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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: Thu, 16 May 2019 23:41:35 +0200

Washington, May 16, 2019 (AFP) - The Church of Scientology said Thursday all the passengers from a cruise ship that was quarantined over a measles case had been cleared to leave.    "All passengers and crew (100%) of the Freewinds have been fully cleared of any possible risk of being infected by the measles or infecting others," the organization said in a statement.   "All passengers and crew are free to come and go as they wish," a spokesman added to AFP.

The infected individual was a member of the crew who, according to the Church, had fully recovered and was given a clean bill of health a week ago. She had been earlier confined on the ship.   The ship, which is based in Willemstad on the island of Curacao in the Dutch West Indies, was quarantined after its arrival in Saint Lucia on April 30.   It remained there for two days before returning to Willemstad on May 4 where local authorities ordered a fresh quarantine to give them time to confirm the passengers were either immunized or had no risk of contracting the virus.
Date: Sat, 4 May 2019 20:37:18 +0200
By Sara MAGNIETTE

The Hague, May 4, 2019 (AFP) - The Dutch territory of Curacao said Saturday it would do what is needed to prevent measles spreading from a Scientology cruise ship, after a crew member came down with the disease.   The Freewinds, which left the Caribbean island of St. Lucia on Friday, arrived back in its home port of Curacao at around 9:00 am (1300 GMT) Saturday, according to myshiptracking.com.

The Curacao government said in a statement that it would "take all necessary precautions to handle the case of measles on board of the Freewinds," including vaccinations.   "An investigation will also be done to determine who will be allowed to leave the ship without (posing) a threat to the population of Curacao," it said.   "It is imperative to make all efforts to prevent a spread of this disease internationally."   Dutch broadcaster NOS reported that three health officials had boarded the boat to examine those on board. Only people able to prove that they have been vaccinated against measles or had already had the disease would be able to leave the boat, its correspondent there reported.

- Anti-vaccine movement -
The Church of Scientology says the 440-foot (134-meter) vessel is used for religious retreats and is normally based in Curacao.   The vessel had arrived in St Lucia from Curacao on Tuesday, when it was placed under quarantine by health authorities there because of a measles patient, said to be a female crew member.   According to NOS, the crew member concerned is a Danish national, who arrived in Curacao from Amsterdam on April 17. It was only when the boat was at sea, on route to St Lucia, that a doctor discovered she had measles, their correspondent said.

The resurgence of the once-eradicated, highly contagious disease is linked to the growing anti-vaccine movement in richer nations, which the World Health Organization (WHO) has identified as a major global health threat.   The authorities in Curacao nevertheless urged local people not to panic, as the risk of the disease spreading in this case was fairly low.   Several people did however visit the cruise ship between April 22 and April 28 before it set sail for St Lucia and the authorities asked them to make themselves known to health officials.

Officials said the Freewinds had travelled between Curacao, St Lucia and another Dutch-held island, Aruba, several times towards the end of April.   There were about 300 people aboard the ship, according to Saint Lucia authorities, which placed the vessel in quarantine. They said they provided 100 doses of measles vaccine at no cost.   The Scientology church, founded by science fiction writer L Ron Hubbard in 1953, did not respond to requests for comment.   Its teachings do not directly oppose vaccination, but followers consider illness a sign of personal failing and generally avoid medical interventions.
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.
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Bolivia

Bolivia US Consular Information Sheet
July 19, 2006

COUNTRY DESCRIPTION: Bolivia is a constitutional democracy and one of the least-developed countries in South America. Tourist facilities are generally adequate, but vary greatly in qualit
. The capital is La Paz, accessible by Bolivia's international airport in El Alto. Read the Department of State Background Notes on Bolivia for additional information.

ENTRY/EXIT REQUIREMENTS: A U.S. passport valid for at least six months from the date of proposed entry into Bolivia is required to enter and depart Bolivia. U.S. citizen tourists do not need a visa for a stay of one month or less (that period can be extended up to 90 days upon application to the Bolivian immigration authorities). Visitors for other purposes must obtain a visa in advance. U.S. citizens whose passports are lost or stolen in Bolivia must obtain a replacement passport and present it, together with a police report of the loss or theft, to a Bolivian government immigration office in order to obtain permission to depart. For more information on replacement passport procedures, please consult the U.S. Embassy's Web site at . An exit tax is charged when departing Bolivia by air. Travelers with Bolivian citizenship or residency pay an additional fee upon departure. While the Bolivian Government does not require travelers to purchase round-trip air tickets in order to enter the country, some airlines have required travelers to purchase round-trip tickets prior to boarding aircraft bound for Bolivia. Some tourists arriving by land report that immigration officials did not place entry stamps in their passports, causing problems at checkpoints and upon departure. See our Foreign Entry Requirements brochure for more information on Bolivia and other countries. Visit the Embassy of Bolivia web site at for the most current visa information (please note that the web site is primarily in Spanish).

Bolivian consulates are located in Houston, Los Angeles, Miami, Oklahoma City, New York, San Francisco, and Seattle. For information on in-country visa procedures and requirements, please consult the Bolivian Immigration Service at (please note that the web site is in Spanish), fax/telephone (591-2) 211-0960, street address Avenida Camacho entre Loayza y Bueno, La Paz, Bolivia. See Entry and Exit Requirements for more information pertaining to dual nationality and the international child abduction . Please refer to our Customs Information to learn more about customs regulations.

ADDITIONAL REQUIREMENTS FOR MINORS: In an effort to prevent international child abduction, the Bolivian Government has initiated procedures at entry/exit points. Minors (under 18) who are citizens or residents of Bolivia and who are traveling alone, with one parent or with a third party, must present a copy of their birth certificate and written authorization from the absent parent(s) or legal guardian, specifically granting permission to travel alone, with one parent or with a third party. When a parent is deceased, a notarized copy of the death certificate is required in lieu of the written authorization. If documents are prepared in the United States, the authorization and the birth certificate must be translated into Spanish, notarized, and authenticated by the Bolivian Embassy or a Bolivian consulate within the United States. If documents are prepared in Bolivia, only notarization by a Bolivian notary is required. Using these documents, a t ravel permit may be obtained from the Juzgado del Menor. This requirement does not apply to children who enter the country with a U.S. passport as tourists, unless they hold dual U.S./Bolivian citizenship or have been in Bolivia for more than 90 consecutive days.

SAFETY AND SECURITY: The countrywide emergency number for the police, including highway patrol, is 110. The corresponding number for the fire department is 119. The National Tourism Police has an office in La Paz, with plans to expand to Cochabamba and Santa Cruz, providing free assistance to tourists 24 hours a day. These services include English-speaking officials who may assist tourists in filing police reports of lost/stolen documents or other valuables. The La Paz office is located at Plaza del Stadium, Edificio Olympia, planta baja, Miraflores, telephone number 222-0516.

Protests, strikes, and other civic actions can occur at any time and disrupt transportation on a local and national level. This is particularly true before, during and after elections or other changes in government. While protest actions generally begin peacefully, they have the potential to become violent. The police have used tear gas to break up protests. In addition to rallies and street demonstrations, protesters sometimes block roads; they sometimes react with force when travelers attempt to pass through or go around roadblocks and occasionally have used the threat of explosives to press their point.

U.S. citizens should avoid roadblocks and demonstrations. Demonstrations protesting government or private company policies occur frequently, even in otherwise peaceful times. Roadblocks and demonstrations in June 2005 led to the closure of the El Alto airport in La Paz, resulting in cancellation and diversion of flights and other inconveniences to travelers. U.S. citizens planning travel to or from Bolivia should take into consideration the possibility of disruptions to air service in and out of La Paz and other airports. Americans should monitor Bolivian media reports for updates. The Embassy strongly recommends that U.S. citizens avoid areas where roadblocks or public demonstrations are occurring or planned. Political rallies should similarly be avoided in light of press reports of violence at some rallies in various parts of Bolivia.

U.S. citizens who find themselves in a roadblock should not attempt to "run" a roadblock, as this may aggravate the situation and lead to physical harm. Taking alternative, safe routes, or returning to where the travel started may be the safest courses of action under these circumstances. U.S. citizens embarking on road trips should monitor news reports and may contact the American Citizen Services Unit of the U.S. Embassy in La Paz at (591)(2)(216-8297 or the U.S. consular agencies in Cochabamba at (591)(4)425-6714 and/or Santa Cruz at (591) (3) 351-3477 for updates. Given that roadblocks may occur without warning and have stranded travelers for several days, travelers should take extra food and water. The U.S. Embassy also advises its employees to maintain at least one week's supply of drinking water and canned food in case roadblocks affect supplies, as occurred in June 2005. For more information on emergency preparedness, please consult the Federal Emergency Management Authority (FEMA) Web site at . That Web site includes a Spanish language version.

Americans living or traveling in Bolivia are encouraged to register and update their contact information at the U.S. Embassy in La Paz and/or the U.S. consular agencies in Cochabamba and Santa Cruz, Bolivia. Registration may be done online and in advance of travel. Information on registering may be found at the Department of State's Consular Affairs website .

In February and October 2003, approximately one hundred people died during violent demonstrations and protests in downtown La Paz and the nearby city of El Alto. These demonstrations also affected Cochabamba and other towns and villages in the Altiplano. While the protests and demonstrations subsided, many of the underlying social, political, and economic causes remain, and in March 2005, several intercity roads, including Bolivia's major east-west highway, were closed by blockades for several weeks.

Since 2000 the resort town of Sorata, located seventy miles north of La Paz, has been cut off by blockades on three occasions, ranging from one week to one month. Visitors contemplating travel to Sorata should contact the Consular Section in La Paz prior to travel.

In the Chapare region between Santa Cruz and Cochabamba and the Yungas region northeast of La Paz violence and civil unrest, primarily associated with anti-narcotics activities, periodically create a risk for travelers to those regions.

Confrontations between area residents and government authorities over coca eradication have resulted in the use of tear gas and stronger force by government authorities to quell disturbances. Pro-coca groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests. U.S. citizen visitors to the Chapare or Yungas regions are encouraged to check with the Consular Section of the U.S. Embassy prior to travel. Violence has also erupted recently between squatters unlawfully invading private land and security forces attempting to remove them.

For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site , where the current Worldwide Caution Public Announcement , Travel Warnings and Public Announcements 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: The U.S. Department of State currently classifies Bolivia as a medium to high crime threat country. Street crime, such as pick pocketing and theft from parked vehicles, occurs with some frequency in Bolivia. Theft of cars and car parts, particularly late-model four-wheel-drive vehicles, is common. Hijacking of vehicles has occurred, and travelers should take appropriate precautions to avoid being victimized. In November 2003, an American citizen was murdered during an attempted carjacking in Santa Cruz.

Bolivian police state that there are currently eight organized criminal groups operating in the La Paz area. The techniques employed by these groups vary, but there are a few major patterns that can be identified.

There have been reports of "false police" -- persons using police uniforms, identification, and even buildings modified to resemble police stations -- intercepting and robbing foreign tourists. Under Bolivian law, police need a warrant from the "fiscal" or prosecutor to detain a suspect. Any searches or seizures must occur at a bona fide police station in the presence of the fiscal. The warrant requirement also applies to suspected drug trafficking cases, although such searches and seizures may occur without a fiscal present. If detained, U.S. citizens should request to see the warrant and demand immediate contact with the nearest U.S. Consular Office (in La Paz, Cochabamba or Santa Cruz).

According to press reports, criminals using the "false police" method focus on foreigners in areas frequented by tourists including bus terminals and tourist markets such as Sagarnaga Street in La Paz. The perpetrators will identify a potential victim and have an accomplice typically driving a white taxi offer taxi services to the potential victim. They focus on European/American tourists who are not wearing a traditional "trekker" backpack and are traveling without a large number of bags. A few blocks after the potential victim boards the taxi another accomplice, pretending to be a recently arrived tourist, boards the taxi with the potential victim. With all the accomplices then in place, the "false police" stop the taxi, "search" the passengers, and rob the victim. As part of this scam, the false police may take the victim to a "false police" station.

A similar variation also introduces a "tourist" to the victims. This introduction can take place on a bus, taxi, train, or just walking down the street. The "tourist" will befriend the victims and might seek assistance in some manner. After a period of time, the "police" intercept the victims and the "tourist." At this point, the "police" discover some sort of contraband (usually drugs) on the "tourist." The entire group is then taken to the "police station." At this point, the "police" seize the documents, credit cards, and ATM cards of the victims. The perpetrators obtain pin numbers, sometimes by threat of violence, and the scam is complete.

Another technique again introduces a "tourist" to the victims. This "tourist" can be any race or gender and will probably be able to speak the language of the victims. This meeting can happen anywhere and the goal of the "tourist" is to build the trust of the victims. Once a certain level of trust is obtained, the "tourist" suggests a particular mode of transportation to a location (usually a taxi). The "taxi" picks up the victims and the "tourist" and delivers the group to a safe house in the area. At this point the victims are informed that they are now kidnapped and are forced to give up their credit cards and ATM cards with pin numbers.

Bolivian police sources state that two Austrian citizens fell victim to this scam and had their bank accounts emptied through use of their ATM card. The perpetrators then suffocated the victims and buried them in clandestine graves, where police found their bodies on April 3, 2006. During that timeframe, a Spanish citizen also purportedly fell prey to this scam, and his body was found nearby.

In most instances, the victims are released, but the murder of the victims is still a possibility. The techniques and the perpetrators are convincing. Authentic uniforms, badges, and props help persuade the victims that the situation is real and valid. All tourists visiting Bolivia should exercise extreme caution. Visitors should be suspicious of all "coincidences" that can happen on a trip. If the tourist has doubts about a situation, the tourist should immediately remove him/herself from the scene.

Thefts of bags, wallets, and backpacks are a problem throughout Bolivia, but especially in the tourist areas of downtown La Paz and the Altiplano. Most thefts involve two or three people who spot a potential victim and wait until the bag or backpack is placed on the ground, often at a restaurant, bus terminal, Internet café, etc. In other cases, the thief places a disagreeable substance on the clothes or backpack of the intended victim, and then offers to assist the victim with the removal of the substance. While the person is distracted, the thief or an accomplice grabs the bag or backpack and flees. In such a situation, the visitor should decline assistance, secure the bag/backpack, and walk briskly from the area. To steal wallets and bags, thieves may spray water on the victim's neck, and while the person is distracted, an accomplice takes the wallet or bag. At times the thief poses as a policeman, and requests that the person accompany him to the police station, using a nearby taxi. The visitor should indicate a desire to contact the U.S. Embassy and not enter the taxi. Under no circumstances should you surrender ATM or credit cards, or release a PIN number. While most thefts do not involve violence, in some instances the victim has been physically harmed and forcibly searched for hidden valuables. Visitors should avoid being alone on the streets, especially at night and in isolated areas.

Five years ago female tourists reported being drugged and raped by a tourist guide in the city of Rurrenabaque in the Beni region. Visitors should be careful when choosing a tour operator and should not accept any type of medication or drugs from unreliable sources. The Embassy has received reports of sexual assaults against female hikers in the Yungas Valley, near the town of Coroico. Visitors to Coroico are advised to avoid hiking alone or in small groups.

