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Antartica

General:
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Cuba is an independent island country situated in the Caribbean. It is the largest of the islands and covers 42,000sq miles. The climate is sub tropical throughout the year with most of the rainfall in
the northern parts of the country. Temperatures of between 20C to 35C are fairly standard throughout the year. Generally the winter effects of the American continent only last for short periods.
Safety & Security:
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The majority of tourists visiting Cuba will have no difficulty but bag snatching and other street crime appears to be increasing. The old Havana area and other major tourist resorts may be particular areas of concern in this regard. On arrival be careful to only use your recognised tour operator. If you are taking a taxi at any stage make sure it is a registered one and not a private vehicle. It is unwise to carry large quantities of money or jewellery away from your hotel and try not to flaunt wealth with your belongings. Pickpockets are too common an occurrence on buses and trains and at train stations so be careful with your essential documents and credit cards. Valuables should not be stored in suitcases when arriving in or departing from Havana as there have been a number of thefts from cases during the time the cases are coming through baggage handling. There is an airport shrink-wrap facility for those departing Havana which reduces the risk of tampering. Remember to carry a photocopy of your main documents (passport, flight tickets etc).
Road Safety:
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Following a number of serious road accidents involving tourists, you are advised not to use mopeds for travelling around Cuba or in Havana. Also, if you are involved in any accident a police investigation will be required to clear you and this may significantly delay your travel plans. On unlit roads at night there have been a number of accidents associated with roaming cattle (sounds like Ireland!). The traffic moves on the right side of the roads. There is a main highway running the length of the country but many of the country roads are in poor repair.
Local Laws & Customs:
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When arriving into Cuba make sure you are not carrying any items which could be considered offensive. Any illicit drug offense is treated very seriously and Cuban law allows for the death penalty to be used under these circumstances. If you require personal medication for your health, make sure it is in original packing and carry a letter from your doctor describing the medication. Never agree to carry any item for another individual and always secure your cases once they are packed. Taking photographs of military or police installations or around harbours, rail and airport facilities is strictly forbidden.

Currency:
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Since 1993 it is now possible to use US dollars for all transactions within Cuba. Remember, there is a 20$ airport departure tax. Certain travellers cheques and credit cards may not be acceptable within Cuba. This is particularly true of American Express cheques and cards but check your situation with the travel operator before departure.
Health Facilities:
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Generally healthcare facilities outside of Havana are limited and many standard medications may not be available. It is important to carry sufficient quantities of any medications which may be required for the duration of your time in Cuba.
Food & Water:
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The level of food and water hygiene varies throughout the country and between resorts. On arrival check the hotel cold water supply for the smell of chlorine. If it is not present then use sealed bottled water for both drinking and brushing your teeth throughout your stay. Cans and bottles of drinks are safe but take care to avoid pre-cut fruit. Peel it yourself to make sure it is not contaminated. Food from street vendors should be avoided in most cases. Bivalve shellfish are also a high risk food in many countries and Cuba is no exception in this regard. (Eg Mussels, Oysters, Clams etc)
Malaria & Mosquito Borne Diseases:
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Malaria transmission does not occur within Cuba and so prophylaxis is not required. However, a different mosquito borne disease called Dengue has begun to reoccur in the country over the past few years. This viral disease can be very sickening and even progress to death. It is rare for tourists to become infected but avoiding mosquito bites is a wise precaution.
Swimming, Sun & Dehydration:
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The extent of the Cuban sun (particular during the summer months (April to October) can be very excessive so make sure your head and shoulders are covered at all times when exposed. Watch children carefully as they will be a significant risk. Drink plenty of fluids to replace what will be lost through perspiration and, unless there is a reason not to,
take extra salt either on your food or in crisps, peanuts etc. Take care if swimming in the Caribbean to stay with others and to listen to local advice. Never swim after a heavy meal or alcohol.
Rabies Risk in Cuba:
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This viral disease does occur throughout Cuba and it is essential that you avoid any contact with all warm blooded animals. Dogs, cats and monkeys are the most commonly involved in spreading the disease to humans. Don't pick up a monkey for a photograph! If bitten, wash out the wound, apply an antiseptic and seek urgent medical attention.
Vaccinations for Cuba:
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There are no essential vaccines for entry / exit if coming from Ireland. However, for your own personal protection travellers are advised to have cover against the following;
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Tetanus (childhood booster)
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Typhoid (food & water borne disease)
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Hepatitis A (food & water borne disease)
For those planning a longer or more rural trip vaccine cover against conditions like Hepatitis B and Rabies may also need to be considered.
Summary:
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Cuba is becoming a popular destination for tourists and generally most will stay very healthy. However commonsense care against food and water borne disease is essential at all times. Also take care with regard to sun exposure, dehydration and mosquito bites.

Travel News Headlines WORLD NEWS

Date: Thu, 17 May 2018 09:57:07 +0200

Buenos Aires, May 17, 2018 (AFP) - Tourism regulation in Antarctica has become an urgent matter due to environmental threats, officials from the 53 member countries of the Antarctic Treaty warned at their annual meeting, held this week in Buenos Aires.

In the absence of rules, travel agencies offer trips to the region on boats sometimes equipped with helicopters or submarines, according to Segolene Royal, French ambassador for the Arctic and Antarctic poles.   "This activity creates considerable disturbance ... we are witnessing a race toward large-scale tourism that is dangerous for ecosystems," she said at the assembly on Wednesday.

During the austral summer of 2016/2017, around 44,000 tourists set off for Antarctica, compared with just 9,000 in 1995/1996, according to French authorities.   However, the push for regulation is not about banning tourism, former environmental minister Royal said, but rather about ensuring it is managed in compliance with the treaty and its environmental protection protocol.

In Buenos Aires, the Antarctic Treaty Consultative Meeting  -- whose mission is to regulate human activity on the continent -- also sought to encourage scientific cooperation between countries that have collectively set up around 100 research bases across the ice.   Also up for analysis is China's proposed fifth permanent scientific station in Antarctica, which would be located in the Ross Sea area south of New Zealand.
Date: Wed, 5 Jul 2017 13:01:49 +0200
By Marlowe HOOD

Paris, July 5, 2017 (AFP) - A chunk of ice bigger than the US state of Delaware is hanging by a thread from the West Antarctic ice shelf, satellite images revealed Wednesday.   When it finally calves from the Larsen C ice shelf, one of the biggest icebergs in recorded history will be set adrift -- some 6,600 square kilometres (2,550 square miles) in total, according to the European Space Agency (ESA).

The iceberg's depth below sea level could be as much as 210 metres (almost 700 feet), or about 60 storeys, it said.   "The crack in the ice is now around 200 kilometres (125 miles) long, leaving just five kilometres between the end of the fissure and the ocean," the ESA said in a statement.   "Icebergs calve from Antarctica all the time, but because this one is particularly large its path across the ocean needs to be monitored as it could pose a hazard to maritime traffic."

Scientists tracking the berg's progression expect it to break of within months.    The Larsen C shelf will lose more than 10 percent of its total surface area.   The massive ice cube will float in water and by itself will not add to sea levels when it melts.   The real danger is from inland glaciers.   Ice shelves float on the sea, extending from the coast, and are fed by slow-flowing glaciers from the land.    They act as giant brakes, preventing glaciers from flowing directly into the ocean.   If the glaciers held in check by Larsen C spilt into the Antarctic Ocean, it would lift the global water mark by about 10 centimetres (four inches), researchers have said.

The calving of ice shelves occurs naturally, though global warming is believed to have accelerated the process.   Warming ocean water erodes the underbelly of the ice shelves, while rising air temperatures weaken them from above.   The nearby Larsen A ice shelf collapsed in 1995, and Larsen B dramatically broke up seven years later.   The ESA is keeping an eye on Larsen C with its Copernicus and CryoSat Earth orbiters.

Man-made global warming has already lifted average global air temperatures by about one degree Celsius (1.8 degrees Fahrenheit) since pre-industrial levels.    Antarctica is one of the world's fastest-warming regions.   The world's nations undertook in the Paris Agreement, inked in 2015, to cap average global warming at "well under" 2 C.
Date: Wed, 22 Jun 2016 21:35:09 +0200
By Jean-Louis SANTINI

Washington, June 22, 2016 (AFP) - Two sick workers were evacuated from a remote US research station near the South Pole on Wednesday in a risky rescue mission carried out in the dead of Antarctica's winter, a US official said.   A Twin Otter turboprop plane flew in dark and cold conditions to pick up the workers from the Amundsen-Scott station, about 250 meters from the geographic South Pole, a spokesman for the US National Science Foundation (NSF), Peter West told AFP.

The plane's crew and a medical team had made the 10-hour journey to the South Pole in the middle of Antarctica's 24-hour winter on Tuesday night to reach the unidentified patients, who could not be treated on site.   The NSF -- the US research agency that operates the Amundsen-Scott Station -- organized the rescue mission last week given the condition of the first patient, which was not disclosed for privacy reasons.   "It was really an emergency," West said.   It later became apparent that the second worker also needed to be evacuated.

The sick workers -- employees of the US company Lockheed Martin who worked on base logistics -- were then taken to the Rothera base, a British research station some 2,200 kilometers (about 1,365 miles) away, the spokesman said.   The pair, who were not identified, were then to be transferred to a hospital in South America, West said, without giving further details.   The Amundsen-Scott base was home to 48 people -- 39 men and nine women -- who work on-site throughout the austral winter, which spans February through October.

- Rare rescue mission -
Near the world's southernmost point, workers spend this period withstanding nearly complete darkness and dramatically low temperatures -- on Tuesday, the thermometer dropped to -60 degrees Celsius (-76 degrees Fahrenheit).   It was only the third time that an emergency rescue operation has been launched in the middle of winter.   In 2001, the only doctor at the Amundsen-Scott station was suffering from a life-threatening pancreatic condition and required urgent evacuation. A second medical evacuation was carried out that year.

In 1999, the US station's doctor Jerri Nielsen, who was self-treating her own breast cancer, required medical evacuation but weather conditions were more favorable, as the mission took place in the spring.  The Twin Otter plane, operated by the Canadian company Kenn Borek Air, is specially designed to operate in extremely cold temperatures.

Research projects at the Amundsen-Scott station include monitoring long-term levels of carbon dioxide (CO2) in the atmosphere.     The station also operates two telescopes that observe "cosmic microwave background" radiation -- the faint light signature left by the Big Bang -- to study the origins of the universe, dark energy and dark matter.
Date: Wed, 18 Jun 2014 09:04:56 +0200 (METDST)
by Martin PARRY

SYDNEY, June 18, 2014 (AFP) - Antarctic scientists warned Wednesday that a surge in tourists visiting the frozen continent and new roads and runways built to service research facilities were threatening its fragile environment.   Tourist numbers have exploded from less than 5,000 in 1990 to about 40,000 a year, according to industry figures, and most people go to the fragmented ice-free areas that make up less than one percent of Antarctica.   A growing number of research facilities are also being built, along with associated infrastructure such as fuel depots and runways, in the tiny ice-free zones.

It is these areas which contain most of the continent's wildlife and plants, yet they are among the planet's least-protected, said a study led by the Australian government-funded National Environmental Research Programme (NERP) and the Australian Antarctic Division.   "Many people think that Antarctica is well protected from threats to its biodiversity because it's isolated and no one lives there," said Justine Shaw from the NERP of the study published in the journal PLoS Biology.   "However, we show that there are threats to Antarctic biodiversity.   "Most of Antarctica is covered in ice, with less than one percent permanently ice-free," she added.   "Only 1.5 percent of this ice-free area belongs to Antarctic Specially Protected Areas under the Antarctic Treaty System, yet ice-free land is where the majority of biodiversity occurs."   Five of the distinct ice-free areas have no protection at all while all 55 of the continent's protected zones are close to sites of human activity.

- Fragile ecosystems -
Steven Chown of Monash University, another collaborator in the study, said the ice-free areas contain very simple ecosystems due to Antarctica's low species diversity.   This makes its native wildlife and plants extremely vulnerable to invasion by outside species, which can be introduced by human activity.   "Antarctica has been invaded by plants and animals, mostly grasses and insects, from other continents," he said.    "The very real current and future threats from invasions are typically located close to protected areas.    "Such threats to protected areas from invasive species have been demonstrated elsewhere in the world, and we find that Antarctica is, unfortunately, no exception."

The study said the current level of protection was "inadequate by any measure" with Shaw saying more was needed to guard against the threat posed by the booming tourism industry.   "(We need) to protect a diverse suite of native insects, plants and seabirds, many of which occur nowhere else in the world," she said.   "We also need to ensure that Antarctic protected areas are not going to be impacted by human activities, such as pollution, trampling or invasive species."   Antarctica is considered one of the last frontiers for adventurous travellers.   Most travel by sea, some paying in excess of US$20,000 for a luxury cabin in the peak period from November to March. There is also a healthy market for sightseeing flights.

Approximately 30 nations operate permanent research stations on the continent including the US, China, Russia, Australia, Britain, France and Argentina, and more are on the way.   China's state media said in December that the country was building its fourth base and a fifth was being planned.   Fellow study author Hugh Possingham, from NERP, said that without better protection "this unique and fragile ecosystem could be lost".   "Although we show that the risks to biodiversity from increasing human activity are high, they are even worse when considered together with climate change," he added.    "This combined effect provides even more incentive for a better system of area protection in Antarctica."
Date: Sun, 17 Nov 2013 12:27:56 +0100 (MET)

WASHINGTON, Nov 17, 2013 (AFP) - A powerful 7.8 magnitude undersea earthquake struck in the Scotia Sea, a remote region in the far south Atlantic near Antarctica, US earthquake monitors reported Sunday.   The quake struck at 0904 GMT in the ocean some 893 kilometers (550 miles) southwest of Grytviken, South Georgia, and 1,140 kilometres (710 miles) southeast of Ushuaia, Argentina, said the US Geological Survey, which monitors earthquakes worldwide.   The epicenter was at a depth of 10 kilometers (6.2 miles), and was near that of a 6.8 magnitude undersea earthquake that the USGS registered in the Scotia Sea some 30 hours earlier.

The quake occurred at the boundary between the Antarctic tectonic plate and the Scotia Sea plate, said geophysicist Randy Baldwin at the National Earthquake Information Center in Golden, Colorado.   "They're sliding past one another horizontally, it's not a subduction zone," Baldwin told AFP. "There will be aftershocks probably for weeks."   There were no tsunami warnings since there were no vertical movements in the seafloor as occur in a subduction quake, when one tectonic plate moves under another one, Baldwin said.   Yet despite the enormous energy unleashed the area is so remote that there is little or no impact to humans, he said.   "You couldn't pick a more remote area for an earthquake," he said.
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Cote d'Ivoire

Cote d'Ivoire - US Consular Information Sheet
May 21, 2007
COUNTRY DESCRIPTION: Cote d'Ivoire (Ivory Coast) is a developing country on the western coast of Africa.
The official capital is Yamoussoukro, but Abidjan is the largest city, the
ain commercial center, and where the Ivorian government and the U.S. Embassy are located.
Cote d'Ivoire is a republic whose constitution provides for separate branches of government under a strong president.

The country has been divided since a 2002 coup attempt developed into a civil war.
Despite several peace agreements and the establishment of a transitional government, key issues remain unresolved, elections have been delayed, and tensions persist throughout the country.

