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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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Chile

Chile US Consular Information Sheet
August 20, 2008
COUNTRY DESCRIPTION:
Chile is a rapidly developing country with a large, educated middle class and a robust free-market economy.
Tourist facilities are generally good and are continu
usly improving.
Read the Department of State’s Background Notes on Chile for additional information.
ENTRY/EXIT REQUIREMENTS:
U.S. citizens entering Chile must have a valid passport.
U.S. visitors will be charged a reciprocity fee at the port of entry, and a small receipt for the fee will be stapled in the last page of the passport.
This visa is valid for multiple entries and remains valid until the expiration of the passport.
In addition, visitors will be issued a tourist visa consisting of a single sheet of paper placed in the passport. This visa is valid for a stay of up to 90 days.
An extension of stay for an additional 90 days is possible, but requires payment of an extension fee.
The visa document must be surrendered to immigration authorities upon departure.

Chilean entry and exit control laws require that a minor child under age 18 traveling unaccompanied must have permission from the parents or legal guardians.
The document must be notarized and, if issued in the United States, authenticated by a Chilean consul in the United States.

If the child is traveling in the company of only one parent or guardian, the non-traveling parent or guardian will also be required to grant permission for travel.
In this case, the document will also need to be notarized and authenticated by a Chilean consul.
The permission to travel may also be notarized by a Chilean notary in Chile.

Parents are required to have documentary evidence of their relationship to the child.
An original birth certificate or certified copy of an original birth certificate is required.
This requirement applies to all foreigners as well as Chileans.
This requirement is increasingly being enforced by Chilean immigration officers.
When traveling with a minor child in Chile on a tourist visa, having such documentation on hand will facilitate entry and departure.

Visit the Embassy of Chile web site www.chile-usa.org for the most current visa information and entry/exit requirements.
Visitors should be aware of the severe Chilean restrictions on the importation of fruit, vegetables & agricultural products.
Check the Ministry of Agriculture web site www.sag.gob.cl for current requirements.

Information about dual nationality and the prevention of international child abduction can be found on our website.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
The potential for terrorist activity is low.
There has been some politically-motivated violence among indigenous communities in southern Chile, none of which has affected Americans.
Potential for civil disturbance is low, although demonstrations, sometimes violent, do occur.
Particularly violent days are March 29, the Day of the Young Combatant, and the anniversary of the September 11, 1973, coup against the government of President Salvador Allende.

For the latest security information, Americans traveling abroad should regularly monitor the Department's web site where the current Worldwide Caution, Travel Warnings and Travel Alerts can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Crime rates are low to moderate throughout Chile and are moderate in Santiago, Valparaiso, and other major cities.
American citizens visiting Chile should be as careful in cities as they would be in any city in the United States.
There have been few violent crimes committed against Americans.
However, American tourists are at a heightened risk for pick-pocketing, purse or camera snatching, and theft from backpacks and rental cars.
Such crimes have been reported in all areas of Chile frequented by tourists.
In Santiago, visitors should be especially alert to the possibility of crime at the Plaza de Armas and the Mercado Central; at major hotels and restaurants in the Las Condes, Vitacura, and Providencia areas, and in the Suecia and Bellavista entertainment districts.
In Valparaiso, visitors should be especially alert in the port and adjoining tourist areas.
Tourists using taxis in Santiago should be alert to possible scams involving currency switching.
Tourists should also be especially alert while using public transportation, such as the Santiago Metro Subway and public buses and while in the vicinity of Metro stations and bus terminals. The emergency number for the police (Carabineros) is 133.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at www.cybercrime.gov/18usc2320.htm.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. You will find information about the Chilean legal system at the following website www.ministeriopublico.cl.
Women that are victims of domestic violence will find helpful information at the website www.sernam.cl.

The local equivalent to the “911” emergency line in Chile is:
131 – AMBULANCE (SAMU)
132 – FIRE DEPARTMENT (BOMBEROS)
133 – POL
ICE DEPARTMENT (CARABINEROS)
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care, though generally good, may not meet U.S. standards, especially in remote areas.
Although emergency rooms in some major hospitals accept credit cards, many doctors and hospitals in Chile expect immediate payment in cash.
Prescriptions written by local doctors and over-the-counter medicines are widely available.
Air pollution is a major source of health concern in Santiago, resulting in severe bronchial ailments affecting infants, small children and the elderly.
The most severe air pollution occurs during the winter (May through August). Additional information on air quality levels is available at the National Air Quality Information Service (SINCA) web site - www.sinca.conama.cl.

The ozone layer is especially thin at the bottom of the world.
Travelers should take proper precautions to protect themselves from ultraviolet radiation.

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-TRI (1-877-394-8747) or from the CDC’s web site 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 www.who.int/en.
Further health information for travelers is available at www.who.int/countries/chl/en/.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Chile.