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 may 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 large cities is adequate for most purposes but of varying quality. Ambulance services are limited-to-non-existent. Medical facilities are generally not adequate to handle serious medical conditions. Pharmacies are located throughout Bolivia, and prescription and over the counter medications are widely available. Western Bolivia, dominated by the Andes and high plains (Altiplano), is largely insect-free. However, altitude sickness (see below) is a major problem. Eastern Bolivia is tropical, and visitors to that area are subject to related illnesses. In March 2005, several cases of yellow fever were reported in the Chapare region. News media periodically report outbreaks of rabies, particularly in the larger cities.

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 Internet site at . For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at . Further health information for travelers is available at .

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. Most medical evacuation flights cannot land at the airport serving La Paz due to the altitude; instead flights may need to use the international airport in Santa Cruz, Bolivia. Please see our information on medical insurance overseas .

HIGH-ALTITUDE HEALTH RISKS: Official U.S. Government travelers to La Paz are provided with the following information: The altitude of La Paz ranges from 10,600 feet to over 13,000 feet (3,400 to 4,000 meters) above sea level. Much of Western Bolivia is at the same altitude or higher, including Lake Titicaca, the Salar de Uyuni, and the cities of Oruro and Potosi. The altitude alone poses a serious risk of illness, hospitalization, and even death, if you have a medical condition that affects blood circulation or breathing.

Prior to departing the U.S. for high-altitude locations (over 10,000 feet above sea level), travelers should discuss the trip with their personal physician and request information on specific recommendations concerning medication and lifestyle tips at high altitudes. Coca-leaf tea is a popular beverage and folk remedy for altitude sickness in Bolivia. Possession of this tea, which is sold in bags in most Bolivian grocery stores, is illegal in the United States.

The State Department's Office of Medical Services does not allow official U.S. Government travelers to visit La Paz if they have any of the following:

Sickle cell anemia or sickle cell trait: 30 percent of persons with sickle cell trait are likely to have a crisis at elevations of more than 8,000 feet.
Heart disease: A man 45 years or older, or a woman 55 years or older, who has two of the following risk factors (hypertension, angina, diabetes, cigarette smoking, or elevated cholesterol) should have a stress EKG and a cardiological evaluation before the trip.
Lung disease: Anyone with asthma and on maximum dosage of medication for daily maintenance, or anyone who has been hospitalized for asthma within the last year should not come to La Paz and surrounding areas.
Given potential complications from altitude sickness, pregnant women should consult their doctor before travel to La Paz and other high-altitude areas of Bolivia.
All people, even healthy and fit persons, will feel symptoms of hypoxia (lack of oxygen) upon arrival at high altitude. Most people will have increased respiration and increased heart rate. Many people will have headaches, difficulty sleeping, lack of appetite, minor gastric and intestinal upsets, and mood changes. Many travelers limit physical activity for the first 36 to 48 hours after arrival and avoid alcohol and smoking for at least one week after arrival.

For additional information, travelers should visit the World Health Organization's website at as well as the CDC's travel warning on high altitude sickness at .

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 Bolivia is provided for general reference only, and may not be totally accurate in a particular location or circumstance. U.S. citizens planning on driving in Bolivia, despite the hazards described below, should obtain an international driver's license through their local automobile club before coming to Bolivia.

Road conditions in Bolivia are hazardous. Although La Paz, Santa Cruz, and Cochabamba are connected by improved highways, the vast majority of roads in Bolivia are unpaved. Few highways have shoulders, fencing or barriers, and highway markings are minimal. Yielding for pedestrians in the cities is not the norm. For trips outside the major cities, especially in mountainous areas, a four-wheel-drive vehicle is highly recommended. Travel during the rainy season (November through March) is difficult, as most routes are potholed, and some roads and bridges are washed out. Added dangers are the absence of formal training for most drivers, poor maintenance and overloaded vehicles, lack of lights on some vehicles at night, and intoxicated or overly tired drivers, including commercial bus and truck drivers.

The majority of intercity travel in Bolivia is by bus, with varying levels of safety and service. In recent years there have been major bus crashes on the highway between La Paz and Oruro, and on the Yungas road. The old Yungas road is considered one of the most dangerous routes in the world. Taxis, vans, and buses dominate intracity transportation. From a crime perspective, public transportation is relatively safe and violent assaults are rare. However, petty theft of unattended backpacks and other personal items does occur. For reasons of safety, visitors are advised to use radio taxis whenever possible.

Drivers of vehicles involved in traffic accidents are expected to remain at the scene until the arrival of local police authorities. Any attempt to leave the scene is in violation of Bolivian law. The Embassy believes any attempt to flee the scene of an accident would place the driver and passengers at greater risk of harm than remaining at the scene until the arrival of local police. 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 Bolivia as being in compliance with ICAO international aviation safety standards for oversight of Bolivia's air carrier operations. For more information, travelers may visit the FAA's Internet web site at www.faa.gov/avr/iasa/index.cfm . There are limited flights within Bolivia and to neighboring countries. Flight delays and cancellations are common. In February and March 2006, strikes at national carrier Lloyd Aereo Boliviano led to the cancellation of both national and international flights with resultant delays and other inconveniences for travelers.

SPECIAL CIRCUMSTANCES: In the run-up to the July 2006 Constituent Assembly elections, President Morales accused the United States military of infiltrating Bolivia with operatives disguised as "students and tourists." As an apparent result of these comments, some U.S. citizens have reported harassment by Bolivian officials and been subjected to unwanted media attention. In one case, a local Bolivian newspaper wrongly identified an American citizen as an operative for the Central Intelligence Agency. Americans planning on traveling to Bolivia should be aware of the political atmosphere and the possibility of unwanted attention from pro-governmental groups and other Bolivian officials.

For information on in-country visa procedures and requirements, please consult the Bolivian Immigration Service at (please note that the Web site is in Spanish), fax/telephone (591-2) 211-0960, street address Avenida Camacho entre Loayza y Bueno, La Paz, Bolivia. In emergency cases, the Immigration Service may permit temporary residency applicants to retrieve their passports from those applications. However, under current regulations in such cases the applicant would need to commence the application anew, including paying the corresponding fees. Any U.S. documents, such as birth, marriage, divorce or death certificates, to be presented in Bolivia must first be authenticated in the U.S. at the nearest Bolivian Embassy or consulate. For information on those procedures, please consult the Department of State Office of Authentications web site, www.state.gov/m/a/auth , and the nearest Bolivian Embassy or consulate.

Please see our information on customs regulations .
MARRIAGE: Please see our information on marriage in Bolivia , available on the Embassy's Web site at
MOUNTAIN TREKKING AND CLIMBING SAFETY: U.S. citizens are advised to exercise extreme care when trekking or climbing in Bolivia. Since June 2002, four American citizens have died in falls while mountain climbing in Bolivia. Three of the deaths occurred on Illimani, a 6,402-meter peak located southeast of La Paz. Many popular trekking routes in the Bolivian Andes cross passes as high as 16,000 feet. Trekkers must have adequate clothing and equipment, not always available locally, and should be experienced mountain travelers. It is not prudent to trek alone. Solo trekking is the most significant factor contributing to injuries and robberies. The safest option is to join an organized group and/or use a reputable firm to provide an experienced guide and porter who can communicate in both Spanish and English. If you develop any of the following symptoms while climbing at altitude - severe headache, weakness, vomiting, shortness of breath at rest, cough, chest tightness, unsteadiness - descend to a lower altitude immediately. Trekkers and climbers are strongly encouraged to purchase adequate insurance to cover expenses in case of injury or death.

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 Bolivian laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Bolivia 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 .

It often takes years to reach a decision in Bolivian legal cases, whether involving property disputes, civil, or criminal matters. Depending on the circumstances of the case, the court can order a defendant held in jail for the duration of the case. Prison conditions are primitive, and prisoners are expected to pay for food and lodging. For further information, please see the Annual Human Rights Report for Bolivia at . Lists of local Bolivian attorneys and their specialties are available from the Consular Section of the U.S. Embassy in La Paz and the Consular Agencies in Santa Cruz and Cochabamba, and may also be found on our Web site at .

CHILDREN'S ISSUES: For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website . Pending U.S. implementation of the Hague Convention on International Adoptions, under Bolivian law U.S. citizens who are not resident in Bolivia are not permitted to adopt Bolivian children./p>

REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Bolivia are encouraged to register with the nearest U.S. Embassy or Consular Agency through the State Department's travel registration website, and to obtain updated information on travel and security within Bolivia. Americans without Internet access may register directly with the nearest U.S. Embassy or Consular Agencies in Cochabamba and Santa Cruz. By registering, American citizens make it easier for the Embassy or Consular Agency to contact them in case of emergency.

The U.S. Embassy is located at 2780 Avenida Arce in La Paz, between calles Cordero and Campos; telephone (591-2) 216-8297 during business hours 8:30 a.m.-5:30 p.m., or (591-2) 216-8000 for after-hours emergencies; fax (591-2) 216-8808; Internet . The U.S. Embassy in La Paz is open for American Citizen Services Monday through Thursday from 1:30PM to 5:00PM and Fridays from 08:30 to12:30 and from 2:00PM to 4:00PM, except U.S. and Bolivian holidays. Questions should be directed to the email address USCit.Services.Bolivia@gmail.com or consularlapaz@state.gov .

There are two consular agencies in Bolivia, which provide limited services to American citizens, but are not authorized to issue passports. Anyone requesting service at one of the consular agencies should call ahead to verify that the service requested would be available on the day you expect to visit the agency.

Santa Cruz: The Consular Agency in Santa Cruz is located at 146 Avenida Roque Aguilera (Tercer Anillo); telephone (591-3) 351-3477, 351-3479, or 351-3480; fax (591-3) 351-3478. The U.S. Consular Agency in Santa Cruz is open to the public Mondays from 09:00 to 12:30 and from 2:00PM to 5:00PM and on Tuesday through Friday from 09:00 to 12:30, except U.S. and Bolivian holidays.

Cochabamba: The Consular Agency in Cochabamba is located at Avenida Oquendo 654, Torres Sofer, room 601; telephone (591-4) 411-6313; fax (591-4) 425 -6714. The U.S. Consular Agency in Cochabamba is open Monday through Friday from 9:00 a.m. - 12:00 noon, excluding U.S. and Bolivian holidays.
* * *
This replaces the Consular Information Sheet dated April 4, 2006 to update Entry/Exit Requirements, Safety and Security, Crime, Marriage, Special Circumstances and web links.

Travel News Headlines WORLD NEWS

Date: Wed 7 Aug 2019
Source: El Deber [in Spanish trans. ProMED Mod.TY, edited]

Soldier LC, who completed his military service in the Bolivian Condors School (ESCONBOL) in Sanadita, died of [a] hantavirus [infection], according to laboratory results issued this [Wed 31 Jul 2019] by the National Center for Tropical Diseases (CENETROP) of the Tarija Department of Health Service (SEDES).

The Chief of Epidemiology, Claudia Montenegro, confirmed that the conscript died from this disease that is transmitted by the long-tailed rat and that he had been infected in a forest locality near to the Campo Largo community, where he was from.

According to Montenegro, this is the 15th hantavirus [infection] case reported in Tarija department in 2019; 5 of them died.

The hantavirus cases correspond to patients from Bermejo and the Chaco region where the rat that carries [the] hantavirus lurks.  [Byline: David Maygua]
=========================
[The case count is now up to 15 in Tarija department; 5 of them, including the case above, died. As noted in earlier posts, cases of hantavirus infections in Tarija department are not new. The department is endemic for hantaviruses, and cases occur there sporadically. Last year (2018), there were 11 cases. The previously reported 2015 cases of hantavirus pulmonary syndrome (HPS) that occurred in Tarija department were confirmed. As noted in the previous comments, earlier cases of hantavirus pulmonary syndrome have been reported from tropical, lowland areas of Bolivia, including 7 cases in Tarija during 2014. The specific hantaviruses involved in these or previous cases in Bolivia were not given.

In the lowland Amazon Basin of Bolivia, the rodent hosts of the hantavirus that might be involved in these hantavirus pulmonary syndrome (HPS) cases, with their images, include the following:
- Laguna Negra virus (small vesper mouse, _Calomys laucha_ <http://www.faunaparaguay.com/calomyslaucha.html> and large vesper mouse, _C. callosus_
- Bermejo (Chaco rice rat, _Oligoryzomys chacoensis_
- Oran (long- tailed pygmy rice rat, _O. longicaudatus_

Since previous cases in Tarija department have occurred in Bermejo, perhaps Bermejo hantavirus was involved.

Dr Jan Clement commented earlier that there is a need to be able to differentiate Seoul orthohantavirus (SEOV) as a causative agent, but that is hampered by the fact that most current commercial ELISA or WB (Western Blot) formats no longer contain a SEOV antigen, so that a preliminary presumption of a hantavirus infection can even be missed in non-research laboratories (Clement J, LeDuc JW, Lloyd G, et al. Wild rats, laboratory rats, pet rats: global Seoul hantavirus disease revisited. Viruses. 2019; 11(7): 652; pii: E652; <https://www.mdpi.com/1999-4915/11/7/652/htm>; and Reynes JM, Carli D, Bour JB et al. Seoul virus infection in humans, France, 2014-2016. Emerg Infect Dis. 2017; 23(6): 973-7; <https://wwwnc.cdc.gov/eid/article/23/6/16-0927_article>.

SEOV is widely distributed around the world in the brown rat and is likely found in Tarija department. - ProMED Mod.TY]

[Maps of Bolivia:
Date: Wed 17 Jul 2019
Source: El Deber [in Spanish trans. ProMED Mod.TY, edited]

The 1st 3 cases of Chapare arenavirus haemorrhagic fever were detected between December 2003 and January 2004, but the vector [reservoir] was not identified. The affected individuals had febrile and cardiac symptoms.

The New World Chapare arenavirus haemorrhagic fever, which has recently affected 5 people in La Paz [department], 3 of whom died, had its 1st outbreak in 16 years in a rural locality in the Cochabamba tropics; however, since then, until now, the vector [reservoir] has not been identified.

It is known that arenaviruses are transmitted by rodents, and because of this the latest investigations in northern La Paz, where the 1st case was reported (that now is known as the Chapare genotype), was focused on searching for _Calomys callous_ [the large vesper mouse. - ProMED Mod.SH], which transmits Machupo virus, but it may also be transmitted by other rodent families, say knowledgeable people.

The chief of epidemiology of the Departmental Health Services (SEDES), Roberto Torrez, recalled that Chapare virus was identified more than a decade ago, after 3 people presented with haemorrhagic fever symptoms in the rural community of Samusaveti (Cochabamba tropics) between December 2002 and January 2004. The ill individuals presented with febrile and haemorrhagic symptoms and, mainly, cardiac problems. The investigation results indicated that they were dealing with a virus that was "very related" to Machupo, but was genetically distinct. In 2006, it was given the name Chapare, for the locality of its origin.