Tourist facilities in and near Abidjan, the commercial capital, are good; accommodations in many other locations are limited in quality and availability.
Read the Department of State Background Notes on Cote d’Ivoire for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport is required, but U.S. citizens traveling to Cote d'Ivoire for business or tourism do not require visas for stays of 90 days or less.
To stay longer than 90 days, the visitor may still enter without a visa, but then must apply for a "carte de sejour" within 90 days of arrival.
(Note: "Cartes de sejour" are not issued to children under the age of 16, who are documented on their parents' visas).
An international health certificate showing current yellow fever immunization is required for entry into Cote d'Ivoire.
Without it, the traveler may be required to submit to vaccination at the airport health office before clearing immigration, at a cost of 5,000 CFA (a little less than $10).

Travelers may obtain the latest information and details on entry requirements from the Embassy of the Republic of Cote d'Ivoire, 3421 Massachusetts Avenue, NW, Washington, D.C. 20007, telephone (202) 797-0300.
There are honorary consulates for Cote d'Ivoire in San Francisco, Stamford, Orlando, Houston and Detroit.
Overseas, travelers should inquire at the nearest Ivorian embassy or consulate.
See our Foreign Entry Requirements brochure for more information on Cote d’Ivoire and other countries.
Visit the Embassy of Cote d'Ivoire web site at http://www.cotedivoireembassy.com/ for the most current visa information.

Foreign travelers are sometimes approached at ports of entry by individuals with offers to expedite passport control and customs, and are then asked to pay an exorbitant fee, both for the service and for the passport and customs officers.
Travelers to Cote d'Ivoire are advised that there is no need to pay a police officer or customs officer at the airport for any service rendered during an arrival or departure, and they should not surrender their passports or other important documents to anyone except easily identifiable government officials in uniform.

See Entry and Exit Requirements for more information pertaining to dual nationality and the prevention of international child abduction.
Please refer to our Customs Information to learn more about customs regulations.

SAFETY AND SECURITY:Cote d'Ivoire has been unstable since the coup in 1999, and territorially divided since 2002.
The New Forces control the northern and some western parts of the country.
There are many road checkpoints manned by security forces and militia in both the government-controlled and New Forces-controlled portions of the country.
Soldiers and militia members check documents and frequently demand cash for permission to pass.
Cote d'Ivoire's border with Liberia is open, but border controls are extensive.

Political instability has contributed to economic stagnation and high unemployment, exacerbating social tensions and creating the potential for labor unrest and civil disorder.
There have been recurring episodes of violence, some of them severe.
In November 2004, there was a brief resumption of hostilities between the two sides followed by widespread attacks against people and property in Abidjan and elsewhere.
Many of these attacks were directed against French and other expatriates, and thousands fled the country.
Americans should avoid crowds and demonstrations, be aware of their surroundings, and use common sense to avoid situations and locations that could be dangerous.
While diplomatic efforts to end the crisis are ongoing, further civil unrest, coup attempts or the resumption of hostilities are possible.

Swimming in coastal waters is dangerous and strongly discouraged, even for excellent swimmers.
The ocean currents along the coast are powerful and treacherous, and numerous people drown each year.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site where the current Travel Warnings and Public Announcements, including the Worldwide Caution Public Announcement, 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 U.S. 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 continues to be a major security threat for Americans living in Cote d'Ivoire.
Grab-and-run street crime and pick pocketing in crowded areas are widespread.
Armed carjacking, robberies of businesses and restaurants, and home invasions are common, and they often target expatriate residents who are perceived as wealthy.
Armed criminals use force when faced with resistance.
Travelers displaying jewelry and carrying cameras are especially at risk.
Travelers are advised to carry limited amounts of cash and only photocopies of key documents.
While there have been relatively few reported cases of sexual assault, given the general climate of criminality, the actual rate of assault may be much higher than that which is reported.
There were allegations of sexual assaults during the November 2004 civil strife.
Given the strong anti-French sentiment, people of non-African appearance may be specifically targeted for violence.
Avoid large gatherings and political demonstrations, as they can turn violent quickly.

Travel outside of Abidjan or at night is strongly discouraged, and it is particularly dangerous to visit Abidjan's Treichville, Adjame, Abobo, and Plateau districts after dark.
The DeGaulle and Houphouet-Boigny bridges in Abidjan are dangerous areas for pedestrians.
Inadequate resources and training limit the ability of the police to combat crime.
Many hotels, restaurants, nightclubs and supermarkets provide security guards to protect clients and vehicles.

Travelers should take the same common sense precautions in Abidjan that they would in any metropolitan area in the United States.
Travelers should stay in well-lit areas and walk confidently at a steady pace on the side of the street facing traffic close to the curb.
Travelers should avoid crowds, mass transit, doorways, bushes, alleys and sparsely populated areas.
Travelers who need transportation at night should take an Orange metered taxi.
Travelers should be discreet about your transactions, especially in sight on the street.
Normal spending habits of Westerners appear extravagant.

Credit card use in Cote d'Ivoire is limited, particularly outside Abidjan, but credit card fraud is an increasing problem.
Travelers should not use credit cards in paper transactions unless the credit card transaction is electronically performed in view of the individual.

Business fraud is rampant and the perpetrators often target foreigners, including Americans.
Schemes previously associated with Nigeria are now prevalent throughout West Africa, including Cote d'Ivoire, and pose a danger of grave financial loss.
Typically these scams begin with unsolicited communication (usually e-mails) from strangers who promise quick financial gain, often by transferring large sums of money or valuables out of the country, but then require a series of "advance fees" to be paid, such as fees for legal documents or taxes.
Of course, the final payoff does not exist; the purpose of the scam is simply to collect the advance fees.
A common variation is the scammer’s claim to be a refugee or émigré of a prominent West African family, or a relative of a present or former political leader who needs assistance in transferring large sums of cash.
Still other variations appear to be legitimate business deals that require advance payments on contracts.
Sometimes victims are convinced to provide bank account and credit card information and financial authorization that drains their accounts, incurs large debts against their credit, and takes their life savings.

The best way to avoid becoming a victim of advance-fee fraud is common sense — if a proposition looks too good to be true, it probably is a scam, particularly if one has never met the correspondent.
Travelers should carefully check and research any unsolicited business proposal before committing any funds, providing any goods or services, and undertaking any travel.
A good clue to a scam is the phone number given to the victim; legitimate businesses and offices provide fixed line numbers, while scams typically use only cell phones.
In Cote d'Ivoire, all cell phone numbers start with zero.

It is virtually impossible to recover money lost through these scams.
For additional information please consult the Department of State's brochure Advance Fee Business Scams.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Abidjan has privately-run medical and dental facilities that are adequate but do not fully meet U.S. standards.
Good physician specialists can be found, though few speak English.
While pharmacies are well stocked with medications produced in Europe, newer drugs may not be available.
Medical care in Cote d'Ivoire outside of Abidjan is extremely limited.
Malaria is a serious health problem in Cote d’Ivoire.
For more information on malaria, including protective measures, see the Centers for Disease Control Travelers’ Health web site at http://www.cdc.gov/malaria/.

The avian influenza or “Bird Flu” virus (H5N1) has been confirmed in animals in Cote d’Ivoire as of June 2006.
For more information regarding Avian Influenza, please visit the CDC’s internet site at http://www.cdc.gov/travel/other/avian_flu/ and the State Department’s Avian Influenza Fact Sheet.

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 http://www.cdc.gov/travel.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website 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 Cote d’Ivoire is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Serious traffic accidents, one of the greatest threats to U.S. citizens in Cote d’Ivoire, occur regularly in Abidjan.
Unsafe road conditions, unskilled drivers, and poorly maintained and overloaded vehicles create very poor driving conditions.
Speed limits, signals, and yielding for pedestrians and cyclists are not respected.
Travelers should drive defensively, watch out for public transportation vehicles that stop and start without warning, and be especially cautious at intersections because traffic lights often malfunction.
Travelers who must travel at night should beware of vehicles without headlights and/or taillights, and pedestrians and bicycles along the roadside.
In case of an accident, travelers are advised not to move their vehicle until a police officer authorizes.
Travelers should go to the nearest hospital or police station if there is no other vehicle to take the injured to a hospital, or if there is reason to believe that their life is in danger from others at the site of the accident.

Abidjan has a poor public transportation system; if traveling by bus, use only the “Express” line.
In Abidjan, taxis are readily available, inexpensive (metered), but poorly maintained and notorious for not respecting the rules of the road.
Communal taxis (“woro-woros”), used only within the limits of each commune, are not metered and are dangerous.
Local vans ("Gbaka") should not be used because they are frequently involved in accidents.

Criminals usually steal vehicles when the driver is in or near the vehicle, so car doors and windows should be kept locked.
While stopped in traffic, travelers should remember to allow enough room between your car and the one in front to maneuver out if needed.
Travelers should look around to see if there is anyone paying unusual attention or if someone appears to be watching, before entering their vehicles. Travelers should not attempt to enter their vehicles, and should go get assistance.
Travelers should enter and exit their vehicles as quickly as possible, to limit their vulnerability to carjacking.

Victims of carjacking should not resist.
Victims should try to remain calm and give the carjackers what they want, which is usually the vehicle and any valuables.
Experience shows that criminals usually don’t use violence unless they are confronted with resistance.
Furthermore, it is not uncommon to take an occupant, usually a woman or child, as hostage to ensure their safe escape; the hostage is usually released unharmed.
This is a very difficult situation; victims should use their best judgment in deciding a course of action.

A newer phenomenon is the staged accidental "bumping" accident.
If your vehicle is "bumped" from the rear or the side, stay locked inside because this ruse is used to get the driver out and leave the vehicle free for carjacking.
Travelers with cell phones should call for assistance.
Victims should report the accident at the nearest police station as soon as possible if they feel their safety is in jeopardy and try to get the license number for any other vehicle involved.

Emergency services such as ambulance service (SAMU) exist in Abidjan and larger towns.
Call 185 or 22-44-55-53.
In smaller towns there is usually no ambulance service available, but ambulances will be dispatched from larger towns

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 Cote d'Ivoire’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Cote d'Ivoire's air carrier operations.
For more information, travelers may visit the FAA’s internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Ivorian customs authorities encourage the use of an ATA (Admission Temporaire/Temporary Admission) Carnet for the temporary admission of professional equipment, commercial samples, and/or goods for exhibitions and fair purposes.
ATA Carnet Headquarters, at the U.S. Council for International Business, 1212 Avenue of the Americas, New York, NY 10036, issues and guarantees the ATA Carnet in the United States.
For additional information, call (212) 354-4480, e-mail atacarnet@uscib.org, or visit http://www.uscib.org.

If traveling to another West African Economic and Monetary Union (WAEMU) country, expatriate residents leaving Cote d’Ivoire must declare the amount of currency being taken out of the country; if going to any other country, tourists are prohibited from taking more than 500,000 CFA francs (approximately $1,000), and business operators two million CFA francs (approximately $4,000), without government approval.
Even with authorization, there is a cash limit of $4,000 for tourists and $5,500 for business people, with any surplus in travelers or bank checks.

Travelers should carry a photocopy of your U.S. passport, visa, and entry stamps.
Travelers should also, carry their international driver's licenses if planning to drive.

Government corruption remains a serious problem in Cote d'Ivoire, and has an impact on judicial proceedings, contract awards, customs, and tax issues.
Security forces (police, military, gendarmes) routinely stop vehicles for traffic violations and security checks. Travelers should politely present identification if stopped.
Travelers who are stopped at one of these check points for any reason and asked to pay a "fine" to these uniformed officials, should politely refuse and present a photocopy of their U.S. passport, visa, and entry stamp.

Taking pictures is prohibited near sensitive installations, including military sites, government buildings such as the radio and television stations, the Presidency building, the airport, and the DeGaulle and Houphouet-Boigny bridges in Abidjan.

Cote d’Ivoire recognizes dual nationality if acquired at birth.
Americans who also are Ivorian nationals may be subject, while in Côte d'Ivoire, to certain aspects of Ivorian law that impose special obligations on citizens of that country.
Please see our information on Customs Regulations.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Cote d'Ivoire's laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Cote d'Ivoire 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 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:
Americans living or traveling in Cote d'Ivoire are urged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website and to obtain updated information on travel and security within Cote d’Ivoire.
Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located in the Riviera Golf neighborhood of the Cocody section of Abidjan, east of the downtown area.
The Embassy's postal address is 01 B.P. 1712 Abidjan 01, and the main telephone number is 22-49-40-00.
The Consular Section fax number is 22-49-42-02, and more information is on the Consular pages of the Embassy's web site at http://Abidjan.usembassy.gov/
*

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*
This replaces the Consular Information Sheet dated November 21, 2006, with no major changes.

Travel News Headlines WORLD NEWS

Date: Tue, 27 Aug 2019 15:33:42 +0200 (METDST)

Bouake, Ivory Coast, Aug 27, 2019 (AFP) - The main market in Bouake, Ivory Coast's second biggest city, was largely destroyed Tuesday in an overnight blaze, although there were no known casualties, an AFP correspondent reported.   The fire broke out around 2:00 am (0200 GMT) and spread fast, market watchmen said.   It took around seven hours to bring under control, mobilising several hundred firefighters, police and troops, partly to put out the blaze but also to secure the area.   "This tragedy has most fortunately caused no loss of life," Bouake mayor Nicolas Djibo said, adding though that he was "dumbstruck by the scale of the damage".

Djibo said the fire had begun in the butchers' area of the market, which hosts hundreds of stalls and is a hub of social activity in Bouake, a city of one million people in the centre of Ivory Coast.   Some traders had been able to remove their wares in time but others wept at the sight of their loss.   Koffi Rachelle, who sold children's toys and various gadgets, told AFP she had lost everything. "I can"t even get into my shop, the fire has destroyed everything over there," she said in tears.

An inquiry into the fire has been opened, according to a police source who asked not to be named.   The market, which had an area of between eight and nine hectares (about 22 to 22 acres), had been razed by a fire in 1998.   Experts had been studying a proposal to house the stalls in a large modern building before the latest blaze.
Date: Tue, 30 Jul 2019 21:28:27 +0200

Abidjan, July 30, 2019 (AFP) - Eighty-nine people have contracted yellow fever and one person has died in recent weeks during an outbreak in Ivory Coast, the health ministry said Tuesday.   Most of the confirmed cases were in the West African country's economic capital Abidjan, the ministry said in a statement.

It recommended that any unvaccinated people be vaccinated against yellow fever.   "The outbreak occurs in the context of a dengue outbreak," the ministry said, adding that dengue and yellow fever are viral diseases transmitted by the same mosquito.    "The vector control measures that have been implemented to deal with dengue also work for the yellow fever outbreak."   In early June, 130 cases of dengue were reported including two deaths, with the authorities launching a major mosquito-control campaign.   Abidjan is going through the end of its rainy season, which spurs mosquito breeding.

Symptoms of yellow fever -- including high fever, vomiting and muscle aches -- usually manifest themselves three to six days after a person is bitten by an infected mosquito.   The infection caused by yellow fever is usually mild, but in some cases can be life-threatening and result in kidney and liver failure.   Yellow fever is found only in parts of South America and Africa.
Date: Tue 30 Jul 2019
Source: Medical Xpress [edited]

In recent weeks, 89 people have contracted yellow fever, and one person has died during an outbreak in Ivory Coast, the health ministry said Tuesday [30 Jul 2019].

