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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: Tue, 22 Oct 2019 09:57:15 +0200 (METDST)
By Tupad POINTU

La Paz, Oct 22, 2019 (AFP) - Bolivia braced for a general strike on Tuesday hours after violence broke out in several cities when the main opposition candidate rejected presidential election results that seemed set to hand a controversial victory to long-time incumbent Evo Morales.   Opposition supporters reacted with fury, torching electoral offices in the southwestern cities of Sucre and Potosi, while rival supporters clashed in the capital La Paz.    Incidents were reported in cities across the South American country.   Carlos Mesa, who came a close second to Morales in Sunday's polls -- forcing a run-off, according to preliminary results -- denounced revised results released by election authorities as a "fraud."   "We are not going to recognize those results that are part of a shameful, consumated fraud, that is putting Bolivian society in a situation of unnecessary tension," said Mesa.

International monitors from the Organization of American States voiced "deep concern" at sudden changes to the election count to show Morales closing in on an outright victory in the first round.   Preliminary results released late Sunday showed neither Morales, 59, nor 66-year-old Mesa with a majority and "clearly indicated a second round," the OAS mission said.   The partial results put Morales in the lead with 45 percent of the votes, with Mesa on 38 percent, meaning Morales would have to contest a run-off for the first time.   But results released late Monday, after a long and unexplained delay, showed Morales edging towards an outright victory with 95 percent of the votes counted.   Mesa, a former president of the country between 2001-2005, accused Morales of colluding with the Supreme Electoral Tribunal (TSE) to tweak delayed results and avoid a run-off.

- Opposition call general strike -
The call for a general strike was issued by Fernando Camacho, head of an influential civil society organization in Bolivia's biggest city, Santa Cruz, where transport and businesses were expected to shut down from noon.   "Tomorrow we start at 12:00 to block this country," Camacho told opposition demonstrators late Monday, before holding talks with leaders from other regions.   Long lines formed at gas stations amid fears of shortages.   Riot-police dispersed a crowd who tried to storm the electoral offices in the Andean city of Oruro, south of La Paz.    Clashes were also reported in Tarija in the south, Cochabamba in the center and Cobija in the north.

- 'Subverting democracy' -
The United States' top diplomat for Latin America said the Electoral Tribunal was attempting "to subvert Bolivia's democracy by delaying the vote count and taking actions that undermine the credibility of Bolivia's elections."   "We call on the TSE to immediately act to restore credibility in the vote counting process," the official, Michael Kozak, said on Twitter.   The OAS observer mission in the country expressed "surprise at the drastic and hard-to-explain change in the trend of the preliminary results revealed after the closing of the polls," it said in a statement.   It urged the election authority to "firmly defend the will of the Bolivian people" and called for calm on the streets.   "It is extremely important that calm is maintained and any form of violence is avoided in this delicate situation."

- Longest serving president -
Morales, Latin America's longest-serving president, is controversially seeking a fourth term.   He obtained Constitutional Court permission in 2017 to run again for president even though the constitution allows only two consecutive terms.   The former coca farmer and leftist union leader has led the poor but resource-rich Latin American country for the past 13 years, though his popularity has waned amid allegations of corruption and authoritarianism.   He has led the country since taking office in 2006, when he became its first indigenous president.

A new mandate would keep him in power until 2025.   As leader of his Movement for Socialism Party (MAS), Morales points to a decade of economic stability and considerable industrialization as his achievements, while insisting he has brought "dignity" to Bolivia's indigenous population, the largest in Latin America.   He has come under severe criticism this year as wildfires in August and September ravaged Bolivia's forests and grasslands, with activists saying his policies encouraged the use of blazes to clear farmland.
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:
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: Wed 30 Oct 2019
Source: Phys.org [abridged, edited]

In the southern African nation of Malawi trypanosomiasis, or sleeping sickness, has caused residents to become ill from tiny parasites [trypanosomes] which are spread by the bite of the tsetse fly. The relocation of hundreds of elephants to Malawi's largest wildlife reserve was meant to be a sign of hope and renewal in this southern African nation. Then nearby residents began falling ill.

The cause of the headaches, weakness, and pain were trypanosomes spread by the bite of the tsetse fly -- a companion of the elephants. Trypanosomiasis, or sleeping sickness, is the result. Authorities said the Nkhotakota Wildlife Reserve has seen a surge in tsetse fly numbers since around 2015 when the elephants and other game animals were reintroduced.

The local hospital said it did not have a number of sleeping sickness cases. One community resident recalled at least 5 deaths from the disease.

The World Health Organization says sleeping sickness is endemic in 36 countries in sub-Saharan Africa but cases have been dropping. Last year [2018] just under 1000 cases were recorded, a new low. The majority of cases are reported in Congo.

Dr Janelisa Misaya, a Malawi College of Medicine principal investigator, underscored the need to control the tsetse fly population. "One tsetse can actually infect a lot of people at once," she said. "So we don't want to take chances." Some villagers expressed concern about the reintroduction of wildlife and the enlargement of the nearby reserve.

The African Parks field operations manager for the reserve, David Robertson, acknowledged that the reintroduction of animals in 2015 led to an increase in tsetse flies. "It is a bit ironic because it is a negative symptom of the success we are having," he said. "By increasing animal numbers, one of the unfortunate consequences could be an increase in tsetse fly numbers. Even though they are a natural part of the system, they contribute to biodiversity." The tsetse flies are something the parks workers need to manage differently, Robertson said. "We don't want to have neighboring communities or tourists to the park having an unpleasant experience or dangerous experience though contact with tsetse flies so we will do our best to manage that in the future."

To address the problem, African Parks in collaboration with Malawi's government has introduced pesticide-impregnated targets and traps that attract the flies. So far 600 have been placed in the wildlife reserve. They are placed near the edge of thickets in areas that will receive morning and evening light but are shaded from the most intense sunlight during midday hours. The area surrounding each is slashed and cleared with hoes to produce a firebreak to protect it from occasional wildfires.