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 Chile is provided for general reference only, and may not be totally accurate in a particular location or circumstance
Driving in Chile is on the right-hand side of the road.
Traffic laws in Chile differ from traffic laws in the United States in some respects.
Right-hand turns are generally prohibited at red lights unless otherwise posted.
Seat belts are mandatory. Several modern toll highways have recently been opened in and around Santiago, dramatically improving transit into and through the city.
Major roads are generally in good condition throughout the country.
Some secondary roads, however, may be poorly maintained.
At night, occasional heavy fog in rural areas may lead to vehicle accidents with occasional deaths and injuries.
Care should be taken while driving in the mountains because the roads tend to have many tight switchbacks and may not have guardrails.
Chains are often required and should be used on mountain roads during the winter.
Many major highways in Chile are toll roads; drivers should carry a sufficient amount of local currency to cover the tolls.
The new major highways in and around Santiago generally collect tolls through use of an electronic transmitter issued by the concessionaire and placed on the vehicle.
“Day passes” may be purchased separately.
Vehicles rented at Santiago airport generally are equipped with the electronic transmitter and the rental car companies charge a surcharge for its use.
Some major arteries remain under construction in Santiago and drivers should be alert for detours and delays. Information on the major highways in the Metropolitan Region requiring an electronic transmitter is found at www.concesiones.cl.
Throughout Chile, care should be exercised when changing lanes or merging because many drivers do not signal lane changes and rarely yield to merging traffic.
Many Chilean drivers exceed posted speed limits, do not maintain safe distances, and do not observe posted road signs.
Buses are especially aggressive in moving between lanes.
Speeding is common, including in urban areas.
Traffic jams and detours in Santiago and other areas are common.
Taxis are plentiful and relatively inexpensive.
Drivers should drive with car doors locked at all times, especially in the southern parts of the city and near the airport, as there have been reports of thieves entering cars stopped at traffic lights or moving in slow traffic.
In Santiago, certain major arteries switch directions during morning and evening rush hours.
Visitors to Santiago should obtain up-to-date information on these changes from their auto rental company or the Chilean Automobile Association (please see below).
Visitors that wish to use the public bus and subway system in Santiago should visit the following websites for information on purchasing a “BIP” card, a prepaid ticket required for public buses, routes and other helpful information regarding the public transportation systems: www.transantiagoinforma.cl; www.metrosantiago.cl and www.micros.cl.
Driving under the influence of alcohol in Chile is severely punished, and can result in incarceration if the driver is involved in an accident. In accidents involving injuries or death, police may detain both drivers for many hours.
Visitors must have an international driver’s permit in order to drive legally in Chile. The international driver’s license must be obtained in the United States before traveling to Chile.
Although car rental firms may rent to customers with only a U.S. driver’s license, the police fine foreigners for driving without a valid international permit.

Please refer to our Road Safety page for more information.
Visit the website of Chile’s national tourist office at www.sernatur.cl and national authority responsible for road safety at www.vialidad.cl.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Chile’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Chile’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Visitors should take care to use only the services of government licensed tour operators throughout Chile as the Embassy is aware of at least one accident involving American fatalities with an unauthorized tour operator.
Special care should be taken by arriving cruise ship passengers if arranging land tours not authorized by the cruise line.
Chile is an earthquake-prone country.
Information on Chilean earthquake preparedness is available from the Oficina Nacional de Emergencia de Chile (ONEMI) at www.onemi.cl.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at www.fema.gov.
Information about emergency preparedness is also available on the Embassy web site at http://santiago.usembassy.gov/.
The U.S. Geological Survey provides earthquake information on Chile at http://earthquake.usgs.gov/regional/world/index.php?regionID=8.
Minefields are found in Chile’s northern border with Peru and Bolivia and on the southern border with Argentina in Patagonia.
Minefields are generally marked, but markers may have been shifted, become obscured or been vandalized.
Travelers should pay attention to markers and follow clearly identified roads and trails when traveling in minefield areas.
Border crossings should only be made at authorized locations.
Persons visiting wilderness areas in the border regions mentioned above should check with park or other local officials concerning minefields and other potential hazards.
Chile is a popular destination for outdoors and adventure sports.
Much of the country is mountain, forest, desert, or glacier.
Despite the best efforts of local authorities, assisting persons lost or injured in such areas can be problematic.
American citizens have been killed in recent years in mountain climbing and whitewater rafting accidents, and seriously injured while skiing.
Persons planning to travel in isolated and wilderness areas should first learn about local hazards and weather conditions.
Information about parks and wilderness areas can be obtained from the Chilean Forestry Service at www.conaf.cl.
Information about mountain climbing in Chile can be obtained from the Federacion de Andinismo de Chile at www.feach.cl.
Current weather forecasts are available from the Chilean Meteorological Service at www.meteochile.cl.
Reports of missing or injured persons should be made immediately to the police so that a search can be mounted or assistance rendered.
Travelers in isolated areas should always inform park rangers, police, or other local authorities of their itinerary before starting off.
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 Chilean laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Chile 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.
Just as in the United States, foreigners in Chile must have proper immigration status and pay taxes on income earned in Chile.
Recently, Americans have been deported for working in Chile without authorization.
Please see our information on Criminal Penalties and ensure compliance with all Chilean immigration regulations; consult the web site of the U.S. Embassy in Chile for more information at http://santiago.usembassy.gov/
CHILDREN'S ISSUES:
See our Office of Children’s Issues web pages for information on intercountry adoption and international parental child abduction.
Chile has demonstrated patterns of noncompliance with the Hague Child Abduction Convention. Chile’s patterns of noncompliance fall in its judicial performance. The courts continue to demonstrate a clear bias toward Chilean mothers.

REGISTRATION/ EMBASSY LOCATION:
Americans living or traveling in Chile are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Chile.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located at Avenida Andres Bello 2800, Las Condes, Santiago, Chile.
The telephone number is (56) (2) 330-3000.
The Embassy web site is http://santiago.usembassy.gov, and the email address for the American Citizen Services Unit is SantiagoAMCIT@state.gov.
The Consular Section fax number is (56) (2) 330-3005.
The American Citizen Services Unit is open to the public from 8:30am-11:30am, Monday through Friday, except U.S. and Chilean holidays and the first Friday of each month.
* * *
This replaces the Country Specific Information dated October 23, 2007 to update all sections except Aviation Safety Oversight.