Torrez explained that the focus [of infection] was controlled, but the vector [reservoir] was not identified. Until now, it is still unknown how the virus has reappeared in northern La Paz, although the possibilities are that the vector [reservoir] has migrated from the Cochabamba tropics or has been inhabiting northern La Paz and that recently infected people have presented [with the disease]. "We know that it is transmitted by rodents, but we do not know the vector [reservoir] of the original Chapare virus, neither of the Cochabamba one, nor of the La Paz one," he said.

The chief of epidemiology discarded the idea that Santa Cruz department is at risk of an outbreak, since that "cases of the disease have never been registered nor have rodents of the _Calomys callous_ family [sic; genus and species] infected with Machupo virus been encountered." Torrez said that many years ago, in San Ignacio de Velasco, in the [municipal] limits of Piso Firme, _Calomys callous_ rodents were taken with Latino virus, which is not a human pathogen.

Technicians of the Ministry of Health have captured rodents in the areas of Caranavi and Guanay, where the 1st fatal case (a farmer) lived and worked. Since calomys rodents were not encountered, the investigation was expanded to other types of rodents.

[A hospitalized medical student who died 4 Jun 2019 was first diagnosed with dengue and later with a fatal arenavirus infection. The legal dispute between the patient's family and the hospital physicians is not translated here, since it adds nothing to the understanding of treatment or of epidemiology of the infection. - ProMED Mod.TY]  [byline: Deisy Ortiz, Miguel A Melendres]
====================
[New World arenavirus haemorrhagic fever virus Chapare, that has recently infected 5 patients in La Paz [department], 3 of whom died, brought to mind the 1st outbreak 16 years ago in a rural area of Cochabamba; however, since then it has not been possible to identify the animal reservoir. At that time, 3 people presented with symptoms of haemorrhagic fever in the rural community of Samusaveti (Cochabamba tropics) between December 2003 and January 2004. - ProMED Mod.JT]

This report definitely identifies the virus involved in these cases as Chapare arenavirus. Symptoms of Chapare and Machupo virus infections include: early clinical manifestations consist of nonspecific signs and symptoms, including fever, headache, fatigue, myalgia, and arthralgia. Within 7 days, patients may develop haemorrhagic signs, including bleeding from the oral and nasal mucosa and from the bronchopulmonary, gastrointestinal, and genitourinary tracts. Case fatality rates range from 5% to 30% (see ProMED-mail post Bolivian haemorrhagic fever - Bolivia: background http://promedmail.org/post/20190705.6553672).

The original cases were investigated by a team of Bolivian health authorities, US Navy health experts based in Lima, Peru, and the US Centers for Disease Control and Prevention. The virus was characterized as Chapare arenavirus, a previously unrecognized arenavirus, discovered in serum samples from a patient in rural Bolivia who eventually died of the infection. A full report of the study was published 18 Apr 2008 in the open-access journal PLoS Pathogens cited below.

Reference
---------
Delgado S, Erickson BR, Agudo R, et al. Chapare virus, a newly discovered arenavirus isolated from a fatal hemorrhagic fever case in Bolivia. PLoS Pathog. 2008; 4(4): e1000047; <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277458/>

It is unfortunate that the rodent reservoir of Chapare virus is still unknown. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Bolivia:
Date: Thu 18 Jul 2019
Source: Centers for Disease Control and Prevention (CDC), Haemorrhagic Fever in Bolivia [edited]

Watch-level 1. Practice usual precautions
-----------------------------------------
Key Points:
- An outbreak of haemorrhagic fever was recently reported in Bolivia.
- The outbreak is caused by an arenavirus that appears similar to Chapare virus, which causes Chapare haemorrhagic fever.
- Travellers to Bolivia should avoid contact with rodents, with rodent urine or faeces (droppings), and with people who are sick.

What is the current situation?
Health officials in Bolivia have reported an outbreak of haemorrhagic fever associated with an arenavirus similar to Chapare arenavirus. The 1st case was in a man from Caranavi Province. A health care provider who treated him became ill and was transferred to La Paz. Currently, several additional cases have been reported; all have been in health care providers or family members of the 1st patient.

Testing suggests that the virus is genetically similar to Chapare virus, a New World arenavirus that was 1st documented in Bolivia in 2003. During that outbreak, a small number of people became ill, and one died. Since then, no additional cases have been reported. Additional testing is ongoing to determine the exact cause of this outbreak.

What can travelers do to protect themselves?
- Although the animal source for this virus has not been confirmed, travellers should avoid contact with rodents and rodent urine or faeces.
- Avoid contact with people who are sick.
- Travellers going to Bolivia to provide health care to local populations may be at risk and should wear full personal protective equipment when treating suspect hemorrhagic fever cases.
===========================
[The above CDC precaution is in response the recent occurrence of Chapare arenavirus hemorrhagic fever in the La Paz department of Bolivia (see Chapare virus - Bolivia: (LP) http://promedmail.org/post/20190719.6573996). The initial 3 cases of Chapare arenavirus hemorrhagic fever were detected between December 2003 and January 2004, but the vector [reservoir] was not identified. The virus recently affected 5 people in La Paz [department], 3 of whom died, had its 1st outbreak in 16 years in a rural locality in the Cochabamba tropics; however, since then, until now, the vector [reservoir] has not been identified.

As noted earlier, the original cases were investigated by a team of Bolivian health authorities, US Navy health experts based in Lima, Peru, and the US Centers for Disease Control and Prevention. The virus was characterized as Chapare arenavirus, a previously unrecognized arenavirus, discovered in serum samples from a patient in rural Bolivia who eventually died of the infection. A full report of the study was published 18 Apr 2008 in the open-access journal PLoS Pathogens cited below.

Citation
--------
Delgado S, Erickson BR, Agudo R, et al. Chapare virus, a newly discovered arenavirus isolated from a fatal hemorrhagic fever case in Bolivia. PLoS Pathog. 2008; 4(4): e1000047;

The rodent reservoir of Chapare virus is still unknown. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Fri 5 Jul 2019
Source: GIDEON (Global Infectious Disease Epidemiology Network) [edited]

Re: ProMED-mail Undiagnosed illness - Bolivia (02): (LP) Bolivian haemorrhagic fever conf. http://promedmail.org/post/20190704.6551379

In 2019, a small outbreak of Bolivian haemorrhagic fever was reported at a hospital in La Paz [department], Bolivia. The following background data on Bolivian haemorrhagic fever are abstracted from Gideon www.GideonOnline.com and the Gideon e-book series.[1,2] Primary references are available from the author.

Bolivian haemorrhagic fever (BHF) is caused by Machupo virus (Arenaviridae, Tacaribe complex, _Mammarenavirus_). The disease was initially described in 1959 as a sporadic hemorrhagic illness in rural areas of Beni department, eastern Bolivia, and the virus itself was 1st identified in 1963. BHF is most common during April to July in the upper savanna region of Beni. Principal exposure occurs through rodents ([the large vesper mouse] _Calomys callosus_), which enter homes in endemic areas.

BHF is one of several human _Arenavirus_ diseases reported in the Americas: Argentine haemorrhagic fever (Junin virus), Brazilian haemorrhagic fever (Sabia virus), lymphocytic choriomeningitis, Venezuelan haemorrhagic fever (Guanarito virus) and Whitewater Arroyo virus infection. (At least 2 related diseases are reported in Africa: Lassa fever and Lujo virus infection.)

Infection of _C. callosus_ results in asymptomatic viral shedding in saliva, urine, and feces; 50% of experimentally infected _C. callosus_ are chronically viremic and shed virus in their bodily excretions or secretions. _C. callosus_ acquires the virus after birth, and start shedding it through their urine and saliva while suckling. When mice acquire the virus as adults, they may develop immunity and no longer shed the virus.

Although the infectious dose of Machupo virus in humans is unknown, exposed persons may become infected by inhaling virus in aerosolized secretions or excretions of infected rodents, ingestion of food contaminated with rodent excreta, or by direct contact of excreta with abraded skin or oropharyngeal mucous membranes. Nosocomial and human-to-human spread have been documented. Hospital contact with a patient has resulted in person-to-person spread of Machupo virus to nursing and pathology laboratory staff.

In 1994, fatal secondary infection of 6 family members in Magdalena, Bolivia from a single naturally acquired infection further suggested the potential for person-to-person transmission.

During December 2003 to January 2004, a small focus of haemorrhagic fever was reported in the area of Cochabamba. A 2nd _Arenavirus_, Chapare virus, was recovered from one patient with fatal infection.

Early clinical manifestations consist of nonspecific signs and symptoms, including fever, headache, fatigue, myalgia, and arthralgia. Within 7 days, patients may develop hemorrhagic signs, including bleeding from the oral and nasal mucosa and from the bronchopulmonary, gastrointestinal, and genitourinary tracts. Case fatality rates range from 5% to 30%.

Ribavirin has been used successfully in several cases of BHF. The recommended adult regimen is 2.0 g intravenously (IV), followed by 1.0 g IV every 6 hours for 4 days, and then 0.5 g every 8 hours for 6 days.

Note that the etiologic agent and clinical features of BHF are similar to those of Argentine hemorrhagic fever (AHF). Neurological signs are more common in AHF, while hemorrhagic diatheses are more common in BHF. A vaccine available for AHF could theoretically be effective against BHF as well.

References
1. Berger S. American hemorrhagic fevers: global status, 2019. Gideon e-books.
2. Berger S. Infectious diseases of Bolivia, 2019. 342 pages, 87 graphs, 495 references.
Communicated by:
Steve Berger
Geographic Medicine
Tel Aviv Medical Center, Israel
=======================
[ProMED-mail thanks Dr. Berger for the overview of Bolivian haemorrhagic fever presented above. As noted in the previous comment, and above, Bolivian haemorrhagic fever, caused by Machupo virus, occurs sporadically in lowland Bolivia, especially in Beni department. There was a case there in 2013, and in 2012 ProMED-mail reported that 13 people had been infected with Machupo virus and 7 had died as a consequence of the disease. In Beni department at that time, 5 municipalities, including Magdalena, were reported to have had large populations of _Calomys callosus_ mice, the reservoir host of Machupo virus, which can persistently infect the mice. It is not surprising to find cases in lowland areas of La Paz department again, where the current cases are occurring. The drylands vesper mouse, _C. musculinus_ mentioned in the previous post, although present in southern Bolivia, is unlikely to be the reservoir rodent involved in the current cases. _C. callosus_ mice are the recognized reservoir hosts of Machupo virus. Health officials can provide information about rodent control and assist in implementing it to reduce the risk of exposure to Machupo virus, but effective long-term implementation of rodent control ultimately rests with local residents.

An image of _C. callosus_, the large vesper mouse and reservoir host of Machupo virus, can be seen at

[HealthMap/ProMED-mail map:
Date: Wed 3 Jul 2019 11:53 BOT
Source: La Razon [in Spanish trans. ProMED Mod.TY, edited]

[The Ministry of] Health confirmed that a virus that killed a hospitalized patient and 2 physicians from La Paz is an arenavirus transmitted by rodents. The disease, after 7 days, causes haemorrhagic fever, a symptom presented by the patients hospitalized in intensive care in 2 health centers in La Paz.

One of the viruses in this family is Machupo that causes Bolivian hemorrhagic fever, a disease that, according to hypotheses, is affecting the patients that are under observation, La Razon reported this [Wed 3 Jul 2019] in its printed edition.

"In laboratory terms, from national laboratories such as INLASA [Instituto Nacional de Laboratorios de Salud; National Institute of Health Laboratories] and CENTROP, [Centro de Enfermedades Tropicales; Tropical Diseases Center] they have identified an arenavirus," said Gabriela Montano in a press conference.

The report is also backed by a report from the [US] Centers for Disease Control and Prevention in Atlanta [CDC], Georgia, USA.

"We have a preliminary result from the CDC in Atlanta that also mentions an arenavirus. All of these elements together allow us to provide this information to the public today," the official added.

This virus is transmitted by rodents, specifically called the corn rat or _Calomys musculinus_, and it may also be transmitted person-to-person.  [Byline: Ruben Arinez]
=========================
[Bolivian haemorrhagic fever, caused by Machupo virus, an arenavirus, occurs sporadically in lowland Bolivia, especially in Beni department. There was a case there in 2013 and in 2012, ProMED-mail reported that 13 people had been infected with Machupo virus and 7 had died as a consequence of the disease. In Beni department at that time, 5 municipalities, including Magdalena, were reported to have had large populations of _Calomys callosus_ mice, the reservoir host of Machupo virus, which can cause persistent infections in the mice. It would not be surprising to find cases in lowland areas of La Paz department as well, where the current cases are occurring. The drylands vesper mouse, _C. musculinus_ mentioned above, although present in southern Bolivia, is unlikely to be the reservoir rodent involved in these cases. _C. callosus_ mice are the recognized reservoir hosts of Machupo virus. Health officials can provide information about rodent control and assist in implementing it, but effective long-term implementation ultimately rests with local residents.

An image of _C. callosus_, the large vesper mouse and reservoir host of Machupo virus can be seen at
<http://www.faunaparaguay.com/calomyscallosus.html>.

An image of _C. musculinus_, the drylands vesper mouse, can be seen at
<http://www.faunaparaguay.com/calomysmusculinus.html>. - ProMED Mod.TY]

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

Timor-Leste

General Information:

The People’s Republic of China is the world’s third largest nation in land mass and shares borders with 16 other countries. It is the worlds most populated country. Nowadays many Irish travellers will b

going to China for business or holiday trips. Much of the country is mountainous or semidesert and the country lies almost entirely in the temperate zone. Only portions of the southern-most area - the provinces of Yunnan and Guangdong, and the Zhuang autonomous region of Guangxi - lie within the tropics. The monsoon climate is a major influence in the south, but the north and west have a typical continental climate.

Weather Profile: 

During the summer, warm moist maritime air masses bring heavy rains to eastern China, and hot humid summer weather is typical. Winter offers a sharp contrast when Siberian air masses dominate. In late winter and spring strong north winds sweep across north China and hazy days caused by dust storms are common. Beijing’s spring is mostly dry. In July and August the weather turns hot and humid. Autumn is the nicest time of the year with many warm, clear days and little wind usually. Chest Complaints  Because of the prevailing dust, increased transportation and the burning of soft coal during the winter, Beijing and other major cities in China have a high rate of pollution. This may exacerbate bronchial and/or sinus complaints. The dust level in Lhasa is also very high and this may lead to respiratory problems.

Safety & Security:

The risk of crime against tourists is low but care of personal belonging should be observed at all times. Maintenance of buildings and general safety precautions may not always be in place and so checking for fire exits (and that they are unblocked) is wise. Use the hotel safety boxes and carry photocopies of any important documents rather than the originals where possible.

Local Medications:

Western brand-name drugs or non-prescription medicines are seldom available locally although some Chinese equivalents are to be found at reasonable prices. Always carry your own medication (well marked) on your person and bring enough for your trip.

Rabies:

Rabies is a serious problem throughout China. Reports indicate that as many as five million people are bitten each year by rabid dogs and that approximately 5,000 of these patients die. Travellers should stay well clear of any warm blooded animals, especially dogs. Any contact (lick, bite or scratch) should be treated seriously and immediately by washing out the wound, applying an antiseptic and then seeking urgent medical attention.