Most of the confirmed cases were in the West African country's economic capital Abidjan, the ministry said in a statement. It recommended that any unvaccinated people be vaccinated against yellow fever.  "The outbreak occurs in the context of a dengue outbreak," the ministry said, adding that dengue and yellow fever are viral diseases transmitted by the same mosquito.

"The vector control measures that have been implemented to deal with dengue also work for the yellow fever outbreak."  In early June [2019], 130 cases of dengue were reported, including 2 deaths, with the authorities launching a major mosquito-control campaign.  Abidjan is going through the end of its rainy season, which spurs mosquito breeding.

Symptoms of yellow fever -- including high fever, vomiting and muscle aches -- usually manifest themselves 3-6 days after a person is bitten by an infected mosquito.  The infection caused by yellow fever is usually mild, but in some cases can be life-threatening and result in kidney and liver failure.  Yellow fever is found only in parts of South America and Africa.
=====================
[Yellow fever (YF) is a serious disease and has a case fatality rate of about 30%. It is surprising that there has been only one death so far among the 89 infected individuals. It is not stated that all 89 individuals were laboratory confirmed YF cases. The above report does not indicate the proportion of the population that has been vaccinated against YF.

YF virus can spread rapidly in a largely unvaccinated population, as it did in Angola in 2016. _Aedes aegypti_ vector control is of limited effectiveness in the face of a YF outbreak. Vaccination is the best preventive measure.

There have been YF cases in Cote d'Ivoire in the past, the most recent in 2011. At that time, more than 700 000 people were vaccinated against yellow fever [YF] in an emergency campaign in the country. There were YF cases in Abidjan in 2008, when the estimated vaccination coverage of the population was around 60 percent after a vaccination campaign. Now, time is of the essence to quickly halt the spread of YF, as it rapidly did in Angola and the DR Congo in that large outbreak. - ProMED Mod.TY]

[Maps of Cote d'Ivoire can be accessed at <http://bit.ly/2uHz53s>
and <http://healthmap.org/promed/p/52>.]
Date: Fri, 14 Jun 2019 06:02:40 +0200
By Clotilde RAVEL

Abidjan, June 14, 2019 (AFP) - "Cover your goods," Diakaria Fofana, a doctor of public health, warns food vendors as a thick cloud of insecticide spray wafts down a street in Abidjan, Ivory Coast's economic capital.   Men in protective clothes, goggles and masks are disgorging plumes of mosquito-killing chemicals in a bid to roll back an outbreak of dengue.   Two people have died and 130 have fallen ill since the fever returned to the West African state last month.

The toll, so far, is tiny compared with other tropical countries, especially in Southeast Asia, where the painful and sometimes deadly disease is an entrenched peril.   But tackling the outbreak is a major challenge for Ivory Coast, a poor country that is having to resort to time-honoured, labour-intensive methods of spraying and neighbourhood awareness campaigns to prevent its spread.   Female mosquitoes carrying the dengue virus transfer the pathogen when they tuck into a blood meal from someone. 

A vaccine does exist, but is not available in Ivory Coast because "it has many secondary effects (and) it's expensive"," explained Joseph Vroh Benie Bi, director of the National Institute for Public Hygiene (INHP).    Developed by French pharmaceutical group Sanofi Pasteur, the vaccine is recommended for use in people aged nine and older, and only for individuals who have already been infected.    Usually accompanied by flu-like symptoms, dengue makes some people very sick indeed, developing into a haemorrhagic fever that can cause difficulty breathing, heavy bleeding or even organ failure. While a first bout of dengue is rarely fatal, subsequent infections are usually worse.

- 'Fighting the mosquito' -
The UN's World Health Organization (WHO) says there are up to 100 million cases of dengue worldwide every year, and almost half the world's population lives in countries where the disease is endemic.   It kills more than 20,000 people each year. Southeast Asia and the Western Pacific are the worst-hit areas.   There is no cure, and the WHO recommends that patients take paracetamol, rest and drinking plenty of fluids.   Five new vaccines are in development, but in the meantime Fofana says: "The only effective means of fighting (dengue) is fighting the mosquito."   In Ivory Coast, most recorded cases have occurred in Abidjan.

Health workers are striving to enlist the public in tackling the mosquito, targeting its life cycle.   "The larvae multiply in stagnant water, for example inside used tyres," said Fofana, deputy director of the vector control unit at the INHP.   "People should never store water in buckets in the open air and they should regularly throw out the water in plates under houseplants."   But he faces an uphill job in a sprawling port city of 4.4 million people in the middle of the rainy season.   What's more, people who are infected, even without knowing it, and can bring the virus to new areas when they are bitten by local mosquitoes.    The WHO has set a goal to halve the number of dengue deaths by 2020, but incidence of the disease has increased 30-fold in the last 50 years.   "Before 1970, only nine countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries," it says.

- 'Malaria's big brother' -
In Ivory Coast, where malaria accounts for a third of all medical consultations, many people self-medicate when they experience symptoms such as high fever, vomiting, nausea or aches and pains.   "This is a real problem, because the symptoms of malaria, dengue, typhus and yellow fever are similar. Doing a blood test is absolutely indispensable," said Fofana.   Treatment with the wrong medicines can worsen the situation, he stressed -- aspirin or ibuprofen can increase the risk of bleeding, for example.   In the meantime, the spraying goes on.    "We know the risks," said Bamba Segbe, an Abidjan resident watching the masked men in action. "It's not for nothing that we call dengue malaria's big brother."
Date: Mon 18 Mar 2019
Source: Abidjan.net [in French, trans. ProMED Corr.SB, edited]

Two people, including a 70-year-old woman, died on [Sun 17 Mar 2019] in the village of Yrouzon and 4 other people were admitted to the general hospital of Duekoue (West, region of Guemon), after having consumed a decoction of herbal tea, supposed to cure malaria.

According to information collected from the victims, a decoction of herbal tea was prepared the day before by the wife of the young -30 years old- BN, that passed away instantly. [BN may have been trying to relieve the pain of what he believed to be chronic malaria]. BN, affected with chromatic [chronic?] malaria took a sip of the product with the hope of relieving his pain.

Also, his family members of who came to visit him, each took a sip, which was supposed to mitigate their "palu" [pain]. But unfortunately, the following events were; BN, having consumed the first liquid, lost consciousness and died during his evacuation. The old woman, aged about 70, fell on her way home and died on the spot. The other 4 affected people were fortunate enough to be admitted to the general hospital.  An investigation is opened to determine the causes of the tragedy.
======================
[Herbs can be healing, or dangerous. They become dangerous when the plant is misidentified, or mistaken. When a toxic plant is incorrectly identified as non-toxic beneficial herb, then disastrous consequences can follow. - ProMED Mod.TG]

[HealthMap/ProMED map available at:
More ...

Georgia

Georgia US Consular Information Sheet
COUNTRY DESCRIPTION:
Georgia is a constitutional republic with a developing economy.
Tourist facilities outside of Tbilisi are not highly developed, and many of the goods and services taken for granted
in other countries are not yet available.
Read the Department of State Background Notes on Georgia for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport is required.
U.S. citizens visiting for 90 days or less do not need a visa to enter Georgia.
For further information, please contact the Embassy of Georgia at 2209 Massachusetts Avenue NW, Washington DC, 20008 tel. (202) 387-2390, fax: (202) 393-4537.
Visit the Embassy of Georgia web site at http://embassy.mfa.gov.ge/index.php?lang_id=GEO&sec_id=2&lang_id=ENG for the most current visa information.

Information on dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.
SAFETY AND SECURITY:
As a result of civil wars in the 1980s and early 1990s, there are two separatist regions in Georgia that are not under the control of the Government of Georgia:
South Ossetia, in north-central Georgia; and Abkhazia, in northwest Georgia.
Although armed conflict between the separatist regions and the central government has ceased, episodes of violence continue and political relations are tense. Political developments have the potential to result in open hostilities.
Due to the volatility of the political situation, high levels of crime, and inability of Embassy personnel to travel to Abkhazia or South Ossetia, the U.S. Embassy advises American citizens not to travel to these separatist-controlled areas.
Because of the restricted access of U.S. officials to Abkhazia and South Ossetia, the ability of the U.S. Government to assist American citizens in these regions is extremely limited, even in emergencies.
All travelers to these regions, regardless of purpose, should register with the U.S. Embassy. The U.S. Embassy recommends that Americans regularly monitor warden messages on the Embassy web site for the latest information on the security situation throughout Georgia.

Political tensions remain high between the Georgian Government and the South Ossetia separatist regime, based in Tskhinvali.
This situation culminated in sniper and mortar exchanges between South Ossetian and Georgian troops in 2004.
Although the fighting did not escalate into an all-out war, low-level violence continues between the two sides, periodically resulting in deaths, and underscoring the potential for instability in the region.
A tense truce also exists between the Georgian Government and the separatist de facto government of Abkhazia; since April 2008, several incidents have increased the tension to a point where cross-border military actions are a possibility.
Over the past several years, a number of attacks, criminal incidents, and kidnappings have occurred in Abkhazia.
While Abkhaz "border officials" may demand that travelers entering the region purchase "visas" from the so-called "Ministry of Foreign Affairs of Abkhazia," the U.S. Government recognizes the territorial integrity of Georgia.
American citizens in areas of western Georgia, near Abkhazia, are advised to be aware of their surroundings at all times and to avoid straying off main roads or traveling after dark.

American citizens should be aware that they cannot legally cross by land, air, rail, or sea between Russia and Georgia, even if in possession of valid Russian or Georgian visas.
In July 2006, the Russian Government closed the only border crossing between Georgia and Russia under the control of both governments (the only other crossings are through Georgia’s separatist regions).
Russian authorities said the closure, at Verkhny Lars, would be temporary, pending necessary repairs at the crossing, although it remains closed as of June 2008.
On August 6, 2007, a missile was fired from an aircraft near a village between the city of Gori and the separatist region of South Ossetia.
Although this was an isolated incident, it serves as a reminder that the situation near the separatist areas remains unpredictable.

Georgia's armed forces have periodically conducted operations against suspected international terrorists, Chechen fighters, and criminals who have taken refuge in the Pankisi Gorge.
American citizens should avoid all travel to the Pankisi Gorge, north of the city of Akhmeta.
American citizens are also advised to exercise caution when traveling in the northern mountainous areas of Georgia bordering the Russian Federation, especially the Chechnya and Dagestan sectors.

Political demonstrations take place from time to time in the capital city, Tbilisi, and normally take place in front of the Parliament building on Rustaveli Avenue.
While these demonstrations are normally peaceful, confrontational demonstrations have occurred, and we wish to remind all Americans that even demonstrations intended to be peaceful can turn confrontational and possibly escalate into violence.

Regardless of the region in Georgia one is planning to visit, American citizens are urged to review their personal security precautions, increase their levels of awareness, register with the consular section and as appropriate, take increased security measures.

In the past, religious minorities in Georgia have been targets of violent attacks.
The victims were primarily Jehovah's Witnesses, but also include Pentecostals, Baptists, and members of the Assembly of God.
Incidents included the burning of literature, the destruction of private property and the beating (sometimes severe) of believers, including American citizens.
Although Georgian authorities arrested, convicted and imprisoned the ringleader of the group responsible for these attacks in 2005, American citizens should remain cautious when engaging in missionary activity in Georgia.

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

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Crime is a very serious problem in Georgia.
There is a great disparity in affluence between foreigners and most Georgians.
Americans in particular are perceived as being wealthy, and are therefore specifically targeted for economic- and property-based crimes.
Incidents such as residential break-in, carjacking, car theft, petty theft, and armed robbery account for most of the crimes involving Americans that are reported to the Embassy.
Petty street crime, such as pick pocketing, purse snatching, and cell phone theft, is also common throughout the country. Furthermore, violent attacks have become more commonplace.
Because illegal firearms are readily available in Georgia, assailants are likely to be armed with firearms and other weapons.

Crime remains a particularly serious issue in Tbilisi, where criminal activity against foreigners remains at levels disproportionate to other metropolitan areas in Europe and the United States.
Many robberies and assaults have occurred in areas frequented by American citizens and foreigners, such as on side streets near Tbilisi’s city center; trouble spots include areas off the main avenues in the Vake and Vera districts, and Chavchavadze and Rustaveli avenues, as well as the Saburtalo region of Tbilisi.
These crimes often occurred when the victim was alone, after dark, and in unfamiliar surroundings.

Petty theft is also a problem on the Tbilisi metro system and in minivans, or “marshrutkas” used for public transport.
American citizens are advised to use personal vehicles or use taxis from established companies that carry passengers door-to-door.
While the security of overland travel in Georgia has improved, vehicular and rail traffic remains vulnerable to robbery.

The threat of kidnapping exists both within and outside of Tbilisi.
In the past, foreign businessmen have been abducted for ransom, and Americans in the Tbilisi area have received kidnapping threats.
The possibility of similar risk to Americans elsewhere in the country cannot be discounted.

Outside of Tbilisi, criminal activity is also a problem, especially in the separatist regions of Abkhazia and South Ossetia, due to the reduced capacity of law enforcement in those areas.
Other regions of concern include:
upper Svanetia, Samtskhe-Javakheti, the administrative border with Abkhazia (including Zugdidi city), and areas along the border with Russia.
When visiting or traveling through these regions, American citizens are urged to increase their vigilance, review their personal security precautions, and take appropriate security measures, e.g. traveling with a native Georgian escort familiar with the local area.

Despite much progress in the Georgian Government’s efforts to reform police and fight internal corruption, serious concerns remain as to the police’s ability to deter criminal activity or conduct effective post-incident investigations.
Although police emergency response is good (see below for contact information), criminals continue to have freedom of movement throughout Tbilisi day or night.

In light of the serious crime situation, all American citizens visiting Georgia are again strongly advised to exercise basic security precautions. American travelers should vary times and routes, especially from places of residence to work locations. Americans should maintain a low profile by not carrying large amounts of cash, not wearing excessive amounts of jewelry, and not behaving in a manner that would draw unnecessary attention.
Additionally, Americans should be aware of their surroundings, travel in pairs or groups, and stay on main streets and routes.
The Embassy recommends that those traveling throughout the country do so during daylight hours only and provide a travel itinerary and contact telephone numbers to a friend or business colleague.
Also, Americans should not hesitate to report any unusual incidents or suspicious vehicles or individuals to the Georgian authorities as soon as possible.
Finally, those that do become a victim of crime should not resist their assailant and should cooperate with the assailant as best they can.
Assailants are most interested in money and/or property; cooperation reduces the chance of being assaulted and/or injured.

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.

The Georgian Ministry of Internal Affairs (MOIA) has established a police emergency hotline.
This service is currently limited to larger cities, but the MOIA is planning to expand this service countrywide.