Travel News Headlines WORLD NEWS

Date: Thu 28 Mar 2019
Source: Cronica Digital [in Spanish, trans. ProMED Mod.TY, edited]

Health authorities in Chile today [28 Mar 2019] confirmed the detection in the north of the country of _Aedes aegypti_, the vector of dangerous diseases such as dengue, Zika, chikungunya, and yellow fever [viruses].

The secretariat of the Ministry of Health in the northern Tarapaca region states that on 21 Mar [2019], a specimen of the mosquito was captured in a ovaposition trap for monitoring the presence of these insects in a women's penitentiary in Iquique city.

According to press reports from this region, the presence of larvae of the mosquito was confirmed by the Public Health Institute, although up to now, no locally acquired clinical cases of these _Aedes aegypti_-transmitted diseases have been reported.

The Tarapaca Secretary of Health, Manuel Fernandez, stated that 193 household visits have been made in the area of detection as part of preventive efforts. The official indicated that the mosquito is not able to transmit the indicated diseases without having previously had contact [bitten] with a person infected by any of these viruses. He also called on the public to collaborate with measures against this vector by opening the doors of their houses to the teams that visit to view hygienic conditions and to maximize the recommended measures with that objective.

According to health authorities, Chile, which borders Peru, Bolivia and Argentina [all of which have the mosquito and these viruses], has natural protection with the Andes mountain chain for the length of the country and extensive deserts in the north that make it difficult, but not impossible, for the mosquito to migrate [into the country]. In this respect, he advised that the effects of climate change could be favourable for the arrival of the mosquito and facilitate its reproduction due to the increase of temperature and humidity in some areas.

To date, no cases of dengue or Zika have been reported in the country except for imported ones.
===========================
[Chile has been fortunate in having escaped locally transmitted cases of these viruses due to the absence of _Aedes aegypti_ (except for far distant Easter Island, which has had cases of dengue and Zika virus infections). That situation of geographic and ecological isolation may now be changing with the discovery of a breeding population of this mosquito in the far north of the country. One hopes that this early detection and a timely surveillance effort will permit the mosquito's elimination. Continued surveillance will be critical, since this mosquito is famous for its ability to be moved around by human activity. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Thu 6 Dec 2018
Source: AND radio [in Spanish, machine trans., edited]
<http://www.adnradio.cl/noticias/nacional/alertan-por-consumo-de-pescado-crudo-tras-brote-de-difilobotriasis-en-puerto-octay/20181203/nota/3832533.aspx>

Health authorities alerted the population about the consumption of raw fish after detecting 6 confirmed cases and another 14 suspects of contagion with difilobotriasis [_Diphyllobothrium latum_] at Puerto Octay Hospital. Also known as the tapeworm of fish, [_Diphyllobothrium latum_] is the largest parasite that infects humans.

This animal has the appearance of a worm, can reach up to 10 m [approx. 32 ft] and is lodged in the intestines, where it is able to reproduce. According to Las Últimas Noticias, the Health Seremi of Los Lagos, Scarlett Molt, called on the population to "be responsible with their health and avoid the risk of getting sick through the consumption of raw fish." He also warned that "food should be consumed and purchased only in established places, with sanitary certification."

The academic and member of the Chilean Society of Parasitology, Veronica Madrid, stressed that the parasite is common in dishes such as ceviche, sushi and even in "smoking processes that do not reach enough temperature to devitalize the larva." According to the specialist, the only way to be sure of avoiding its presence in fish is to cook it or freeze it to more than 24 deg C below zero [approx. -11 deg F], something that can only be achieved at an industrial level.
=================================
[_Diphyllobothrium latum_ is only seen in fish caught in fresh water, not in salt water fish. A 10 years-old report from Chile indicated that a resurgence of _D. latum_ in Chile could be linked to salmon aquaculture (Cabello FC. Aquaculture and public health. The emergence of diphyllobothriasis in Chile and the world. Rev Med Chil. 2007;135:1064-71, available at: <https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872007000800016&lng=en&nrm=iso&tlng=en>).

Another study found that introduced trout in Lake Panguipulli was much more susceptible to _D. latum_ than the native fish (Torres P, Leyán V and Puga S. Prevalence, intensity, and abundance of infection and pathogenesis caused by diphyllobothriosis in vulnerable, native fish and introduced trout in Lake Panguipulli, Chile. J Wildl Dis. 2012;48:937-50, abstract available at: < http://www.bioone.org/doi/10.7589/2011-08-235?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&>).

More information about the parasite can be found at:
<https://www.cdc.gov/parasites/diphyllobothrium/index.html>. - ProMED Mod.EP]
Date: Thu 27 Sep 2018
Source: Bio Bio Chile [in Spanish, machine trans., edited]
<https://www.biobiochile.cl/noticias/nacional/region-del-bio-bio/2018/09/27/explosivo-incremento-casos-de-hepatitis-a-aumentan-un-140-en-regiones-del-bio-bio-y-nuble.shtml>

A 140% increase has occurred in 2018 in cases of hepatitis A, in the area that includes the regions of Bio Bio and Nuble, compared to the same date of 2017. In fact, in 2018, 779 cases have been reported, worrying figures for the authorities due to the increase registered since the start of the outbreak of the disease in 2013. According to the health secretary in Bio Bio, Erick Jimenez, the causes could be associated with the consumption of non-potable water, incorrect handwashing, and lack of adequate cooking of seafood.