River Boat Travel:

Many of the older river boats in China use untreated river water for washing dishes and in the bathrooms. This increases the risk of illnesses such as traveller’s diarrhoea and a parasitic disease called schistosomiasis (Bilharzia). Also be careful that the ferry is not overcrowded and be aware of any sharp corners or rusty edges due to lack of maintenance.

Altitude Sickness in Tibet:

Virtually all of the Tibetan Autonomous region, much of Quinghai and Xinjiang, parts of Sichuan, Yannan and Gansu are above 13,000 feet in altitude. Some main roads in Tibet, Qinghai and Xinjiand go above 17,000 feet. At these levels the available oxygen is very low and altitude sickness may occur. Travellers may experience severe headaches, nausea, dizziness, shortness of breath or a dry cough. These symptoms usually settle over a few days with rest, but if not travellers should seek medical assistance and, if possible, descend to a lower altitude. Travellers with a history of cardiac problems or respiratory difficulties should avoid such high altitudes where possible.

Insect Bites and Malaria:

During the summer months, carry a supply of insect repellent ointments for your trip and use sensible, light coloured clothing to cover yourself when there are mosquitoes or sandflies about. The risk of malaria in most of China is limited but prophylactic tablets may be prescribed depending on your actual itinerary. Other serious mosquito borne diseases do occur so these will need to be considered.

Sunlight:

The sunlight during the summer months and in Tibet at high elevations can be intense so travellers should bring sun screen and sun-glasses and a sensible wide-brimmed hat.

Acupuncture:

Many tourists are tempted to experience this oriental art in its homeland while visiting China. It is essential to ensure that sterile needles are used at all times as otherwise there may be a risk of transmission of a blood borne disease such as the HIV virus or Hepatitis B.

AIDS risk in China:

Official figures suggest that AIDS is a very limited risk in China. Only 707 cases were reported up to October 2000. These very low figures are very difficult to verify and so all travellers should take care not to place themselves at risk where possible.

Customs Regulations: 

Never carry any medication for another individual unless they are part of your family. The Chinese authorities have strict drug regulations which may be enforced.

Vaccination Requirements: 

 There are no vaccination requirements for entry / exit purposes but travellers on short trips should consider the following ... * Poliomyelitis (childhood booster) * Typhoid (food & water disease) * Tetanus (childhood booster) * Hepatitis A (food & water disease) Those planning to spend a longer time in China should consider additional vaccination against conditions like Rabies, Hepatitis B, Japanese B Encephalitis, Meningococcal Meningitis, Diphtheria and Mantoux Test / BCG vaccination.

Summary: 

China is teeming with people and a culture very different to ours. It is a land of many contrasts. Travellers generally stay healthy if they follow standard commonsense healthcare advice.

Travel News Headlines WORLD NEWS

Date: Thu, 5 Mar 2015 13:53:47 +0100 (MET)

Dili, East Timor, March 5, 2015 (AFP) - An American tourist has returned to the United States after six months trapped in East Timor over the discovery of drugs in a taxi that she was sharing.    Stacey Addison arrived back in Portland, Oregon, on Wednesday, embracing her mother tightly during an emotional reunion at the city's airport, TV reports showed.    "It's a great feeling, it's a relief to finally be back home, be out of there," she told a local station, adding her experience in East Timor, a tiny half-island nation bordering Indonesia, had been an "emotional rollercoaster".   A Facebook group set up to advocate for her release carried a celebratory message on Tuesday announcing that she had left East Timor: "IT'S FINALLY HAPPENED! STACEY IS ON HER WAY HOME!!!!"   Addision was arrested on September 5 after methamphetamine was found in the shared taxi that was en route to the capital Dili, but denied any wrongdoing.

The veterinarian, who had just crossed from Indonesia when she was arrested, wrote on Facebook that another passenger -- who was a stranger -- picked up a package containing the drugs, and police later detained everyone in the car.   She was initially released from jail after several days but was later re-arrested, although no charges were laid against her.    Addison was released again in December, but East Timor authorities hung on to her passport while they continued to investigate her case.    Her lawyer had warned that the probe could take two years but last week the East Timor government announced that prosecutors had decided not to pursue her case and "Ms. Addison is now free to leave".   The State Department had supported Addison and pressed for her release.   East Timor, a poor half-island nation that was occupied by Indonesia for over two decades, imposes tough punishments for drugs cases, including the death penalty for traffickers.
Date: Tue, 4 Feb 2014 00:59:28 +0100 (MET)

JAKARTA, Feb 03, 2014 (AFP) - A strong 6.1-magnitude earthquake hit eastern Indonesia Tuesday but there was no tsunami alert, seismologists said.   The quake struck at 7:36 am local time (2236 GMT Monday), 318 kilometres (197 miles) east-northeast of the East Timor capital Dili in the Banda Sea at a depth of 18 kilometres, the US Geological Survey said.

The Pacific Tsunami Warning Center did not issue any alerts following the tremor in the remote region at the eastern end of the Indonesian archipelago between East Timor and the Maluku islands.   In an initial assessment, the USGS said there was a low likelihood of damage or casualties.

Indonesia sits on the Pacific "Ring of Fire", where tectonic plates collide, causing frequent seismic and volcanic activity.   A 6.1-magnitude quake struck Indonesia's main island of Java in January, damaging dozens of buildings.   Another 6.1 quake that hit Aceh province on Sumatra island in July 2013 killed at least 35 people and left thousands homeless.
Date: Sun, 1 Dec 2013 04:07:58 +0100 (MET)

AMBON, Indonesia, Dec 01, 2013 (AFP) - A 6.3-magnitude quake hit off eastern Indonesia and East Timor Sunday, seismologists said, but there was no tsunami alert or reports of damage or casualties.   The quake struck at 10:24 am local time (0124 GMT), 351 kilometres (217 miles) east-northeast of the East Timor capital Dili at a relatively shallow depth of 10 km, the US Geological Survey said.

The Pacific Tsunami Warning Center did not issue any alerts following the tremor in the remote region at the eastern end of the Indonesian archipelago between the islands of Timor and New Guinea.   In an initial assessment, the USGS said there was a low likelihood of damage or casualties.   Indonesian officials said they had not received any reports of casualties or damage so far.   "From data, the epicentre is quite a distance from the nearest cities and the intensity of shaking is not destructive," Suharjono, the technical head of Indonesia's geophysics and meteorology agency, told AFP.

An AFP correspondent in Dili said no tremor was felt.   Johanes Huwae, a police official in the Maluku provincial capital Ambon, one of the cities closest to the epicentre, said "there was no shaking, everything's safe", while the national disaster management agency reported "slight shaking for three to five seconds" in Southwest Maluku.   Indonesia sits on the Pacific "Ring of Fire", where tectonic plates collide, causing frequent seismic and volcanic activity.   A 6.1-magnitude quake that struck Aceh province on Sumatra island in July killed at least 35 people and left thousands homeless.
Date: Tue 20 Mar 2012
From: Helen Hanson <helenjhanson@gmail.com> [edited]

Re: Meng Ling Moi's post from Japan re: DENV-3 in 3 Japanese travelers returning from East Timor in March [see ProMED-mail archives 20120319.1074013 and 20120306.1060914]

I am the Australian Embassy's doctor in Dili, East Timor. Our clinic sees expatriates and some locals.

It is likely that I saw one or more of the travellers concerned prior to their return to Japan.

Our small one-doctor clinic saw 45 test-confirmed cases of dengue in February [2012] alone, mostly expatriates. These are not included in the 161 test confirmed cases for East Timor quoted in the previous post. Serotyping is not available in Dili, however reports from my colleagues at the ASPEN military medical facility, where blood samples have been sent to Australia for analysis, have also shown DEN-3 to be the circulating serotype.
-------------------------------------------------
Dr Helen Hanson
Australian Embassy Clinic
Dili, East Timor
helenjhanson@gmail.com
=========================
[ProMED-mail thanks Dr Helen Hanson for this 1st hand report. These types of reports from health professionals in the field who are dealing with outbreaks are especially valuable sources of reliable, current information. Her report confirms the circulation of dengue virus 3 in East Timor.

A HealthMap/ProMED-mail interactive map of East Timor can be accessed at
<http://healthmap.org/r/1KlU>. - ProMed Mod.TY]
Tuesday 6th March 2012
A ProMED-mail post
<http://www.promedmail.org>

- East Timor (national). 2 Mar 2012. As of 24 Feb [2012], the Ministry of Health had received 563 reports of dengue (161 confirmed by laboratory tests) in every district except one, including 192 reports of DHF that causes severe abdominal pain, vomiting, and in worst cases, death. This is a 36 per cent increase over reports for the 1st 2 months of 2011. As of 1 Mar [2012], 10 people had died from dengue, according to the government.
=====================
[A HealthMap/ProMED-mail interactive map of East Timor can be accessed at <http://healthmap.org/r/1KlU>. - ProMed Mod.TY]
More ...

Malawi

General: Often referred to as the 'warm heart of Africa', Malawi is a small land-locked country situated between Mozambique, Zambia and Tanzania. It is dominated by the lake which forms its border with Mozambique in the central portion and Tanzania in the
northeast. The amount of tourism is still limited - associated with various issues including the fact that it has been relatively expensive to fly into the country directly. However this is changing and many find their way to this beautiful country and enjoy all that it as to offer.
Climate: Malawi is in the southern hemisphere and experiences a fairly typical sub-tropical climate with a rainy season from around October to May each year.
Dress Code: Quite uniquely Malawi has always had quite a strong dress-code applied for travellers and many tourists have found it necessary to change into more modest garments on request from the authorities. It is probably wise not to be the one to act too differently and to at least start with this in mind when arriving into the country. This includes avoiding short dresses for women and long unkept hair for men.
Banking Facilities: There are some ATM's in the main cities but generally they may not accept an international bank card. Credit cards are not accepted outside the main urban areas.

Security and Safety: In many regions of the world the level of crime and personal risk rises after nightfall. Malawi is no different in this respect and so travelling throughout the country at night is not recommended. It is especially unwise to walk in main cities during the hours of darkness.
Medical Facilities: Generally medical facilities throughout Malawi are limited and anyone with a serious illness would be recommended to move to more adequate facilities in either Zambia, Zimbabwe or ideally to South Africa if at all possible. Travellers on any personal medication should ensure that they carry sufficient supplies for the duration of their time abroad.
East African Safari: Many travel through Malawi on their way between Nairobi in Kenya and Capetown in South Africa. The road infrastructure and other facilities along this route is frequently difficult and it is unwise to consider travelling alone. Being part of an organised respected safari group is a very much wiser option. Even then it is essential to 'assess' the professionalism of the specific group you are travelling with during the first few days before granting them total control of your safety. It is important to listen to the leaders advice on the safety of food & water and their opinion on the necessity for adequate malaria prophylaxis to see if they can be trusted. Generally the answer is that among the well known groups there are excellent and superbly professional guides so this is not often an issue.
Food & Water: Like any trip to the tropics, what you eat and drink will largely determine how well you remain. Eat hot recently cooked food and steer clear of any street vendors. Eat what you know your stomach likes as otherwise it will be quick enough to tell you - often in the most unpleasant ways! Water is essential for survival but, despite this, it is better to remain thirsty for a short while rather than drink anything potentially contaminated. A cup of tea is often safer (if taken from a clean cup) as the water will have been boiled. Even when brushing your teeth make sure you use boiled filtered water if safe bottled water is unavailable.
Lake Malawi: It is hot. Everyone else is swimming in the Lake and they say it is safe. The answer is no, as unfortunately this is without doubt not the case, no matter what you hear. Schistosomiasis (Bilharzia) is a parasitic disease which abounds in Lake Malawi and can infect a person very easily - even from very minimal contact with the water. This can occur from paddling along the water edge or showering close to the lakeside where the same water is used. If you do partake make certain that you report to medical staff on your return home so this risk can be adequately checked through as appropriate.
Sun Exposure & Dehydration: Africa is a hot continent and regularly travellers become quite significantly dehydrated as their water intake may not be sufficiently high to cope with the loss through perspiration. Also, at this time, salt is removed from the body and this may lead to tiredness, headaches and muscular crampy pains etc. It is important to increase your fluid intake and (for most travellers quite safely) to increase the amount of salt you take with your meals. Avoid salt tablets as these are unnecessary and can be quite harmful.
Malaria: There is a considerable risk of contracting Malaria in this region throughout the year - even in the dry season. Adequate insect repellents, good mosquito nets for night time, covering your arms and legs and appropriate malaria tablets are all essential. Don't take any chance as you protect yourself again malaria. It is a killing disease and yet with care you can significantly help to protect yourself. The tablets do not however provide 100% cover.
Vaccines: There are no essential vaccines required for entry into Malawi - unless you are coming from a Yellow Fever country. However, it is always recommended that you ensure you are covered against a number of different diseases before your trip and this all needs to be talked through well before leaving home. The doctor at that time can also discuss some of the other extremely important health issues relating to Malawi to try to ensure that you remain safe and healthy.
Summary: Malawi is a beautiful country with a lot to offer for the wise traveller. However staying healthy and well is essential and taking unnecessary risks with your long term health is foolhardy.

Travel News Headlines WORLD NEWS

Date: Fri 21 Jun 2019
From: Lucille Blumberg <lucilleb@nicd.ac.za> [edited]

East African trypanosomiasis (EAT) has been confirmed on a 36-year-old teacher, a USA citizen who has been in Malawi for the past 14 years and is currently resident in Lilongwe.

He went fishing in the Nkhotakota Wildlife Reserve at the beginning of June 2019, but did not recall seeing any tsetse flies or experiencing any tsetse bites. EAT is well documented in the reserve.

Twelve days later, he developed an acute febrile illness, initially managed as a bacterial infection and then as malaria -- 2 rapid diagnostic tests [RDT] for malaria were negative, but gametocytes were reported on a smear. The doctor was concerned by the negative malaria RDT results and non-response to IVI [intravenous infusion] artesunate.

The blood smear was reviewed and trypomastigotes seen. Although suramin treatment was accessed from a hospital further north in Kasungu [Central region of Malawi], the decision was made to transfer the patient to a Johannesburg [South Africa] hospital on [19 Jun 2019] because of the decreasing platelet count.

In Johannesburg EAT (parasitaemia 5000/microL) was confirmed and the following complications have been noted: hepatic dysfunction with clinical jaundice, thrombocytopenia (platelet count 15 x 109/L) with a petechial rash, mild renal dysfunction, and early ARDS [adult respiratory distress syndrome]. There is no evidence of a trypanosomal chancre (present in about 80% of patients with EAT), his mental state was normal, and the patient was hemodynamically stable with no evidence of a myocarditis.

Suramin (test and 1st doses) has been administered with good response. A CSF [cerebrospinal fluid] examination will be conducted once the peripheral parasitaemia has cleared and the platelet count has increased.
------------------------------------------------
Communicated by:
Lucille Blumberg and John Frean
Centre for Emerging Zoonotic and Parasitic Diseases
National Institute for Communicable Diseases -- a GeoSentinel Site
PRF Building, 1 Modderfontein Rd, Sandringham
Johannesburg, 2131
South Africa
<lucilleb@nicd.ac.za>
and
Kim Roberg and Brian Levy, physicians (Infectious Diseases and Critical Care) Johannesburg, South Africa
==============================
[The Nkhotakota Wildlife Reserve in northern Malawi is the largest and oldest of the national parks in the country

African trypanosomiasis is a zoonotic disease with a reservoir in wild game animals and is a risk throughout game parks in Africa including Malawi. More information can be found on the FAO (Food and Agricultural Organization of the United Nations) website on African trypanosomiasis at <http://www.fao.org/paat/en/>.