Controlling the flies and animal populations are ways to help fight the disease. More assertive diagnosis and treatment are others. Local medical personnel are receiving more training to screen for and diagnose trypanosomiasis. The community has benefited from African Parks' support for screening efforts, said Tenson Mkumbwa, deputy lab manager at the Nkhotakota District Hospital. "This leads to early diagnosis and treatment," he said.  [byline: Kenneth Jali]
=====================
[ProMED-mail thanks John Frean and Lucille Blumberg for information on trypanosomiasis in wildlife, including elephants.

Many African game animals, including elephants, are reservoirs of _Trypanosoma brucei_. Antelopes are usually emphasised as the most important reservoirs rather than elephants.

The "less than 1000 cases/year" mostly refers to West African trypanosomiasis, which has a different epidemiology and a mainly human population reservoir. There are probably only about 100 cases of East African trypanosomiasis per year (Molyneux DH, Ashford RW. The Biology of _Trypanosoma_ and _Leishmania_. Parasites of Man and Animals. London: Taylor and Francis, 1983. pp. 140-43).

The vector, _Glossina_ spp. or tsetse flies feed on man, and a wide variety of domesticated and wild animals, reptiles, and birds. Thus it seems that it is the overall repopulation of the game reserve with wildlife that is responsible for an increase in the number of tsetse flies and the increase in human cases of trypanosomiasis. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Malawi:
Date: Thu, 24 Oct 2019 14:58:29 +0200 (METDST)

Lilongwe, Malawi, Oct 24, 2019 (AFP) - A pay strike by truckers in landlocked Malawi has crippled oil and power supplies, leading to prolonged blackouts and fuel shortages on Thursday.   Over 1,000 truck drivers stopped work from Monday, preventing all lorries from entering and exiting the country's borders with Zambia, Mozambique and Tanzania.

Their leader Richard Jubeki said the drivers are demanding a giant wage increase to push monthly salaries from the current $40 (35 euros) to $450.   "We have closed all the borders across the country for trucks to try and force our employers to increase our wages," Jubeki said.   As of Thursday morning, government and trucking companies' representatives were still locked in negotiations.    An outcome is expected soon as Malawi relies on road transport to move goods mainly from the ports of Dar es Salaam in Tanzania and Beira in Mozambique.   By Wednesday, the effects of the strike were felt by the 18 million population, particularly in the capital city Lilongwe where motorists were stranded after fuel stations ran dry.   "I spent the better part of today driving around the city looking for petrol but I have been unsuccessful. This is not on," Lilongwe resident Patrick Banda said. 

The protest has also disrupted power generation as the Electricity Supply Commission of Malawi (Escom) sources some of its power from diesel-powered generators.   The company said its tankers carrying diesel from the National Oil Company of Malawi (NOCMA) fuel depot to diesel generators were barred from passing through.   "Massive load-shedding will result," it said in a statement.   Most parts of the country experienced 8-hour long blackouts on Wednesday.    The state-owned oil firm told AFP there were adequate local "strategic fuel reserves".   But spokesman Telephorous Chigwenembe said the responsibility of ensuring that this fuel is available to on the market rests with the power regulatory body -- the Malawi Energy Regulatory Authority.
Date: Fri 18 Oct 2019
From: Lucille Blumberg <lucilleb@nicd.ac.za> [edited]

East African trypanosomiasis has been confirmed in an expatriate wildlife researcher working in the Vwaza Marsh Game Reserve, Malawi. The patient presented with an acute febrile illness and a typical chancre. A scanty parasitaemia was noted. The patient is being treated with suramin in a Johannesburg hospital. This is the 2nd case admitted here in the past week with infection acquired in Vwaza Marsh Game Reserve.

The ProMED commentaries about recent cases have suggested that trypanosomiasis is endemic in all southern African game reserves, which is not accurate. The most southern extent of trypanosomiasis is the Zambezi River valley, between Zambia and Zimbabwe. East African trypanosomiasis patients evacuated to Johannesburg in 2018 and 2019 acquired the infection in Malawi, Uganda, and Zambia.
--------------------------------------
Lucille Blumberg
<lucilleb@nicd.ac.za>
John Frean
National Institute for Communicable Diseases
GeoSentinel
Johannesburg, South Africa
Evan Shoul
Infectious disease specialist
=====================
[ProMED thanks Lucille Blumberg, John Frean and Evan Shoul for submitting this report, the 2nd case within a week from the Vwaza Marsh Game Reserve. - ProMED Mod.EP]

[HealthMap/ProMED-mail maps:
Date: Mon 14 Oct 2019 8:25 AM SAST
From: John Frean  <johnf@nicd.ac.za> [edited]

East African trypanosomiasis (EAT) has been confirmed in an expatriate working in conservation research in the Vwaza Marsh Game Reserve, Malawi. The patient had worked with the expatiate volunteer who died in December 2018 after having contracted EAT. The patient developed an acute febrile illness and a typical trypanosomal chancre, and sought medical care. She has been transferred to a Johannesburg hospital for treatment. Profound thrombocytopenia, jaundice, and hepatic and renal dysfunction were noted. Initial doses of suramin have been commenced.
-----------------------------------------
Lucille Blumberg
John Frean
<johnf@nicd.ac.za>
National Institute for Communicable Diseases, and Geosentinel Site,
Johannesburg
Evan Shoul (infectious diseases specialist)
=======================
[ProMED-mail thanks Lucille Blumberg, John Frean, and Evan Shoul for their submission. African trypanosomiasis is endemic in the game reserves of southern Africa. Cases are reported regularly, usually evacuated from the country of infection to South Africa. African trypanosomiasis (sleeping sickness) should be suspected in persons visiting the game reserves in southern Africa if tested malaria negative. - ProMED Mod.EP]

