox virus transmission continued over a broad geographic area in Nigeria last year (2018). The report above provides the most recent update of the monkeypox situation in Nigeria. This outbreak has been unusual. Rather than sporadic or rare cases, there have been over 100 cases scattered over a large geographic area since 2017 and again this year (2019). The reasons for this relatively sudden appearance are not clear. Perhaps there has been an epizootic of monkeypox virus infections among its rodent hosts, with spill-over to people. As mentioned earlier, prevention will require a proactive public education effort to convince local people to take measures to prevent contact with the infected rodents and their excreta to avoid transmission, a difficult task involving so many local people over such a large geographic area.

Interested readers can see the graphs of cases by week and a map showing the location of cases by state.

Non-human primates are not monkeypox virus reservoirs. The main reservoirs of monkeypox virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp, an arboreal rodent) and terrestrial rodents (genera _Cricetomys_ and _Graphiurus_). - ProMED Mod.TY]

[Maps of Nigeria:
Date: Wed 20 Feb 2019
Source: Daily Times [edited]

The Sindh Health Department, on Tue 19 Feb 2019, admitted its failure to formulate an action plan to prevent the spread of the extensively drug-resistant (XDR) strain of typhoid fever in the province. The provincial minister for health, Dr Azra Fazal Pechuho, sighed that the health department still awaited vaccines for XDR typhoid from the federal government as the province battles the outbreak caused by a bacterial strain resistant to most known antimicrobials. She added that the strain had claimed 4 lives since its outbreak from Hyderabad [Sindh] in November 2016, which later spread to Karachi and other cities and towns of the province.

Dr Pechuho said that the Sindh Health Department had asked the local governments to improve the chlorination in water supplies, noting that the disease had spread due to the lack of sanitation and the presence of open garbage dumps in Karachi and other places. More than 5000 children have been affected by this typhoid strain, she continued. XDR typhoid is caused by antimicrobial resistant (AMR) strains of _Salmonella enterica_ serotype Typhi (or _S._ Typhi) and has been declared by WHO as a notable public health concern.

A report by the Provincial Disease Surveillance and Response Unit (PDSRU) reported 5274 cases of XDR typhoid out of 8188 typhoid fever cases in Sindh from 1 Nov 2016 through 9 Dec 2018. 69 percent of these cases was reported in Karachi, while 27 per cent in Hyderabad district, and 4 percent in other districts across the province.

The WHO recommended typhoid vaccination in response to confirmed outbreaks of typhoid fever. These vaccinations should be implemented in combination with other efforts to control the disease. At present, azithromycin remains the only affordable first-line oral therapeutic option to manage patients with XDR typhoid in low-resource settings.
====================
[The following is extracted from the CDC notice regarding this multiply-resistant typhoid strain in Pakistan

"The XDR strain of _Salmonella_ Typhi is resistant to most antibiotics (ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ciprofloxacin, and ceftriaxone) used to treat typhoid fever. Healthcare providers should:
- Obtain a complete travel history (asking about travel to South Asia, including Pakistan) from patients with suspected typhoid fever.
- Collect stool and blood cultures from patients with suspected typhoid fever and request antimicrobial susceptibility testing on isolates.
- Be aware that the Pakistan outbreak strain remains susceptible to azithromycin and carbapenems. Azithromycin is effective for uncomplicated (diarrhea or bacteremia without secondary complications) typhoid fever and should be used to treat patients with suspected uncomplicated typhoid fever who have traveled to Pakistan. When culture and sensitivity results are available, adjust treatment accordingly. Adult azithromycin dosage is usually 1000 mg orally once, then 500 mg orally daily OR 1000 mg orally once daily for at least 5-7 days. Pediatric azithromycin dose is 20 mg/kg orally, once then 10-20 mg/kg orally once per day (maximum 1000 mg per day) for at least 5-7 days.
- Carbapenems should be used for patients with suspected severe or complicated typhoid fever who have traveled to Pakistan. Severe or complicated typhoid fever would include, but not be limited to, patients with gastrointestinal complications (such as typhoid-related intestinal perforation, peritonitis, intestinal haemorrhage, hepatitis), neurologic complications (such as typhoid encephalopathy, including altered consciousness, delirium, confusion), or bacteraemia with sepsis or shock. When culture and sensitivity results are available, adjust treatment accordingly. Consider getting an infectious diseases consultation for these patients.
- Be aware that relapses can occur, often 1-3 weeks after clinical improvement.
- Be aware that most (90%) _S._ Typhi isolates from patients coming from South Asia have decreased susceptibility or resistance to fluoroquinolones, including ciprofloxacin; therefore, fluoroquinolones should not be used as empiric treatment for suspected typhoid fever in patients who have traveled to this area.
- Report all cases of confirmed typhoid fever to the appropriate local or state health departments." - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Pakistan:
Date: Tue, 19 Feb 2019 21:26:43 +0100

Geneva, Feb 19, 2019 (AFP) - An avalanche left four skiers injured Tuesday at a resort in the Swiss Alps where rescue operations went on after dark with police fearing people could still be trapped under the snow.   The authorities held a press conference to announce the injuries, including one person seriously hurt, after local reports said up to a dozen people were engulfed by the avalanche.   Police officers said that based on witness reports other skiers could still be buried and the search would continue into the night.