The communes most affected by hepatitis A are Coronel, where 122 cases were reported, followed by Talcahuano with 94 and Concepción with 78. Despite the figures recorded in the commune of Cuenca del Carbón, epidemiologist Andrea Silva indicated that there will be no focused work in that commune. As of 9 Sep 2018, a total of 11 940 infants in the area had been vaccinated against hepatitis A. [byline: Nicolas Parra]
======================
[The cases are not broken down in regards to age. In children, most cases of HAV infection are subclinical so it is likely that the cases reported were in adults. In the developing world, HAV is not reported much in adults as most children have been infected, and therefore immune to subsequent infection, by the age of 10. That outbreaks are occurring in the area suggests improvement in potable water so less children are infected and therefore still susceptible to HAV as adults. - ProMED Mod.LL]

[Maps of Chile: <https://tinyurl.com/yaklcu2s>
and <http://healthmap.org/promed/p/7>.]
Date: Fri 21 Sep 2018
Source: Biobiochile [machine trans., edited]

The Ministry of Health confirmed that from June 2018 to date, 31 people have been infected with cholera in 3 different regions of the country. The microorganism has been present in Chile for some time, but the Undersecretary of Public Health, Paula Daza, told El Mercurio that "this year [2018] what we have had is an outbreak, because we've had a larger number of cases in a short period of time."

According to data from the Regional Ministerial Secretariat (Seremi) of Health of the [Santiago] Metropolitan Region, of the total number of patients, 29 are in this region, with the municipality of La Florida leading the list with 4 infections. Other communes with reported cases are Huechuraba, Las Condes, Vitacura, La Reina, Penalolen, Puente Alto, La Cisterna, Pedro Aguirre Cerda, Santiago, Maipu, Central Station, Renca, Quinta Normal, Conchali, Independencia, Recoleta, and Providencia.

The list is magnified by other cases that occurred in the regions of Valparaiso and Atacama. Of the total number of patients registered so far, 19 are women, and 18 had a history of other underlying diseases.

The symptoms of the infection are similar to a prominent gastroenteritis. The Ministry of Health confirmed that currently no deaths have been recorded as a result of the infections, but 9 people had to be hospitalized.

As to which polluted irrigated waters were the trigger of the outbreak, the Health Seremi of the Metropolitan Region, Rosa Oyarce, assured the same media that "it was ruled out because all the necessary tests were done to the irrigation canals that go directly to the irrigations of the vegetables." Meanwhile, Deputy Secretary Paula Daza indicated that the cause of the outbreak cannot yet be determined. The health authority stressed that it has been ruled out that the bacterium came from abroad, because the ministry's information indicates that none of the patients took previous trips to other countries that could have caused the infection.  [Byline: Felipe Diaz]
===============================
[In the previous post, 14 cases were reported; now that number has more than doubled. Chile had a toxigenic cholera outbreak that originated in neighboring Peru between 1991 and 1994, affecting approximately 150 persons.

It is not stated if this cluster of cases is related to a non-toxigenic O1 or O139 strain or a non-epidemic strain of non-O1, non-O139 _Vibrio cholerae_. As a review, the flagellar (H) antigens of _V. cholerae_ are shared with many water vibrios and therefore are of no use in distinguishing strains causing epidemic cholera. The O (somatic) antigens, however, do distinguish strains of _V. cholerae_ into 139 known serogroups. Almost all of these strains of _V. cholerae_ are non-virulent. Until the emergence of the Bengal (O139) strain (which is "non-O1"), a single serogroup, designated O1, has been responsible for epidemic cholera.

There are 3 distinct O1 serotypes -- Ogawa, Inaba, and Hikojima -- each of which may display the "classical" or El Tor phenotype (or biotype). The biotypes are distinguished by their expression of surface antigens A, B, and C. Ogawa contains antigens A and B; Inaba contains antigens A and C; and Hikojima contains antigens A, B, and C. The latter serotype is relatively rare.

In almost all cases, non-O1, non-O139 _V. cholerae_ isolates do not possess the genes for cholera toxin. Some isolates can cause substantial diarrhea (1-4). The type III secretion system (TTSS) is a mechanism for Gram-negative bacilli to introduce effector proteins into host cell cytoplasm (5). It has been reported that a functional TTSS is required for at least in some non-O1, non-O139 isolates to induce diarrhea in an animal model associated with small-bowel damage and production of proinflammatory cytokines (6). In addition, TTSS contributes to virulence even in the presence of cholera toxin and TCP (6).

References
----------
1. Bhattacharya MK, Dutta D, Bhattacharya SK, et al. Association of disease approximating cholera caused by _Vibrio cholerae_ of serogroups other than O1 and O139. Epidemiol Infect. 1998; 120(1): 1-5; <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809342/>.
2. Sharma C, Thungapathra M, Ghosh A, et al. Molecular analysis of non-O1, non-O139 _Vibrio cholerae_ associated with an unusual upsurge in the incidence of cholera-like disease in Calcutta, India. J Clin Microbiol. 1998; 36: 756-63;  <http://jcm.asm.org/content/36/3/756.long>.
3. Bidinost C, Saka HA, Aliendro O, et al. Virulence factors of non-O1, non-O139 _Vibrio cholerae_ in Cordoba, Argentina. Rev Argent Microbiol. 2004; 36: 158-63;  <https://www.ncbi.nlm.nih.gov/pubmed/15786867>.
4. Chatterjee SC, Ghosh K, Raychoudhuri A, et al. Incidence, virulence factors, and clonality among clinical strains of non-O1, non-O139 _Vibrio cholerae_ isolates from hospitalized diarrheal patients in Kolkata, India. J Clin Microbiol. 2009; 47(4): 1087-95; <http://jcm.asm.org/content/47/4/1087.long>.
5. Gatan JE, Colimer A. Type III secretion machines: bacterial devices for protein delivery into host cells. Science 1999: 284(5418): 1322-8; <http://science.sciencemag.org/content/284/5418/1322.long>.
6. Shin OS, Tam VC, Suzuki M, et al. Type III secretion is essential for the rapidly fatal diarrheal disease caused by non-O1, non-O139 _Vibrio cholerae_. mBio 2011; 2(3): e00106-11; <http://mbio.asm.org/content/2/3/e00106-11.long>.
- ProMed Mod.LL]