The case story presented here shows that trypanosomiasis is a differential diagnosis to malaria and indeed haemorrhagic fever in endemic areas. Thus, patients with a negative malaria blood film should be suspected and investigated for trypanosomiasis, also called African sleeping sickness. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Malawi:
Date: Tue, 23 Apr 2019 18:46:50 +0200
By Jack MCBRAMS

Lilongwe, Malawi, April 23, 2019 (AFP) - Malawi on Tuesday rolled out the world's first licensed malaria vaccine in a landmark campaign against a disease that each year kills hundreds of thousands of people, especially African children.   After more than three decades in development and almost $1 billion (890 million euros) in investment, the new vaccine began to be distributed in Malawi's capital Lilongwe. It will be extended to Kenya and Ghana in coming weeks.   "We have seen tremendous gains from bed nets and other measures to control malaria in the last 15 years but progress has stalled and even reversed in some areas," World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus said in a statement.   "We need new solutions to get the malaria response back on track, and this vaccine gives us a promising tool to get there."

Known by its lab initials as RTS,S but branded Mosquirix, the vaccine has passed lengthy scientific trials, which found it to be safe and reduced the risk of malaria by nearly 40 percent -- the best-ever recorded. It was approved by European regulators in 2015.   But Mosquirix provides only a partial protection, which means it has to be supplemented by traditional anti-malaria tools such as insecticide-treated bed nets.   In addition, four successive doses must be administered on a strict timetable for it to work -- a relatively onerous schedule in rural Africa.   The three-country programme aims to immunise 360,000 children aged two years and under, partly to get a wider view on the vaccine's effectiveness but also to see whether the delivery process is feasible.

- Promising weapon -
The first vaccinations were administered at Mitundu Health Centre, 45 kilometres (28 miles) west of Lilongwe.    "This new vaccination is a new tool for the control and elimination of malaria in this country," Michael Kayange, deputy director in Malawi's health ministry, told AFP.   Kayange said that the vaccine had the capacity to prevent one million of the six million malaria cases recorded annually in Malawi, helping to prevent 4,000 deaths.   "So, this vaccine is a huge plus to Malawi," he said.   Mosquirix has been developed by British pharmaceutical giant GlaxoSmithKline in partnership with the PATH Malaria Vaccine Initiative.   Its scientific testing including five years of clinical trials on 15,000 people in seven countries.   Scientists say if it was rolled out on a large scale it could save hundreds of thousands of lives.

The WHO believes that the new vaccine brings a key new tool in addition to mosquito nets, insecticides and drugs in the battle against a disease which kills a child every two minutes.   Malaria is spread to people through the bites of female Anopheles mosquitoes who transfer the malarial parasite when they take a blood meal.   The WHO says malaria killed 435,000 people in 2017. The number of cases climbed to 219 million in 2017, two million more than in 2016. More than 90 percent of cases occurred in Africa.   The fight against the disease has been complicated by mosquitoes building up resistance to commonly-used drugs, according to the WHO.   "Despite gains over the last decade, we have seen a stagnation in malaria control efforts in recent years," said researcher Jonathan Juliano from the University of North Carolina.   "In certain areas of Africa, we have actually seen rates of malaria infection get worse.

- 'Milestone' -
CEO of PATH Steve Davis described the vaccine's launch as a "historic milestone".   "A vaccine for malaria is among many innovations needed to bring an end to this disease," said Davis.   GlaxoSmithKline Vaccines' chief medical officer, Thomas Breuer said "delivering the world's first malaria vaccine will help reduce the burden of one of the most pressing health challenges globally".   Malawi, Ghana and Kenya were selected for the rollout because their malaria rates are high and they have a long history of use of bed nets and other preventative measures.   Despite concerns over the recent rise in malaria cases, the numbers dying from the disease has fallen nearly two-thirds since the turn of the century.
Date: Sun, 21 Apr 2019 09:55:31 +0200

Lilongwe, Malawi, April 21, 2019 (AFP) - Three people died after a landslide hit a village in the Rumphi district in northern Malawi, with at least five still missing Sunday and many others injured and hospitalised.   Rumphi police spokesperson Tupeliwe Kabwilo told AFP that incessant rains in the area led to the landslide early Saturday which washed away an entire village nestled between Mphompha Hills and Lake Malawi.   Among the dead are two boys aged 12 and 15 and a 35-year-old woman, according to police.   The missing persons, who are feared dead, include a one-year-old boy, two other boys aged six and 10 as well as two women aged 35 and 46.

A Rumphi district council official who was at the scene of the disaster told AFP that the affected area was inaccessible by road and it would be impossible to mount a rescue operation.   "Huge boulders rolled from the mountain and these are the ones that cause the biggest damage and if the missing victims are buried under these rocks, then we will need an excavator to move them." said council official Wakisa Mtete.    "But there is no access by road to the area so this is an impossible task. The boulders are so big that moving them by hand is not possible," Mtete said.    He added that it was also possible for some of the missing bodies to have been washed into the lake, in which case the bodies would resurface within the next two days.

Disaster management officer Alufeyo Mhango told AFP that government ministries were preparing to step in to transport heavy duty excavation equipment over the lake as soon as the weather cleared.   "We have been informed by government ministries that we should get ready to transport the equipment. But this will depend on whether we get a large boat for that and on whether the hailstorm stops because there could be a recurrence of the landslide," he said.   According to Mhango, Police officers, soldiers and emergency personnel are on site attending to the disaster.
Date: Thu, 21 Mar 2019 22:32:17 +0100

Blantyre, Malawi, March 21, 2019 (AFP) - Heavy rains could cause a dam in southern Malawi to give way if there is no let-up, authorities said Thursday, urging local residents to take shelter.   The warning came after cyclone Idai battered neighbouring Mozambique last Friday killing 242 people    Hurricane-force winds and rains have also ravaged hit eastern Zimbabwe where over 100 have died.

In Malawi, the storm has affected nearly a million people with over 80,000 displaced, according to the WHO.   The Chagwa dam "has had one of its major embankments eroded due to heavy rains," the interior security ministry said in a statement. "(It) is likely to burst in the event of heavy and incessant rains."   The statement advised local residents in the southern African country to evacuate "in case of an emergency".
Date: Wed, 13 Mar 2019 12:11:21 +0100

Maputo, March 13, 2019 (AFP) - At least 66 people have been killed and 141,000 affected after heavy rains deluged central and northern Mozambique, the government has said as it appealed for funds to manage the crisis.   "The government has decreed a red alert due to the continuing rains and the approach of the tropical cyclone Idai, expected to reach the country between Thursday to Friday," said cabinet spokeswoman Ana Comoana.   She spoke to reporters late Tuesday after a cabinet meeting in Maputo to discuss the emergency.   The floods in one of Africa's poorest countries have already destroyed 5,756 homes, affecting 15,467 households and 141,325 people.    In neighbouring Malawi, floods have already claimed 45 lives and left over 230,000 people without shelter.   Malawi's Meteorological Department has warned of more rains and flooding in the country's south between Thursday and Sunday.

In Mozambique, 111 people have been injured, 18 hospitals destroyed, 938 classrooms destroyed and 9,763 students affected.   More than 168,000 hectares (415,000 acres) of crops were destroyed, the government spokeswoman added.   Authorities have ordered the compulsory evacuation of people living in flood-prone areas.    "Sixteen accommodation centres have been opened in the provinces of Zambezia and Tete to accommodate the displaced," Comoana said.    "The government needs 1.1 billion meticais ($16 million) to assist 80,000 families affected by the rains".   Mozambique is prone to extreme weather events. Floods in 2000 claimed at least 800 lives while more than 100 were killed in 2015.
More ...

Aruba

Aruba US Consular Information Sheet
April 02, 2008
COUNTRY DESCRIPTION:
Aruba is an autonomous part of the Kingdom of the Netherlands. Tourist facilities are widely available. Read the Department of State Background Notes on Aruba for addi
ional 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 WHTI compliant document such as a passport card for entry or re-entry to the U.S.
Sea travelers should also check with their cruise line and countries of destination for any foreign entry requirements.

Applications for the new U.S. Passport Card are now being accepted.
We expect cards will be available and mailed to applicants in spring 2008.
The card may not be used to travel by air and is available only to U.S. citizens. Further information 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.

In addition visitors to Aruba may be asked to show onward/return tickets, proof of sufficient funds and proof of lodging accommodations for their stay. Length of stay for U.S. citizens is granted for thirty days and may be extended to 180 days by the office of immigration.
For further information, travelers may contact the Royal Netherlands Embassy, 4200 Linnean Avenue NW, Washington, DC
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 and the Aruban Department of Immigration at http://www.aruba.com/about/entryrequirements.php 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 are no known extremist groups, areas of instability or organized crime on Aruba, although drug trafficking rings do operate on the island.
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 Worldwide Caution, Travel Warnings, and Travel Alerts 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: The crime threat in Aruba is generally considered low although travelers should always take normal precautions when in unfamiliar surroundings.
There have been incidents of theft from hotel rooms and armed robberies have been known to occur. Valuables left unattended on beaches, in cars and in hotel lobbies are easy targets for theft.
Car theft, especially that of rental vehicles for joy riding and stripping, can occur. Vehicle leases or rentals may not be fully covered by local insurance when a vehicle is stolen or damaged.
Be sure you are sufficiently insured when renting vehicles and jet skis.

Parents of young travelers should be aware that the legal drinking age of 18 is not always rigorously enforced in Aruba, so extra parental supervision may be appropriate. Young female travelers in particular are urged to take the same precautions they would when going out in the United States, e.g. to travel in pairs or in groups if they choose frequenting Aruba’s nightclubs and bars, and if they opt to consume alcohol, to do so responsibly.

Anyone who is a victim of a crime should make a report to Aruban police as well as report it immediately to the nearest U.S. consular office.
Do not rely on hotel/restaurant/tour company management to make the report for you.

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 are solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

Please see our information for American Victims of Crime Overseas.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care is good in Aruba. There is one hospital, Dr. H.E. Oduber Hospital, whose medical standards can be compared with an average small hospital in the U.S. The hospital has three classes of services and patients are accommodated according to the level of their insurance (i.e. first class: one patient to a room, TV, better food; second class: two to three patients to a room, shared bathroom, etc; third class: 15 to 20 people in one hall). There is a small medical center in San Nicolas. The many drug stores, or “boticas” provide prescription and over the counter medicine. Emergency services are usually quick to respond.
There are no country-specific health concerns.

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 Aruba is provided for general reference only and may not be totally accurate for a particular location or circumstance.

Driving in Aruba is on the right-hand side of the road. Local laws require drivers and passengers to wear seat belts and motorcyclists to wear helmets. Children under 5 years of age should be in a child safety seat; older children should ride in the back seat. Right turns on red are prohibited in Aruba.

Aruba's main thoroughfare, L.G. Smith Boulevard, is well lit and most hotels and tourist attractions can be easily located.
There is a speed limit in Aruba and driving while intoxicated may result in the loss of a driver’s license and/or a fine.
However, these are not consistently enforced.
Drivers should be alert at all times for speeding cars, which have caused fatal accidents.
In the interior areas of the island, drivers should be alert for herds of goats or donkeys that may cross the roads unexpectedly.
Buses provide convenient and inexpensive service to and from many hotels and downtown shopping areas.
Taxis, while expensive, are safe and well regulated.
As there are no meters, passengers should verify the price before entering the taxi.
The emergency service telephone number is 911. Police and ambulance tend to respond quickly to emergency situations.

Please refer to our Road Safety page for more information. Also, travelers may wish to visit the web site of the country’s national tourist office and national authority responsible for road safety in Aruba for information: http://www.aruba.com/pages/traffictips.htm.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Aruba’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Aruba’s air carrier operations. For more information, travelers may visit the FAA web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES: The time-share industry and other real estate investments are two of the fastest-growing tourist industries in Aruba. Time-share buyers are cautioned about contracts that do not have a "non-disturbance or perpetuity protective clause" incorporated in the purchase agreement.
Such a clause gives the time-share owner perpetuity of ownership should the facility be sold.
Americans have also sometimes complained that the time-share units are not adequately maintained, despite generally high annual maintenance fees.

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 jet skis or other water sports equipment could indicate that the dealer is unlicensed or uninsured. Visitors planning to rent jet skis or other water sports equipment should carefully review all liability and insurance forms presented to them before signing any contracts or agreements. 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 being allowed to leave Aruba, and may be subject to civil or criminal penalties if they cannot or will not make payment.

Dutch law in principle does not permit dual nationality. However, there are several exceptions to the rule. 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 information, contact the Embassy of the Netherlands in Washington, DC, or one of the Dutch consulates in the U.S.
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 offenses.
Persons violating Aruba’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Aruba 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 on international adoption of children and international parental child abduction, see the Office of Children’s Issues web pages.
REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Aruba 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 Aruba. 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 number (599-9) 461-3066; fax (599-9) 461-6489; e-mail address: acscuracao@state.gov
* * *
This replaces the Consular Information Sheet dated January 3, 2008, to update Entry/Exit Requirements and Crime sections.

Travel News Headlines WORLD NEWS

Date: Sat, 20 Jun 2009 10:52:09 +0200 (METDST)

MADRID, June 20, 2009 (AFP) - A Spanish cruise ship was turned away from three Caribbean islands after swine flu cases emerged among the crew and the 800-odd passengers finally got off in Aruba, the tour operator said Saturday.   The "Ocean Dream" docked in Aruba late Friday after being denied entry in Grenada, Saint Lucia and Barbados, Pullmantur said. Three swine flu cases were reported among the crew but the passengers were unaffected.

On Thursday, 376 Venezuelan passengers were allowed to disembark on the island of Margarita, which belongs to Venezuela.   The ship's nine-day cruise through the Caribbean was hampered by the flu outbreak and the ship could not dock at three destinations on the itinerary.   The A(H1N1) virus has infected more than 44,000 people around the world, resulting in 180 deaths since late March, WHO figures show.
Date: Wed 14 Jan 2009
Source: Amigoe.com [Dutch, machine trans., edited]

Department of Health has called an urgent press conference on Tuesday [13 Jan 2009] to issue a dengue update. The department has done this following the hundreds of calls that have come into Health, after media reports of a 53-year-old woman who died of dengue [virus infection].

According to Trevor Gellecum, Director of Health, it is still not clear that this woman indeed died of dengue. "First, certain tests can be carried out, and it will be 3 weeks before the results could be known," says Van Gellecum. "These tests should be carried out in a laboratory abroad."