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

Israel

General Information:
***************************************
The Middle East is a favourite destination for many Irish holiday makers. The combination of a beautiful climate linked with such historical richness is hard to beat. Unfortunately the
security situation throughout the region has led to some significant concerns over the years. Nevertheless, in the vast majority of cases those visiting the region will not encounter any particular concerns in this regard. It is a wise precaution to ensure that your passport is valid for at least a further six months beyond the time of your holiday as otherwise you may be refused entry.
Security Situation:
***************************************
Security throughout the Middle East is generally tight. Carry some means of identification at all times in case you are requested to produce it by police or army personnel. In Jerusalem the city has been divided and it is sensible to remember which quarter you are in at all times.
Health Facilities:
***************************************
Generally the health facilities throughout the region are excellent. However, when visiting certain rural regions you may find it difficult to obtain hospital care similar to that at home. In Israel, travellers can find information in English about emergency medical facilities and after-hours pharmacies in the "Jerusalem Post" and English language "Ha'aretz" newspapers.
Food & Water Facilities:
***************************************
Again, this depends on your location and the facilities which are there at the time of the year you visit. Bottled water is easily available and food hygiene is usually excellent throughout all the main tourist destinations. However, it is generally wiser not to drink hotel tap water and only to use it for brushing your teeth if there is a clear smell of chlorine. When on organised trips tourists are sometimes offered local tea or other drinks. Generally this will be safe as the water is boiled but take care that the cup hygiene is acceptable.
Sun Exposure:
***************************************
The climatic conditions in the Middle East vary considerably throughout the year. Many tourists visit in late autumn or early spring. At these times the climate is much cooler and the evenings can be distinctly chilly. However, during the main tourist season (May to September) the temperatures rise high into the 80’s or 90’s and dehydration can easily occur. Increasing fluid and salt intake is important under these circumstances. It is essential that travellers are aware of the climatic conditions which should be present for their trip and that sensible clothing is used at all times.
Rabies:
***************************************
Tourists should avoid all animals as this viral disease is transmitted through the bite, lick or scratch of any infected warm blooded animal. In Israel the most common animals involved are foxes and jackals and in Jordan, dogs tend to be the main culprits.
Exploring the Region:
***************************************
Leaving the main tourist routes is unwise. There are a number of security risks which have to be considered and there are also significant health concerns which may be encountered. In July 2000 an 18 year old American tourist died of sunstroke when she became separated from her group in the Dead Sea region of Israel. Those exploring caves and parts of the desert areas also run the risk of diseases like Borreliosis and Rabies.
Walking & Trekking:
***************************************
For many going to these countries their trip will involve visiting some of the major ruins and archeological sites. This will involve a good deal of walking and trekking. Good supporting foot wear is essential and it would be wise to carry a crepe bandage in case of a sprained ankle. Having a suitable painkiller or anti-inflammatory medication would also be advantageous. Check your health will be up to the journey.
Swimming:
***************************************
Pools are usually very well maintained and the risk of disease is small. Those swimming in the sea should remember that the Mediterranean is home to many jelly fish. Swim with others and never alone and especially after alcohol or a heavy meal.
Anthrax:
***************************************
This bacterial disease is rare in the Middle east though travellers should be aware that it can be transmitted through unprepared leather goods usually bought in the local market places. Typically the disease may then present with a black ulcerated skin lesion.

Malaria:
***************************************
Fortunately this disease does not occur in Israel or Jordan. However other mosquito and sandfly diseases do occur and so protection against their bites should be used when necessary.
Hepatitis:
***************************************
There are many forms of this disease but the most common is Hepatitis A, often known as Infectious Jaundice. This disease can keep an infected individual off work for many weeks and it is wise to consider vaccination cover before exposure. In Israel approx 65% of the population will have been infected before 18 years of age.
Vaccinations:
***************************************
There are no essential vaccines for entry/exit however most Irish tourists are recommended to receive cover against; Poliomyelitis, Typhoid, Tetanus and Hepatitis A. Those living in these countries or planning an extended trip should also consider cover against Hepatitis B and Rabies.
Summary:
***************************************
Due to the unrest within Israel there are concerns regarding the safety of tourists at this time. If you are travelling to this region it is wise to ensure that your insurance policy is sufficient if your circumstances or travel plans change.

Travel News Headlines WORLD NEWS

Date: Thu 5 Sep 2019
Source: Newsweek [abridged, edited]

The Israeli Health Ministry recorded more than 4300 cases between July 2018 and July 2019, representing a monumental uptick from the year prior, when only about 30 cases were reported.

A 43-year-old flight attendant with El Al died last month [August 2019] after reportedly contracting measles from a passenger in March [2019].

[She] was admitted to Petah Tikva's Rabin Medical Center-Beilinson Campus with a high fever, then fell into a coma and had to be placed on a respirator. Tests indicated she had been vaccinated against the measles with only a single shot, instead of the recommended 2.

The Health Ministry also issued warnings this year [2019] about potential measles exposures on El Al flights from London and Thailand, at medical centers, public transportation stops and at Eilat's Underwater Observatory Marine Park.

Despite the outbreaks, Israel's immunization rates are among the highest in the world: According to The World Bank, 98% of Israeli children between 12 and 23 months have measles vaccinations.

The immunization gap, say health experts, is within the country's Haredi, or ultra-Orthodox, population. Israel's measles outbreak began in March 2018 in a Haredi community in Safed in northern Israel.

But the lack of vaccinations isn't because of any religious prohibition. "In general, those closed communities use our health care system much less than nonreligious people," Dr. Roy Zucker, a specialist in internal medicine in Israel, told Newsweek.

As of July 2019, there have been more than 1400 cases reported in Jerusalem, plus 400 in Beit Shemesh, 279 in Safed and 212 in Bnei Brak -- all of which have heavily Orthodox populations.  [Byline: Daniel Avery]
Source: Arutz Sheva 7 [edited]
Date: Tue 13 Aug 2019

A stewardess of Israel's El Al airline died Tuesday [13 Aug 2019], following a months-long battle with measles. The 43-year-old stewardess was infected with the measles virus during a flight from New York to Israel 5 months ago.

After she was infected, the stewardess was hospitalized in serious condition at Meir Medical Center in Kfar Saba in central Israel after she was found unconscious and struggling to breathe. During her hospitalization, the stewardess' condition deteriorated, and she was transferred to the quarantine section of the hospital's intensive care wing.