[HealthMap/ProMED-mail map:
Date: Wed 5 Sep 2018
Source: El Comercio [in Spanish, machine trans. edited]
<https://elcomercio.pe/mundo/latinoamerica/chile-brote-hepatitis-suma-201-casos-region-antofagasta-noticia-nndc-554166>

Health authorities in the region of Antofagasta in northern Chile are on alert for an outbreak of hepatitis A that adds 201 cases so far in 2018, 2 more than those recorded throughout 2017, they said today, 5 Sep 2018. "Unfortunately, we are having about 5 cases every 2 weeks, which means that we are facing an epidemic," Cooperativa Rossana Díaz, ministerial regional Secretary of Health, told Radio. It is a situation "that is controllable with the help of the community," which, in his opinion, has a fundamental role in the prevention of this disease, which can "be fulminating, create a risk to life, and require organ transplantation." Diaz stressed that hepatitis A can be prevented with simple measures, such as constant hand washing and optimal handling and preparation of food.

The authorities must combat street food sales and control businesses, "but we do not get anything if people continue to consume food on the street or in places that do not have sanitary authorization for that," he said. The profusion of cases, according to the official, corresponds to the increase in the consumption of food in unauthorized places and the lack of vaccinated personnel or strict hygiene regulations in establishments that do have a permit.

The authorities have set up an Outbreak Response Committee in the region and questioned contacts of the confirmed cases and of the suspects in order to find the origin of transmission. The cases registered in Antofagasta range from 2 to 60 years, with an average of 23 years, of which 62% are men and 38% are women, and although the presence of immigrants is large in the region, 98% of the cases are Chileans, the regional authorities reported.

Hepatitis A, according to the Institute of Public Health, can be prevented with a vaccine, and its detection requires a medical diagnosis in addition to laboratory tests or diagnostic imaging studies. It is transmitted through water, contaminated food, or through contact with an infected person. It is considered a disease with worldwide distribution that occurs sporadically or epidemically with a seasonal cycle, which in Chile is an intermediate endemic, with epidemic outbreaks every 4 or 5 years, and there are no chronic carriers.
==============================
[It seems to be the case that the cases are occurring at a low, steady rate rather than from a specific recent exposure.

Antofagasta (<https://en.wikipedia.org/wiki/Antofagasta>) is a port city in northern Chile, about 1100 km (700 mile) north of Santiago. It is the capital of Antofagasta province and the Antofagasta region. Formerly part of Bolivia, Antofagasta was captured by Chile in the War of the Pacific (1879-83), and the transfer of sovereignty was finalized in the 1904 Treaty of Peace and Friendship between the 2 countries. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Antofagasta, Antofagasta, Chile:
<http://healthmap.org/promed/p/11048>]
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Travel News Headlines WORLD NEWS

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World Travel News Headlines

31st May 2019

A volcano on the Indonesian island of Bali erupted Friday, spewing a plume of ash and smoke more than 2,000 metres (6,500 feet) into the sky. Mount Agung, about 70 kilometres from the tourist hub of Kuta, has been erupting periodically since it rumbled back to life in 2017, sometimes grounding flights and forcing residents to flee their homes.
Mount Agung is about 70 kilometres from the tourist hub of Kuta

The latest shortly before noon on Friday shot a cloud of volcanic ash high into the sky, but caused no disruption to flights, Indonesia's geological agency said.  Agung remained at the second highest danger warning level, and there is a four-kilometre no-go zone around the crater.

Last summer, dozens of flights were cancelled after Agung erupted, while tens of thousands of locals fled to evacuation centres after an eruption in 2017.

The last major eruption of Agung in 1963 killed around 1,600 people.

Indonesia is situated on the Pacific "Ring of Fire", a vast zone of geological instability where the collision of tectonic plates causes frequent quakes and major volcanic activity.

31st May 2019

Heatwaves across India have exacted heavy casualties this year, including dozens of deaths by sunstroke and other heat-related causes. The deaths have been mainly reported from states like Maharashtra (particularly Vidarbha), Andhra Pradesh (mainly Rayalseema) and Telangana, due to the temperature extremes in these regions. What's worrying is, a study suggests that the heatwave conditions are likely to increase from next year and continue till 2064 because of El Niño Modoki and depletion in soil moisture. Here's how the heatwave is taking a toll in the above states.

Maharashtra

Parts of Maharashtra have been reeling under high temperatures accompanied by severe heatwave condition during this summer. According to a report in The Times Of India, a 50-year old man in Beed succumbed to death because of heatstroke recently, taking the overall number to 8. Reports show a total of 456 cases of heat-related illnesses in Maharashtra this summer. Last year, the number of cases reported was 568. However, the death toll this year is more than last year's figure of 2 victims.