Swiss RTS television said the army had set up lighting to aid the 240 rescue workers at the site.   The police had earlier tweeted that several people were under the avalanche that hit early afternoon on a slope 2,600 metres (8,600 feet) up at Crans-Montana, which was busy with skiers during school holidays.   A local newspaper, Le Nouvelliste, had quoted the head of Crans-Montana's municipal government, Nicolas Feraud, as estimating that "between 10 and 12 people" were buried under the snow.   "We are shocked and hope for good news about these people," Feraud was quoted as saying. 

A first attempt at locating victims using sniffer dogs was unsuccessful, a rescue worker told Le Nouvelliste, with four helicopters joining the search from the air.   Pierre Huguenin, of the Institute for Snow and Avalanche Research, described the snow in the area as damp and dense.   According to statistics from his institute, after 15 minutes under an avalanche, the chances of survival are no more than 50 percent.   Le Nouvelliste said the avalanche swept over 300 to 400 metres (yards) of the lower section of the Kandahar piste.   It quoted rescue workers as saying the snow was compacted and more than two metres (seven feet) thick.

Crans-Montana's website had listed the risk of an avalanche at two on a scale that runs from one (lowest risk) to five.    As the victims were on a designated ski slope, they were unlikely to have detector equipment to help rescue workers locate them.   The vast majority of deadly avalanches in the Alpine nation hit people skiing off-piste.    "We don't know yet whether the avalanche detached by itself or was set off by skiers, or a rockfall," Swiss avalanche expert Robert Bolognesi told the daily 20 Minutes.
Date: Wed, 20 Feb 2019 16:17:29 +0100

Prague, Feb 20, 2019 (AFP) - Czech authorities said Wednesday they would slap checks on beef imported from Poland after veterinarians found the dangerous Salmonella bacteria in a 700-kilogramme batch of Polish beef.   "Tests have shown the presence of Salmonella enteritidis, which can cause serious diarrhoea and affect human health, in beef imported from Poland on February 13," Agriculture Minister Miroslav Toman told reporters.

Czech veterinary authorities have warned the European Commission and Polish authorities through a rapid warning system, he said, adding that they are also checking whether any of the meat has been consumed.   "The State Veterinary Administration (SVS) will immediately adopt an extraordinary measure -- all beef imported from Poland must be tested in a lab before hitting the market," Toman added.

SVS head Zbynek Semerad said meat from the 700-kilo (1,500-pound) batch had been distributed to five "places" in the Czech Republic and one in Slovakia.   "I will inform my Slovak counterpart. As far as we know, not all of the meat has been distributed to the end customer," Semerad said.   The case comes on the heels of a scandal which saw Poland export a total of 2.7 tonnes of suspect beef to around a dozen fellow EU members, triggering an EU probe.

The scandal erupted in January when the TVN24 commercial news channel aired footage of apparently sick or lame cows being butchered at a small slaughterhouse in northeast Poland in secret late at night when veterinary authorities were unlikely to visit.   Poland is a leading producer and exporter of meat in Europe, turning out around 600,000 tonnes of beef per year and exporting most of it mainly to the EU, according to meat producer associations.
Date: Wed, 20 Feb 2019 09:56:54 +0100

Kuala Lumpur, Feb 20, 2019 (AFP) - Six people, including three foreigners, were killed when a fire broke out Wednesday in a Malaysian karaoke centre, with rescuers describing scenes of chaos as the blaze engulfed the building.   The fire erupted before dawn on the fourth floor of an eight-storey building in the city of Ipoh, northern Perak state.

Firefighters rushed to the scene and found the bodies of six people who had died of smoke inhalation, Perak fire department acting director Sayani Saidon told AFP.   "We came across two locals, two Vietnamese women and a Bangladeshi man. We are still determining the identity of the sixth person," she said.

Firefighters rescued eight people alive, including two in critical condition, she added.     People inside were unable to find the way out after the fire erupted as exit lights did not come on, she said. Those that survived had run to an upper level to escape the flames.   "When the fire happened, all the electricity went out, and it was dark, so the exit signs weren't clear," she said.   The building was originally an office block, and had 30 karaoke rooms on the fourth and fifth floors.