According to Wilmer Salazar, microbiologist at Health, the woman had a fever at the weekend, but on Monday [12 Jan 2009] she felt better and she went to work. "Later that day, she was admitted to the hospital in shock. At night she died, "said Salazar. "Until now, there is no confirmed diagnosis of the cause of death, but dengue is suspected. Today [14 Jan 2009], an autopsy was performed so that the tests to be done abroad can take place."

Maribel Tromp, manager at the department of epidemiology and research of the Infectious Disease Service, has indicated that so far 612 suspected cases of dengue have been registered. "Of these, 218 cases [have been] confirmed as positive by the laboratory, and 394 are still under investigation, reports Tromp. "This does not mean that they are negative" [The dates over which these cases occurred are not specified. - ProMed Mod.TY].

 From the moment the news of a potentially fatal dengue victim arose lately, Charline Koolma, director of the Yellow Fever Fight Unit (GKMB), indicated that they have been overwhelmed with calls from people reporting family members possibly with dengue-like symptoms or who want information about the disease. "It is good that we now receive phone calls, although it also had previously been possible. These kinds of extreme cases can be avoided," according Koolman.

"From November last year [2008], the GKMB made several visits to monitor presence of [the dengue virus vector mosquito _Aedes_] breeding sites and adult mosquitoes. Often, the residents are not home, and then a letter was left with an invitation to make contact with the GKMB for the transmission of important information. But there is never a return call until something bad happens, and then it is often too late."

The more information and reports the GKMB gets, the better the service and their work, said Tromp. Finally, all speakers [at the press conference] called on the population and general practitioners to join forces against breeding of the _Aedes_ dengue vector mosquito. Health officials indicated that is the only way to avoid [virus] infection and prevent dengue.
------------------------
[A map showing the location of Aruba in the Caribbean can be accessed at <http://www.aruba-travelguide.com/map/index.html>. - ProMed Mod.TY]
Date: Sun, 2 Sep 2007 19:04:55 +0200 (METDST) MIAMI, Sept 2, 2007 (AFP) - Hurricane Felix barreled through the Caribban Sunday, with forecasters predicting a brush with Aruba and warning of its potential to strengthen into a devastating storm. Forecasters issued a tropical storm warning and hurricane watch for the islands of Aruba, Bonaire and Curacao -- popular tourist destinations in the Netherlands Antilles. A tropical storm watch also has been issued for Jamaica, which was gearing up for violence-marred elections Monday, after Felix was upgraded overnight to Category Two strength on the Saffir-Sampson scale, which peaks at five. At around 1500 GMT Felix's maximum sustained winds were 105 miles (165 kilometers) per hour, and its trek across the open waters of the Caribbean could allow it to attain "major hurricane" status, US forecasters said. "I see no reason why Felix will not become a major hurricane within 12 hours or so," said Richard Pasch, a hurricane specialist with the National Oceanographic and Atmospheric Administration. On Saturday, a weaker Felix passed close to Grenada, reportedly ripping roofs, downing power lines and knocking radio and TV stations off the air. No injuries were reported. The center of the hurricane around 1600 GMT Sunday was about 50 miles (75 kilometers) north of Aruba and about 550 miles (900 kilometers) southeast of Kingston, Jamaica. Felix was moving in a west-northwesterly direction at around 18 miles (30 kilometers) per hour, and was expected to follow the same course throughout Sunday. The storm was not expected to hit Jamaica directly, but its strong outer squalls could rock the island ahead of the elections on Monday. Jamaican officials had already postponed the general election from August 27, after the island was struck last month by Hurricane Dean. Last week, Dean swept through the southern Caribbean with severe winds and rains, leaving a wide swathe of damage and a death toll of 30 from Martinique to Mexico. Felix's track was expected to take it toward Belize or the Yucatan in Mexico, possibly making landfall as a major Category Three hurricane Wednesday. The storm could dump two to four inches (five to 10 centimeters) of rain over islands off the Venezuela coast and the Netherlands Antilles, US forecasters said. On its current path Felix is expected to graze the coastlines of Nicaragua and Honduras late Tuesday and make landfall in Belize on Wednesday. Felix is the second hurricane of the three-month-old Atlantic season, and the first in September, historically the busiest month for hurricanes.
Date: Thu, 9 Sep 2004 10:12:08 +0200 (METDST) CARACAS, Sept 9 (AFP) - Hurricane Ivan has killed at least 11 people in Tobago, Grenada and Venezuela as the it churned off Venezuela's coast Thursday, strengthening to the top Category 5 storm, officials and local media said. Ivan was 135 kilometers (85 miles) northeast of Aruba and 915 kilometers (570 miles) from Jamaica, the Miami-based National Hurricane Center said at 0600 GMT. Its category was raised to a Category 5 hurricane -the top level on the Saffir Simpson hurricane scale, with maximum sustained winds near 255 kilometers (160 miles) per hour. "Some fluctuations in strength are likely," the center said. The "extremely dangerous" hurricane was moving west-northwest at 28 kilometers (17 miles) per hour with urricane force winds extend outward from Ivan's eye up to 95 kilometers (60 miles). Storm surges of 1.0-1.5 meters (three to five feet) as well as rains of 13-18 centimeters (seven five to seven inches) are to be expected. The center issued hurricane warnings for Aruba, Bonaire and Curacao. A television station in Trinidad and Tobago said nine people had died in Grenada, a tiny island nation of 90,000 inhabitants, which Prime Minister Keith Mitchell said was 85 percent destroyed. Power lines were down and hundreds of persons have taken refuge in shelters. Mitchell, whose own house was destroyed, told a Trinidad radio station that the island is without electricity. Another woman was killed by a falling tree in Tobago, according to local media. Prime Minister Patrick Manning headed to Tobago to view the destruction. His government has promised 1.6 million dollars to St. Vincent to help with the construction. Hundreds were evacuated to shelters. Cuba has also begun preparing for the storm in 11 of its 14 provinces, although the island has not fully recovered from Hurricane Charley, which struck August 13. Children in the Netherlands Antilles were sent home from school, as were many workers. Several Venezuelan airports, including the oil-exporting country's main international airport, Maiquetia, which serves Caracas, suspended operations until conditions improve, Air Force colonel Francisco Paz Freitas told Union Radio. In Venezuela, a man was crushed to death when hurricane-force winds toppled a wall in a coastal town near Caracas, emergency service officials said, adding that another person was hurt and 150 people were affected by flooding. Along the low-lying Caribbean coast, authorities reported mudslides and road closings just as early rain bands from the storm unleashed the first downpours. The storm was expected to be off the central coast later in the day, triggering heavy rains and rough surf. The capital, Caracas, lies just a bit inland from there, protected somewhat by the El Avila mountain range. Though the storm is not expected to make landfall in Venezuela, Interior and Justice Minister Jesse Chacon was urging calm and said heavy winds and rain associated with the storm could last for 72 hours. Ivan was expected to pass just north of Aruba, Bonaire and Curacao on Friday as the Caribbean islands were under a hurricane warning, which means hurricane winds could hit them within 24 hours or less, the US hurricane center said. A hurricane watch and a tropical storm warning remain in effect for the Guajira peninsula of Colombia and for the entire northern coast of Venezuela, it noted. Haiti also issued a hurricane watch, meaning it could experience hurricane conditions within 36 hours.
Date: Wed, 8 Sep 2004 05:03:07 +0200 (METDST) PORT-OF-SPAIN, Trinidad Sept 7 (AFP) - Ivan, an "extremely dangerous" hurricane Tuesday knocked out power in Barbados and threatened eastern Caribbean islands, forecasters and emergency officials said. The eye of the powerful storm moved over Barbados Tuesday afternoon, and headed for the eastern Caribbean, where officials issued a hurricane warning for St Vincent, the Grenadines, Grenada and the Netherlands Antilles islands of Aruba, Bonaire and Curacao. Ivan packed sustained winds of 215 kilometers (135 miles) per hour, which made it "an extremely dangerous category four hurricane," the Miami-based National Hurricane Center (NHC) said. In Barbados, "there is an island-wide power outage, expect for the major health care facility, the Queen Elizabeth Hospital," the Caribbean Disaster Emergency Response Agency (CDERA) said. "There are also reports of roof loss, downed utility poles and trees," the agency said, adding that there were also reports of coastal damage from storm surge. Late Tuesday night, the center of the powerful hurricane, the second in just days, was located 175 kilometers (110 miles) west of Grenada. The Netherlands Antilles Tuesday morning put the islands of Aruba, Bonaire and Curacao under a hurricane watch, which means the storm could hit them within 36 hours. In central and eastern Venezuela, officials suspended all air and maritime traffic. Long-term forecasts, which have a wide margin of error, have the hurricane slamming into Jamaica on Friday and then into Cuba on Sunday. This would bring the storm dangerously close to Florida, which has just been pounded by Frances, the second hurricane to hit the southeastern US state in three weeks. The Bahamas islands also were severely impacted by the passage of Frances last week.
More ...

Equatorial Guinea

Equatorial Guinea US Consular Information Sheet
March 02, 2009
COUNTRY DESCRIPTION:
Equatorial Guinea is an oil-rich, developing country on the western coast of central Africa.
Its capital and main port, Malabo, is located on the isla
d of Bioko, off the coast of Cameroon.
A secondary port, Luba, is also on Bioko.
The mainland territory of Equatorial Guinea is bordered by Cameroon and Gabon.
The principal city on the mainland is Bata.
Facilities for tourism are limited but growing.
Official languages are Spanish, which is widely spoken, and French, which is not widely understood, but sometimes used in business dealings.
Read the Department of State Background Notes on Equatorial Guinea for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport and evidence of a yellow fever vaccination are required to enter Equatorial Guinea.
Visas are not required for U.S. citizens unless the traveler will be there for an extended stay or is intending to work there.
U.S. citizens entering without a visa but staying longer than 90 days should register with the local police station.

Private vessels landing in an Equato-Guinean port must get clearance prior to approaching the shore.
Travelers should obtain the latest information and details from the Embassy of the Republic of Equatorial Guinea, 2020 16th Street NW, Washington, DC
20009, telephone (202) 518-5700, fax (202) 518-5252.

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

SAFETY AND SECURITY:
Although large public demonstrations are uncommon, U.S. citizens should avoid large crowds, political rallies, and street demonstrations.

In February 2009, approximately 50 gunmen arriving by speedboats attacked government buildings in Malabo but were repelled by Equato Guinean military and police.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State's, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

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

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

CRIME:
Violent crime is rare and the overall level of criminal activity is low in comparison to other countries in the region.
However, there has been a rise in non-violent street crime and residential burglaries.
Travelers should exercise prudence and normal caution, including avoiding dark alleys, remote locations, and traveling alone.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the U.S. Embassy in Malabo at (240) 098895; Embassy personnel will assist in contacting the local police.
If you are the victim of a crime while in Equatorial Guinea, please remember to report the incident to local police, and contact the U.S. Embassy in Malabo for assistance.
The Embassy staff can, for example, assist you in finding 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, the consular officer can help you understand the local criminal justice process and to find an attorney if needed.

Please see our information on Victims of Crime, including possible victim compensation programs in the United States.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Equato-Guinean laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Equatorial Guinea 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:
It is not uncommon for a uniformed member of the security forces to stop motorists on the pretext of minor or nonexistent violations of the local motor vehicle regulations in order to extort small bribes.
Visitors are advised not to pay bribes, and to request that the officer provide a citation to be paid at the local court.
If visitors encounter any of these problems they should contact the Embassy Consular Officer at 516008 and inform him/her of the situation.

Equatorial Guinea has a strictly cash economy.
Credit cards and checks are not accepted; credit card cash advances are not available and there are no ATMs.
In addition, most local businesses do not accept travelers' checks, dollars or euros.
However, dollars can be changed at local banks for CFA.
Cash in CFA is usually the only form of payment accepted throughout the country.

Special permits from the Ministry of Information and Tourism (or from the local delegation if outside Malabo) are required for virtually all types of photography.
Police or security officials may charge a fine, attempt to take a violator into custody, or seize the camera and film of persons photographing the Presidential Palace and its environs, military installations, airports, harbors, government buildings, and other areas.

Travelers are advised that the possession of camouflage-patterned clothing, large knives, binoculars, firearms, or a variety of other items may be deemed suspicious by the security forces and grounds for confiscation of the item and detention of the carrier.
Please see our Customs Information sheet.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are extremely limited. Pharmacies in Malabo and Bata stock basic medicines including antibiotics, but cannot be counted on to supply advanced medications. Outside of these cities, many medicines are unavailable. Travelers are advised to carry any special medication that they require. The sanitation levels in even the best hospitals are very low though the new Israeli-built and staffed La Paz Hospital in Bata approaches European standards of sanitation and is reported by Red Cross officials to be the best in the region. Doctors and hospitals often require immediate payment for health services, and patients are often expected to supply their own bandages, linen and toiletries.
The Malabo hospital is likewise undergoing a complete update, with expected completion in late 2009.

Malaria is a serious and sometimes fatal disease. The national government, along with U.S. oil companies in the country, has taken aggressive steps to control the mosquito population and limit the impact of malaria on the population centers in Malabo and Bata.
Plasmodium falciparum malaria, the type that predominates in Equatorial Guinea, is resistant to the anti-malarial drug chloroquine. Because travelers to the country are at high risk for contracting malaria, the Centers for Disease Control and Prevention (CDC) advises that travelers should take one of the following anti-malarial drugs: mefloquine (Lariam™), doxycycline, or atovaquone/proguanil (Malarone™). Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and tell the physician their travel history and what anti-malarials they have been taking.
Visit the CDC travelers’ health page for additional information on malaria, including protective measures.

There are periodic outbreaks of cholera in Equatorial Guinea. Yellow fever can cause serious medical problems, but the vaccine, required for entry, is very effective in preventing the disease.

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

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.
Hospitals, clinics, and other businesses and hotels do not accept credit cards.
If there are any concerns that travelers may need medical care or assistance while in Equatorial Guinea, they should make arrangements to have access to enough cash to cover possible expenses.
There are companies such as Western Union where international money orders can be arranged and cash obtained.
There are no ATM machines in the country (See SPECIAL CIRCUMSTANCES Section above).
You can see more 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 Equatorial Guinea is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Generally, Equatorial Guinea's road networks are underdeveloped.
There are few road and traffic signs, though more signs are becoming evident.
Livestock and pedestrians create constant road hazards.
During the rainy season, many roads are passable only with four-wheel-drive vehicles.
However, new road construction and repair is taking place all over the country and road conditions have improved markedly over the course of the past year.
If you plan on staying and driving around the country for any length of time you should attempt to purchase a cell phone for assistance in case of an emergency.

Travelers outside the limits of Malabo and Bata may expect to encounter occasional military roadblocks.
Travelers should be prepared to show proper identification (for example, a U.S. passport) and to explain their reason for being at that particular location.
The personnel staffing these checkpoints normally do not speak or understand English or French; travelers who do not speak Spanish would do well to have their reason for being in the country and their itinerary written down in Spanish before venturing into the countryside.

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 Equatorial Guinea, the U.S. Federal Aviation Administration (FAA) has not assessed Equatorial Guinea’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA web site.

Commercial air travel to and from Equatorial Guinea can be difficult.
Malabo is served by European airlines a few times per week.
The island of Bioko and the African mainland are connected by several small local airlines offering daily service.
Schedules are subject to change or cancellation without notice; flights are often overbooked and reservations may not guarantee seats.