Regions like Nagpur and Akola show the most number of deaths and illnesses in the Vidarbha region. About 163 cases of heat-related illness were reported in Nagpur and 76 ailments were reported in Latur region. Recently, Chandrapur in Maharashtra (which lies 150km south of Nagpur) registered a day temperature of 48°C, the highest recorded in India this summer.

Andhra Pradesh

Parts of Andhra Pradesh have been experiencing temperatures of 45°C and more since the last few days. These conditions have persisted in the state after the heavy rains caused by Cyclone Fani.

Two women going on a two-wheeler and covered themselves with scarfs to protect themselves from the heat wave, in Vijayawada
(Mahesh G, TOI, BCCL, Vijayawada.)

Three people have died in Andhra Pradesh due to heat-related causes this year. Also, 433 people have been diagnosed with heatstroke. Earlier this month, electrical transformers had blown up in many parts of Krishna and Guntur districts, disrupting power supply for more than five hours and intensifying the effects of heatwave conditions and the severe temperatures.

In 2015, Andhra Pradesh experienced the most number of heat deaths in the country: 1,369 people died that year from heat-related illnesses.

Telangana

Seventeen people have succumbed in Telangana over the last 22 days. However, the number of unconfirmed deaths is expected to be higher. The region saw 541 heat-related deaths in 2015, and 27 in 2018. The farmers and those who work in the sun are usually the ones to be affected the most by high temperatures and heatwave conditions.

As heat blankets the country, make sure you stay protected. Follow official guidelines and do not step out in the Sun, especially in the afternoon hours, unless absolutely necessary.

(With inputs from The Times Of India.)

11th June 2019
https://afro.who.int/news/confirmation-case-ebola-virus-disease-uganda

Kampala, 11 June 2019 - The Ministry of Health and the World Health Organization (WHO) have confirmed a case of Ebola Virus Disease in Uganda. Although there have been numerous previous alerts, this is the first confirmed case in Uganda during the Ebola outbreak on-going in neighbouring Democratic Republic of the Congo.

The confirmed case is a 5-year-old child from the Democratic Republic of the Congo who travelled with his family on 9th June 2019. The child and his family entered the country through Bwera Border post and sought medical care at Kagando hospital where health workers identified Ebola as a possible cause of illness. The child was transferred to Bwera Ebola Treatment Unit for management. The confirmation was made today by the Uganda Virus Institute (UVRI). The child is under care and receiving supportive treatment at Bwera ETU, and contacts are being monitored.

The Ministry of Health and WHO have dispatched a Rapid Response Team to Kasese to identify other people who may be at risk, and ensure they are monitored and provided with care if they also become ill. Uganda has previous experience managing Ebola outbreaks. In preparation for a possible imported case during the current outbreak in DRC, Uganda has vaccinated nearly 4700 health workers in 165 health facilities (including in the facility where the child is being cared for); disease monitoring has been intensified; and health workers trained on recognizing symptoms of the disease. Ebola Treatment Units are in place.

In response to this case, the Ministry is intensifying community education, psychosocial support and will undertake vaccination for those who have come into contact with the patient and at-risk health workers who were not previously vaccinated.  

Ebola virus disease is a severe illness that is spread through contact with the body fluids of a person sick with the disease (fluids such as vomit, faeces or blood). First symptoms are similar to other diseases and thus require vigilant health and community workers, especially in areas where there is Ebola transmission, to help make diagnosis. Symptoms can be sudden and include:
  • Fever
  • Fatigue
  • Muscle pain
  • Headache
  • Sore throat
People who have been in contact with someone with the disease are offered vaccine and asked to monitor their health for 21 days to ensure they do not become ill as well.

The investigational vaccine being used in DRC and by health and frontline workers in Uganda has so far been effective in protecting people from developing the disease, and has helped those who do develop the disease to have a better chance of survival. The Ministry strongly urges those who are identified as contacts to take this protective measure.

Investigational therapeutics and advanced supportive care, along with patients seeking care early once they have symptoms, increase chances of survival.

The Ministry of Health has taken the following actions to contain spread of the disease in the country:
  • The District administration and local councils in the affected area have been directed to ensure that any person with Ebola signs and symptoms in the community is reported to the health workers immediately and provided with advice and testing.
  • The Ministry of Health is setting up units in the affected district and at referral hospitals to handle cases if they occur.
  • •Social mobilization activities are being intensified and education materials are being disseminated.

There are no confirmed cases in any other parts of the country.

The Ministry is working with international partners coordinated by the World Health Organization.

The Ministry of Health appeals to the general public and health workers to work together closely, to be vigilant and support each other in helping anyone with symptoms to receive care quickly. The Ministry will continue to update the general public on progress and new developments.
Date: Mon, 10 Jun 2019 14:24:43 +0200

Lima, June 10, 2019 (AFP) - Peru has declared a health emergency in five regions, including Lima, after the deaths of at least four people linked to Guillain-Barre syndrome, an autoimmune disorder that attacks the nervous system.   Health Minister Zulema Tomas said Sunday that in addition to the deaths there were currently 206 cases of the disease.   "We have an outbreak, there has been a brusque increase" since June 5, Tomas said on state-run TV Peru, adding that health authorities were taking steps to control and contain the disease.

While the syndrome is not contagious, a 90-day health emergency was declared because the current cases "have unusual and atypical characteristics that require rapid or immediate initial treatment," Peru's Institute of Neurological Sciences said.   The precise cause of the disorder is unknown, but most cases develop after a person has been sick with diarrhoea or a respiratory infection.