On Tuesday [13 Aug 2019], doctors at Meir hospital declared her death, following the 5-month struggle.  [Byline: Orly Harari]
===========================
[This is a very sad outcome, and our condolences go out to the family of the flight attendant, who worked for El Al, the Israeli national airline. It is not clear whether she contracted the virus in New York, in Israel, or on a flight between the two locations. The flight attendant received only one dose of the measles vaccine when she was a child. It wasn't discovered until later that one dose is only about 93% effective. More recently -- in the USA, starting in 1989 -- children have been given 2 doses, which is about 97% effective, according to the CDC. See Measles update (27) http://promedmail.org/post/20190418.6429834 for an earlier report on the flight attendant. - ProMED Mod.LK]
Date: Wed, 14 Aug 2019 17:55:43 +0200 (METDST)

Jerusalem, Aug 14, 2019 (AFP) - An Israeli flight attendant has died months after contracting measles on a flight from New York to Tel Aviv, Israel's health ministry and local media said Wednesday.   Rotem Amitai, 43 and a mother of three, was hospitalised in March following the flight with Israeli airline El Al, Israeli media reported.

She died on Tuesday at a hospital near the coastal city of Tel Aviv, a hospital spokeswoman said.   The health ministry confirmed her death and said her condition had been complicated by encephalitis, inflammation of the brain.   "The immediate cause of death was not defined as measles," it said in a statement. "However, the disability (caused by) the disease was a secondary cause."

The World Health Organization said Tuesday that measles cases had nearly tripled globally during the first seven months of the year compared to the same period in 2018.   The global body warned against "misinformation about vaccines".   The so-called anti-vax movement -- driven by fraudulent claims linking the MMR vaccine against measles, mumps and rubella to a risk of autism in children -- has gained traction.

So far this year, 364,808 measles cases have been reported around the world, compared to 129,239 cases during the first seven months a year earlier -- the highest registered since 2006.   Amitai's death was the first related to measles in Israel this year, following two last year, according to the ministry.   The highly contagious disease can be entirely prevented through a two-dose vaccine.   Amitai had only received one dose, Israeli media reported.

The Democratic Republic of Congo, Madagascar and Ukraine registered the highest number of cases, WHO said.   The United States has registered 1,164 cases so far this year, up from 372 for the whole of 2018 and the highest number on record in a quarter-century.   Nearly 90,000 cases have been registered in Europe this year -- well above the 84,462 cases registered last year.   The airborne infection, which causes fever, coughing and rashes that can be deadly in rare cases -- had been officially eliminated in many countries with advanced healthcare systems.
Date: Fri, 26 Jul 2019 15:53:07 +0200

Jerusalem, July 26, 2019 (AFP) - A forest fire in northern Israel's Galilee region is threatening a church where Christians believe the transfiguration of Jesus took place, the fire service said Friday.    It said in a statement that the blaze broke out on Thursday and monks were evacuated from the  Basilica of the Transfiguration overnight.

Fanned by strong winds the flames still menaced the church on Friday afternoon, fire service spokesman Dudi Peretz told AFP.   "An additional front of the fire is at the moment advancing  toward the church," he said in Hebrew.   "The fire's centre is far from main roads and the topography of the area and difficulty of access are hindering the work of the firefighting teams."    He said that the church itself had so far not been damaged.   Police said that arson was not suspected.   Israel has been gripped by record high temperatures accompanied by drought and strong winds over the past week, with wildfires reported across the country.

The basilica, built in 1924, by the Roman Catholic Franciscan order, sits atop the wooded Mount Tabor at a site where the Christian gospels say that Jesus -- accompanied by disciples Peter, John and James -- glowed with light and spoke with the prophets Moses and Elijah.   Hundreds of thousands of pilgrims visit the church every year, according to the Franciscan Custody of the Holy Land, which oversees Roman Catholic properties in the area.   In a statement Friday it accused Israeli authorities of neglecting essential infrastructure at the site, failing to provide a proper water supply.   The fire, it said,"is a direct consequence of state negligence".
Date: Wed 17 Apr 2019
Source: Jerusalem Post [abridged, edited]

More than 2 million Israelis [population 8.2 million] are either unvaccinated or only partially vaccinated for the measles, according to a Channel 13 report. An outbreak of the measles has been worrying Israelis for months as it spread throughout the country, as well as in the rest of the world. But Israeli media reports on Tuesday night [16 Apr 2019] exposed the severity of the situation and the difficulty in solving the crisis.

The Health Ministry claims that it has only 115,000 doses of measles, mumps and rubella (MMR) vaccine available and 100,000 additional doses of the MMRV vaccine, which combines the diminished measles, mumps, rubella and varicella vaccine with the addition of chickenpox vaccine, according to Channel 13.

State comptroller Yosef Shapira has considered examining the Health Ministry's handling of the recent measles outbreak, according to a report released in January [2019].

The comptroller's office contacted infectious disease and public health experts and is working on compiling data about past efforts regarding the measles outbreak, examining if they were sufficient. However, no formal decision has been made so far over the next steps to take in combating the outbreak.

The ministry released a statement in the past warning the general public about the dangers of measles, including that one out of every 10 patients requires hospitalization after contracting the virus. Nearly 3% of hospitalized patients also have encountered issues with pneumonia. According to data presented at that time, 3 have contracted meningitis, and 2 measles cases resulted in fatalities.

The ministry has been facing intense criticism for its "ineffective" efforts in containing the outbreak. Critics cite the delayed start of vaccination efforts in the Jerusalem area, the city with the largest amount of unvaccinated people. Moreover, those born between 1957 and 1977 only received one dose of the measles vaccine and are only partially protected.

For years, the ministry has also not taken action against doctors who distributed false information about vaccines and has not worked to exhort the public to vaccinate their children. Finally, critics mentioned the lack of government support for Tipat Halav (early childhood clinics), where most infants receive their 1st vaccinations.

The measles surfaced due to the failure of thousands of parents to vaccinate themselves or their children, particularly among the Haredi (ultra-Orthodox) communities in Jerusalem, according to Health Ministry officials. Community leaders and rabbis in recent months have sent mobile units to entire neighbourhoods to vaccinate citizens living in the affected areas.

Several members of Knesset have reacted to the outbreak in the past.

The Health Ministry has since shown their inability to contain the outbreak within Israel's affected communities, and at the moment, there have been 2000 reported cases of Israelis who have contracted measles during the last few months, according to Israel Hayom.

The Health Ministry has not held any informational seminars to encourage these parents to immunize their children, and even though the Health Ministry offers to pay for these services, the parents still decline them just the same, according to Israel Hayom.  [Byline: Zachary Keyser]
More ...

Travel News Headlines WORLD NEWS

More ...

World Travel News Headlines

Date: Mon, 18 Nov 2019 08:37:15 +0100 (MET)

Jakarta, Nov 18, 2019 (AFP) - An endangered Sumatran Tiger has mauled to death an Indonesian farmer and seriously injured a domestic tourist, a conservation official said Monday.   The fatal attack happened Sunday at the farmer's coffee plantation on Sumatra island where the 57-year-old wrestled with the big cat before it killed him, according to Genman Hasibuan, head of the South Sumatra conservation agency.   "The farmer was attacked while he was cutting a tree at his plantation," he told AFP on Monday.   The mauling came a day after the same tiger attacked a group of Indonesian tourists who were camping at a local tea plantation in South Sumatra's Mount Dempo region.

One of the tourists was rushed to hospital for wounds to his back after the cat stormed into his tent, Hasibuan said.   The animal, which remains loose in the protected-forest area, is believed to be one of just 15 critically endangered tigers in South Sumatra, which has seen five tiger attacks this year, including two fatal incidents, Hasibuan said.

Human-animal conflicts are common in the vast Southeast Asian archipelago, especially in areas where the clearing of rainforest to make way for palm oil plantations is destroying animals' habitats and bringing them into closer contact with people.   In March last year, a man was killed by a tiger in Sumatra's Riau province while several months earlier a tiger also killed a plantation worker in the area.   Sumatran tigers are considered critically endangered by protection group the International Union for Conservation of Nature, with 400 to 500 remaining in the wild.
Date: Fri, 15 Nov 2019 17:12:24 +0100 (MET)

Karachi, Nov 15, 2019 (AFP) - Pakistan has become the first country in the world to introduce a new typhoid vaccine, officials said Friday, as the country grapples with an ongoing outbreak of a drug-resistant strain of the potentially fatal disease.   The vaccine, approved by the World Health Organization (WHO), will be used during a two-week immunisation campaign in southern Sindh province.

Sindh is where most of Pakistan's 10,000 cases of typhoid have been documented since 2017.    "The two-week campaign beginning from today would target over 10 million children of nine months to 15 years of age," Azra Pechuho, the health minister in Sindh province, said in Karachi on Friday.   The new vaccines have been provided by Gavi, the Vaccine Alliance, to the Pakistani government free of cost.

After the two-week campaign, it will be introduced into routine immunisations in Sindh, and in other areas of Pakistan in the coming years.   Pakistan spends a meagre amount of its national resources on public health and a majority of its population remains vulnerable to contagious diseases such as typhoid.   In 2017, 63 percent of the typhoid cases documented and 70 percent of the fatalities were children, according to a joint press release from the Pakistani government, WHO and Gavi.
Date: Sat, 16 Nov 2019 05:50:25 +0100 (MET)
By Abhaya SRIVASTAVA

New Delhi, Nov 16, 2019 (AFP) - A thick grey smog choked New Delhi for the fifth day Saturday, adding to a mounting pollution health crisis, but retired naval commander Anil Charan is one of the vast majority of the city's 20 million inhabitants who do not wear a mask.   Indian media is packed with warnings about the risk of premature death, lung cancer and particular danger to children from PM2.5 -- tiny particles that get into the bloodstream and vital organs -- carried in the smog.   But the smartly-dressed Charan was among shoppers in Delhi's upmarket Khan Market district browsing the luxury clothes and jewellery stores without a mask, seemingly oblivious to the risk.   Many are too poor to afford protection but others simply do not like the way a pollution mask looks.

Charan, wearing aviator sunglasses, said it did not fit his "rough and tough" image.   "I have been brought up in this kind of atmosphere, the smog and all, so I am kind of used to it. And being a naval officer I think if I wear a mask I will think I am a sissy," he said.   Doctors say face masks must be worn and air purifiers used at home and in offices.   There are a variety of masks to choose from. A basic cloth version can cost as little as 50 rupees (70 US cents) but the protection they offer is debatable.    More reputable types start from 2,500 rupees ($34) while some Khan Market stores charge more than 5,500 rupees ($75) for top of the range imported models.

- Bare-faced bravado -
The mask-look worried a lot of the Khan Market shoppers and diners however. Some said the danger had been overblown.   "I know I am risking my health but I am not very comfortable wearing them (masks)," said Ritancia Cardoz, who works for a private company.   "I don't find it appealing," she told AFP.   Lopa Diwan, on a visit to the capital from the provinces, said the Delhi air was "not as bad as it is being made out to be."   "So many people advised me not to go to Delhi because of the pollution but I don't think it's that bad. I don't see people dying," she said.

Pollution -- blamed on industrial and car emissions mixed with stubble fires on thousands of farms surrounding the city -- has been building up each winter for the past decade. The past five years have been particularly bad.   The toxic air cuts short the lives of one million people in India every year, according to government research published earlier this year.    Concentrations of the most harmful airborne pollutants in Delhi are regularly about 20 times the World Health Organisation safe limit. That rams home the city's reputation as the world's most polluted capital.   Some foreign companies and embassies now do not let families move to Delhi, or at least give strong warnings about the pollution.

The Delhi government has given out hundreds of thousands of masks to children and closed schools for four of the past five days. Construction is banned and cars can only go on the roads on alternate days.   But still only a tiny number of inhabitants follow medical advice when outside. Rickshaw drivers who earn about $7 a day on an average say they cannot afford masks.   Chand Babu, a car park attendant at Khan Market, said he could buy one of the cheaper masks but it was too much of a hassle to wear.   "I have to blow the whistle all the time so it's inconvenient."   Babu does worry, however, about his three children who also do not have masks. "They go outside to play. The problem is real, but what do we do, tell me?"
Date: Sun, 17 Nov 2019 14:28:44 +0100 (MET)
By Filippo MONTEFORTE with Charles ONIANS in Rome

Venice, Nov 17, 2019 (AFP) - Venice's St Mark's Square was closed on Sunday as the historic city suffered its  third major flooding in less than a week, while rain lashing the rest of Italy prompted warnings in Florence and Pisa.   Venice's latest "acqua alta", or high water, hit 150 centimetres (just under five feet) on Sunday, lower than Tuesday's 187 centimetres -- the highest level in half a century -- but still dangerous.   "The water has stopped rising," tweeted mayor Luigi Brugnaro, who has estimated damage so far from the invading salt water at over one billion euros (dollars).   "High of 150 centimetres... Venice is working to restart," Brugnaro said after the sea water swamped the already devastated city where authorities have declared a state of emergency.   To the south, Tuscany president Enrico Rossi tweeted a warning of a "flood wave" on the Arno and said boards were being installed on the swollen river's banks in Pisa "as a precautionary measure".

The Italian army tweeted photos of paratroopers helping to bolster river defences in Pisa, with authorities monitoring the same river in Florence after heavy rain made it rise dramatically overnight.   Arno flooding devastated Renaissance jewel Florence in 1966, killing around 100 people and destroying thousands of priceless works of art. Civil protection units in Florence advised citizens "not to stand near the Arno's riverbanks".   Firefighters tweeted footage of a hovercraft being deployed to rescue stranded citizens in southern Tuscany's Grossetano province.

- Brief respite -
The renewed threat from exceptionally high tides in Venice came after a brief respite on Saturday.   Emergency workers removed temporary walkways from St Mark's Square as the water started to rise on Sunday, with only police and soldiers visible at around midday.   The top tourist site had already been shut for several hours on Friday as strong storms and winds battered the region, leaving it submerged by sea surges.

Churches, shops and homes have also been inundated in the Renaissance city, a UNESCO World Heritage site.   A massive infrastructure project called MOSE has been under way since 2003 to protect the city, but the multi-billion euro project has been plagued by cost overruns, corruption scandals and delays.   "We weren't expecting the high waters to be so exceptionally high," said Guido Fulgenzi, who had planned to open his cafe on St Mark's square this week.   "We're paying the price" for the MOSE project not being completed, he said, sloshing around in his flooded kitchen and pointing to Tuesday's high water mark on the wall.   The crisis has prompted the government to release 20 million euros ($22 million) in funds to tackle the devastation.   Culture Minister Dario Franceschini has warned that the task of repairing the city, where more than 50 churches have suffered damage, will be huge.

- Hotel reservations cancelled -
Residents whose houses have been hit are eligible for up to 5,000 euros in immediate government aid, while restaurant and shop owners can receive up to 20,000 euros and apply for more later.   Most of the city's cash machines were no longer working, making life even more difficult for tourists and Venetians.   "We didn't expect there to be so much water, now we're soaked," said French tourist Magali Mariolou, visiting Venice for her wedding anniversary.   "We'll come back another year when it's a bit drier. The boots are heavy, they're full of water!"

Older residents who remember the infamous "acqua alta" of 1966, when the water rose to 1.94 metres, say they have not seen such frequent flooding before.   Hotels reported cancelled reservations, some as far ahead as December, following the widespread diffusion of images of Venice underwater.   Tuesday's high waters submerged around 80 percent of the city, officials said.   Many, including Venice's mayor, have blamed the disaster on global warming and warned that the country prone to natural disasters must wake up to the risks posed by ever more volatile seasons.   The Serenissima, as the floating city is called, is home to 50,000 residents but receives 36 million visitors each year.
Date: Mon, 18 Nov 2019 06:41:11 +0100 (MET)

Wellington, Nov 18, 2019 (AFP) - Samoa finalised plans for a compulsory measles vaccination programme Monday, after declaring a state of emergency as a deadly epidemic sweeps the Pacific nation.   At least six fatalities, including five children, have been linked to the outbreak of the virus, which has also hit other island states such as Tonga and Fiji.   Samoa is the worst affected with more than 700 cases reported from across all areas of the country, prompting the government on Friday to invoke emergency powers.

Declaring a state of emergency, the government said plans for compulsory measles, mumps and rubella (MMR) immunisations would be published on Monday.   "MMR vaccinations for members of the public who have not yet received a vaccination injection is now a mandatory legal requirement for all of Samoa," it said.   A national emergency operations centre to coordinate the measles response in the nation of 200,000 people was opened on Monday, with children aged six months to 19 years and non-pregnant females aged 20-35 given priority.

However, no information was immediately available on how the vaccinations would be administered or whether those who were not immunised would face sanctions.   Children are the most vulnerable to measles, which typically causes a rash and fever but can also lead to brain damage and death.   Samoa has closed all schools, kindergartens and the country's only university in a bid to halt the spread of the virus.   New Zealand, which is experiencing its own measles outbreak in the Auckland region, will this week send 30 nurses, 10 doctors and 3,000 MMR doses to Samoa.

University of Auckland immunologist Helen Petousis-Harris said even though measles was already widespread, the mass rollout of vaccinations could help limit the number of cases and reduce the death count.   She said it was also important to boost Samoa's low levels of immunisation and help prevent future outbreaks.   "In Samoa, the proportion of people who are immune to measles is very, very low, one of the lowest in the world," she told AFP.   "So if they aren't able to improve that, this is going to happen again."   The country's vaccination programme was briefly suspended last year when two babies died shortly after being given the MMR vaccine.   Subsequent investigations found the problem was not the widely used vaccine but the fact that nurses had prepared it incorrectly.

Neighbouring Tonga last week announced government primary schools and kindergartens would be closed until later this month as the number of measles cases in the kingdom approaches 200.   Fiji has reported four cases but says they are contained to a township west of the capital Suva.
Date: Sun, 17 Nov 2019 18:10:23 +0100 (MET)

Johannesburg, Nov 17, 2019 (AFP) - South African unions on Sunday called on all aviation workers to join striking South African Airways (SAA) staff after the cash-strapped airline failed to meet their demands.   The country's embattled flag carrier has been losing 52 million rand ($3.5 million) per day since more than 3,000 workers started an open-ended strike on Friday -- forcing the airline to cancel hundreds of flights.   Talks with the two unions representing the striking workers ended without resolution on Saturday, prompting threats of further action.   "In response to this deliberate provocation by the SAA board and its executive management, (the) NUMSA (metalworkers' union) is in the process of consulting workers for a secondary strike in aviation," NUMSA spokeswoman Phakamile Hlubi-Majola told reporters outside the SAA headquarters in Johannesburg.

NUMSA and the South African Cabin Crew Association (SACCA) first threatened to strike after SAA announced this week that almost 1,000 employees could lose their jobs as part of a restructuring process.   Initial talks with management deadlocked after they failed to agree on wage hikes, prompting the unions to press on with their threats.   SAA is offering a 5.9 percent pay rise, while unions are demanding an eight percent across-the-board hike and a three-year guaranteeof job security.   They are also asking the airline to in-source more jobs.    "We are fighting against retrenchment, corruption and privatisation," Hlubi-Majola told journalists.   She said discussions with SAA subsidiaries, South Africa's airport management company and airline service providers were under way.   Two transport unions have also been called on to join the action.   "This secondary strike will have the impact of shutting down the entire aviation sector," NUMSA and SACCA said in a joint statement.   SAA CEO Zuks Ramasia voiced "concern" about the unions' intentions and urged them to "reconsider".   "The intent of a secondary strike is to cause disruption, bring all airport operations to a halt and create huge damage to the South African economy," Ramasia said in a statement on Sunday.

- Embattled airline -
The CEO added that SAA could not "afford to pay any salary increases" and reiterated the 5.9 percent rise offer.   "The company has repeatedly communicated the precarious financial position of the company," Ramasia said.      More than 300 SAA flights have been grounded as a result of the open-ended strike.   International flights started slowly resuming on Sunday, while regional and domestic flights remain grounded.   "We hope all our customers understand that the cancellations have been beyond our control," Ramasia said.   South Africa is struggling to get its state-owned companies back on track after nine years of corruption and mismanagement under former president Jacob Zuma.   SAA -- one of Africa's biggest airlines -- is deep in debt and has not posted a profit since 2011, despite several government bailouts.   Finance Minister Tito boweni announced in February that the government would reimburse the company's 9.2 billion rand ($620 million) debt over the next three years.   Ramasia said discussions with unions would resume once the airline had considered "options on the way forward".
Date: Tue, 12 Nov 2019 13:10:01 +0100 (MET)
By Holly ROBERTSON, Andrew BEATTY, with Daniel De Cartert in Hillville

Sydney, Nov 12, 2019 (AFP) - Bushfires raging across eastern Australia singed Sydney's suburbs on Tuesday, with firefighters scrambling planes and helicopters to douse a built-up neighbourhood with water and red retardant.   Experts have described the conditions as the worst on record, as spring temperatures climbed toward 40 degrees Celsius (104 Fahrenheit) and winds topped 80 kilometres (50 miles) per hour across a zone which has been plagued by persistent drought.   Although the bushfire season is in its infancy, scientists predict it to be one of Australia's toughest ever, with climate change and unfavourable weather cycles helping created a tinderbox of strong winds, low humidity and high temperatures.

Twin blazes in the north shore suburb of Turramurra -- around 15 kilometres (nine miles) from the centre of Australia's largest city -- tore through a eucalypt forest park and sparked spot fires in homes, before eventually being brought under control.   As night fell, authorities said they were bringing another "clearly suspicious" blaze in a national park in the city's southern suburbs under control.    Throughout the day, more than 300 bushfires burned up and down Australia's east coast, fanned by gale-force winds, scorching temperatures and tinder-dry bushland that has brought some of the most dangerous conditions the country has seen.

In Turramurra, gardens smouldered, thick smoke hung heavy in the air and cars, houses and roads were caked in raspberry-red retardant as if hit by a giant paintball.   "It was the embers that floated up that actually went across and set off spot fires in the front yards" resident Nigel Lush told AFP, adding that one roof had been set alight.   Another resident, Julia Gretton-Roberts, said the blaze spread shockingly quickly.   "Next thing I know the fire was opposite our house and it was massive and the police came and grabbed our kids and took them away," she said.   "My daughter is pretty freaked out."   Firefighter Andrew Connon told AFP "a number of homes were threatened but it was contained by the aerial bombing".

- 'Catastrophic conditions' -
From early morning thousands of firefighters spread out across New South Wales in anticipation of what they called "off the scale" fire risk and "catastrophic" conditions.   They were unable to prevent several bushfires from breaching containment lines and trapping residents who had not already evacuated.   New South Wales Rural Fire Service Commissioner Shane Fitzsimmons said so far only a dozen buildings had been damaged Tuesday and a handful non-life-threatening injuries were reported, but the crisis was far from over.

Firefighters will be "working on these fires for days and weeks given the enormity of the firegrounds," he said.    Even before unfavourable weather hit, days of fires had killed three people and destroyed at least 150 homes.   "The conditions are expected to get worse," Fitzsimmons said, warning residents in adjacent areas to stay alert.   "Complacency kills," he added.   Up to 600 schools were closed, as well as many national parks, a total fire ban was introduced for the affected area and Rally Australia -- due to be held in Coffs Harbour at the weekend -- was cancelled.   The military pitched in, helping firefighters with logistics and water-dropping sorties using more than 100 aircraft.

- 'We'll fight it first' -
In the town of Hillville a fire that has ripped through an area the size of 25,000 soccer fields approached the home of Daniel Stevens.   Like many, his family -- including his mother nursing a broken leg -- have packed their bags, but have resisted leaving their house and everything they own.    "We'll fight it first," he told AFP, "but if it jumps the fence line into the paddock, we'll go."

In the nearby town of Taree, dozens of people have already moved to a showground that has become a makeshift evacuation centre.   Fifty-nine-year-old Caroline Watson arrived last night with her husband and their dog.    "The fires are just rife. They are absolutely everywhere" she told AFP. "They didn't ask us to get out, but we figured it was coming."

Further south in the Blue Mountains on the outskirts of Sydney, veteran Winmalee firefighter Alan Gardiner said locals were "terrified and on edge".    The town still bears the scars of a 2013 blaze that destroyed 200 homes, and residents are acutely aware that with few roads in and out of the mountains, a decision to leave late can be fatal.   Efforts to burn fuel in a controlled way have been limited by months of drought-like conditions that made it too dangerous.
Date: Tue, 12 Nov 2019 10:03:07 +0100 (MET)

Denpasar, Indonesia, Nov 12, 2019 (AFP) - An Australian tourist who fly-kicked a motorcyclist and assaulted a man in his own home during a drunken rampage was jailed for four months on Tuesday.   The ruling comes after Nicholas Carr's antics were caught in a viral video that saw him carry out a campaign of destruction in Seminyak, a popular tourist area on the Indonesian holiday island.   "The defendant Nicholas Carr is found guilty and is sentenced to four months" in jail, presiding judge Soebandi, who goes by one name, told the Denpasar District Court.    A lawyer for Carr, charged with assault and property damage, said the 26-year-old would not appeal the ruling.    He is expected to be released next month because of time already served.   In August, Carr ran barefoot on to a street and shouted expletives before the apprentice builder slammed into the bonnet of a moving car and then fly-kicked an unsuspecting motorcycle rider.

The biker, who was thrown from the moving scooter, sustained minor injuries -- later the pair embraced during a court hearing as Carr apologised to the victim.   Carr also shattered a convenience store's glass door before stealing a motorcycle.   Later, he broke into a house where he assaulted the sleeping homeowner, leaving him with injuries, police said earlier.    He was eventually caught by locals and police and taken to hospital.    Pictures that circulated on social media showed at the time showed Carr bloodied and bruised, and trussed with hosepipe and rope.   Shortly after his arrest, Carr apologised and admitted drinking more than 10 small bottles of vodka as well as other alcohol.

After a string of embarrassing incidents by tourists, Bali officials recently warned that boorish visitors may be kicked off the island, which attracts millions annually to its palm-fringed beaches, colourful nightlife and ancient temples.   Australian professional rugby league player David Fifita returned home this week after he was briefly arrested in Bali for assaulting a nightclub security guard.   Several days after Carr's arrest, a Czech couple who were slammed for disrespecting a Balinese temple took part in a ritual purification ceremony.
Date: Mon, 11 Nov 2019 16:19:54 +0100 (MET)

Lyon, Nov 11, 2019 (AFP) - An unusually strong earthquake hit south-eastern France on Monday, injuring four people, one of them seriously, authorities said.   A physicist at a geophysics institute the IPGP said that quakes of this strength are rare in that region, but warned of possible aftershocks and said people should leave fragile buildings.   The quake, with a magnitude of 5.4, was felt in a vast area between the cities of Lyon and Montelimar which are about 150 kilometres (93 miles) apart, the national seismological office said.   "I was leaning against the oven in my mother's bakery when I felt the tremor," said Victoria Brielle, a resident in Privas, some 25 kilometres from the quake's epicentre.   "A customer said her sideboard had moved and all her crockery was broken,"  she said.

Another resident in the area, Didier Levy, who lives in a 15th century castle, told AFP that "chandeliers were still trembling" several minutes after the quake.   Levy, who said his dog starting barking even before humans felt the tremors, added: "I have never experienced anything like it, I could feel the trembling even though these wall are one metre thick."   One person was seriously hurt when some scaffolding collapsed, the regional prefect's office said.   Three other people in the neighbouring Ardeche region were slightly injured.

Quakes in this region are rarely higher than Magnitude 5, said Mustapha Meghraoui of the IPGP's office in Strasbourg.   "We can say that this is a rare one," he added. But he said there might be an aftershock of around 4.5.   "If people are in a fragile house, they would be better leaving it" for something more robust for a while, he said.   The scale of the damage suggested the quake happened at a depth of between five and 10 kilometres, he added. But they were working on a more accurate reading.
Date: Mon, 11 Nov 2019 13:19:54 +0100 (MET)

Goma, DR Congo, Nov 11, 2019 (AFP) - A local radio station that has been involved in the fight against Ebola in eastern DR Congo said Monday it was closing down after one of its broadcasters was murdered.   Joel Musavuli, head of Lwemba radio in Mambasa in Ituri province, told AFP that the station had been targeted by armed groups hostile to the campaign to roll back the Ebola epidemic.

"Each of us have received threats since last month. We have now decided to stop broadcasting, Musavuli said, adding that he himself had escaped two kidnap attempts.   "We are victims of our commitment to the awareness campaign about the spread of Ebola virus disease. We don't know why the militiamen are targeting us."   Nearly 2,200 people have died since the notorious haemorrhagic disease erupted in eastern Democratic Republic of Congo in August 2018, according to the latest official figures.

The fight against the outbreak has been hampered by local fears and superstititions, exploited by militia groups that are rampant in the remote region.   Several health workers have been killed and media that have supported the campaign have received threats.

Several radio stations in the Mambasa area say they have stopped broadcasting anti-Ebola messages because of intimidation.   On November 2, Lwemba broadcaster Papy Mahamba was killed at his home by unidentified men. His wife was injured and their house set ablaze.    The station said the authorities had failed to take action against the threats. It said it would resume broadcasts after "the state has restored authority in the area".