The local “911” equivalent to contact police in an emergency is: “022”.
Please note that the police dispatcher speaks only Georgian or Russian.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care in Georgia is limited.
There is a severe shortage of basic medical supplies, including disposable needles, anesthetics, and antibiotics.
Elderly travelers and those with pre-existing health problems may be at risk due to inadequate medical facilities.
It is recommended that travelers who intend to visit Georgia for at least two weeks get the hepatitis A vaccine and a pre-exposure rabies vaccine.
Travelers are also encouraged to bring medicine to treat diarrhea, which regularly afflicts newcomers.
Georgian doctors and hospitals often expect immediate cash payment before rendering medical services.

Medical Information: Tuberculosis (TB) is an increasingly serious health concern in Georgia.
For further information, please consult the Centers for Disease Control and Prevention’s (CDC) Travel Notice on TB http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company before traveling abroad to confirm whether their policy applies overseas and if 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 Georgia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

As in the United States, vehicular traffic in Georgia moves along the right side of roadways.
Speed limits range from 80 to 100 km/hr on highways, and from 30 to 60 km/hr on urban thoroughfares.
Motorists are not permitted to make right turns on red traffic lights.
While legislation mandating seat belt use has yet to be enacted, drivers and passengers are nevertheless strongly advised to buckle up on Georgian roads.
Georgian law requires that children under seven (7) years of age be restrained in child-safety seats.
A driver with any blood alcohol concentration exceeding 0.00% is considered to be driving under the influence of alcohol.

Motorists should exercise extreme caution when driving in Georgia, as many local drivers do not operate their vehicles in accordance with established traffic laws.
Traffic signals and rules of the road are often completely ignored.
Motorists drive erratically, often recklessly, and at excessive speeds.
Motorists may frequently encounter oncoming high-speed traffic attempting to pass other vehicles at blind turns or over hilltops.
Pedestrians enjoy no right-of-way and need to be extremely careful when crossing streets.
The Georgian Patrol Police, who come under the authority of the Ministry of Internal Affairs, are responsible for maintaining traffic safety in Georgia, but enforcement of traffic regulations is haphazard.

Undivided two-lane roads connect most major cities in Georgia.
Roads are generally in poor condition and often lack shoulder markings and centerlines.
In addition, traffic signals may not work because of power outages or poor maintenance.
Driving at night can be especially dangerous.
Travel on mountain roads is treacherous in both rain and snow, and during winter, heavy snowfalls may make some roads impassable.

Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://tourism.gov.ge/start.php
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Georgia, the U.S. Federal Aviation Administration (FAA) has not assessed Georgia’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

Travelers on regional airlines among the countries of the South Caucasus may experience prolonged delays and sudden cancellations of flights.
In addition to frequent delays, flights are often overcrowded or overbooked.
Basic safety features such as seat belts are sometimes missing.
Air travel to Georgia on international carriers via Europe is typically more reliable.
Ticketed passengers on flights departing from Georgia should reconfirm reservations with the airline 24 hours prior to departure.

SPECIAL CIRCUMSTANCES:
Georgia has been subject to energy crises in the last few years.
During the winter months, frequent and prolonged power outages are common, especially outside of Tbilisi.
The lack of lighting in public places, even when electricity is available, heightens vulnerability to crime (please see the Crime section above for details).

Georgia’s customs authorities may enforce strict regulations concerning the temporary import into or export from Georgia of items such as alcohol, tobacco, jewelry, religious materials, art or artifacts, antiquities, and business equipment.
Only personal medicines with a doctor’s statement can be imported without the permission of the Georgian Drug Agency section of the Ministry of Health.

American citizens may not import firearms into Georgia; however, hunting weapons may be brought into the country for a two-week period, based on valid Georgian hunting licenses.
While there is no limit to the amount of currency that can be imported, if more money is exported than was declared at the time of entry, the traveler is obligated to prove it was legally obtained.
There are limits on the amount of Georgian currency that may be exported.

American citizens should exercise extreme caution in purchasing property in Abkhazia.
Land for sale in that region rightfully may belong to internally displaced persons forced to leave Abkhazia in the early 1990s and may have improperly been placed on the market by the de facto authorities in Abkhazia.
In such cases, the government of Georgia considers the sale of property in Abkhazia illegal under Georgian law and the property could be reclaimed by original owners at a future date.

The Ministry of Culture, Department of Expertise and Evaluation must license any valuables such as artwork, antiques, jewelry, paintings, etc.
This license describes the object, assesses its value, and provides permission to export it from Georgia.
The U.S. Embassy in Tbilisi can provide more specific information on quantities of items that can be imported duty-free, as well as duties excised for specific items.
It is also advisable to contact the Embassy of Georgia in Washington, DC for specific information regarding customs requirements.
Please see our information on Customs Regulations.

While the Georgian lari is the only legal tender, dollars can be freely exchanged for laris at market rates.
ATMs are also becoming more widespread, but only within the city of Tbilisi.
Credit cards are rarely accepted outside of upscale hotels and restaurants, and travelers’ checks are difficult to cash.
American citizens in Georgia have reported incidents of credit card fraud and identity theft.

CRIMINAL PENALTIES:
While in a foreign country, an American 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 Georgian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Georgia are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

CHILDREN'S ISSUES:
For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Georgia are strongly encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration web site, https://travelregistration.state.gov, and to obtain updated information on travel and security within Georgia.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy in Tbilisi is located at 11 George Balanchine Street.
Office hours from American Citizens Services are from 2 to 5 pm on weekdays; no appointment is necessary.
The telephone number is (995) (32) 27-70-00, which can also be reached after hours, and the fax number is: (995) (32) 53-23-10.
The U.S. Embassy in Tbilisi’s web site is http://georgia.usembassy.gov/.
*
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This replaces the Country Specific Information dated October 3, 2007 to update the section on Entry and Exit Requirements, Safety and Security, Crime, Information of Victims of Crime, ion, Traffic Safety and Road Condition, Special Circumstances, and Aviation Safety Oversight.

Travel News Headlines WORLD NEWS

Date: Sat, 22 Jun 2019 21:45:46 +0200
By Anna SMOLCHENKO with Irakli METREVELI in Tbilisi

Moscow, June 22, 2019 (AFP) - Russia's government on Saturday banned Georgian airlines from flying into its territory, extending restrictions imposed by President Vladimir Putin as part of growing tensions between Moscow and its ex-Soviet neighbour.   Putin had signed a decree late Friday banning Russian airlines from flying to pro-Western Georgia from July 8 in response to anti-Moscow rallies in the Georgian capital Tbilisi.

The protests broke out after a Russian lawmaker addressed parliament from the speaker's seat earlier this week, a hugely sensitive move for two countries whose relations remain tense after a brief war in 2008.   The rallies have morphed into a broader movement against the Georgian authorities while the Kremlin has branded them a "Russophobic provocation".   On Saturday, protesters took to the streets of the Georgian capital for a third day of rallies, with some 3,000 demanding snap elections and electoral reform.   The crowd sang a profanity-laced, anti-Putin chant and some of the demonstrators held up placards insulting the Russian president.   Demonstrators also shot paper airplanes into the sky in response to the Russian bans.

Russia's transportation ministry said that from July 8 two Georgian airlines would be banned from flying to Russia, citing the need to ensure "aviation safety" and debt owned by the Georgian companies.   The Kremlin has said the ban against travel to Georgia was to "ensure Russia's national security and protect Russian nationals from criminal and other unlawful activities."

Authorities recommended travel companies stop selling holiday packages to Georgia and advised Russian tourists to return home.   Russia's travel industry and ordinary Russians hit out at the decision by the Kremlin, saying it was a politically motivated move that has little to do with safety concerns.   "Tourism in Georgia is on the rise, and the decision has shocked the whole industry," Aleksan Mkrtchyan, head of Pink Elephant, a chain of travel agencies, said in a statement.

- 'This is politics' -
The ban during high season is expected to hit the travel industry in both countries hard and become a major nuisance for Russian holidaymakers.   Russia and Georgia fought a brief but bloody war in 2008 and tensions between the two governments remain high.   But Georgia -- known for its picturesque Black Sea resorts, rich national cuisine and generous hospitality -- has emerged as one of the most popular destinations for Russian tourists over the past few years, with more than 1.3 million visiting last year.

Irina Tyurina, a spokeswoman for the Russian Tourism Union, said that most in the industry believed that Georgia was not a dangerous destination.   "Georgians have traditionally treated Russians well," Tyurina told AFP.    It was too early to estimate potential industry losses from the ban, she said.   More than 7,000 people have signed a petition calling on Moscow to resume flights.

Russian tourists in Tbilisi expressed regret at the restrictions.   "We are against the ban," Nina Guseva told AFP in the Georgian capital. "We are not guilty and we do not have to suffer."   Fellow traveller Mikhail Strelkov added: "This is politics and has nothing to do with people on holidays."   In Russia, many struck a similar note.   Elena Chekalova, a prominent chef and culinary blogger, said the latest Kremlin move "shocked" her.   "Why are they deciding for us what we cannot eat, where we cannot fly, who we cannot be friends with?" she wrote on Facebook.

- Simmering discontent -
Moscow has suspended flights to Georgia before -- during a spike in tensions in October 2006 and in August 2008 following the outbreak of the five-day war over the breakaway regions of Abkhazia and South Ossetia.   "Putin decided to punish Georgia because there are street protests there," opposition leader Alexei Navalny said on Twitter.   A senior government official in Tbilisi said the Kremlin ban was politically motivated.   "Putin's decision is of course political and has nothing to do with safety concerns," the official told AFP on condition of anonymity.

Analysts say the latest restrictions may further fuel simmering discontent with Kremlin policies.   Since 2014, Russians have been chafing under numerous rounds of Western sanctions over Moscow's role in Ukraine and other crises, with real incomes falling for the fifth year in a row.    During an annual phone-in with Russians this week, Putin dismissed calls to "reconcile" with the West to alleviate economic hardship, saying Moscow needed to protect its interests and "nothing" would change anyway.
Date: Thu, 6 Jun 2019 11:24:00 +0200

Tbilisi, June 6, 2019 (AFP) - Three people died on Thursday when a helicopter owned by one of Georgia's top luxury hotels crashed in a northern mountainous region of the country, emergency services said.   A chopper belonging to the Rooms luxury hotel "crashed in an unpopulated area near the Qulo mountain in the Kazbegi municipality," the spokesman of Georgia's emergency situations department, Rati Mujiri, told AFP.   "All three people onboard have died," he said.  "The helicopter pilot and two staff members of the Adjara Group (which owns Kazbegi Rooms hotel) have been killed in the accident," the company said in a statement.

The Rooms hotel operates Bell 505 Jet Ranger helicopters, according to the hotel's website.   Famed for its spectacular landscapes with snow-capped peaks of the Greater Caucasus mountain range, dramatic rocky gorges, and medieval churches, Kazbegi is a popular tourist destination.
Date: Thu 2 May 2019
Source: PLoS One [edited]

Citation
--------
Rao S, Traxler R, Napetavaridze T, et al. Risk factors associated with the occurrence of anthrax outbreaks in livestock in the country of Georgia: A case-control investigation 2013-2015. PLoS One. 2019;14(5):e0215228. doi: 10.1371/journal.pone.0215228

Abstract
--------
Introduction
Anthrax is considered endemic in livestock in Georgia. In 2007, the annual vaccination became the responsibility of livestock owners, while contracting of private veterinarians was not officially required. Six years later, due to increase in human outbreaks associated with livestock handling there is a need to find out the risk factors of livestock anthrax in Georgia.

Objective
To identify exposures and risk factors associated with livestock anthrax.

Methods
A matched case-control study design was used to recruit the owners of individual livestock anthrax cases that occurred between June 2013 and May 2015, and owners of unaffected livestock from within ("village control") and outside the village ("area control"). We collected data about the case and control livestock animals' exposure and risk factors within the one-month prior to the disease onset of the case livestock (or matched case for the controls). We used logistic regression analysis (univariate and multivariable) to calculate the odds ratios of exposures and risk factors.

Results
During the study period, 36 anthrax cases met the case definition and were enrolled in the study; 67 matched village control livestock and 71 matched area control livestock were also enrolled. The findings from multivariable logistic regression analysis demonstrate that vaccination within the last 2 years significantly reduced the odds of anthrax in cattle (OR = 0.014; 95% Confidence interval = or less 0.001, 0.99). The other factors that were significantly protective against anthrax were 'animals being in covered fence area/barn' (OR = 0.065; p-value = 0.036), and 'female animal being pregnant or milking compared to heifer' (OR = 0.006; p-value = 0.037).

Conclusions
The information obtained from this study has involved and been presented to decision makers, used to build technical capacity of veterinary staff, and to foster a One Health approach to the control of zoonotic diseases which will optimize prevention and control strategies. Georgia has embedded the knowledge and specific evidence that vaccination is a highly protective measure to prevent anthrax deaths among livestock, to which primary emphasis of the anthrax control program will be given. Education of livestock keepers in Georgia is an overriding priority.
------------------------------------------------------
Communicated by
Debby Reynolds
===============================
[The major benefits of this research project were not scientific but instructional in bringing home to all concerned at all levels that livestock anthrax is not inevitable but extremely preventable with many benefits in both animal health and public health. The article conclusions needed to be emphasised: "The control strategies that were recommended for anthrax included a combination of vaccination, quarantine, and proper carcass handling and disposal. Overall, the information obtained from this study has involved and been presented to decision makers, used to build technical capacity of regional and national veterinary staff, and fostered a One Health approach to the control of zoonotic diseases like anthrax, which will optimize prevention and control strategies. For example, a multi-agency anthrax One Health team was established to investigate cases and co-develop educational materials for farmers.

"The investigation process involved a series of trainings and workshops for participants and stakeholders to promote an understanding of epidemiological investigations and the economics of disease control with anthrax as a model. Georgia now has embedded the knowledge and specific evidence that vaccination is a highly protective measure to prevent anthrax deaths among livestock. Hence, primary emphasis for disease prevention will be given to vaccination, with a specific mark/tag for vaccination being desirable. Alternatively, a formal vaccination record given to the owner, or livestock registration is recommended. Education of livestock keepers in Georgia on the importance of vaccination is an overriding priority. Vaccination teams can play an increased role with more attention paid to delivery of standard memorable messages at the time of vaccination and to disseminating public announcements. It is overwhelmingly the case that vaccination of livestock against anthrax is protective and is an effective risk mitigation for anthrax in Georgia."

And if the Georgians can do it, anybody anywhere can do it. And you will note that their last outbreak was in 2017. Our thanks to Debby for forwarding this article. - ProMED Mod.MHJ]

[Maps of Georgia can be seen at
Date: Fri, 16 Mar 2018 16:59:07 +0100

Tbilisi, March 16, 2018 (AFP) - At least eight tourists, including a pregnant woman from Sweden, were injured on Friday when a chair lift ran out of control in the Georgian ski resort of Gudauri, officials said.   Video of the accident showed skiers being flung out of their chairs as they
turned a bend as other resort visitors screamed in terror. 

An emergency stop led to the chairs sliding back at high speed, Economy Minister Dimitry Kumsishvili told journalists, adding that the incident was "allegedly caused by an electricity outage".   "The interior ministry has launched a criminal probe into alleged violation of safety norms," he added.   Health Minister David Sergeenko said the tourists -- who were Georgiain, Russian, Swedish and Ukrainian -- did not suffer serious injuries.

"Two of them - including a pregnant woman from Sweden -- were airlifted to a hospital in (the Georgian capital) Tbilisi," he added.   Video footage (https://www.facebook.com/yanshyn/videos/10210410103119989/) of the accident posted on Facebook has been viewed more than 600,000 times.   The Caucasus nation of Georgia is an emerging ski destination.
Date: Wed 8 Nov 2017 8:36 PM GET
Source: KyivPost, Interfax-Ukraine report [edited]

Georgia's 2nd anthrax fatality this year [2017] has been confirmed. A Poti [Samegrelo-Zemo Svaneti region] resident, aged 28, died from exposure to anthrax, Maka Gabunia, an epidemiologist of the Georgian Healthcare Ministry's Poti regional laboratory, told reporters on [8 Nov 2017].

The tentative cause of death is that the woman sought medical aid too late, Gabunia said. The patient was showing symptoms of the disease when she was admitted to a hospital, she said. "The appropriate medical assistance was provided to the patient, but, unfortunately, doctors were unable to save her," Gabunia said.

Laboratory tests confirmed the diagnosis of anthrax exposure, she said. She said she believes that there are no reasons for panic among residents of Poti.

The 1st anthrax fatality this year [2017] was recorded in Adjara, Georgia, in September. A 58-year-old resident of the village of Akhalsopeli in the Khelvachauri district died following exposure to an infected animal, the Georgian National Center for Disease Control and Public Health told reporters.

The last time an anthrax fatality was recorded in Georgia was in 2013.
****************************
Date: Thu 9 Nov 2017
Source: Rosbalt.ru [in Russian, trans., edited]

A young Poti resident died of anthrax infection. The citizen turned to the doctors late, the Ministry of Health of Georgia informed. The 28-year-old woman died, despite the help she received from epidemiologists.

In September [2017], a man died from anthrax in Adjara.
------------------------------
Communicated by:
Sabine Zentis
Castleview English Longhorns
Gut Laach
D-52385 Nideggen
Germany
**************************
Date: Fri 10 Nov 2017
From: Ana Kasradze [edited]

Anthrax is an endemic zoonotic disease in Georgia. The majority of cases are cutaneous, generalized forms of the disease are rare; 1-2 gastrointestinal tract anthrax cases were registered in total. From August [2017], the human anthrax cases in the west part of Georgia were related to ongoing epizootics in one of the regions.

In the beginning of November 2017, a 28-year-old female was admitted to the hospital in the west part of the country with high temperature, severe sore throat, neck swelling, predominantly unilateral. Lymph nodes were swollen and a pseudomembranous plaque in the mouth -- predominantly on the right side -- was observed. The hospital suspected diphtheria and notified. For a bacteriological study, the sample was sent to NCDC's [National Center for Disease Control and Public Health] Regional Laboratory. The patient was transferred to the referral hospital in the same city, where the laboratory is located. After 24 hours, the culture was identified as anthrax.

Additional laboratory testing was conducted in the center of Lugar, and the bronchial aspirate sample was PCR positive for anthrax.

The condition of the patient was severe, and despite the specific treatment, she died on the 6th day of hospitalization.

Diagnosis: anthrax, oropharyngeal form.

The case was defined as unusual for Georgia, as no oropharyngeal anthrax cases had been identified before in the country. The suspected source of infection is minced meat, that case bought in the local market. Because of her severe condition, we were not able to interview her, but most likely she tasted the raw minced meat before cooking. The person selling the meat at the local market is a private merchant and the meat is not sold in the food chain. National Food Agency was notified. Environmental samples were collected from the slaughterhouse.
-------------------------------
EpiCore Global Surveillance Project member
Ana Kasradze
National Center for Disease Control and Public Health
=================
[Maps of Georgia can be seen at
and <http://healthmap.org/promed/p/63383>.

According to Wikipedia (<https://en.wikipedia.org/wiki/Poti>) Poti is a port city in Georgia, located on the eastern Black Sea coast in the region of Samegrelo-Zemo Svaneti in the west of the country. The city has become a major port city and industrial center since the early 20th century. It is also home to a main naval base and the headquarters of the Georgian navy. Adjacent to the Poti port area is the RAKIA owned Free Industrial Zone.

Poti, a busy city, is distant from the usual rural areas afflicted with livestock anthrax. As the third report notes the patient was confirmed to have oropharyngeal anthrax which is rare in humans though not uncommon in certain livestock. The suggestion that she had sampled the rare minced meat is logical, as we know from hamburgers such is very easy to cook and the cooked surface would have been sterile. The less cooked interior, if eaten, would have possibly resulted in an enteric infection. If the meat had been mixed with some fibrous matter it would have increased the chance of scratching the throat and have facilitated spore entry. Our thanks to Dr Kasradze for her very quick response. - ProMED Mod.MHJ]
More ...

Grenada

Grenada US Consular Information Sheet
March 30, 2007
COUNTRY DESCRIPTION:
Grenada is a developing Caribbean island nation.
The capital is St. George’s. Tourism facilities vary, according to price and area. Read the Department of Sta
e Background Notes on Grenada for additional information.
ENTRY/EXIT REQUIREMENTS: Although Grenada has its own entry requirements, the Intelligence Reform and Terrorism Prevention Act of 2004 requires all U.S. citizen travelers to and from the Caribbean to have a valid, unexpired passport to depart or enter the United States by air. Effective January 23, 2007, U.S. citizens, including infants and children, must have a valid, unexpired U.S. passport, or a “passport card” (which is now under development) when departing or entering the U.S. by air.
IMPORTANT NEW INFORMATION:The new passport requirement will be extended to all land border crossings as well as sea travel no later than June 1, 2009.
We strongly encourage all American citizen travelers to apply for a U.S. passport or “passport card” 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. Until the passport requirement is in place for sea travel, U.S. citizens traveling by ship to Grenada may refer to our Foreign Entry Requirements brochure for documentation that is acceptable for travel to and from Grenada.
There is no visa requirement for stays up to three months. There is an airport departure fee of US$20 for adults and US$10 for children between the ages of five and twelve.
See our Foreign Entry Requirements brochure for more information on Grenada and other countries.

For additional information concerning entry/exit requirements, travelers may contact the Embassy of Grenada, 1701 New Hampshire Avenue, N.W., Washington, D.C. 20009, telephone: (202) 265-2561, Fax: (202) 265-2468: e-mail: grenada@oas.org, or the Consulate of Grenada in New York.
Read our information on dual Nationality and the prevention of international child abduction. Also, please see our Customs Information.
SAFETY AND SECURITY:
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. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Street crime occurs in Grenada.
Tourists have been victims of armed robbery especially in isolated areas and thieves frequently steal credit cards, jewelry, U.S. passports and money.
Mugging, purse snatching and other robberies may occur in areas near hotels, beaches and restaurants, particularly after dark.
Visitors should exercise appropriate caution when walking after dark or when using the local bus system or taxis hired on the road.
It is advisable to hire taxis to and from restaurants.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical care is limited.
U.S. citizens requiring medical treatment may contact the U.S Embassy in St. George’s for a list of local doctors, dentists, pharmacies and hospitals.
Serious medical problems requiring hospitalization and/or medical evacuation to the U.S. can cost thousands of dollars.
Doctors and hospitals often expect immediate cash payment for health services.
Pharmacies are usually well stocked, and prescription medicine is available, but travelers are advised to bring with them sufficient prescription medicine for the length of their stay as occasionally there are temporary shortages of medicines; most pharmacies will check with others in the area to see if they can get what is needed.

Grenada chlorinates its water, making it generally safe to drink.
However, during especially heavy rains, quality control can slip, particularly in the city of St. George’s.
It is recommended that visitors to Grenada request bottled water, which is widely available and relatively inexpensive.
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 http://www.cdc.gov/travel.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) website 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 Grenada is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Traffic moves on the left in Grenada; the majority of vehicles are right hand drive. Grenada’s roads, paved and unpaved, are mostly narrow and winding, with many blind corners and narrow or no shoulders.
Road surfaces often deteriorate; especially in the rainy season (June –November) before maintenance work begins.
Driving conditions in Grenada, including road conditions, increasing numbers of vehicles, and sometimes undisciplined minibus drivers all require caution and reduced speed for safety.
The Government of Grenada has a seat belt law; drivers and passengers found not wearing seat belts are subject to a fine of EC$1,000 (US$400).
Getting a local temporary drivers license, based on valid U.S. drivers license plus EC$30 (US$12), is highly recommended.
In the event of an accident, not having a valid local driver’s license may result in a fine, regardless of who is at fault.
Rental vehicle companies are widely available; most of them will assist in applying for temporary driving licenses.
The adequacy of road signage varies, but is generally poor to nonexistent.
For specific information concerning Grenada driver’s permits, road safety, vehicle inspection, road tax and mandatory insurance, please contact the Grenada Board of Tourism in New York at 317 Madison Avenue, Suite 1704, New York, N.Y. 10017, telephone 1-800-927-9554, (212) 599 0301; Fax: 212-573-9731; e-mail: gbt@caribsurf.com or www.grenadagrenadines.com
Please refer to our Road Safety Page for more information.
Visit the website of the country’s national tourist office at www.grenadagrenadines.com.
Additional general information can be found on Grenada’s Internet website at: http://www.grenadaconsulate.org.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Grenada’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Grenada’s air carrier operations.
For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
SPECIAL CIRCUMSTANCES:
Recovery efforts have been made from the damage caused by Hurricane Ivan in September 2004 and Hurricane Emily in July 2005.
All utilities have been restored.
Cruise ships have returned and all the main shopping areas are open.
While the majority of hotels are up and running, there is still one major resort (Le Source), which remain closed.
The resort’s management hopes to have the hotel open by the time Cricket World Cup 2007 Super Eight games take place in Grenada (alternate days April 10-21).

The February 1 merger of Liat and Caribbean Star airlines has reduced the number of daily flights between Grenada and the other Eastern Caribbean islands from six to three.
Travelers coming into the region from the U.S. and elsewhere should verify in advance directly with Liat that they have a valid reservation.
Some travelers making reservations from outside the region have arrived in the Eastern Caribbean and discovered that the reservation they thought they had on Liat, is not recognized by the airline, resulting in delayed travel as well as additional hotel costs.

Grenada experiences tropical storms during the hurricane season, from June through November. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov.
It is difficult to cash personal U.S. checks in Grenada.
If accepted, they will take approximately six weeks to clear by a local bank. Major credit cards are widely accepted, and ATM facilities are available at most banks.
Most hotels and restaurants take U.S. currency; however, change will be in local currency.
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 Grenada laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Grenada 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.
For more information, 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 website.
REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Grenada are encouraged to register with the U.S. Embassy through the State Department’s travel registration website , and to obtain updated information on travel and security within Grenada.
Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located on the main road to Lance Aux Epines after the Christian Scientist Church, and is approximately 15 minutes from the Point Salines International Airport. Telephone: 1-(473) 444-1173/4/5/6; Fax: 1-(473) 444-4820; Internet e-mail: usemb_gd@caribsurf.com. Embassy hours are 8:00 am to 12:30 pm, Monday to Friday except local and American holidays.
*

*

*
This replaces the Consular Information Sheet dated October 13, 2006, to update all sections.

Travel News Headlines WORLD NEWS

Date: Mon 7 Mar 2016
Source: Outbreak News Today [edited]

Two weeks ago, health officials in Grenada reported on a chickenpox outbreak that affected 17 students at St. George's Anglican Junior School. The school was closed for the week to monitor and treat affected students.

This pustulovesicular rash represents a generalized herpes outbreak due to the Varicella-zoster virus (VZV) pathogen/CDC.

Last week, the Ministry of Health screened over 400 students from the St. George's Anglican School. The exercise saw a team of qualified nursing personnel conducting screening and evaluation of students at the St. George's Anglican Junior and Senior Schools.

A total of 255 and 183 students from the junior and senior schools respectively were examined on the compound as the institution reopened its doors following the completion of sanitation and cleaning operations.

During the screening/examination at the school, several students with skin lesions, fever, cold, headaches and skin rashes were identified and were not given clearance for a return to the classroom. Some of the students were referred to the doctor, and others were requested to be observed at home.

Meanwhile, the ministry will undertake a daily monitoring of the school, conduct education sessions with teachers and undertake another medical evaluation of students, in particular the ones that are to be observed at home and referred.

Chickenpox is a common, usually benign childhood disease caused by the varicella-zoster virus (VZV), a member of the herpes family. This virus causes 2 distinct diseases; varicella (chickenpox) is the primary infection, and later when VSV reactivates, herpes zoster (shingles).

Chickenpox is highly contagious and is spread by coughing and sneezing, by direct contact and by aerosolization of the virus from skin lesions. You can also get it by contact with the vesicle secretions from shingles.

The disease is characterized by fever and a red, itchy skin rash that usually starts on the abdomen, back or face and then spreads to nearly all parts of the body. The rash begins as small red bumps that appear as pimples or insect bites. They then develop into thin-walled blisters that are filled with clear fluid which collapse on puncture. The blisters then break, crust over, and leave dry brown scabs.

The chickenpox lesions may be present in several stages of maturity and are more abundant on covered skin rather than exposed. Lesions may also be found in the mouth, upper respiratory tract and genitals.

Chickenpox is contagious from 1-2 days before the rash forms and continues until all the lesions are crusted over (usually about 5 days).

This disease is more serious in adults than in children. Complications of chickenpox are rare, but include pneumonia, encephalitis and secondary bacterial infections.

Infection with this virus usually gives lifelong immunity, although 2nd attacks have been documented in immunocompromised people. The viral infection remains latent, and disease may recur years later as shingles.

According to the Centers for Disease Control and Prevention (CDC), the chickenpox vaccine is the best protection against chickenpox. The vaccine is made from weakened varicella virus that produces an immune response in your body that protects you against chickenpox. The chickenpox vaccine was licensed for use in the United States in 1995.  [Byline: Robert Herriman]
===================
[A map of Grenada can be found at <http://healthmap.org/promed/p/34>. - ProMED Mod.LK]
Date: Sat 28 Aug 2010
Source: Spice Grenada.com, The New Today [edited]
<http://www.spicegrenada.com/index.php?option=com_content&view=article&id=2505:dengue-fever-is-present&catid=546:august-28th-2010&Itemid=143>

After weeks of speculation among the population that there are dengue cases on the island, the officials within the Ministry of Health confirmed last week that 39 people in Grenada had come down with the fever. Head of the Epidemiology Unit within the Ministry of Health, Dr Alister Antoine, told reorters last week Tuesday [24 Aug 2010] that every parish, including Carriacou, has been affected by dengue fever, with the youngest case being a 2 year old and the oldest being 72.

He said: "In total, we have 20 males and 19 females. The figures we have now are what we have just confirmed with the lab, meaning that there were 17 new cases diagnosed during the 1st week in August [2010]." According to Dr Antoine, there was a noted increase in infection during the months of July and August. As compared to only one case in February, 6 by June, and with the number jumping to 15 in July.

"People should be making it difficult for the mosquitoes to breed, just make it difficult by cleaning up the place," he said. Presently there are 2 types of [dengue virus] strains recorded in Grenada -- type 1 and type 2, and there have been 2 cases of DHF both of which were mild and were treated successfully.
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[A HealthMap/ProMED-mail interactive map showing the location of Grenada in the southern Caribbean can be accessed at <http://healthmap.org/r/05Pe>. - ProMed Mod.TY]
Date: Mon, 3 Sep 2007 11:53:29 +0200 (METDST) MIAMI, Sept 3, 2007 (AFP) - A potentially catastrophic class-five Hurricane Felix ripped across the warm waters of the Caribbean early Monday towards Honduras and Belize after damaging homes and power lines in Grenada. The storm was so powerful that it tossed around a US 'hurricane hunter' data gathering airplane and forced it to abort its mission, the Miami Herald reported. At 0900 GMT the center of Felix was located some 445 kilometers (275 miles) south-southeast of Kingston, Jamaica, packing winds of 270 kilometers (165 miles) per hour, with higher gusts, the Florida-based National Hurricane Center said in its latest advisory. The hurricane was moving west at around 33 kilometers (21 miles) per hour, and "on this track the center of Felix will be near the coasts of extreme northeastern Nicaragua and northeastern Honduras early on Tuesday morning," the Hurricane Center said. Felix is then forecast to head for Belize and Mexico's Yucatan peninsula, where it could make landfall on Wednesday. No casualties were reported since Felix became the second hurricane of the Atlantic storm season on Saturday, though one person was reported missing in northern Venezuela. In just 15 hours on Sunday, Felix jumped from a Category Two storm with winds at 160 kilometers (100 miles) per hour to a rare Category Five hurricane, the most powerful on the Saffir-Simpson scale. The speed at which Felix reached maximum strength was one of the fastest ever recorded, Hurricane Center specialists said. Felix was so powerful that one of the US National Oceanic and Atmospheric Administration's 'hurricane hunter' airplanes was caught in a rapid updraft-downdraft cycle as it gathered data, the Miami Herald reported. The violent cycle placed four times the weight of gravity on those aboard the plane. "Four Gs can put a fair strain on the aircraft, and it also got some very heavy hail that can rip the paint off the plane," Hurricane Center forecaster James Franklin told the newspaper. The airplane, a modified Orion P-3 that normally carries 14 people, was ordered backto its base at Saint Croix, one of the US Virgin Islands, Franklin said. The storm, nourished by the warm Caribbean ocean, was expected to maintain its strength as it followed the general path that another Category Five storm, Hurricane Dean, took just last week. Though extremely powerful, Felix "has a very small wind field," the Hurricane Center said. "Hurricane force winds extend outward up to 45 kilometers (30 miles) from the center, and tropical storm force winds extend outward up to 185 kilometers (115 miles)," the Hurricane Center said. The Honduran government early Monday warned officials along its Caribbean coast to prepare for the hurricane. Hurricane conditions "are also possible over extreme northeastern Nicaragua," the Hurricane Center said. In Venezuela civil defense officials said a person went missing as beaches were evacuated in Puerto Cabello, 120 kilometers (75 miles) west of Caracas, where Felix generated high winds, heavy rains and up to three meter (10 foot) swells. There were no immediate reports of damage as the storm skimmed just north of the Paraguana peninsula, site of Venezuela's main oil refineries. Meanwhile Jamaica, which lay well to the north of Felix's track, was under a tropical storm watch as it prepared to hold elections Monday, already postponed from one week ago by Hurricane Dean. Warnings for Aruba, Bonaire and Curacao were discontinued as Felix swiped the popular tourist destinations in the Netherlands Antilles after wreaking some damage in Grenada, ripping roofs, downing power lines and knocking radio and TV stations off the air. Last week, Dean, also reaching category five, swept through the Caribbean with severe winds and rains, leaving a wide swathe of damage and a death toll of 30 from Martinique to Mexico.
Date: Thu, 14 Jul 2005 17:59:59 +0200 (METDST) MIAMI, July 14 (AFP) - Hurricane Emily, the Atlantic's second big storm of the season, headed west, gathering strength Thursday, the National Hurricane Center said, just after its predecessor Dennis carved a trail of death and destruction across the region. Packing 100-mile-per-hour (160-kilometer-per-hour) winds and growing stronger, Emily -- now a Category Two hurricane on the Saffir-Simpson intensity scale, on which five is the top-force storm -- lashed Grenada and headed toward Hispaniola island. Shared by the Dominican Republic and Haiti, Hispaniola's southern coast was grazed last week by Dennis, leaving at least 40 people dead in Haiti. Dennis went on to kill 16 in Cuba and one man in Jamaica. Emily was expected to produce heavy rain across much of the southern Caribbean and northern Venezuela, as well as the Netherlands Antilles. "These rains could produce life-threatening flash floods and mudslides," the center warned. In Grenada, where 30,000 people -- one-third of the permanent population -- remain homeless 10 months after Hurricane Ivan, there were widespread fears about the new storm. There were no immediate reports of fatalities in Grenada Thursday, though authorities said they were inspecting damage. At 1500 GMT, the storm's center was about 560 miles (905 kilometers) southeast of Santo Domingo in the Dominican Republic, moving west-northwest near 18 miles (30 kilometers) per hour, the US center said. "Additional strengthening is forecast during the next 24 hours," the center added. The government of the Dominican Republic has issued a tropical storm watch from Punta Salinas westward to the Haitian border. And the government of Haiti has issued a tropical storm watch from the border with the Dominican Republic to Port-au-Prince. In Haiti, civil protection agency spokesman Jeffe Delorges said after Dennis roared past last Thursday that 23 bodies were found in the southwestern town of Grand-Goave. Most were killed when a bridge collapsed. Another 10 were killed in the Grande-Anse region, also in the southwest, along with five in the southeast and two in the southern city of Cayes. The agency estimates that about 15,000 people are without homes or means to feed themselves, with hundreds of houses completely destroyed. It said there had been widespread flooding and damage to plantations. The Haitian government announced emergency aid totaling the equivalent of 30,000 dollars. Cuban President Fidel Castro said in a televised address late Monday that the toll from Dennis had climbed to 16 and that Dennis destroyed or damaged 120,000 homes and caused more than 1.4 billion dollars in damage. Castro also read from a lengthy list of agricultural devastation: "The entire crop of citrus fruits was lost -- 200,000 tonnes of grapefruit fell from the trees, as did 160,000 tonnes of oranges. "At hundreds of dollars per tonne, that's a huge loss for our exports," he said. Dennis, the first hurricane of the season, was estimated to have caused a further one billion to five billion dollars in insured losses in the United States, according to Risk Management Solutions.
Date: Thu, 7 Oct 2004 03:19:49 +0200 (METDST) by Laura Bonilla POINT SALINES, Grenada, Oct 6 (AFP) - US Secretaty of State Colin Powell flew over the Caribbean island state of Grenada on Wednesday to survey the damage caused by Hurricane Ivan and vowed to bring more help to this devastated spice island. The hurricane killed 39 people and destroyed 90 percent of the tiny island's buildings when it blasted across the Caribbean on September 7, causing an estimated 800 million dollars in damage. This island of 90,000 people is heavily dependent on tourism and nutmeg production, which together account for 40 percent of the economy. The United States has given one million dollars in aid to Grenada and pledged an additional 3.6 million, US officials said. The island will receive additional help in a 100-million-dollar emergency aid package that US President George W. Bush has requested from Congress for Caribbean nations hit by a wave of hurricanes this storm season, Powell said. "We'll do everything we can to expedite the flow of that money," Powell said in a news conference at the airport in Point Salines, the island's southernmost point, after surveying the destruction from his plane's cockpit. "There's an urgent need to reconstruct the economy as well as rebuilding houses and rebuilding schools," Powell said, noting that Grenada's schools, homes, farms and power system were hit by the hurricane. Residents are receiving food and water, "but it'll be a continuing challenge," he said. Shelters need to be built for people who remain homeless, the infrastructure needs to be repaired and power needs to be restored, he said. Only one-third of the island has electricity. Grenada's Prime Minister Keith Mitchell said his government's priority is to reopen schools, which remain closed. "After the devastation arrived we've gone through quite a lot in every respect," Mitchell said. He told Powell: "You understood what was happening, you had a good grasp of the problems that we've faced." From an airplane, much of the island appeared still in ruins. Some areas appeared deserted, while some buildings looked as if they had been eaten up by a raging blaze and palm trees stood leafless. "When those roofs went away, there was water damage done in all of these homes, in some cases destroying a family's entire possessions, all that they owned," Powell said. "What makes this situation so difficult for Grenada is that not only was their infrastructure hit -- schools, housing, roads, the power system -- but their means of production and the economic base of the country," he said. The nutmeg industry -- Grenada is world's second producer of the aromatic seed -- was devastated, and it takes five to 10 years for its evergreen trees to regrow, Powell said. "We want to see if there are things we can do to help with that or perhaps diversify the agricultural sector," he said.
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Bolivia

Bolivia US Consular Information Sheet
July 19, 2006

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

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

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

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

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

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

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

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

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

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

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

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

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

For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site , where the current Worldwide Caution Public Announcement , Travel Warnings and Public Announcements can be found.

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

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

CRIME: The U.S. Department of State currently classifies Bolivia as a medium to high crime threat country. Street crime, such as pick pocketing and theft from parked vehicles, occurs with some frequency in Bolivia. Theft of cars and car parts, particularly late-model four-wheel-drive vehicles, is common. Hijacking of vehicles has occurred, and travelers should take appropriate precautions to avoid being victimized. In November 2003, an American citizen was murdered during an attempted carjacking in Santa Cruz.

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

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

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

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

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

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

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

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

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

INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends, and explain how funds may be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

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

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention's hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC's Internet site at . For information about outbreaks of infectious diseases abroad consult the World Health Organization's (WHO) website at . Further health information for travelers is available at .

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Most medical evacuation flights cannot land at the airport serving La Paz due to the altitude; instead flights may need to use the international airport in Santa Cruz, Bolivia. Please see our information on medical insurance overseas .

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

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

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

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

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

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Bolivia is provided for general reference only, and may not be totally accurate in a particular location or circumstance. U.S. citizens planning on driving in Bolivia, despite the hazards described below, should obtain an international driver's license through their local automobile club before coming to Bolivia.

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

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

Drivers of vehicles involved in traffic accidents are expected to remain at the scene until the arrival of local police authorities. Any attempt to leave the scene is in violation of Bolivian law. The Embassy believes any attempt to flee the scene of an accident would place the driver and passengers at greater risk of harm than remaining at the scene until the arrival of local police. Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Bolivia as being in compliance with ICAO international aviation safety standards for oversight of Bolivia's air carrier operations. For more information, travelers may visit the FAA's Internet web site at www.faa.gov/avr/iasa/index.cfm . There are limited flights within Bolivia and to neighboring countries. Flight delays and cancellations are common. In February and March 2006, strikes at national carrier Lloyd Aereo Boliviano led to the cancellation of both national and international flights with resultant delays and other inconveniences for travelers.

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

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

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

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Bolivian laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Bolivia are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties .

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

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

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

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

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

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

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

Travel News Headlines WORLD NEWS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Andorra

General
************************************
This small country is situated between France and Spain. Because of its elevation and proximity to the Pyrenees the climate is generally pleasant throughout the year.
Climate
**************
*********************
During the summer months the temperatures can rise to 30c but there is usually a cooling breeze. Lightening storms can occur during the summer months associated with torrential rain.
Sun Exposure and Dehydration
***************************************
Those from Northern Europe can develop significant sun exposure and so remember to use a wide brimmed hat when necessary. The altitude can also lead to significant tiredness and dehydration so take sufficient initial rest and drink plenty of fluids.
Safety & Security
************************************
The level of crime throughout the country directed at tourists is very low. Nevertheless take care of your personal belongings at all times and use hotel safety boxes where possible.
Local Customs
************************************
There are strict laws regarding the use of illegal drugs. Make sure you have sufficient supplies of any medication you required for your trip and that it is clearly marked. The European E111 form is not accepted in Andorra and so it is essential that you have sufficient travel insurance for your trip.
Winter Sports
************************************
Andorra is one of the regions where many travel to partake of their winter sport facilities. Generally this is well controlled and one of the safer regions. Nevertheless, make certain your travel insurance is adequate for the activities you are planning to undertake.
Vaccination
************************************
The only standard vaccine to consider for Andorra would be tetanus in line with many other developed countries of the world.

Travel News Headlines WORLD NEWS

Date: Thu, 12 Jul 2018 15:24:06 +0200

Andorra la Vella, Andorra, July 12, 2018 (AFP) - The tax haven of Andorra has long been a favourite destination for smokers looking to stock up on cheap cigarettes, but the enclave said Thursday that it would soon stop advertising the fact.   The government said it had signed up to the World Health Organization's (WHO) anti-tobacco convention, which aims to encourage people to quit smoking and combat contraband sales.   "The goal is to contribute to public health and pursue the fight against trafficking," government spokesman Jordi Cinca said at a press conference.

The tiny principality of Andorra, perched in the Pyrenees on the border between France and Spain, attracts millions of shoppers each year to duty-free stores, where prices of alcohol, cigarettes, electronics and clothes can be up to 20 percent cheaper than elsewhere in the EU.   High taxes on tobacco imposed by many countries to help people kick smoking make Andorra's cigarettes a particularly good deal.   The average pack costs just three euros ($3.50) compared with eight euros in France, which has said it will gradually raise the price to 10 euros a pack by November 2020.

Tobacco sales bring in some 110 million euros a year for Andorra, whose economy is otherwise based almost entirely on tourism.   It is also an enticing destination for smugglers, with French and Spanish border agents regularly seizing cartons from people trying to sneak them out, either by car or by hiking down the mountain trails which criss-cross the Pyrenees.   No date has been set for the advertising ban, which will come into effect three months after the ratification of the WHO accord is voted by parliament.
Date: Fri, 16 Mar 2018 02:41:51 +0100

Andorra la Vella, Andorra, March 16, 2018 (AFP) - The tiny principality of Andorra is witnessing a once in a generation phenomenon -- a widespread strike.   Around a third of civil servants across the mountainous micro-state have walked out to protest proposed reforms to their sector in what has been described as Andorra's first large-scale strike since 1933.

With no negotiation breakthrough in sight, picket lines are expected to be manned again on Friday with customs officers, police, teachers and prison staff among those taking part.   The first major strike in 85 years was sparked by plans from the government of Antoni Marti to reform civil servant contracts.   He has assured officials "will not do an hour more" work under the reforms and that 49 million euros would be allocated for the next 25 years to supplement civil servant salaries.   But government workers are unconvinced with unions warning the reforms could risk their 35 hour working week and pay.

Customs officers involved in the strike interrupted traffic on the Andorran-Spanish border this week, according to unions, while some 80 percent of teachers have walked out of classes.   Strikers have occupied the government's main administrative building and held noisy protests outside parliament calling for Marti's resignation.    "We have started collecting signatures to demand the resignation of the head of government and now nobody will stop us," Gabriel Ubach, spokesman for the public service union, told reporters.
Date: Mon 27 Sep 2017
Source: Contagion Live [edited]

A recent Dispatch article published in the Centers for Disease Control and Prevention (CDC)'s Emerging Infectious Diseases journal, offers insight into a large norovirus outbreak that sprung up in Spain in 2016 that had been linked with bottled spring water. The Public Health Agency of Catalonia (ASPCAT) reported a staggering 4136 cases of gastroenteritis from 11-25 Apr 2016. Of the 4136 cases, 6 individuals required hospitalization. The CDC defines a "case-patient" as an "exposed person who had vomiting or diarrhoea (3 or more loose stools within 24 hours)," as well as 2 or more of the following symptoms: nausea, stomach pain, or fever.

ASPCAT investigators traced back the outbreak to contaminated bottled spring water in office water coolers. The water came from a source in Andorra, a small independent principality located between Spain and France. Norovirus is a "very contagious virus," according to the CDC, and it is common for individuals to become infected by eating contaminated food. Although it is possible to be infected by consuming contaminated drinking water, this mode of transmission is "rare in developed countries," according to the article.

The investigators collected water samples from a total of 4 19-L water coolers in 2 different offices located in Barcelona, "from which affected persons had drunk; samples 1 and 2 came from 2 water coolers in one office, while samples 3 and 4 came from 2 water coolers in another office. Using "positively charged glass wool and polyethylene glycol precipitation for virus concentration," the investigators tested the samples.

"We detected high RNA levels for norovirus genotype I and II, around 103 and 104 genome copies/L, in 2 of the 4 water cooler samples concentrated by glass wool filtration and polyethylene glycol precipitation," according to the article. The investigators noted that a drawback of using molecular methods is that they are not able to differentiate between particles that are infectious and those that are not. Therefore, they "predicted the infectivity of norovirus in the concentrated samples by treating the samples with the nucleic acid intercalating dye PMA propidium monoazide and Triton X surfactant before RT-qPCR," which allowed them to "distinguish between virions with intact and altered capsids."

In those 2 water samples, they found high genome copy values -- 49 and 327 genome copies/L for norovirus genotype I and 33 and 660 genomes copies/L for norovirus genotype II. This was not an unexpected finding, due to the large number of infected individuals associated with the outbreak. Through "PMA/Triton treatment before RT-qPCR assays," the investigators found that the proportion of infected virions accounted for 0.3% to 5.6% of the total number of physical particles in the water samples, "which was enough to cause gastrointestinal illness."

The investigators also analyzed faecal samples collected from infected individuals who worked at the office in which the 1st 2 water samples were collected. They detected the following genotypes in those faecal samples: GI.2 and GII.17. In the faecal samples collected from the other office, they isolated the following genotypes: GII.4/Sydney/2012, GI.2, GII.17, and GII.2.

"We hypothesize that the spring water was contaminated by all 4 strains (GI.2, GII.2, GII.4, and GII.17) but levels of viral contamination for each genotype were not homogeneous in all bottled coolers," the investigators wrote. "We may have detected only the GII.4 genotype in water samples 1 and 2 because of a higher concentration of this specific genotype or because of bias caused by the sampling, concentration, and molecular detection procedures."

The investigators admit one limitation to their study: the small number of water samples collected and analyzed. They attribute this to the fact that on 15 Apr 2016, 4 days after the onset of the outbreak, the company that produced the drinking water recalled over 6150 containers of water "of suspected quality" as a precautionary measure. The recall prevented the investigators from collecting more samples to assess, according to the article.

Although the exact cause of the contamination has not yet been identified, the investigators posit that "the high number of affected persons from 381 offices that received water coolers, and the many different genotypes found in some patients' faecal specimens" suggest that the spring aquifer had been contaminated by "sewage pollution," and the Andorra Ministry of Health and Welfare banned further use of the spring.

The investigators suggest that assessing commercially-produced mineral waters for different harmful pathogens, such as norovirus would be beneficial. They note, however, that creating, enhancing, and managing such "virus surveillance systems" would be costly. Thus, the investigators suggest taking a "balanced approach to keep both the cost and the time required for the analyses within feasibility limits."  [Byline: Kristi Rosa]
=====================
[The interesting article published in the September 2017 issue of Emerging Infectious Diseases is:
Blanco A, Guix S, Fuster N, et al: Norovirus in bottled water associated with gastroenteritis outbreak, Spain, 2016. Emerg Infect Dis. 2017; 23(9): 1531-34; https://wwwnc.cdc.gov/eid/article/23/9/16-1489_article. - ProMED Mod.LL]

[Catalonia and Andorra can be located on the HealthMap/ProMED-mail map at http://healthmap.org/promed/p/1341. - ProMED Sr.Tech.Ed.MJ]
Date: Thu, 26 Dec 2013 22:25:05 +0100 (MET)

ANDORRA LA VELLA, Andorra, Dec 26, 2013 (AFP) - A Spanish skier and a French snowboarder have died in avalanches in different mountain ranges in Europe, officials said Thursday.

The 27-year-old skier, a woman from Barcelona, died Wednesday while going off-piste alone in the Soldeu resort in Andorra, in the Pyrenees mountains between France and Spain, a resort manager told AFP.   Although she was rescued within 10 minutes, after her glove was spotted on the surface, she was unable to be revived despite a helicopter dash to hospital.

In the Italian Alps, close to the border with France, a 24-year-old Frenchman who was snowboarding with three friends on a closed run died Thursday when an avalanche swept over him in the resort town of Les Arnauds.   Local officials said he succumbed to multiple injuries, asphyxia and hypothermia.

Avalanches are common in Europe's ski resorts at this time of year, when early snows are heavy with moisture, and several deaths occur each winter.   Last Sunday, a 35-year-old Frenchman died in an avalanche in the Alps near the Italian border while on a three-day trek with a friend.
Date: Fri 7 Feb 2003 From: Jaime R. Torres Source: EFE Salud, Thu 6 Feb 2003 (translated by Maria Jacobs) [edited] -------------------------------------------------- Close to 300 students in one school and 173 tourists staying in 7 hotels in the Principality of Andorra have been affected by outbreaks of gastroenteritis that, according to local authorities, are not related to each other. Monica Codina, Minister of Health, stated that the outbreak that has affected almost 300 children and 8 adults in the San Ermengol school was detected last Monday [3 Feb 2003] but that it may have started Wednesday or Thursday of the previous week. The epidemiological surveys of a group of pre-school and grammar school students that may also be affected have not been performed yet. Also pending are the results of the microbiological tests of the food and water served in the school dining room, but the minister has indicated that the probable cause of the outbreak is the fact that water pitchers were filled with hoses directly from the faucet. The Minister stated that this outbreak of gastroenteritis is not related to the one that affected 173 tourists, most of them young people on holiday, who where staying in 7 hotels of the Principality. The government is also investigating the cause of this outbreak and has indicated that an anomaly in the system that supplies water to the hotels was detected, requiring a process of chlorination, which has not been carried out due to the heavy snowfall of the past few days. * * * * * * * * * * [The suspicion that defective water supplies may be responsible for all of these independent outbreaks suggests that the etiologic agent may be an enterovirus, hepatitis A virus, or non-viral, rather than one of the noroviruses associated with sudden-onset viral gastroenteritis. Information on the outcome of diagnostic tests in progress would be welcomed. - ProMed Mod.CP]
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World Travel News Headlines

Date: Tue 17 Sep 2019
Source: Boston Globe [edited]

Rhode Island officials announced Tuesday [17 Sep 2019] that 2 more human cases of eastern equine encephalitis [EEE] were confirmed in the state.

The 2 people -- one a Coventry child younger than 10 and the other a person in their 50s from Charlestown -- have been discharged from the hospital and are recovering, according to a statement from the state's Department of Public Health.

Authorities think the 2 people contracted EEE in late August [2019]. The cases were confirmed by tests done at the Centers for Disease Control and Prevention. There have been 3 confirmed EEE cases in Rhode Island this year [2019]. A West Warwick resident diagnosed with the mosquito-borne illness died this month [September 2019].

All 3 people contracted EEE before areas at critical risk for the disease were aerially sprayed with pesticide, state officials said.

EEE is a rare but potentially fatal disease that can cause brain inflammation and is transmitted to humans bitten by infected mosquitoes, according to federal authorities. About 1/3 of infected people who develop the disease will die, officials have said, and those who recover often live with severe and devastating neurological complications. There is no treatment for EEE.

"This [2019] has been a year with significantly elevated EEE activity, and mosquitoes will remain a threat in Rhode Island until our 1st hard frost, which is still several weeks out," said Ana Novais, the deputy director for the state's health department. "Personal mosquito-prevention measures remain everyone's 1st defence against EEE. If possible, people should limit their time outdoors at sunrise and sunset. If you are going to be out, long sleeves and pants are very important, as is bug spray [repellent]."

EEE was also confirmed in a deer in Exeter this week [week of Mon 16 Sep 2019].

In Massachusetts, 8 human cases of EEE have been confirmed this year [2019]. Last month [August 2019], a Fairhaven woman with EEE died.
========================
[The 1st Rhode Island case died. Now there are 2 additional EEE cases who have recovered sufficiently to have been discharged from the hospital. Although most reported cases of EEE this year [2019] have occurred in horses, there have been several recent human cases as well. Individuals living in areas where human or equine EEE cases have occurred should heed the above recommendations to prevent mosquito bites. Avoidance of mosquito bites is the only preventive measure available. Fortunately, horses can be vaccinated, but there is no vaccine available for humans.

The risk of EEE virus infection for humans and horses will continue in Rhode Island and the other affected states until the 1st killing frosts occur, likely in October (2019). - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Rhode Island, United States: <http://healthmap.org/promed/p/241>]
Date: Tue 17 Sep 2019
Source: Detroit Free Press [edited]

State health officials said Tuesday [17 Sep 2019] that 3 Michiganders have died from the rare and dangerous mosquito-borne virus eastern equine encephalitis [EEE], and 4 others have been sickened by the disease, amid the biggest outbreak in more than a decade.

Those who live in all 8 of the affected counties -- Kalamazoo, Cass, Van Buren, Berrien, Barry, St. Joseph, Genesee, and Lapeer counties -- are urged to consider canceling, postponing, or rescheduling outdoor events that occur at or after dusk, especially those that involve children, according to the Michigan Department of Health and Human Services. This would include events such as late-evening sports practices or games or outdoor music practices "out of an abundance of caution to protect the public health, and applies until the 1st hard frost of the year [2019]," according to an MDHHS news release.

The 3 people who died were all adults and lived in Kalamazoo, Cass, and Van Buren counties, [respectively], said Bob Wheaton, a spokesman for the Michigan Department of Health and Human Services. The 4 other confirmed cases are in Kalamazoo, Berrien, and Barry counties.

Animals have also been confirmed to have the virus in St. Joseph, Genesee, and Lapeer counties.

The Kalamazoo County Health and Community Services Department also issued a recommendation to local communities and school districts to consider canceling outdoor events at dusk or after dark, when mosquitoes are most active, or move [the events] indoors.  "Michigan is currently experiencing its worst eastern equine encephalitis outbreak in more than a decade," said Dr. Joneigh Khaldun, MDHHS chief medical executive and chief deputy for health. "The ongoing cases reported in humans and animals and the severity of this disease illustrate the importance of taking precautions against mosquito bites."

EEE is one of the deadliest mosquito-borne viruses in the US. One in 3 people who are infected with the virus die. The only way to prevent it is to avoid mosquito bites. The MDHHS says residents should
- apply insect repellents that contain the active ingredient DEET or other US Environmental Protection Agency-registered product to exposed skin or clothing, and always follow the manufacturer's directions for use;
- wear long-sleeved shirts and long pants when outdoors. Apply insect repellent to clothing to help prevent bites;
- maintain window and door screening to help keep mosquitoes outside;
- empty water from mosquito breeding sites around the home, such as buckets, unused kiddie pools, old tires, or similar sites where mosquitoes may lay eggs; and
- use nets and/or fans over outdoor eating areas.

Symptoms of EEE include
- sudden onset of fever, chills;
- body and joint aches, which can progress to a severe encephalitis;
- headache;
- disorientation;
- tremors;
- seizures;
- paralysis; and
- coma.

Anyone experiencing these symptoms should visit a doctor.

[Byline: Kristen Jordan Shamus]
=======================
[The number of human cases remains at 7. However, 3 of these have died since the 6 Sep 2019 report (see Eastern equine encephalitis - North America (18): USA human, horse, deer http://promedmail.org/post/20190910.6667626). However, even among the survivors, there is a significant risk of permanent neurological damage following clinical encephalitis. CDC reports that many individuals with clinical encephalitis "are left with disabling and progressive mental and physical sequelae, which can range from minimal brain dysfunction to severe intellectual impairment, personality disorders, seizures, paralysis, and cranial nerve dysfunction. Many patients with severe sequelae die within a few years" (<https://www.cdc.gov/easternequineencephalitis/tech/symptoms.html>). - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Michigan, United States: <http://healthmap.org/promed/p/225>
Michigan county map:
Date: Mon 16 Sep 2019
Source: Patch [edited]

The state Department of Public Health is warning that an adult resident of East Lyme has tested positive for eastern equine encephalitis (EEE). This is the 1st human case of EEE identified in Connecticut this season [2019].  The patient became ill during the last week of August [2019] with encephalitis and remains hospitalized. Laboratory tests, which were completed today at the Centers for Disease Control and Prevention (CDC) Laboratory in Ft. Collins, Colorado, confirmed the presence of antibodies to the virus that causes EEE.  "EEE is a rare but serious and potentially fatal disease that can affect people of all ages," said DPH commissioner Renee Coleman Mitchell in a release. "Using insect repellent, covering bare skin, and avoiding being outdoors from dusk to dawn are effective ways to help keep you from being bitten by mosquitoes."  The EEE virus has been identified in mosquitoes in 12 towns and in horses in 2 other towns.

Towns where mosquitoes have tested positive for EEE include Chester, Haddam, Hampton, Groton, Killingworth, Ledyard, Madison, North Stonington, Plainfield, Shelton, Stonington, and Voluntown. Horses have tested positive for EEE virus in Colchester and Columbia this season, and the virus has been detected in a flock of wild pheasants.  Other states throughout the northeast are also experiencing an active season for EEE. In addition to the virus being found in mosquitoes, there have been a total of 8 human cases of EEE infection in Massachusetts and one human case in Rhode Island, with one case in each state resulting in a fatality. "This is the 2nd human case of EEE ever reported in Connecticut," said Dr. Matthew Cartter, director of infectious diseases for the DPH. "The 1st human case of EEE reported in Connecticut occurred in the fall of 2013."

The DPH advises against unnecessary trips into mosquito breeding grounds and marshes, as the mosquitoes that transmit EEE virus are associated with freshwater swamps and are most active at dusk and dawn. Overnight camping or other substantial outdoor exposure in freshwater swamps in Connecticut should be avoided. Even though the temperatures are getting cooler, the DPH is advising that mosquito season is not over, and residents should continue to take measures to prevent mosquito bites, including wearing protective clothing and using repellents.  Although EEE-infected mosquitoes continue to be detected in the south-eastern corner of the state, the numbers are declining, and we are not experiencing the excessively high levels of activity seen in Massachusetts. There are currently no plans to implement widespread aerial pesticide spraying in the state.

Severe cases of EEE virus infection (involving encephalitis, an inflammation of the brain) begin with the sudden onset of headache, high fever, chills, and vomiting. The illness may then progress into disorientation, seizures, and coma. Approximately 1/3 of patients who develop EEE die, and many of those who survive have mild to severe brain damage, according to the DPH.

There is no specific treatment for EEE. Antibiotics are not effective against viruses, and no effective anti-viral drugs have been discovered. Severe illnesses are treated by supportive therapy, which may include hospitalization, respiratory support, IV fluids, and prevention of other infections. It takes 4-10 days after the bite of an infected mosquito to develop symptoms of EEE.

The management of mosquitoes in Connecticut is a collaborative effort involving the Department of Energy and Environmental Protection, the Connecticut Agricultural Experiment Station, and the DPH, together with the Department of Agriculture and the Department of Pathobiology at the University of Connecticut. These agencies are responsible for monitoring and managing the state's mosquito population levels to reduce the potential public health threat of mosquito-borne diseases.

Information on what can be done to prevent getting bitten by mosquitoes and the latest mosquito test results and human infections is available online.  [Byline: Rich Kirby]
===========================
[This has been an active year for EEE virus transmission in the eastern USA from the upper Midwest to the northeastern states and south to Florida. Although historically, EEE human cases in Connecticut have been very rare, the occurrence of a human case in the state this year (2019) is not surprising. There have been equine and/or human EEE cases this summer (2019) in the 3 bordering states: Rhode Island, Massachusetts, and New York. Interestingly, pheasants are mentioned in the above report. They are susceptible and, after being infected with the virus from the bite of an EEE-carrying mosquito, become ill or moribund with viremia titers that can reach 10^9 per ml. Ill or moribund pheasant can be attacked and cannibalized by pen mates that, in turn, are infected orally and may become ill and die as well. As the above report cautions, the only way to avoid infection is for people to avoid mosquito bites. Although the incidence of EEE cases and virus-positive mosquitoes may be declining, there is a risk of infection until the 1st killing frost occurs in autumn, when the mosquitoes are no longer active. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Connecticut, United States: <http://healthmap.org/promed/p/210>]
Date: Wed 11 Sep 2019
Source: BBC Afrique [In French, trans. Mod.LXL, edited]

At least 18 people died in 10 days after eating pesticide-contaminated food in 2 localities in Burkina Faso. A dozen still remain under observation in hospitals, according to the Minister of Health.  The 1st cases were reported on [1 Sep 2019] in the town of Didyr in the centre-west of the country, said Professor Claudine Lougue, Minister of Health.  About 15 members of the same families felt unwell after eating local dishes made from bean leaves and small millet seeds, which are actually seed remains. Thirteen died later despite medical care.

On Monday [2 Sep 2019], the ministry received another alert, this time from the central-eastern region. Here again, 14 people from the same family were admitted to the health centres. Five have lost their lives. After analysis, doctors diagnosed massive food poisoning, said the minister. Complementary examinations incriminate pesticides, she said.  "Investigations have been made on samples of biological products such as blood and urine, and we found an unusually high level of pesticides in foods that were consumed. There was an abnormally high level of pesticides, and these pesticides were strongly incriminated," said the minister.

The remains of food have been secured, announced Professor Lougue, who calls on citizens to observe strict hygiene measures in the use of plant leaves for consumption. Pesticides are used for the needs of field work, especially in the countryside during this period of wintering.
Date: Wed, 18 Sep 2019 16:44:19 +0200 (METDST)

London, Sept 18, 2019 (AFP) - British Airways pilots on Wednesday cancelled a strike that had been due September 27, the British Airline Pilots Association union said after two walkouts last week that cost the company dear.   "Someone has to take the initiative to sort out this (pay) dispute and with no sign of that from BA the pilots have decided to take the responsible course," BALPA General Secretary Brian Strutton said in a statement.    The union chief added that the airline's "passengers rightly expect BA and its pilots to resolve their issues without disruption and now is the time for cool heads and pragmatism to be brought to bear.    "I hope BA and its owner IAG show as much responsibility as the pilots," he added.   It was now "time for a period of reflection before the dispute escalates further and irreparable damage is done to the (BA) brand."

However the union added that should the airline "refuse meaningful new negotiations, BALPA retains the right to announce further strike dates".   British Airways, which likes to call itself "the world's favourite airline", flew into turbulence last week as pilots staged a costly and historic two-day strike, tarnishing its global reputation according to aviation analysts.   Pilots walked out for the first time in the company's 100-year history, sparked by a bitter and long-running feud over pay.   BA faced the embarrassment of grounding its entire UK fleet on September 9 and 10, causing the cancellation of about 1,600 flights.   The move sparked travel chaos for about 200,000 passengers who had been due to fly in and out of London's Gatwick and Heathrow airports.

The disruption continued into September 11 because half of BA's 300 aircraft and more than 700 pilots were mostly in the wrong place.   As a result, BA was forced to cancel approximately ten percent of its daily 850 flights in and out of Britain that day.    BALPA and its members are demanding a bigger share of British Airways profits.   The airline has offered a salary increase of 11.5 percent over three years, which it argues would boost the annual pay of some captains to £200,000 ($250,000 or 226,000 euros).   However, the union has rejected the proposal made in July.   BALPA meanwhile estimates that last week's 48-hour strike cost the airline £80 million.   BA is owned by IAG, which was formed in 2011 with the merger of British Airways and Spain's Iberia. IAG has since added other carriers, including Austria's Vueling and Ireland's Aer Lingus.
Date: Wed, 18 Sep 2019 12:26:37 +0200 (METDST)
By Sam Reeves

Kuala Lumpur, Sept 18, 2019 (AFP) - Toxic haze from Indonesian forest fires closed schools and airports across the country and in neighbouring Malaysia Wednesday, while air quality worsened in Singapore just days before the city's Formula One motor race.   Illegal fires to clear land for agriculture are blazing out of control on Sumatra and Borneo islands, with Jakarta deploying thousands of security forces and water-bombing aircraft to tackle them.

Indonesian blazes belch smog across Southeast Asia annually, but this year's are the worst since 2015 and have added to concerns about wildfire outbreaks worldwide exacerbating global warming.   On Wednesday, air quality deteriorated to "very unhealthy" levels on an official index in many parts of peninsular Malaysia, to the east of Sumatra, with the Kuala Lumpur skyline shrouded by dense smog.    Nearly 1,500 schools were closed across Malaysia due to the air pollution, with over one million pupils affected, according to the education ministry.

A growing number of Malaysians were suffering health problems due to the haze, with authorities saying there had been a sharp increase in outpatients at government hospitals -- many suffering dry and itchy eyes.   Indonesian authorities said hundreds of schools in hard-hit Riau province on Sumatra were shut, without providing a precise number, while about 1,300 were closed in Central Kalimantan province on Borneo.    Borneo is shared between Indonesia, Malaysia and Brunei.   Poor visibility closed seven airports in the Indonesian part of Borneo, the transport ministry in Jakarta said. Scores of flights have already been diverted and cancelled in the region in recent days due to the smog.

- Singapore smog race? -
Air quality in Singapore worsened to unhealthy levels and a white smog obscured the striking waterfront skyline, featuring the Marina Bay Sands casino resort with its three towers and boat-shaped top level.    The worsening pollution increased fears that this weekend's Formula One race may be affected. Organisers say the possibility of haze is one of the issues in their contingency plan for Sunday's showpiece night race, but have not given further details.

The city-state's tourism board said spectators would be able to buy masks as protection from the haze if conditions did not improve and assistance would be provided for those who feel unwell, the Today news portal reported.   The fires have sparked tensions between Indonesia and Malaysia.    Indonesia's environment minister initially suggested the haze was from Malaysian fires despite satellite data showing hundreds of blazes in Indonesia and only a handful in its neighbour, prompting anger from her Malaysian counterpart.

Indonesia later sealed off dozens of plantations where it said fires were blazing, including some owned by Malaysia-based firms, deepening the row.   But Prime Minister Mahathir Mohamad, who has struck a diplomatic tone throughout the crisis, said Malaysia may pass legislation forcing its companies to tackle fires on plantations abroad.   Malaysia wants its firms with sites overseas to put out blazes contributing to the haze, he said, adding: "Of course, if we find they are unwilling to take action, we may have to pass a law to make them responsible."

The Indonesian government has insisted it is doing all it can to fight the blazes. But this year's fires have been worsened by dry weather and experts believe there is little chance of them being extinguished until the onset of the rainy season in October.   Indonesia's meteorology, climate and geophysics agency said Wednesday that over 1,000 hotspots -- areas of intense heat detected by satellite that indicate a likely fire -- had been sighted, most of them on Sumatra.
Date: Wed, 18 Sep 2019 12:14:44 +0200 (METDST)
By Aishwarya KUMAR

New Delhi, Sept 18, 2019 (AFP) - India announced on Wednesday a ban on the sale of electronic cigarettes, as a backlash gathers pace worldwide due to health concerns about a product promoted as less harmful than smoking tobacco.   The Indian announcement, also outlawing production, import and distribution, came a day after New York became the second US state to ban flavoured e-cigarettes following a string of vaping-linked deaths.   "The decision was made keeping in mind the impact that e-cigarettes have on the youth of today," Finance Minister Nirmala Sitharaman told reporters in New Delhi.

E-cigarettes do not "burn" but instead heat up a liquid -- tasting of everything from bourbon to bubble gum and which usually contains nicotine -- that turns into vapour and is inhaled.   The vapour is missing the estimated 7,000 chemicals in tobacco smoke but does contain a number of substances that could potentially be harmful.   They have been pushed by producers, and also by some governments including in Britain, as a safer alternative to traditional smoking -- and as a way to kick the habit.

However critics say that apart from being harmful in themselves, the flavours of e-cigarette liquids appeal particularly to children and risk getting them addicted to nicotine.   Some 3.6 million middle and high school students in the United States used vaping products in 2018, an increase of 1.5 million on the year before.   The New York emergency legislation followed an outbreak of severe pulmonary disease that has killed seven people and sickened hundreds.   President Donald Trump's administration announced last week that it would soon ban flavoured e-cigarette products to stem a rising tide of youth users.

- Big E-Tobacco -
Although few Indians vape at present, the Indian ban also cuts off a vast potential market of 1.3 billion consumers for makers of e-cigarettes.   Tobacco firms have been investing heavily in the technology to compensate for falling demand for cigarettes due to high taxes and public smoking bans, particularly in the West.

In 2018 Altria, the US maker of brands such as Marlboro and Chesterfield, splashed out almost $13 billion on a stake in one of the biggest e-cigarette makers, Juul.   A few Indian states have already banned e-cigarettes although the restrictions have been ineffective since online sale of vaping products continue.   The new ban does not cover traditional tobacco products in India.   According to the World Health Organization, India is the world's second-largest consumer of tobacco products, killing nearly 900,000 people every year.

Nearly 275 million people over 15, or 35 percent of adults, are users, although chewing tobacco -- which also causes cancer -- is more prevalent than smoking.   India is also the world's third--largest producer of tobacco, the WHO says, and tobacco farmers are an important vote bank for political parties.   According to the Associated Chambers of Commerce and Industry, an estimated 45.7 million people depend on the tobacco sector in India for their livelihood.   Tobacco is also a major Indian export, and the government holds substantial stakes, directly or indirectly, in tobacco firms including in ITC, one of India's biggest companies.
Date: Wed, 18 Sep 2019 03:56:31 +0200 (METDST)

Washington, Sept 18, 2019 (AFP) - Hurricane Humberto strengthened to a major Category 3 storm on Tuesday and was expected to pass near Bermuda, threatening it with dangerous waves and heavy rain, the US National Hurricane Center said.   "Hurricane conditions are expected to reach Bermuda by Wednesday night and continue into early Thursday morning," the Miami-based NHC said.   "Some fluctuations in intensity are likely during the next day or so, but Humberto should remain a powerful hurricane through Thursday," it said.   As of 8:00 pm (0000 GMT), the storm had maximum sustained winds of 115 miles per hour (185 kilometers per hour) and was moving east-northeast at 12 miles per hour.
Date: Wed, 18 Sep 2019 01:36:21 +0200 (METDST)

Dakar, Sept 17, 2019 (AFP) - Four people died after a boat carrying dozens of tourists capsized during heavy storms in Senegal, authorities and emergency services said Tuesday.   The death toll could rise as three passengers were said to be missing after the accident.  The boat was carrying several Senegalese nationals, six French people, two Germans, two Swedes and one person from Guinea-Bissau, when it turned over Monday in driving rain and a heavy swell, fire department chief Papa Angel Michel Diatta said.   All the dead were Senegalese, officials and emergency services said.

Two worked in a national park, one was a woman and the other victim was a child, Diatta said.   The boat was heading for the Madeleine islands, site of an offshore national park popular with tourists who travel from Dakar, coastal capital of the West African country.   Senegalese President Macky Sall appealed for "greater caution and respect for existing security norms duing the rainy season" in a tweet.

Emergency services continued to look for those missing on Tuesday. AFP journalists saw a dozen divers at the scene. Distressed families were waiting on the shore to get news of their loved ones.    "The gendarmerie called us at 5:00 am (GMT and local time). My brother was on the boat. The worst thing is not knowing," said Aminata Diop, who was among the relatives on the beach.   There are "four dead bodies and between three and four people are missing. Thirty-five people were on the boat. Search and rescue operations are continuing this morning," Interior Minister Aly Ngouille Ndiaye told AFP by telephone.

The causes of the accident were unclear. The interior minister told Senegalese media overnight that several tourists were worried about the heavy rains and wanted to return to the pier but others wanted to stay on the boat.   The survivors spent the night on the island, Ndiaye told local radio on Tuesday. Blankets and food were sent to them and they were to be ferried back to the mainland in the morning, he added.   The rainy season arrived late this year and heavy storms have resulted in several casualties this month.    Two fishermen were killed on their canoe in the same area nearly two weeks ago.
Date: Tue, 17 Sep 2019 15:38:37 +0200 (METDST)

Jakarta, Sept 17, 2019 (AFP) - Massive forest fires in Indonesia that have caused a toxic haze to spread as far as Singapore and peninsular Malaysia are also seriously affecting endangered orangutans and their habitat, a rescue foundation said Tuesday.   Jakarta has deployed thousands of troops as temporary fireman and deployed dozens of water-bombing aircraft to battle blazes that are turning pristine forest into charred landscape in Sumatra and Borneo islands.   The fires -- usually started by illegal burning to clear land for farming -- have unleashed a choking haze across parts of southeast Asia.

The Borneo Orangutan Survival Foundation said Tuesday that the haze was affecting hundreds of great apes in its care at rescue centres and wildlife re-introduction shelters.   "The thick smoke does not only endanger the health of our staff... but also it affects the 355 orangutans we currently care for", the foundation said in a statement, referring to just once cetre in Kalimantan   "As many as 37 young orangutans are suspected to have contracted a mild respiratory infection," it added.   Conditions were so bad at their Samboja Lestari facility in East Kalimantan that outdoor activities for the animals had been restricted to a few hours a day.

Orangutans have been particularly vulnerable to commercial land clearances and have seen their natural habitat shrink dramatically in the last few decades.   The population of orangutan in Borneo has plummeted from about 288,500 in 1973 to about 100,000 today, according to the International Union for Conservation of Nature.   The toxic smoke caused by the forest fires is an annual problem for Indonesia and its neighbours, but has been worsened this year by particularly dry weather.   On Borneo island, which Indonesia shares with Malaysia and Brunei, pollution levels were "hazardous", according to environment ministry data.   Hundreds of schools across Indonesia and Malaysia were shut.