The Centers for Disease Control and Prevention in the US says its research suggests that the syndrome is "strongly associated" with the Zika virus, a mosquito-borne illness.   The regions affected by GBS include three on the country's northern coast -- Piura, Lambayeque, La Libertad -- tourist destinations known for their archaeological sites and beaches.   Also included was the central region of Junin and Lima, which has nine million inhabitants.   Two deaths were reported in Piura, one in La Libertad and another in Junin.
Date: Mon, 10 Jun 2019 16:39:03 +0200

Madrid, June 10, 2019 (AFP) - Three tourists have fallen from their hotel balconies in Spain's Balearic Islands in recent days, one of them dying on impact, police said Monday as the summer season in the party archipelago begins.   The incidents came as Britain's foreign office warned holidaymakers heading to Spain against "balcony falls" and asked them not to "take unnecessary risks... particularly if you're under the influence of drink or drugs."   On Friday in Magaluf, a party resort notorious for its booze-fuelled tourism, a 19-year-old British man fell to his death from the second floor of his hotel, Spain's Civil Guard police force said.

A spokesman said police were looking at two theories -- either "he threw himself off voluntarily, or he fell by accident."   He did not know whether the victim had consumed drugs or alcohol.   On Thursday, a 35-year-old German man fell from the second floor of his hotel too, this time in Palma de Majorca, and was seriously injured, police said.   A source close to the probe, who declined to be named, said the man had drunk, dozed off, woken up and subsequently fallen from the balcony, possibly disorientated.   And on Monday, an Australian man in his early thirties fell from the second floor of his hotel in Ibiza and was seriously hurt, police said, without giving further details.

Balcony falls happen every year in the Balearic Islands and other party resorts in Spain, most of them due to excessive drinking or drug-taking/   Some are accidental slips, while others happen when tourists miss while trying to jump into pools or onto another balcony -- a practice known as "balconing."   The British foreign office's online travel advice for Spain has an entire section warning against "balcony falls".   "There have been a number of very serious accidents (some fatal) as a result of falls from balconies," says the website.    "Many of these incidents have involved British nationals and have had a devastating impact on those involved and their loved ones."
Date: Mon, 10 Jun 2019 06:44:54 +0200

Sydney, June 10, 2019 (AFP) - Australian police said Monday they were scouring bushland for a Belgian teenage tourist missing in a popular surf town for more than a week.   Theo Hayez, an 18-year-old backpacker, was last seen on May 31 at a hotel in the coastal tourist town of Byron Bay -- some 750 kilometres (470 miles) north of Sydney -- New South Wales state police said.   "We have a large amount of resources searching... in bushland that is towards the east and northeast of the town," police Chief Inspector Matthew Kehoe said in a statement.   "We are advised that this disappearance is completely out of character for him."   Police said they were alerted to his disappearance on Thursday after he failed to return to a hostel he was staying in.   Hayez's passport and personal belongings were all left at the hostel, and police believe he had not made any financial transactions since his disappearance or used his mobile phone.
Date: Sat 8 Jun 2019
Source: New Jersey 101.5 [edited]

The potentially deadly Powassan tick-borne virus has been confirmed in 2 Sussex county residents, one of whom died last month [May 2019], state health officials confirmed [Sat 8 Jun 2019].

The Powassan virus is spread by the deer tick [_Ixodes scapularis_]. The illness is rarer than Lyme disease, which is also spread by the tick, but 10% of people who contract the [Powassan virus] illness die from it.

A Department of Health official on [Sat 8 Jun 2019] said that the department had not determined the cause of death for the patient who died last month [May 2019] but said that lab results this week [week of 3 Jun 2019] confirmed that he had the virus.

A 2nd victim continues to recover at home.

Symptoms of the virus include brain swelling, meningitis, fever, headache, vomiting, weakness, confusion, loss of coordination, trouble speaking, and memory loss. Symptoms can appear a week to a month after a tick bite, although some people show no symptoms and do not require treatment.

There is no vaccine or cure for the disease. Treatment includes hospitalization, support for breathing, and intravenous fluids.

Prevention involves the same precautions that should be taken to avoid Lyme disease: avoid wooded areas with tall grasses, use insect repellent while outdoors, and check for ticks after being outdoors.

Powassan [virus] -- first discovered in Powassan, Ontario, in 1958 -- has been confirmed in recent years in New Jersey, with one case each in 2013, 2014, and 2015, and 4 cases in 2017, the most recent year for which data is available. The cases were reported in Sussex, Warren, Morris, and Essex counties.

Between 2008 and 2017, there were 125 confirmed cases in the entire country and 9 deaths.

A person who said they were close to the man who died last month [May 2019] posted on Facebook that the man was bitten in the arm by a tick while gardening and fell ill about 2 weeks later. The Facebook post said that there was no bull's-eye mark around the bite -- a known tell-tale sign for Lyme infection. About a day before he was hospitalized, the man reported feeling like he was coming down with a cold and had a high fever.