Malabo Airport has navigational aids and can accommodate night landings.
There are no navigational aids at Bata Airport.
Special clearances are required to land in or overfly Equatorial Guinea territory.

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 Equatorial Guinea are encouraged to register with the U.S. Embassy in Malabo through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Equatorial Guinea.
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 in Malabo to contact them in case of emergency.

The United States reopened its Embassy in Malabo in October 2003.
However, due to reduced staffing, it can offer only limited services to U.S. citizens in distress.
The U.S. Embassy in Malabo can be contacted at (240) 098-895.
Additional services are provided through the U.S. Embassy in Yaoundé, Cameroon, located on Avenue Rosa Parks in the Mbankolo Quartier, adjacent to the Mount Febe Golf Club; mailing address P.O. Box 817; embassy tel. (237) 2220-1500, fax: (237) 2220-1572.
The Embassy Branch Office in Douala, Cameroon, is located on Rue Flatters, in the Citibank Building, tel.: (237) 3342-53-31, fax: (237) 3342-77-90.
* * *
This replaces the Country Specific Information for Equatorial Guinea, dated November 15, 2007, to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Special Circumstances, Medical Facilities and Health Information, Medical Insurance, Traffic Safety and Road Conditions, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Sun, 26 May 2019 06:31:33 +0200
By Camille MALPLAT

Sipopo, Equatorial Guinea, May 26, 2019 (AFP) - Gleaming but eerily empty, the luxurious Sipopo resort with its five-star hotel and exclusive facilities rises from a tropical beach, symbolising the dilemma of Equatorial Guinea -- a notoriously closed country that has turned to tourism to help fill its coffers.  The purpose-built town was carved out of an ancient forest in 2011 at a cost of 600 million euros ($670 million), initially to host a week-long African Union summit and showcase the rise of the tiny oil-rich state.   A 16-kilometre (10-mile) drive from Equatorial Guinea's capital Malabo, the resort boasts a vast conference centre, the Sofitel Malabo Sipopo Le Golf hotel, as well as 52 luxury villas -- one for every head of state to attend the summit -- each with its own swimming pool.    There is also an 18-hole golf course, several restaurants and exclusive beaches guarded by police.

For almost a decade, Sipopo has been the crown jewel in a strategy to lure high-end visitors to Equatorial Guinea to diversify an economy badly hit by a slump in oil revenue.   But the town, visited by an AFP reporter two months ago, seemed quite empty -- an impression strengthened by conversations with people who live or who work there.   "It's depressing, there's no-one," said a visiting Gabonese consultant.   A worker, who asked not to be named, said the complex was quiet year-round: "You can hear the sound of your own footsteps."   The occasional visitors tend to be well connected, rich and in search of privacy, the sources said.    Many are guests of a government described by Human Rights Watch as corrupt and repressive.    One of the villas, according to the sources, was occupied by former Gambian dictator Yahya Jammeh after he fled his country in 2017.

- Empty lobby -
At Easter, the 200-room hotel's guests included a Spanish couple on honeymoon, a few families and some businessmen, who were all foreigners.   In the echoing lobby, a huge black and white portrait of the country's 76-year-old authoritarian president, Teodoro Obiang Nguema -- Africa's longest-serving ruler -- hung on the wall, watching over the vacant reception area.   A 1.5-kilometre (nearly mile-long) beach -- an artificial shore secluded from curious eyes -- was virtually deserted, in contrast to a public beach near the capital. The three-lane highway leading from Malabo to Sipopo was mostly empty of traffic.   A hospital was added after the villas were built, but is unused, the sources said.   In 2014, a mall was built at the resort to house 50 shops, a bowling alley, two cinemas and a children's play area.   But a hotel receptionist said the complex was not open yet, adding: "If you want to buy a souvenir, you will have to go to Malabo." At night-time, shiny limousines arrived at a luxury restaurant to drop off diners.

- Tourism hopes -
Located on the mid-Atlantic coast of central Africa, Equatorial Guinea has flooded social media with messages of its allure as a holiday destination.   Plans to build a new passenger terminal at the airport in Bata city have also just received a 120-million-euro ($133-million) injection from the Development Bank of Central African States.   Figures for visitors are unavailable, and the tourism ministry in Malabo did not respond to AFP's requests for information. In the latest global compilation of figures posted by the World Bank, the number of tourists for Equatorial Guinea has been left blank.   But much of the tourism in evidence are business people, such as oil company workers, relaxing for a few days, or attending energy or economic conferences. 

A few travel firms offer trips tailor-made for both luxury and adventure, but they also allude to the difficulties, notably of being allowed to enter the country.   "The country has been a mystery to outsiders, who were discouraged from entering by a difficult visa process and a lack of tourism infrastructure," says the website of British tour operator Undiscovered Destinations.   The firm claimed, however, that "things are changing fast... with an excellent road network and numerous hotels springing up seemingly overnight."   Few Equatoguineans have the chance of staying in such places. At Sipopo's hotel, a basic room costs the equivalent of more than 200 euros ($224) a night, while exclusive accommodation tops 850 euros.   The discovery of vast oil reserves off the coast in the mid-1990s has boosted the country's gross national income to a theoretical annual $19,500 per person per year, according to the UN Development Programme.   But that wealth benefits a small elite among the country's 1.2 million inhabitants. More than two-thirds of Equatoguineans live below the poverty line, and 55 percent of the population aged over 15 are unemployed.
Date: Wed 14 Jan 2015
Source: Eye Witness News [edited]

The Africa Cup of Nations (Afcon) finally gets underway on Sat [17 Jan 2015] after a controversial build-up to the 30th edition, which included a hasty late switch of hosts to Equatorial Guinea in the wake of concerns over the Ebola virus.

16 nations again line up for the biennial continental championship, seeking Africa's top sporting prize at the tournament, which starts on Sat [17 Jan 2015] and finishes on 8 Feb [2015].

Few previous editions have had such a dramatic backdrop, with the hosting of the 2015 finals being switched 2 months ago after Morocco asked for a postponement in the wake of the spread of the Ebola virus in West Africa. That request precipitated a crisis that left the tournament having to be organised almost from scratch in a few weeks.

Fears that travelling fans could spread Ebola and damage Morocco's tourist industry were seen as alarmist by the Confederation of African Football (CAF), who rejected the request and then stripped Morocco of their hosting rights.

>From a country with plentiful resources, who have previously bid to host the World Cup, Afcon is now being played in one of Africa's smallest and most enigmatic countries.

Equatorial Guinea is a family-ruled former Spanish colony which has newfound oil wealth and is reveling in rescuing the continent's most eagerly anticipated sporting event. ... - more
Date: Thu 17 Apr 2014
Source: WHO Global Alert and Response [edited]

Update on polio in central Africa -- polio confirmed in Equatorial Guinea, linked to outbreak in Cameroon
--------------------------------------------------------------------------------
In Equatorial Guinea, 3 new wild poliovirus type 1 (WPV1) cases have been reported, the 1st polio in the country since 1999. Genetic sequencing indicates these cases are linked to an on-going WPV1 outbreak in Cameroon which has subsequently been detected in Equatorial Guinea. The cases had onset of paralysis on [28 Jan 2014], [19 Jan 2014] and [24 Mar 2014], from Centro Sur, Bioko Norte and Litoral. Outbreak response in Equatorial Guinea is currently being planned, including National Immunization Days (NIDs) with bivalent oral polio vaccine (OPV) on [21-24 Apr 2014]. An estimated 40 percent of children are fully immunized against polio in the country.

On [17 Mar 2014], the World Health Organization (WHO) had elevated the risk assessment of international spread of polio from Cameroon to 'very high' (http://www.who.int/csr/don/2014_03_17_polio/en/). The risk assessment was elevated due to: confirmation of 3 additional WPV1 cases (with onset of paralysis on [6, 25 and 31 Jan 2014]) from 3 new regions of Cameroon, confirming continued WPV transmission and geographic expansion of infected areas following detection of 4 cases in October 2013; gaps in surveillance; and, influx of vulnerable refugee populations from Central African Republic. The confirmation of new cases in Cameroon resulted in planning additional emergency outbreak response activities, including converting a subnational immunization campaign to a full nationwide activity on [11-13 Apr 2014], and implementing nationwide campaigns in May and June 2014. Critical to success will be to ensure substantial improvement in the quality of immunization campaigns that reach all children multiple times with OPV. Equally important will be efforts to rapidly improve the quality of surveillance so that the full extent of the outbreak can be determined and tracked.

Immunity levels and surveillance sensitivity are also being assessed in neighbouring countries, in particular in Gabon and the Republic of Congo. In Gabon, a nationwide immunization campaign is planned for [22-26 Apr 2014] (targeting all children aged less than 15 years), and in the Republic of Congo, a nationwide activity will be conducted on 1 May 2014.

It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for acute flaccid paralysis (AFP) cases in order to rapidly detect any new virus importations and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.

WHO's International Travel and Health (http://www.who.int/ith/chapters/en/) recommends that all travellers to and from polio-affected areas be fully vaccinated against polio.
Date: Sat 23 June 2012
Source: Guinea Equatorial [in Spanish, trans. ProMed Mod.JG, edited]

After the last measles vaccination campaign that took place last April 2012, a new outbreak of the disease has been reported in some communities in Malabo district, and for this reason, the Ministry of Health initiated a new vaccination campaign [Malabo is the capital of Equatorial Guinea, located on the northern coast of Bioko Island. - ProMed Mod.CP].

Activities started last Thursday, with the cooperation of the National Vaccination Programme (PAV, according to its Spanish initials). The campaign will concentrate its activities in the most severely affected communities, such as Santa Maria III, Lampert and Sunco.

Some medical officers gathered in Madre Bisila Health Centre in order to organise local vaccination units and to deal with mothers who brought their children to the Health Centre in order to have them vaccinated. Vaccine will be dispensed throughout the next 10 days, and subsequently, the vaccination campaign will continue in the Continental region of Equatorial Guinea.

Local officials from the Ministry of Health are inviting the population, particularly mothers, to bring their children to local health centres or to bring their children to mobile vaccination units when these teams arrive to their communities.
=====================
[According to La Voz de Rusia (<http://spanish.ruvr.ru/2012_06_22/Guinea-epidemia-sarampion/>), the last major measles epidemic in the country occurred in November 2008, when more than a dozen children died in various hospitals in Equatorial Guinea. No fatalities have been reported in the current outbreak so far.

Equatorial Guinea, officially the Republic of Equatorial Guinea, is a country located in central Africa. It has 2 parts: a Continental Region (Rio Muni), including several small offshore islands including Corisco, Elobey Grande and Elobey Chico; and an insular region containing Annobon island and Bioko island (formerly Fernando Po), where the capital Malabo is situated. A map of Equatorial Guinea can be accessed at: <http://www.africa.upenn.edu/CIA_Maps/Equatorial_Guinea_19871.gif>. - ProMed Mod.CP]

[The ProMED HealthMap for Equatorial Guinea can be found at
<http://healthmap.org/r/1KlO>.]
Date: Wed 30 Dec 2009
From: Patricio Leite (translated and edited)

Three people are sick with malaria in the Madeira archipelago of Portugal. One is in intensive care for complications of the disease in the Central Hospital of Funchal; the other 2 remain hospitalized but stabilized.

These people from Madeira were working in Equatorial Guinea and returned for the Christmas holidays. There is a 4th, a Brazilian national who also may be infected and is undergoing diagnostic tests.

Although they are cases of imported malaria, it is noteworthy that the archipelago of Madeira has a sub-tropical humid climate, conducive to the development of emerging diseases which are usually more prevalent in the tropics.

For example, for about the last 3 years the presence of the vector _Aedes aegypti_ has been documented, and it is now endemic in Madeira, posing the threat of dengue in the short term. In the archipelago, including the island of Porto Santo, weather conditions have allowed the survival of _Anopheles_.

Studies indicate that the next 30 years will see the emergence of diseases in Madeira, such as dengue, yellow fever, and malaria.
-------------------------------------------
Patricio Leite, MD
Specialist in General & Family Medicine
Regional Health Administrator for Lisbon & the Tejo Valley, Ministry
of Health, Portugal
Ex-collaborator of Travel Medicine Consultation, Institute of Hygiene
& Tropical Medicine,
New University of Lisbon
Portugal
========================
[Portugal reported 41 imported malaria cases in 2008 (Source: <http://data.euro.who.int/cisid/>). The climate of Madeira in December with temperatures below 20 C do not support local transmission of _Plasmodium falciparum_. Malaria is endemic in Equatorial Guinea, and the risk of infection is high without proper prophylaxis.

The introduction of dengue fever is a possibility, as in most of southern Europe. The introduction of yellow fever is a risk because the vector is present; however, yellow fever is limited to tropical areas, and Madeira probably does not, at present, have a climate which supports sustained transmission of yellow fever. - ProMed Mod.EP]
More ...

Bahrain

Bahrain - US Consular Information Sheet
June 27, 2008
COUNTRY DESCRIPTION:
Bahrain is a hereditary kingdom governed by the Al-Khalifa family. In 2002, the country adopted a new constitution that reinstated a parliament, which consists of o
e elected and one appointed chamber. Islamic ideals and beliefs provide the conservative foundation of the country's customs, laws and practices. Bahrain is a modern, developed country and tourist facilities are widely available. The capital is Manama. Read the Department of State Background Notes on Bahrain for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and a visa are required. Passports should be valid for at least six months after the date of arrival. U.S. passport holders outside of Bahrain may apply and pay for a two-week tourist visa online through the Bahraini government web site at http://www.evisa.gov.bh, or may obtain it upon arrival at the airport. U.S. diplomatic passport holders receive a no-fee two-week visa. Prior to travel, visitors may obtain five-year multiple-entry visas valid for stays as long as one month from Bahraini embassies overseas. Bahrain assesses heavy fines on visitors who fail to depart Bahrain at the end of their authorized stay. The amount of the fine is determined by a formula related to the visa type, duration, and location of issuance. An exit tax is included in the ticket price for flights out of Bahrain, and no additional exit fees are required upon departure. Residents of Bahrain who intend to return must obtain a re-entry permit before departing. For further information on entry/exit requirements, travelers may contact the Embassy of the Kingdom of Bahrain, 3502 International Drive NW, Washington, DC 20008, telephone (202) 342-1111; or the Bahrain Permanent Mission to the U.N., 2 United Nations Plaza, East 44th St., New York, NY 10017, telephone (212) 223-6200. Visit the Embassy of Bahrain web site at www.bahrainembassy.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:
Americans in Bahrain should maintain a high level of security awareness. Spontaneous demonstrations take place in Bahrain from time to time in response to world events or local developments. We remind American citizens that even demonstrations intended to be peaceful can turn confrontational and possible escalate into violence. American citizens are therefore urged to avoid the areas of demonstrations if possible, and to exercise caution if within the vicinity of any demonstrations. American citizens should stay current with media coverage of local events and be aware of their surroundings at all times. Information regarding demonstrations in Bahrain can be found on the U.S. Embassy Manama’s web site at http://bahrain.usembassy.gov/information_for_travelers.html.

Visiting U.S. citizens should register with the U.S. Embassy in Manama upon arrival. The Department of State remains concerned about the possibility of terrorist attacks against U.S. citizens and interests throughout the world. Americans should maintain a low profile, vary routes and times for all required travel, and treat mail and packages from unfamiliar sources with caution. In addition, U.S. citizens are urged to avoid contact with any suspicious, unfamiliar objects, and to report the presence of the objects to local authorities. Please report any security concerns to the U.S. Embassy's Regional Security Office at telephone (973) 1724-2700 during office hours or (973) 1727–5126 after hours.
For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site at http://travel.state.gov, where the current Worldwide Caution, Travel Warnings and Travel Alerts 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 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:
The crime rate in Bahrain is low and violent crime is rare. However, burglary, petty theft, and robberies do occur. Visiting Americans are urged to take the same security precautions in Bahrain that one would practice in the United States. Hotel room doors should be locked when visitors are in their rooms, and travelers are encouraged to store valuables in hotel room safes when they are available. Women are encouraged to keep their purses firmly under their arms, and men should avoid keeping their wallets in their hip pockets while in the old market area. The U.S. Embassy in Manama recommends that travelers using local taxis insist on the use of a meter since unexpectedly high fares may otherwise be charged. Bahrain has a professional police force, and visitors are encouraged to contact the police if problems are encountered.

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 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 to transfer funds. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local equivalent to the “911” emergency line in Bahrain is 999.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Basic modern medical care and medicines are available in several hospitals and health centers in Bahrain. Two government hospitals, several private hospitals, and numerous private clinics located throughout the country offer a wide range of medical services. Cardiac care, general surgery, internal medicine, obstetrics, gynecology, pediatrics, orthopedics and dentistry services are readily available, as are x-rays, CT-scan and MRI testing. The government hospitals house both trauma and ICU units. Pharmacies are common throughout Bahrain and carry a wide range of medications. Prescriptions are normally required.
Payment at all medical facilities is due at the time of service. Some hospitals have limited direct billing capability for certain insurance carriers. Billing and insurance practices vary among the medical facilities.

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 Bahrain is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Travel by road in Bahrain is generally safe although unsafe driving practices are common. Highways and major roads in the northern third of Bahrain are four to six lanes wide and well maintained; roads in villages and older parts of Manama and Muharraq are narrow and twisting. As in the United States, traffic in Bahrain moves on the right. Roundabouts (traffic circles) follow the British system, with those automobiles within the traffic circle having right of way over those attempting to enter. Although the Bahraini penal code calls for fines of up to 100 dinars ($270.00) or imprisonment of up to six months for driving above posted speed limits, it is not uncommon for drivers to drive well over the posted speed limits of 50-120 km per hour. The law allows the police to detain drivers for traffic violations until they can appear before a magistrate. It is illegal to use a cell phone while driving.

Under Bahraini law, any sign of having consumed alcohol may be taken as prima facie evidence of driving under the influence, which can lead to imprisonment and/or fines of up to 1,000 Bahraini Dinars (2,700 U.S. dollars). Except for minor accidents, drivers may not move their vehicles after an accident until a report has been filed with the traffic police. This is true even in cases of single-car accidents. Insurance companies may not provide coverage if the cars are moved. However, drivers involved in minor, non-injury accidents no longer need to wait at the scene for the police. Individuals should get their vehicles off the road to avoid further accidents. Drivers can call the accident hotline at 199 (if there are no injuries) or 999 (when someone is injured) where they will be directed to one of five centers to file the accident report. This report must be filed within 24 hours of the accident. Both drivers may be prohibited from leaving the country until the matter is resolved if an accident results in legal proceedings. The main switchboard at the traffic department is 1787-2222.
Emergency numbers are as follows:
Fire/Ambulance/Police: 999
Traffic/Accidents: 199 (no injuries) OR 999 (injuries)
Please refer to our Road Safety page for more information. Visit the web site of Bahrain’s national authority responsible for road safety at http://www.traffic.gov.bh/main.htm.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Bahrain, the U.S. Federal Aviation Administration (FAA) has not assessed Bahrain’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Individuals subject to Bahraini court orders arising from indebtedness, labor disagreements, or other legal disputes may be prevented from departing Bahrain until their cases are resolved. Instances have occurred in which departure was prohibited for several years, since the legal process can be both lengthy and complex. The Consular Section of the U.S. Embassy in Manama maintains a list of local attorneys capable of representing Americans.
Please see our Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Persons violating Bahrain’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for breaking the law can be more severe than in the United States for similar offenses. Disrespect to officials in word or deed can result in heavy fines. Travelers who are driving should be aware that one drink may be sufficient grounds for a DUI arrest. Penalties for possession, use, or trafficking in illegal drugs in Bahrain 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 Bahrain 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 Bahrain. 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 Bldg. 979, Road no. 3119, Zinj District (next to Al Ahli Sports Club). The mailing address is P.O. Box 26431, Manama, Bahrain. The telephone number is (973) 1724-2700. The after-hours number is (973) 1727-5126. The Consular Section’s fax number is (973) 1725-6242. The Embassy's web site, which includes consular information and the most recent messages to the American community in Bahrain is at http://bahrain.usembassy.gov/. The workweek in Bahrain is Sunday through Thursday.
* * *
This replaces the Country Specific Information for Bahrain dated November 23, 2007 without substantive changes.

Travel News Headlines WORLD NEWS

Date: Mon, 2 Oct 2017 19:26:47 +0200

Dubai, Oct 2, 2017 (AFP) - A "terrorist explosion" during a Shiite procession commemorating Ashura lightly wounded five policemen on Monday, the interior ministry in Sunni-ruled Bahrain announced.   "A terrorist explosion caused five light injuries among policemen deployed as security for a procession along Budaiya Avenue" in western Manama, a tweet from the ministry said.

Shiites in the tiny Gulf kingdom mark Ashura with processions in Manama and in villages around the capital.   The annual Ashura commemorations mark the killing of Imam Hussein by the forces of the Caliph Yazid in 680 AD -- a formative event in Shiite Islam.   Imam Hussein's death was part of a dispute over who should succeed the Prophet Mohammed, which eventually developed into a bitter schism between the Sunni and Shiite branches of Islam.

Bahrain, home to the US Fifth Fleet, has seen sporadic violence since the repression in 2011 of a protest movement by the Shiite majority, demanding a constitutional monarchy and an elected prime minister.   Hundreds of protesters, mainly but not all Shiites, were arrested and sentenced to lengthy prison terms for their role in the demonstrations.   Bahrain says it does not discriminate towards the country's Shiites, and regularly accuses Shiite Iran of meddling in its internal affairs, an allegation Tehran denies.
Date: Sun, 26 Feb 2017 20:11:48 +0100

Dubai, Feb 26, 2017 (AFP) - Four Bahraini policemen were wounded in a bomb attack Sunday near the village of Jaw, south of the capital Manama, the interior ministry said.   "Terrorist blast in police bus near Jua village. 4 policemen injured and they are in a stable condition. Necessary steps are being taken," the ministry said on its Twitter account.   It gave no further details.

On January 1, gunmen attacked the prison in Jaw, killing a policeman and allowing 10 inmates to escape.   Shiites convicted over anti-government protests in Sunni-ruled Bahrain were held at Jaw.   Tiny but strategic Bahrain, home to the US Fifth Fleet, has been rocked by unrest since the authorities crushed Shiite-led protests in 2011 demanding a constitutional monarchy and an elected prime minister.

Hundreds of Shiites have been arrested and many have faced trials over their role in the demonstrations.   One of those on trial is Sheikh Issa Qassem, the country's Shiite spiritual leader.   He was stripped of his citizenship last year for "serving foreign interests" -- a reference to Shiite Iran.   On Sunday, clashes broke out between security forces and protesters in several Shiite villages as a new hearing in Qassem's case was underway, witnesses said.   Protesters chanted anti-government slogans and carried portraits of Qassem, they said.
Date: Wed, 15 Feb 2017 11:55:11 +0100

Dubai, Feb 15, 2017 (AFP) - An explosion wounded two civilian passers-by in Bahrain, the interior ministry said early Wednesday, as demonstrators were marking the sixth anniversary of an anti-government uprising that was bloodily suppressed.   The ministry did not say what caused Tuesday evening's blast in a village outside the capital Manama but demonstrators sometimes throw petrol bombs during the sporadic protests that still grip the Sunni-ruled but Shiite-majority kingdom.   "Terrorist blast in Sitra causes minor injuries to a married couple passing the site. Police at the scene," the ministry said on its Twitter account without elaborating.   It also tweeted a picture of a black 4X4 with a shattered windscreen and significant damage to the front bonnet.   The blast came as demonstrators clashed with police in Manama and several nearby villages.   The demonstration in the capital ended when police fired tear gas and stun grenades, witnesses said.

Activists posted pictures of injured protesters online, but the interior ministry has not published any official statements about the reported demonstrations.   The Shiite-led protests of February 2011 sought a constitutional monarchy and an elected prime minister to replace the current government dominated by the ruling Al-Khalifa family.   Authorities crushed them the following month with the support of Saudi-led forces who secured key installations.   Since then, the authorities have banned the Shiite opposition and handed long jail terms to many of its leaders. Some have been stripped of their citizenship.   Tiny but strategic Bahrain lies just across the Gulf from Iran and is home to the US Navy's Fifth Fleet.
Date: Thu, 19 May 2016 21:53:48 +0000
From: Dr Manaf Alqahtani <drmanaf@gmail.com> [edited]
BDF Hospital, Bahrain
-----------------------------------
Measles is a highly infectious virus that spreads easily from person to person through the air, through breathing, coughing and sneezing. Although measles is largely considered a disease of children, we have noticed increasing numbers of adults infected. Since 9 May 2016, we had a total of 7 cases with measles. 4 were adults (30-40 years old) and 3 children (less than 12 months old). All adults were Bahraini (3 originally born in Yemen and one in Pakistan). All of the adults either have no documentation of MMR or received one dose MMR only.

Regarding the 3 children with measles, all were non-vaccinated and got infected from their infected adult family member.

3 out of 7 cases needed to be admitted for hydration and symptomatic treatment. Luckily, all our HCWs [health care workers] have documented 2 doses of MMR.

In the 2014 measles outbreak in Bahrain, 32 cases were registered, of which 27 were among children under 15 years and 5 among adults. Of the total, 14 cases were detected among expatriates.

Bahrain and the other member states of the EMR [Eastern Mediterranean Region] adopted a resolution for elimination of measles from the region by 2010. In 1996, the Ministry of Health (MOH) developed a plan for measles elimination that included a revised measles immunization schedule, introduction of case-based surveillance, and annual immunization campaigns of school children.

Most of recent measles cases are imported.
------------------------------
Dr. Manaf Alqahtani
BDF Hospital
Bahrain
=================
[ProMED thanks Dr. Alqahtani for sending this information.

Also see: JS Jawad et al. Toward Measles Elimination in Bahrain -- A Middle East Country Experience. The Journal of Infectious Diseases 2011;204:S299-S304

"Abstract
---------
Measles was a leading cause of infant and child morbidity and mortality in Bahrain before the introduction of measles vaccine in 1974. With the establishment of the Expanded Program on Immunization (EPI) in 1981 and the introduction of a 2nd dose of measles vaccine in 1985, coverage for 1st and 2nd doses of measles vaccine increased to 94 percent by 1997 and has been sustained greater than 97 percent since 2001. Measles, mumps, and rubella (MMR) immunization campaigns targeting 12-year-old students were conducted annually during 1998-2006 and achieved coverage of greater than 95 percent. As a result, the incidence of measles in Bahrain has declined markedly over the past 4 decades, to 2.7 cases per million persons in 2009. Recent confirmed measles cases have occurred sporadically, in under-vaccinated children or in infants too young or adults too old to receive measles vaccine. Bahrain has made significant progress toward measles elimination by sustaining high immunization coverage and strengthening case-based measles surveillance activities. Further success will depend on improved identification and immunization of under-vaccinated expatriate workers and their families."

A map of Bahrain can be accessed at <http://healthmap.org/promed/p/127>.
Bahrain is an archipelago in the middle of the Arabian Gulf encompassing 33 islands, the largest of which is Bahrain Island. - ProMED Mod.LK]
Date: Fri 6 Nov 2015
Source: Reuters [edited]

A cholera outbreak in Iraq has spread to Kuwait and Bahrain, and risks turning into a region-wide epidemic as millions of pilgrims prepare to visit the country, UNICEF's Iraq director has said. The disease, which can lead to death by dehydration and kidney failure within hours if left untreated, was detected west of Baghdad in September 2015 and has since infected at least 2200 people in Iraq and has killed 6.

"It [the outbreak] already has a regional dynamic and the risk of that can only be increased by people from all over the region coming into Iraq," UNICEF country director, Peter Hawkins, said on Thu 5 Nov 2015. Hawkins said cholera had spread to Bahrain, Kuwait and Syria, but in a later statement, UNICEF said the cases in Syria were not confirmed: "However, given the scale of the outbreak in Iraq the risk of cholera spreading across Iraq's borders remains high," it said.

Millions of Shi'ite Muslims are due to visit Iraq in December for Arbaeen, a religious ritual marking the end of an annual mourning period for the Prophet Mohammad's grandson Hussein, whose death in 680 AD entrenched the schism between Shi'ites and Sunnis.

Hawkins said UNICEF was working with clerics in the Shi'ite shrine cities of Najaf and Kerbala to convey information about how to guard against cholera, which is endemic in Iraq and the wider region. The outbreak can be traced to a number of factors including low water levels in the Euphrates and winter flooding that has contaminated the river and shallow wells with sewage water.

The war against [the so-called] Islamic State militants who control large swathes of territory in northern and western Iraq has also contributed to the outbreak. The conflict has displaced more than 3 million people, with many living in camps where conditions are conducive to the spread of cholera -- a bite of contaminated food or a sip of contaminated water is enough to cause infection.

Hawkins said UNICEF has only limited access to areas controlled by Islamic State, which swept across the Syrian border in mid-2014 in a bid to establish a modern caliphate.

Higher military expenditure and other costs associated with the battle against Islamist militancy has aggravated a cash crunch for Iraq, a major OPEC oil producer that has suffered from the drop in global crude prices over the past year. A higher proportion of the government budget is also being spent on security at the expense of other services and infrastructure such as water supply, Hawkins said.

1 in 5 of the confirmed cases in Iraq is among children, and in large parts of the country the start of the school year was delayed by a month as a precaution, UNICEF said in a statement. In response to the outbreak, UNICEF is providing bottled water, oral rehydration salts and installing community water tanks, but like most humanitarian operations in Iraq it is severely underfunded.  [byline: Isabel Coles]
=====================
[The conflicts in the Middle East have exacerbated the endemic cholera in Iraq, and it has spread beyond Iraq's borders. The number of cases of cholera in Kuwait and Bahrain are not reported, nor is it clear whether the cases were acquired in these countries or imported. UNICEF has not confirmed any cases in war-torn Syria, but there are informal reports circulating. - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
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World Travel News Headlines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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