State health department's tip sheet for preventing Powassan [virus infection]:
- avoid contact with ticks by avoiding wooded areas with high grass;
- when hiking, stay on the center of the trail;
- picnic in areas away from wooded and bushy areas;
- keep children on playground equipment and away from tall grass and shrubs;
- when outdoors, apply insect repellents;
- wear light-colored clothes so it is easy to see and remove ticks;
- wear long-sleeve shirts and pants;
- tuck long pants into socks so ticks cannot crawl under pants;
- do tick checks every couple hours while outdoors and before coming indoors;
- if you see a tick during tick checks, remove it right away;
- keep grass mowed short;
- keep children's toys, playground equipment, pools, and lawn furniture at least 15 feet [4.6 m] from wooded areas;
- create a woodchip or mulch border between your yard and wooded areas;
- keep areas under bird feeders and pet dishes clean, so they do not attract animals that may carry ticks;
- keep trash in closed containers or areas so it does not attract animals that may carry ticks.  [Byline: Sergio Bichao]
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[Powassan virus is endemic in New Jersey, and cases occur there sporadically. The tick vector is the deer tick, _Ixodes scapularis_. Humans become infected with POWV during spillover transmission from the natural transmission cycles. In humans, POWV can be a causative agent of a severe neuroinvasive illness, with 50% of survivors displaying long-term neurological sequelae. Individuals living or visiting areas where the deer tick occurs, should follow the above recommendations to avoid tick bites. If a tick is found feeding, it should be removed with forceps or tweezers grasping the tick at skin level and then gentle, constant force applied. The tick should never be removed by grasping it with thumb and forefinger, as squeezing the tick may cause inoculation of contents containing the pathogenic agent into the feeding site.

POWV was recognized as a human pathogen in 1958, when a young boy died of severe encephalitis in Powassan, Ontario, Canada. In that case, POWV was isolated from the brain autopsy. There are 2 distinct genetic lineages now recognized: POWV (lineage I) and deer tick virus (lineage II). Since the index case in 1958, over 100 human cases of POWV have been reported, with an apparent rise in disease incidence in the past 16 years. This recent increase in cases may represent a true emergence of POWV in regions where the tick vector species are prevalent, or it could represent an increase in POWV surveillance and diagnosis. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of New Jersey, United States:
New Jersey county map:
Date: 6 Jun 2019
Source: Washington Post [edited]

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

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

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

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

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

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

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

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

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

Dominican authorities initially did not run toxicology tests for MSW because there were no signs of violence, said Ramon Brito, a spokesman for the National Police's special tourism unit. After the Maryland couple was found, investigators ordered a set of tests to determine whether anything the 3 Americans consumed may have led to their deaths, Brito said.  [Byline: Arelis R. Hernandez]
Date: 31 May 2019
Source: 4 News [edited]

The Alachua County Health Department is warning residents that there are 12 confirmed cases of mumps, primarily from college students at the University of Florida.  "This is a little more than usual," says Steve Orlando, University of Florida spokesman.

Alachua County normally receives around 2 reported cases a year, and UF believes more students could be infected.  "So, it's curious because these are individuals who are vaccinated, and that's what we are seeing nationwide," says Paul Myers, Alachua County Health Department administrator.

Officials say it is still unclear why there has been an uptick with the virus. So far, the CDC shows 736 people have contracted mumps nationwide in 2019.

"The sharing of the utensils, sharing of the cups, sharing of the water bottles, you know it is a very common thing for students to share those things, and that's exactly the kind of thing that could lead to transmission," says Orlando.
Date: Sat 8 Jun 2019
Source: Business Standard [edited]

As many as 14 children have died due to acute encephalitis syndrome (AES) in the district, while over a dozen are admitted in hospitals with high fever and other symptoms of the infection.

Sunil Shahi, Superintendent of Shri Krishna Medical College and Hospital (SKMCH), told ANI, "We have received 38 patients so far; most of them have a deficiency of glucose in their blood. Of these, 2 have also tested JE [Japanese encephalitis] positive; the overall casualty till now is 14."

Dr Gopal Sahni, head of Critical Care Unit, said, "When heat and humidity rise, the body's sweat cannot evaporate. The humidity level is over 50 per cent in the last few days. We have about 15 such children admitted in the hospital currently, and 89 such cases come regularly."

Encephalitis is a viral infection, which causes mild flu-like symptoms such as a fever or a headache.
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[Again, this year (2019), cases of AES and JE are appearing in north-western India. Of the 14 AES cases, 2 tested positive for JE. The aetiology of the remaining cases is not stated, but the majority are reported as hypoglycaemic. As noted previously, frequently, in reports of JE cases in India, acute encephalitis syndrome (AES) of undefined aetiology is often mentioned with JE cases that are a minority of those hospitalized.

The determination of the aetiology or aetiologies of AES has been confusing and elusive. Various etiological agents have been proposed in recent years as responsible for AES cases. AES has continued to be attributed to a variety of aetiologies, including Reye syndrome-like disease, possible enterovirus infection from polluted water, heatstroke, lychee fruit consumption, and scrub typhus (_Orientia tsutsugamushi_). Recently, scrub typhus has been implicated in many AES cases. A recent publication (reference below) states that dengue virus is one of the 3 most common agents identified in acute encephalitis syndrome (AES). Unfortunately, existing surveillance for AES does not include routine testing for dengue. Dengue accounts for 5% of AES cases in India, especially in the absence of laboratory evidence for other pathogens tested. Dengue should be added to the list of possible AES etiological agents.

Reference:
Vasanthapuram Ravi, Shafeeq Keeran Shahul Hameed, Anita Desai, Reeta Subramaniam Mani, Vijayalakshmi Reddy, et al.: Dengue virus is an under-recognised causative agent of acute encephalitis syndrome (AES): Results from a 4-year AES surveillance study of Japanese encephalitis in selected states of India. International Journal of Infectious Diseases. 2019. doi: <https://doi.org/10.1016/j.ijid.2019.01.008>.

Maps of India:

[HealthMap/ProMED map available at: