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Argentina

Irish Diplomatic and Consular Information for Argentina
**********************************************************************
Address:
Embassy of Ireland
Suipacha 1380
2nd Floor
1011 Buenos Aires
Telephone:
+54-1
-4325-8588 / 4325-0849
Fax:
+54-11-4325-7572
Email:

Ambassador:
Her Excellency Paula Ní Shlattara
Secretary:

Jonathan Conlon
***************************************
Argentina - US Consular Information Sheet
October 02, 2008
COUNTRY DESCRIPTION:
Last year, Argentina's charm, natural beauty and diversity attracted more than 400,000 American citizen visitors, and this year's total is expected to be even higher. Buenos Aires and other large cities have well-developed tourist facilities and services, including many four- and five-star hotels. The quality of tourist facilities in smaller towns outside the capital varies. The country suffered a major financial crisis in 2001-2002. While it has made a dramatic recovery, continued economic hardship has been linked to a rise in street crime. Read the Department of State Background Notes on Argentina for additional information.

ENTRY/EXIT REQUIREMENTS: A valid passport is required for U.S. citizens to enter Argentina. U.S. citizens do not need a visa for visits of up to 90 days for tourism and business. U.S. citizens who arrive in Argentina with expired or damaged passports may be refused entry and returned to the United States at their own expense. The U.S. Embassy cannot provide guarantees on behalf of travelers in such situations, and therefore encourages U.S. citizens to ensure their travel documents are valid and in good condition prior to departure from the United States. Different rules apply to U.S. citizens who also have Argentine nationality, depending on their dates of U.S. naturalization. For more information, check the Argentine Ministry of the Interior web site at www.mininterior.gov.ar/migraciones/. Most dual nationals are permitted 60-day visits. Dual nationals who stay beyond their permitted time are required to depart on an Argentine passport.
The application process for an Argentine passport is lengthy, and the U.S. Embassy is not able to provide assistance in obtaining Argentine passports or other local identity documents. Children under 21 years of age who reside in Argentina, regardless of nationality, are required to present a notarized document that certifies both parents' permission for the child's departure from Argentina when the child is traveling alone, with only one parent, or in someone else's custody (click on the "international child abduction" link below for more information). An airport tax is collected upon departure, payable in dollars or Argentine pesos.

American citizens wishing to enter Brazil are required to obtain a visa in advance from the Brazilian Embassy or consulate nearest to the traveler's place of residence. The U.S. Embassy in Buenos Aires cannot assist travelers to obtain Brazilian visas. For more information, see the Country Specific Information for Brazil.
Visit the Embassy of Argentina’s web site at http://www.embassyofargentina.us/ for the most current visa information. Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
Traffic accidents are the primary threat to life and limb in Argentina. Pedestrians and drivers should exercise caution. Drivers frequently ignore traffic laws and vehicles often travel at excessive speeds. The rate and toll of traffic accidents has been a topic of much media attention over the past year. The Institute of Road Safety and Education, a private Buenos Aires organization dedicated to transportation safety issues, reports that Argentina has the highest traffic mortality rate in South America per 100,000 inhabitants.

Care should be exercised when traveling in Brazil and Paraguay, near the Argentine border, where criminal entities are known to operate. These organizations are involved in the trafficking of illicit goods, and some individuals in the area have been designated by the U.S. Treasury Department for financially supporting terrorist organizations.
The U.S. government is supportive of coordinated efforts by Argentina, Brazil, and Paraguay to combat illegal activity in that region. Americans crossing from Argentina into Paraguay or Brazil may wish to consult the most recent Country Specific Information for those countries.

Demonstrations are common in metropolitan Buenos Aires and occur in other major cities as well. Protesters on occasion block streets, highways, and major intersections, causing traffic jams and delaying travel. While demonstrations are usually nonviolent, hooligans in some of the groups sometimes seek confrontation with the police and vandalize private property. Groups occasionally protest in front of the U.S. Embassy and U.S.-affiliated businesses. U.S. citizens should take common-sense precautions and avoid gatherings or any other event where crowds have congregated to protest. Information about the location of possible demonstrations is available from a variety of sources, including the local media. Additional information and advice may be obtained from the U.S. Embassy at the telephone numbers or email address listed at the end of this document.

Domestic flight schedules can be unreliable. Occasional work stoppages, over-scheduling of flights and other technical problems can result in flight delays, cancellations, or missed connections. Consult local media for information about possible strikes or slow-downs before planning travel within Argentina.
Public transportation is generally reliable and safe. The preferred option for travel within Buenos Aires and other major cities is by radio taxi or "remise" (private car with driver). The best way to obtain safe taxis and remises is to call for one or go to an established stand, rather than hailing one on the street. Hotels, restaurants, and other businesses can order remises or radio taxis, or provide phone numbers for such services, upon request. Passengers on buses, trains, and the subway should be alert for pickpockets and should also be aware that these forms of transport are sometimes interrupted by strikes or work stoppages.

Argentina is a geographically diverse country with mountains, forests, expansive deserts, and glaciers, making it a popular destination for outdoor and adventure sports. Despite the best efforts of local authorities, assisting visitors lost or injured in such remote areas can be problematic. American citizens have been killed in recent years while mountain climbing, skiing, trekking, and hunting. Travelers visiting isolated and wilderness areas should learn about local hazards and weather conditions and always inform park or police authorities of their itineraries. Reports of missing or injured persons should be made immediately to the police so that a search can be mounted or assistance rendered.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs' web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the United States, 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 pamphlet A Safe Trip Abroad.

CRIME: Most American citizens visit Argentina without incident. Nevertheless, street crime in the larger cities, especially greater Buenos Aires and Mendoza, is a problem for residents and visitors alike. As in any big city, visitors to Buenos Aires and popular tourist destinations should be alert to muggers, pickpockets, scam artists, and purse-snatchers on the street, in hotel lobbies, at bus and train stations, and in cruise ship ports. Criminals usually work in groups and travelers should assume they are armed. Criminals employ a variety of ruses to distract and victimize unsuspecting visitors.
A common scam is to spray mustard or a similar substance on the tourist from a distance. A pickpocket will then approach the tourist offering to help clean the stain, and while doing so, he or an accomplice robs the victim. Thieves regularly nab unattended purses, backpacks, laptops, and luggage, and criminals will often distract visitors for a few seconds to steal valuables. While most American victims are not physically injured when robbed, criminals typically do not hesitate to use force when they encounter resistance. Visitors are advised to immediately hand over all cash and valuables if confronted. Thieves will target visitors wearing expensive watches or jewelry.

Your passport is a valuable document and should be guarded. Passports and other valuables should be locked in a hotel safe, and a photocopy of your passport should be carried for identification purposes. The U.S. Embassy has observed a notable rise in reports of stolen passports in the past year. Some travelers have received counterfeit currency in Argentina. Unscrupulous vendors and taxi drivers sometimes pretend to help tourists review their pesos, then trade bad bills for good ones. Characteristics of good currency can be reviewed at the Argentine Central Bank web site at www.bcra.gov.ar.
Along with conventional muggings, so-called express kidnappings continue to occur. Victims are grabbed off the street based on their appearance and vulnerability. They are made to withdraw as much money as possible from ATM machines, and then their family or co-workers are contacted and told to deliver all the cash that they have on hand or can gather in a couple of hours. Once the ransom is paid, the victim is usually quickly released unharmed. There have been some foreign victims. Visitors are particularly advised not to let children and adolescents travel alone.
Travelers worldwide are advised to avoid packing valuables in their checked baggage. In Argentina, officials have publicly acknowledged the systematic theft of valuables and money from checked baggage at Buenos Aires airports. Authorities are working to resolve the problem and have made a number of arrests, but travelers should exercise continued care and caution. In many countries around the world, counterfeit and pirated goods are widely available. Transactions involving such products may be illegal under local law. In addition, bringing them back to the United States may result in forfeitures and/or fines. More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds can 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 Argentine Federal Police have established a special Tourist Police Unit to receive complaints and investigate crimes against tourists. The unit, located at Corrientes 436 in Buenos Aires, responds to calls around the clock at 4346-5748 or toll-free 0800-999-5000 from anywhere in the country. The local equivalent to the "911" emergency line in the city of Buenos Aires or in the surrounding Province of Buenos Aires is 911 for police assistance. In the city of Buenos Aires, dial 100 in case of fire and 107 for an ambulance. In the Province of Buenos Aires, fire and ambulance numbers vary by location. See our information for Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: The public health system in Argentina provides emergency and non-emergency services free of charge to all, regardless of nationality or immigration status. However, the quality of non-emergency care in public hospitals is generally below U.S. standards. Medical care in private hospitals in Buenos Aires is generally good, but varies in quality outside the capital. Serious medical problems requiring hospitalization in private facilities and/or medical evacuation to the United States can cost thousands of dollars or more. Private physicians, clinics, and hospitals often expect immediate cash payment for health services.
HIV/AIDS restrictions. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Argentina.
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 Preventions hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC's Internet site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad, consult the World Health Organization (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith
MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policies apply overseas and will cover prior conditions and emergency expenses such as a medical evacuation, which could cost tens of thousands of dollars. If not covered, visitors are encouraged to consider purchasing travel insurance. No Medicare benefits are available abroad. 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 Argentina is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving in Argentina is generally more dangerous than driving in the United States. By comparison, drivers in Argentina tend to be very aggressive, especially in the capital city of Buenos Aires, and frequently ignore traffic regulations. U.S. driver's licenses are valid in the capital and the province of Buenos Aires, but Argentine or international licenses are required to drive in the rest of the country. For further information, please contact the Argentine Automobile Club, Av. Libertador 1850, 1112 Capital Federal, telephone (011) (54)(11) 4802-6061, or contact the Embassy of Argentina as listed in the above section on Entry Requirements. Please refer to our Road Safety page for more information. Visit the websites of Argentina's national tourist office and national roadways office at www.turismo.gov.ar and www.vialidad.gov.ar.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Argentina’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Argentina’s air carrier operations. For more information, travelers may visit the FAA web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES: In addition to being subject to all Argentine laws affecting U.S. citizens, dual nationals may also be subject to other laws that impose special obligations on Argentine citizens. In some instances, dual nationality may hamper U.S. Government efforts to provide protection abroad. 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 also be more severe than in the United States for similar offenses. Persons violating Argentina's laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Argentina are strict, and convicted offenders can expect lengthy jail sentences and fines. Engaging in sexual conduct with children and using or disseminating child pornography in a foreign country are crimes 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 Argentina are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, so that they can obtain updated information on travel and security within Argentina. Americans without Internet access may register directly with the U.S. Embassy. By registering, American citizens make it much easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at Avenida Colombia 4300 in the Palermo neighborhood of Buenos Aires (near the Plaza Italia stop on the "D" line subway). The main Embassy switchboard telephone is (54) (11) 5777-4533. Recorded consular information, including instructions on whom to contact in case of an American citizen emergency, is available at tel. (54) (11) 4514-1830. The Consular Section fax is (54) (11) 5777-4293. The Consular Section is open to the public from 8:30 a.m. to noon and 2:30 p.m. to 4 p.m. Monday through Friday, except on American and Argentine holidays. Additional information on Embassy services is available on the Internet at http://argentina.usembassy.gov or by e-mail: BuenosAires-ACS@state.gov
* * *
This replaces the Country Specific Information December 28, 2007 to update Sections on Country Description, Safety and Security, Information for Victims of Crime, Medical Facilities, Traffic Safety and Road Conditions, and Registration/Embassy Locations.

Travel News Headlines WORLD NEWS

Date: Mon 13 Jan 2020
Source: Food Safety News [edited]

An emergency committee to control the sale of food has been created in a city in northwest Argentina after a spike in _Salmonella_ cases in early 2020. There have been 51 confirmed cases of salmonellosis in Salta so far in 2020. At least 5 people have been hospitalized but recovered after treatment.

The committee will be responsible for controlling food sold on public roads at street stalls and at commercial premises. It includes experts from the National University of Salta (UNSA) and Catholic University of Salta (Ucasal). Officials hope by increasing controls they can bring the rise in infections under control and minimize the risk to the public. The group, created by the Mayor of Salta Bettina Romero and Undersecretary of Health and Human Environment Monica Torfe, held a meeting with Juan Jose Esteban, manager of the Hospital Senor del Milagro, and teams from the department of epidemiology of the province on preventive measures to tackle the salmonellosis rise this past week.

Norma Sponton, head of the microbiology sector; Teresita Cruz, of the epidemiological surveillance program of the province; Paula Herrera, from the Ministry of Health, and Jose Herrera, from the hospital also participated. Experts from the 2 universities are involved in training the inspectors who will be in charge of carrying out the control tasks.

Food contaminated with _Salmonella_ bacteria does not usually look, smell, or taste spoiled. Symptoms of salmonellosis infection can include diarrhoea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for 4 to 7 days. In some cases, however, diarrhoea may be so severe that patients require hospitalization.
===================
[The serotype of _S. enterica_ is not stated and it is not clear what the food reservoir for this ongoing outbreak is. A food diary of affected persons may be helpful.

The city of Salta is located in north-western Argentina in the province of the same name which can be found on a map at

[HealthMap/ProMED-mail map of Argentina:
Date: Sun 22 Sep 2019
Source: La Voz [in Spanish trans. Mod.TY, edited]

Viruses transmitted by mosquitoes are emerging in the Americas. To historic dengue in recent years have been added Zika and chikungunya [viruses], 2 pathogens that before were restricted only to Africa. Madariaga has now been added to that list [of viruses new in the Americas].

Researchers from the Instituto de Medicina Regional of the Universidad Nacional del Nordeste (IMR-Unne) and from the Instituto de Virologia, and J. M. Vanella of the Universidad Nacional de Cordoba (Inviv, UNC) detected its presence in mosquitoes captured in the Chaco. "Madariaga is a virus that causes disease in equine animals and is of low pathogenicity for humans, but in 2010 caused an outbreak in humans in Panama with 10 cases," said Marta Contigiani, who works in the UNC laboratory. It was also isolated in 2015 and 2016 from human samples in Haiti.

Ornella Stechina, of the IMR-Unne, was the person who detected presence of the virus in the mosquitoes. The work was done with the financial support of this institution with Mariana Stein, a researcher from CONICET [the national science agency] as the person in charge.

Contigiani explained that there have been no subsequent cases in horses since 1988. "In other provinces in the country, serological studies have detected [Madariaga] virus infections. There is a vaccine for equine animals, but its application is not obligatory," she said.

However, she warned that global climate change (including deforestation in the Amazon Basin) influences the geographic distribution and emergence of diseases, with appearance of new environments that are favorable for the development of vectors and that favor the development of the [transmission] cycle.

"To this we must add the genetic changes that are observed in these viruses," she stated.

For some time, experts have been issuing alerts about the emergence and reemergence of arboviruses, pathogens that are transmitted by insects.

"West Nile virus rapidly invaded North America, and now cases are being found in Central and South America. Also, Mayaro and eastern equine encephalitis viruses have increased their activity and have been found in new regions," said Raquel Gleiser, a researcher at the Instituto Multidisciplinario de Biologia Vegetal of the UNC (Imbiv) in an article published in the Journal of Medical Entomology.

Madariaga virus is a strain of eastern equine encephalitis virus, which was early on detected in Argentina. Contigiani did not discard the possibility that a variant that had greater capacity to replicate, the proliferation of competent vectors, and propitious environmental conditions could cause an outbreak in the region.

The evidence for warning about Madariaga virus is not at the same level as for chikungunya [virus], although they are in the same family (Togaviridae). "For now, the epidemiological behavior is different. Chikungunya virus has _Aedes aegypti_ as its vector, whereas the vector of Madariaga virus is within the _Culex_ genus," she said.

This study detected the virus in mosquitoes of the _Culex_ genus in wildland areas in Choco province. Thus, they identified this vector in Argentinian territory for the 1st time.

Although the mosquito species or species that had the virus could not be detected, the genus _Culex_ has more than 1000 species, many of which are of urban habits such as _Culex pipiens_ that we hear buzzing at night.

Madariaga virus can infect various mammals that could serve as hosts, such as rats and bats, as well as birds.

In Argentina, it was found for the 1st time in animals in the decade of the 1930s. The strain found in the Chaco belongs to the same lineage discovered in those years, which indicates that the virus is endemic in the region.

For now, the infections studied in humans has been for the most part mild and asymptomatic.

Adrian Diaz of the Cordoba Institute, Griselda Oria (IMR-Unne), and Carolina Torres of the Universidad de Buenos Aires participated as part of the work that was published a week ago in the American Journal of Tropical Medicine and Hygiene [reference below].

The researchers suggest that more epidemiological studies be done to determine the vectors and potential hosts and do deeper studies about the genetic characteristics of the [virus] strains that circulate in the country in order to know whether this virus is endemic in the region or is reintroduced.

"Ideally, studies will be done [in the field] with sentinel animals to detect virus circulation as well. In other countries, they use sentinel chickens for these types of studies," Contigiani commented, and clarified that in case [virus] circulation was detected, animal health officials must take relevant measures.

"There is no human vaccine, so [human] health officials must indicate measures [needed] for prevention and control," she added.

The vector is the most common, _Culex_. However, there is no virus circulation in Cordoba.

_Culex_ is a genus of hematophagous mosquitoes in the Culiidae family, many species of which act as vectors of important diseases, such as West Nile, filariasis, virus encephalitis (Japanese, Venezuelan, equine, and St. Louis) and avian malaria, as well as Madariaga virus. There are more than 80 varieties [of what?].  [Byline: Lucas Viano]
=================
[The isolation of Madariaga virus from Culex mosquitoes in northern Argentina is interesting, but, as the authors point out, merits additional studies to determine whether it is a human or animal (especially equine) pathogen of importance for human or animal health in Argentina. Studies of the Culex species involved in transmission of the virus and determination of the animal hosts are essential to understand cycles of transmission.

Reference:
Ornela Sofia Stechina, Griselda Ines Oria, Carolina Torres, Luis Adrian Diaz, Marta Contigiani and Marina Stein. First Detection of Madariaga virus in Mosquitoes Collected in a Wild Environment of Northeastern Argentina. 2019. Am. J. Trop. Med. Hyg., 00(0), 2019, pp. 1-3 DOI: <https://doi.org/10.4269/ajtmh.19-0475>.

Chaco province is in the far north of Argentina. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Chaco Province, Argentina: <http://healthmap.org/promed/p/54342>]
Date: Sun 4 Aug 2019
Source: Diario Uno [in Spanish, trans. ProMED Mod.JG, edited]

A family living in El Borbollon, Las Heras, ate ham and sausages after fixing pork at their home, but after this, 11 persons needed medical attention because of the occurrence of symptoms related to trichinellosis.

It was reported that the Provincial Livestock Direction confiscated homemade ham and sausages after receiving an alert from the Epidemiology Area of Lagomaggiore Hospital, which stated they received and attended (infected) people with symptoms of thichinellosis.

The operation was carried out last Friday in a household located in El Borbollon, which was pointed out as the infection source after 3 persons (2 of them less than legal age) were brought to Lagomaggiore Hospital seeking medical care. As days went by, 8 additional compatible cases -- presenting with similar symptoms -- were reported in Lencinas Hospital.

Once the protocol involving Food Hygiene, Zoonoses, Livestock Farming, and Epidemiology local departments and also the local municipality was activated, 2 pieces of ham, 2 pork shoulders, one piece of pork tenderloin, dry sausages and Bondiola pork were confiscated. Considering the size of these pieces, it is thought a large animal was involved.

Laboratory tests were immediately performed, and because of positive results, the meat products were destroyed and properly disposed of in a local slaughterhouse, aiming to prevent the dissemination of this disease.

Trichinellosis is a parasitic disease caused by ingesting _Trichinella spiralis_ larvae located in muscles (meat). This condition is characterized by high fever, muscle pain and vomiting or diarrhoea. The disease affects humans and many mammals. This condition is acquired by eating infected pork meat.

Common symptoms are diarrhoea, abdominal pain, fatigue, nausea, vomiting, and in severe cases also fever.
=====================
[Trichinellosis caused by _Trichinella spiralis_ is common in Argentina, especially in northern Argentina (see ProMED reports below). The source of meat is pigs from small farms or even "backyard pigs" slaughtered and processed without proper veterinary control. - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Mendoza, Mendoza, Argentina: <http://healthmap.org/promed/p/5900>]
Date: Wed 24 Jul 2019
Source: Jujuy al Momento [in Spanish, trans. ProMED Mod.TY, edited]

The disease [virus], transmitted by rodents, has now taken the life of a man, and there are 18 confirmed cases [of hantavirus infection]. There is concern in the health sector because of the lack of environmental policies to confront the problem of trash dumps, one of the environments where these animals [rodents] proliferate.

- There are now 18 confirmed cases of hantavirus [infections].
- There are 372 suspected cases.
- The increase in the number of trash dumps in the whole province contributes to aggravation of the situation.

The Ministry of Health indicated that there are 372 suspected cases of hantavirus [infections] in Jujuy, with 18 confirmed cases. An adolescent died in the Talar locality, and 17 patients are recuperating favorably.

The majority of the cases are registered in Palma Sola and San Pedro with 4 in each locality.

There was also a case of hantavirus [infection] very close to San Salvador that occurred in the Palpala rural area. This city is one of those with evidence of the greatest increase in trash dumps, to the point that several of them begin to increase in proximity to the plazas and urban neighborhoods.

_Hantavirus_ is a genus that groups various RNA viruses that are transmitted by rodents and, in humans, generally produces 2 types of afflictions: a type of viral hemorrhagic fever, a hemorrhagic fever with renal syndrome; or hantavirus pulmonary syndrome, a very serious affliction.

The disease has a strict relationship to trash deposits since this is where these [reservoir] animals eat and reproduce. Despite this, the Ministry of the Environment, headed by Maria Ines Zigaran, still has not recognized policies to attack the problem.
=====================
[Cases of hantavirus infections have been increasing in Jujuy province since early April 2019. The number of confirmed hantavirus infections in Jujuy province has increased from 11 cases reported on 8 Apr 2019, in the localities of San Pedro, Palma Sola, Libertador General San Martin, and Calilegua, to 15 cases on 10 May 2019, and now to 18 cases reported above. The above report of 372 suspected cases is a surprisingly large number. It will be interesting to learn how many of these cases are ultimately confirmed as hantavirus infections. The confirmed cases are from a variety of locations, indicating that the virus and its reservoir rodent hosts are widespread in the province. The public is well advised to follow the Ministry's recommendations for avoidance of infection.

The hantaviruses responsible for these 18 confirmed cases are not stated in the earlier reports or the one above. An earlier report from Jujuy province this year (2019) apparently presumed that the hantavirus involved in that case was Laguna Negra, although it is not stated that this virus had been laboratory confirmed. As noted in ProMED-mail archive no. http://promedmail.org/post/20110430.1348, several hantaviruses have been associated with human infection and hantavirus pulmonary syndrome in Argentina: Andes virus (in western Argentina, in the long-tailed pygmy rice rat host, _Oligoryzomys longicaudatus_); related Andes-like viruses Hu39694 (in central Argentina; rodent host unknown); Lechiguana (in central Argentina, in the yellow pygmy rice rat, _O. flavescens_); Oran (in northwestern Argentina, in _O. longicaudatus_); Bermejo (in western Argentina, in _O. flavescens_); and Laguna Negra (in northern Argentina, in _Calomys laucha_). Seoul virus with its brown rat (_Rattus norvegicus_) host (a frequenter of trash dumps) is another possibility. Without laboratory confirmation, it is not possible to say with certainty which hantavirus was involved. Andes virus seems unlikely in these cases in Jujuy province. - ProMED Mod.TY]

[Map of Argentina:

HealthMap/ProMED-mail map:
Jujuy province, Argentina: <http://healthmap.org/promed/p/53166>]
Date: Sat 29 Jun 2019 10:38 ART
Source: La Voz, Argentina [in Spanish, trans. Rapp. Kathryn Soderholm, abridged, edited]

The Ministry of Health of San Luis issued an epidemiological alert after 3 cases of trichinosis were confirmed by laboratory. The cases are one child, his father, and his mother. Another 12 probable cases are under investigation, all from the distant towns of Concaran and Villa Mercedes, 163 [101 mi] and 100 kilometres [62 mi], respectively, from the provincial capital [San Luis].

The affected patients would have contracted the disease after consuming sausages purchased in La Punilla at the beginning of June [2019], and the symptoms were detected 48 hours ago, the News Agency of the provincial state declared.

The head of Epidemiology, Rodrigo Verdugo, confirmed that the analyses were performed last [Thu 27 Jun 2019] after the suspected cases were referred on [26 Jun 2019].

The other 12 cases are being investigated and will be confirmed by blood sample.

The boy, who is 8 years old, remains hospitalized in the San Luis Hospital; another patient hospitalized in Merlo and another in Villa Mercedes.

Representatives from the department of Epidemiology with the Sanitary and Fiscal Control Program (Cosafi) toured La Punilla and Concaran, where the other cases originated, making visits to the premises that may have samples of these foods, explained Claudia Olarte, head of the Epidemiological Surveillance Service.

Verdugo noted that "this is the 1st outbreak" of this year [2019] and recalled that in 2018, 3 cases were detected, one of which also originated in La Punilla, so the Health department is also investigating in nearby towns such as Papagayos and Villa del Carmen.
=====================
[La Punilla is approximately 200 km [about 125 mi] south of Cordoba, in San Luis province. Trichinellosis has been reported often from Argentina. The source is homemade sausages from backyard pigs, slaughtered and used or sold at local markets without veterinary control. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Argentina:
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Rwanda

Rwanda US Consular Information Sheet
May 19, 2008
COUNTRY DESCRIPTION:
Rwanda is a landlocked developing country in central Africa which has made considerable progress in rebuilding its infrastructure and establishing security since the 19
4 civil war and genocide in which at least 800,000 people were killed. Economic activity and tourism are on the rise in Rwanda. Hotels and guesthouses are adequate in Kigali, the capital, and in major towns, but are limited in remote areas. Read the Department of State Background Notes on Rwanda for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and evidence of yellow fever immunization are required. Visas are not required for American citizens entering Rwanda for less than 90 days. U.S. citizens planning on working in Rwanda should apply for a work permit at the Directorate of Immigration as soon as possible after arrival in Rwanda. Detailed entry information may be obtained from Rwanda’s Directorate of Immigration at: http://www.migration.gov.rw/ or from the Embassy of the Republic of Rwanda, 1714 New Hampshire Avenue NW, Washington DC 20009, telephone 202-232-2882, fax 202-232-4544, web site http://www.rwandaembassy.org. Overseas, inquiries may be made at the nearest Rwandan Embassy or Consulate.
Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
There are currently no travel restrictions in place within Rwanda, but travelers should use caution when traveling near or crossing the border into Burundi, eastern Democratic Republic of the Congo (DRC), and Uganda.

In March 2005, the Congo-based Democratic Forces for the Liberation of Rwanda (FDLR), comprising ex-Rwandese Armed Forces, Interahamwe, and other extremists, announced it would end its armed struggle against the Government of Rwanda, but thousands of combatants are estimated to remain in eastern Congo. The combatants currently are not well-organized or funded, nor do they pose a serious threat to Rwandan security. However, in early March 2007, in Gisenyi Province (near the Volcanoes National Park in northwestern Rwanda) they launched a mortar round and rocket into Rwandan territory. There were no casualties, and it appears to have been an isolated incident. While visitors may travel freely to Volcanoes National Park, they are not permitted to visit the park without permission from Rwanda's Office of Tourism and National Parks (ORTPN). ORTPN stipulates that the park can only be used for gorilla tours and nature walks. Since December 2006, all restrictions have been lifted in the Nyungwe Forest near the Burundian border in southwestern Rwanda. In the past, the FDLR infiltrated Rwanda from Burundi through the Nyungwe Forest, but the last reported incident in the park was in November 2003. However, FDLR rebel factions are known to operate in northeastern DRC, Burundi, Tanzania, and Uganda, including near the popular tourist area of Bwindi Impenetrable Forest National Park. For information on travel to those and other countries, and for the latest security information, American citizens traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs web site at http://travel.state.gov, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
From time to time, travel by U.S. Embassy personnel may be restricted based on changing security conditions. Visitors are encouraged to contact the appropriate U.S. Embassy Regional Security Office or Consular Section for the latest security information, including developments in eastern Congo, Uganda and Burundi. (See Registration/Embassy Location section below.)

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: Pick-pocketing in crowded public places is common, as is petty theft from cars and hotel rooms. Although violent crimes such as carjacking, robbery, and home invasion occur in Kigali, they are rarely committed against foreigners. Americans are advised to remain alert, exercise caution, and follow appropriate personal security measures. Although many parts of Kigali are safe at night, walking alone after dark is not recommended since foreigners, including Americans, have occasionally been the targets of robbery.

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. The U.S. Embassy provides some information on its web site about criminal justice in Rwanda at http://rwanda.usembassy.gov/criminal_justice_in_rwanda.html.

MEDICAL FACILITIES AND HEALTH INFORMATION: Medical and dental facilities are limited, and some medicines are in short supply or unavailable. Travelers should bring their own supplies of prescription drugs and preventive medicines. In Kigali, Americans may go to King Faisal Hospital, a private facility that offers limited services and dental facilities. There is also a missionary dental clinic and a few private dentists. American-operated charitable hospitals with some surgical facilities can be found in Kibagora, in southwestern Rwanda, in Ruhengeri, near the gorilla trekking area, and in Rwinkavu, near the entrance to Akagera National Park. The U.S. Embassy maintains on its website a current list of healthcare providers and facilities in Rwanda at http://rwanda.usembassy.gov/medical_information.html; this list is also included in the Consular Section’s welcome packets for American citizens. There are periodic outbreaks of meningitis in Rwanda. Yellow fever can cause serious medical problems, but the vaccine, required for entry, is very effective in preventing the disease. Malaria is endemic to Rwanda. All visitors are strongly encouraged to take prophylactic medications to prevent malaria. These should be initiated prior to entry into the endemic area. Because of possible counterfeit of antimalarial medications, these should be obtained from a reliable pharmaceutical source. Multiple outbreaks of ebola have been reported in neighboring Democratic Republic of Congo and Uganda in the past year, but none within Rwanda.
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 website at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en.

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Rwanda is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Due to safety concerns, the use of motorbikes or van taxis for transportation is not recommended. Regulated orange-striped (along the base of the vehicle) sedan auto taxis are safer, but be sure to agree on a fare before beginning the trip. Public transportation can be dangerous due to overloading, inadequate maintenance, and careless drivers.
While the main roads in Rwanda are in relatively good condition, during the rainy season many side roads are passable only with four-wheel drive vehicles. Nighttime driving, particularly outside major cities, is hazardous and is discouraged. Often, roadways are not marked and lack streetlights and shoulders. Many sections have deteriorated surfaces. Due to possible language barriers and lack of roadside assistance, receiving help may be difficult. Travelers may be stopped at police roadblocks throughout the country, where their vehicles and luggage may be searched. Service stations are available along main roads.
In Rwanda, as in the U.S., traffic moves on the right-hand side of the road. Cars already in a traffic circle have the right of way. Until 2004, cars entering traffic circles had the right-of-way. Drivers should exercise caution at traffic circles, since some drivers might forget this change. Excessive speed, careless driving, and the lack of basic safety equipment on many vehicles are hazards on Rwanda's roads. Many vehicles are not well maintained, and headlights are either extremely dim or not used. Drivers also tend to speed and pass other cars with little discretion. Some streets in Kigali have sidewalks or sufficient space for pedestrian traffic; others do not, and pedestrians are forced to walk along the roadway. With the limited street lighting, drivers often have difficulty seeing pedestrians. Drivers frequently have unexpected encounters with cyclists, pedestrians and livestock.
Third-party insurance is required and will cover any damages from involvement in an accident resulting in injuries, if one is found not to have been at fault. The driver’s license of individuals determined to have caused an accident may be confiscated for three months. Causing a fatal accident could result in three to six months' imprisonment. Drunk drivers are jailed for 24 hours and fined Rwandan Francs 20,000 (approximately $35). In the city of Kigali, contact the following numbers for police assistance in the event of an accident: Kigali Center, 08311112; Nyamirambo, 08311113; Kacyiru, 08311114; Kicukiro, 08311115; Remera, 08311116. Ambulance assistance is very limited. Wear seat belts and drive with care and patience at all times. In case of an emergency, American citizens can contact the Embassy duty officer at 0830-0345.
For specific information concerning Rwandan driving permits, vehicle inspection, road tax, and mandatory insurance, please contact the Rwandan Office of Tourism and National Parks, B.P. 905, Kigali, Rwanda, telephone 250-76514, fax 250-76512.
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://www.gov.rw/.
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Rwanda, the U.S. Federal Aviation Administration (FAA) has not assessed Rwanda’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.

In recent months, Rwandair, which charters aircraft to fly its routes, has had difficulties maintaining its schedule, resulting in delayed and cancelled flights which have left passengers stranded for extended periods.

SPECIAL CIRCUMSTANCES:
Telephone communication to and from Rwanda is generally reliable. Cellular telephones and Internet connections are available in Kigali and large towns.
Non-biodegradable plastic bags have been banned in Rwanda, and travelers carrying them upon arrival at the Kayibanda International airport may have them confiscated and have to pay approximately $4 for a reusable cloth replacement.
International ATMs are not available in Rwanda. The Rwandan franc is freely exchangeable for hard currencies in banks and the Bureaux de Change. Several Kigali banks can handle wire transfers from U.S. banks, including Western Union. Credit cards are accepted at only a few hotels in Kigali and only to settle hotel bills. Hotels currently accepting credit cards for payment include the Kigali Serena (formerly Intercontinental) Hotel, the Hotel des Mille Collines, the Novotel Umubano, Stipp Hotel and the Kivu Sun Hotel. Note that there may be an added fee for using a credit card. Travelers should expect to handle most expenses, including air tickets, in cash.

Traveler's checks can be cashed only at commercial banks. Because some travelers have had difficulty using U.S. currency printed before the year 2000, the Embassy recommends traveling with newer U.S. currency notes.
Please see our Customs Information.
CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Rwandan laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Rwanda 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.
The U.S. Embassy provides some information on its website about criminal justice in Rwanda.

CHILDREN'S ISSUES: For information see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction. Both foreigners and Rwandans taking Rwandan children to live outside Rwanda, e.g., after adoption, must obtain an exit permission letter from the Ministry of Family and Gender located within the Primature complex at P.O. Box 969, Kigali, Rwanda; Tel: 011-250-587-128; Fax: 011-250-587-127.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Rwanda are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Rwanda. Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency. The U.S. Embassy is located at 2657 Avenue de la Gendarmerie; the mailing address is B.P. 28, Kigali, Rwanda; tel. (250) 596-400,; fax: (250) 596-591. The Consular Section’s email address is consularkigali@state.gov. The Embassy's web site is http://rwanda.usembassy.gov/. American Citizen Services hours are Tuesdays from 9:00 -17:00 and Fridays from 9:00 - 12:00 except on U.S. and Rwandan holidays.
* * *
This replaces the Country Specific Information for Rwanda dated October 4, 2007, to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Information for Victims of Crime, Medical Facilities and Health Information, Traffic Safety and Road Conditions, Aviation Safety Oversight, Criminal Penalties, Children’s Issues, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Sun, 8 Dec 2019 17:30:45 +0100 (MET)

Kigali, Dec 8, 2019 (AFP) - Rwanda on Sunday started a voluntary Ebola vaccination programme at its border with the Democratic Republic of Congo in a bid to prevent the spread of the deadly virus from its neighbour.   All countries in high-risk areas, even if not hit by Ebola, had been advised by the WHO to use a new vaccine developed by US group Johnson & Johnson, the country's health minister, Diane Gashumba, told journalists.   The idea was "to protect those with high chances of getting in contact with people living in areas where Ebola has been reported to be active", she said.

The vaccine, Ad26-ZEBOV-GP, is an experimental drug produced by US pharmaceuticals giant, Johnson & Johnson. It was used for the first time in mid-November in Goma in DR Congo, on the other side of the border.    So far, there have no confirmed cases of Ebola in Rwanda.   The epicentre of the outbreak in DR Congo, which has killed more than 2,200 people since August 2018, is located 350 kilometres (217 miles) north of Goma, in the Beni-Butembo region.   That region sits on the DR Congo border with Uganda.   More than 250,000 people in DR Congo have already been vaccinated using another product, rVSV-ZEBOV, made by US drug company, Merck Shape and Dohme.

- Ebola in Goma -
People working in the health sector, at border crossings, police officers, and business executives who frequently travel between the two countries are being given priority in the vaccination campaign.   But all residents in the border districts can ask to be vaccinated if they wish.    The first volunteers expressed relief at the measure.    "We lived in a life of worry because of what was going on in DR Congo," Joel Ntwari Murihe, one of the first Rwandans to be vaccinated, told AFP.   "It caused a lot of border disruptions as we were restricted to buying or selling with DR Congo residents who live in Goma.    "The vaccine is an assurance to the safety for our lives and our children's lives."

The head of DR Congo's anti-Ebola efforts, Jean-Jacques Muyembe, and the WHO's representative in Rwanda, Kasonde Mwinga, were present at the campaign launch.    In August, Rwanda briefly closed its border with DR Congo and ordered its citizens not to visit the country when the first Ebola cases were recorded in Goma.   The city, which is the regional capital of the Congolese province of North Kivu, sits on the border with Rwanda.    The border has since been reopened, but strict medical checks are being enforced.
Date: Tue 6 Aug 2018
Source: New Times (Kigali, Rwanda) [summ., edited]
<https://www.newtimes.co.rw/news/livestock-vaccinations>

Livestock farmers have appealed to the government to ensure that cows get timely vaccination in order to effectively control deadly epidemics in cattle. The appeal comes after an outbreak of Rift Valley Fever [RVF] -- a deadly and infectious viral disease -- killed 154 cows countrywide since May [2018], according to figures from Rwanda Agricultural Board (RAB). Gahiga Gashumba, the chairman of Rwanda National Dairy Farmers' Federation, told The New Times that in their performance contracts, districts set themselves targets to inoculate cows, which leaves a gap in achieving effective vaccination.

Efforts to contain the recent outbreak of RVF included vaccinating 257 902 cows countrywide of which 119 520 were from Ngoma, Kirehe, and Kayonza -- the hardest hit by the disease. "All cows should be vaccinated at least in areas prone to given diseases," Gashumba said adding, "We need a clear vaccination calendar detailing the cows that should be immunised in a given period of time. When there are heavy rains, we should be prepared of [immunising cows against] East Coast fever."

Also known as theileriosis, East Coast fever is a deadly tickborne disease in cattle. Ngoma district vice mayor for Finance and Economic Development, Jean Marie Vianney Rwiririza, said that this year [2018], they want many cows to get vaccines against different diseases, including RVF and foot and mouth disease [FMD]. "With using funds from the district's budget alone, we cannot manage to give vaccines to all cows.

We request farmers' cooperatives and the farmers themselves to partake in the activity so that all the cows can be inoculated," he told The New Times. In Kirehe district, there are over 52 000 cows and over 30 000 of them were vaccinated against different diseases, including Rift Valley fever in the 2017/2018 financial year, according to Jean Damascane Nsengiyumva, Kirehe district vice mayor for Finance and Economic Development. "We have increased funding for the vaccination activity so that we inject all cows which we should vaccinate because we do not want the recurrence of such a problem," he said referring to RVF.

Rwanda Agriculture Board (RAB) said that they do not vaccinate all the cows because it can be wastage of resources or poor management when vaccination is done in areas where a disease has not been reported while it can be contained by vaccinating livestock in the risk zone. Instead of spending money on vaccinating all cows, currently estimated at over a million countrywide, appropriate strategies are devised to control the spread of outbreaks, said RAB director general Dr Patrick Karangwa. "We give more attention to diseases that spread faster than others. We do impact assessment based on spread pattern of a disease.

If a disease can be transmitted through air, measures taken to prevent its spreading should be different from the disease that cows or people catch through contact," Karangwa said. He cited FMD which often affects cattle on areas bordering Tanzania, such as Gatsibo, Kayonza, and Nyagatare, observing that when the disease has been checked in those areas, it dose spread elsewhere, pointing out that if all cows in the country are vaccinated, all the funds used [for the development of the livestock] sector might be consumed by such a single activity. Some vaccines are given free of charge, while others have to be paid for by farmers with government subsidy. [byline: Emmanuel Ntirenganya]
=======================
[RVF has become, according to local media, active in Rwanda in April 2018, as reported from the districts of Ngoma, Kirehe, and Kayonza, in the south west of the Eastern province. It was expressed mainly by cattle death and abortions. Later, Kamonyi, a southern province was added. The Rwandan Ministry of Agriculture and Animal Resources announced on [Mon 30 Jul 2018] the lifting of the ban imposed since mid-June [2018] on the movement of cattle in several parts of Eastern province. According to the ministry, 99 of the 147 604 cows in the affected districts died, and 452 aborted. This differs from other statistics from various sources, including the 154 deaths in cattle, as mentioned in the above media report, quoting the Rwanda Agricultural Board.

Official statistics are expected to be included in Rwanda's RVF report to the OIE, which all member countries are obliged to submit. In the absence of data on the number of susceptible animals on the affected holdings, the mortality rate in cattle is not known. Based on accumulated field observations and experimental RVF infection trials, the mortality in adult cattle would, generally, not exceed 10 per cent. No human cases have been reported in Rwanda during the recent event. Vaccination of livestock against RVF can be applied either with a live attenuated (Smithburn) vaccine (relatively cheap, several years immunity rendered, but may cause foetal abnormalities or abortion in pregnant animals).

Alternatively, particularly in pregnant animals, an inactivated (formalin-killed) RVF vaccine can be selected (more costly, safer in all breeds/ages/reproductive stages of cattle, sheep, and goats, but requires a booster 3-6 months after the initial vaccination, then followed by yearly boosters). For the considerations related to vaccine policies, vaccines to be selected, and other tools for the prevention and control of RVF under various epidemiological situations, please refer to references 1-3.

References
------------------------------
1. Consultative Group for RVF Decision Support. Decision-support tool for prevention and control of Rift Valley fever epizootics in the Greater Horn of Africa. Am J Trop Med Hyg. 2010. 83(2 Suppl): 75-85. DOI: 10.4269/ajtmh.2010.83s2a03; <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913494/>.

2. Anonymous. Risk-based decision-support framework for prevention and control of Rift Valley fever epidemics in eastern Africa. EU Collaborative Project, Seventh Framework Programme. 2015. (Grant Agreement no. 266327); <http://www.healthyfutures.eu/images/healthy/deliverables/d5.4%20risk-based%20decision-support%20framework.pdf>.

3. Mariner J. Rift Valley fever surveillance. FAO animal production and health manual no. 21. Rome: FAO. 80 pages; <http://www.fao.org/3/i8475en/I8475EN.pdf>. - ProMED Mod.AS]

[Maps of Rwanda: <http://www.geographicguide.com/pictures/map-rwanda.jpg>
and <http://healthmap.org/promed/p/173>.]
Date: Mon 30 Jul 2018
Source: Journalducameroun.com, APA News report [summ., edited]
<https://www.journalducameroun.com/en/rift-valley-fever-rwanda-lifts-quarantine-on-cattle-movement/>

The Rwandan Ministry of Agriculture and Animal Resources, on [Mon 30 Jul 2018] announced it was lifting the quarantine on the movement of cattle that was imposed to control the deadly Rift Valley fever [RVF] in several parts of Eastern province. A quarantine on cattle in the country's 4 affected eastern districts has been imposed since mid-June [2018] after about 100 heads of cattle were killed by the virus. In a notice issued [Mon 30 Jul 2018], the minister Ministry of Agriculture and Animal Resources, Gérardine Mukeshimana, said the quarantine is no longer serving the purpose of slowing the spread of the deadly Rift Valley fever.

Reports indicate that the outbreak was first detected on 18 May 2018 in 4 districts in Eastern Rwanda including Ngoma, Kirehe, Rwamagana, and Kayonza. Of the 147 604 cows in the affected districts, the ministry says 99 died while 452 aborted. The ministry says it has treated 1638 cows, with 36 930 sheep and 245 goats vaccinated against the disease. To combat further deaths among animals, the ministry says it has dispatched veterinary doctors across the affected districts. Official reports indicate that no human case has been reported so far in Rwanda, yet the number of affected livestock is thought to be much higher.

According to the Director General of Rwanda Agriculture Board (RAB), Dr Patrick Karangwa, the cause of the outbreak is unusually heavy rains, which have created ponds and lakes where mosquitoes can breed, in this region which is normally dry. "Most human infections result from contact with the blood or organs of infected animals", Dr Karangwa said.
========================
[RVF, expressed mainly by cattle death and abortions, became active in Rwanda in April 2018, in the districts of Ngoma, Kirehe and Kayonza, in the southwest of the Eastern Province. Later, Kamonyi, a southern province was added.

An administrative map of Rwanda and detailed districts maps are available at
<https://en.wikipedia.org/wiki/Districts_of_Rwanda#Eastern_Province>.

In the absence of data on the number of susceptible animals on the affected holdings, the mortality rate in cattle is not known. Based on accumulated field observations and experimental RVF infection trials, the mortality in adult cattle would, generally, not exceed 10 percent. No human cases have been reported in Rwanda during the recent event. The tests upon which RVF, an OIE-listed disease, has been confirmed and statistics pertaining to the number, locations, morbidity, and mortality rates in Rwanda's animal population, are expected to be included in an official report to the OIE, as anticipated from all OIE member countries. - ProMED Mod.AS]

[HealthMap/ProMED-mail map of Eastern Province, Rwanda:
<http://healthmap.org/promed/p/15277>]
Date: Sun, 11 Mar 2018 11:43:19 +0100

Kigali, March 11, 2018 (AFP) - At least 16 people were killed and dozens more injured after lightning struck a Seventh-Day Adventist church in Rwanda, a local official said Sunday.   Fourteen victims were killed on the spot as lightning hit the church in the Nyaruguru district in the Southern Province on Saturday, local mayor Habitegeko Francois told AFP over the phone.

Two others died later from their injuries, he said.   He added that 140 people involved in the incident had been rushed to hospital and district health centres, but that many had already been discharged.   "Doctors say that only three of them are in critical condition but they are getting better," he said.   According to the mayor, a similar accident took place on Friday when lightning struck a group of 18 students, killing one of them.
Date: Wed, 26 Jul 2017 11:31:06 +0200
By Fran BLANDY

Volcanoes National Park, Rwanda, July 26, 2017 (AFP) - Nicaraguan singer Hernaldo Zuniga brought his entire family to trek through the lush forests and mist-shrouded volcanoes of northwestern Rwanda in search of mountain gorillas.   He described their encounter with the critically endangered primates as "an almost spiritual" experience, and said it was the only reason they made Rwanda a stop on a trip taking in a safari in Kenya, and a tour of South Africa.

But Rwanda is no longer content with being a whirlwind stop on a tourist's itinerary, and is working hard to broaden its appeal beyond its world-famous mountain gorillas while narrowing its niche market to the wealthiest of visitors.   Zuniga counts himself lucky that his family of five scored their permits to see the gorillas before Rwanda's eyebrow-raising move to double the cost to $1,500 (1,300 euros) per person in May.   "I think that is going to be a drawback for many people. It is just going to be an elite group of people who can pay that," said Zuniga, a well-known star in Latin America.

For Rwanda however, the price hike is part of a careful strategy to boost conservation efforts while positioning itself as a luxury tourist destination.   "The idea behind (the increase) is that it is an exclusive experience which also needs to be limited in numbers. Our tourism is very much based on natural resources and we are very serious about conservation," said Clare Akamanzi, the chief executive of the Rwanda Development Board.   It is a high-value, low-impact strategy that has worked well for countries such as Botswana and Bhutan.

- Safe and clean -
The remote, mountainous border area straddling Rwanda, the Democratic Republic of Congo and Uganda is the only place in the world where one can see the gorillas, whose numbers have slowly increased to nearly 900 due to conservation efforts.   Permits in the DRC ($400) and Uganda ($600) are far cheaper, but Rwandan officials are not concerned that they will lose tourists to their neighbours, arguing the country offers an experience that is rare in the region.   Ever since the devastating 1994 genocide in which 800,000 mainly Tutsis were killed, the country has been praised for a swift economic turnaround.   "When you come to Rwanda it is a clean, organised, safe country with zero tolerance for corruption. We have concentrated on creating a good experience," said Akamanzi, also highlighting a quick visa process.

The challenge is getting tourists to make Rwanda their main destination, and spend more than the usual four days it takes to visit the gorillas and maybe the genocide museum before heading elsewhere.   "We want to keep it high-end as an anchor for tourism but provide other offerings," said Akamanzi. She said tourism is already the country's top foreign exchange earner, but believes they "have only scratched the surface".   So the country, known as the Land of a Thousand Hills is looking into sports tourism such as cycling, cultural tourism and becoming a Big Five safari destination in its own right.   In the past two years Rwanda has re-introduced both lions and rhino to its Akagera National Park -- which had gone extinct due to poor conservation -- and visitor numbers to the reserve have doubled, said Akamanzi.

- 'There will be an impact' -
However gorillas remain the main lure, and industry players are concerned about the impact the price increase could have on the whole tourism chain.   "We risk losing substantial revenue for the industry and government as a whole. Currently a number of gorilla permits are already not sold in the low season," the Rwanda Tours and Travel Association (RTTA) said in a statement after the decision was announced.   Mid-range hotels around the Volcanoes National Park say it is too soon to tell what the fallout will be, but several managers expressed concerns they would lose their main clientele.   "Either way there will be an impact," said Fulgence Nkwenprana, who runs the La Palme hotel.

Aloys Kamanzi, a guide with Individual Tours, acknowledged there has been an initial slowdown in reservations, but is convinced people will keep coming, adding his clients are mostly "retired tourists who have saved their whole lives", some of whom come three or four times.   The singer Zuniga said coming to Rwanda was a hard decision, as he had not heard much about what the country was like today from Mexico, where he lives with his family.   "Rwanda has a lot of sensitive echoes in my generation, the genocide ... we had to cross over all these personal obstacles to make the decision to come here," he said.   "They have to do better in promoting their tourism. Once you are here it is amazing, the people are unique, the country is beautiful. I would like to stay longer."
More ...

Azerbaijan

Azerbaijan US Consular Information Sheet
January 27, 2009
COUNTRY DESCRIPTION:
Azerbaijan is a constitutional republic with a developing economy.
Western-style amenities are found in the capital, Baku, but they are generally not avail
ble outside that city.
Read the Department of State Background Notes on Azerbaijan for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
Travelers may obtain single-entry visas for USD 131 by mail or in person from either the Azerbaijani Embassy in Washington, DC or any other Azerbaijani embassy offering consular services.
Travelers may also obtain single-entry, 30-day visas at the airport upon arrival for USD 131.
Visas are not available at the land borders with Georgia or Russia.
Double-entry, 90-day visas (cost: USD 131) and one-year multiple-entry visas (cost: USD 250) are only available through an Azerbaijani embassy or through the Ministry of Foreign Affairs.
A letter of invitation from a contact in Azerbaijan is required, and travelers who expect to travel in the region should request a one-year, multiple-entry visa.
According to Azerbaijani law, foreign nationals intending to remain in Azerbaijan for more than 30 days must register with local police within three days of their arrival. Foreign citizens should approach the passport section of the local district police office and fill out an application form. The registration fee is AZN 9.90 (approximately USD 12).

American citizens of Armenian ancestry should be aware their visa applications may be denied by the Government of Azerbaijan on the grounds that their safety cannot be guaranteed.
U.S. citizens who obtain a single-entry visa at the port of entry are permitted to remain in Azerbaijan for up to one month, after which an extension of stay must be requested (cost: USD 131).
For persons already in Azerbaijan, visa applications, extensions or renewals are made at the Ministry of Foreign Affairs, Shikhali Gurbanov St., 4, Baku; tel. (9-9412) 492 34 01, or the State Migration Service, Ataturk Avenue 53, Baku; tel (9-9412) 498-9464.
For additional information, please contact the Embassy of Azerbaijan, 2741 34th Street NW, Washington, DC
20008 (tel. 202-337-3500); e-mail: azerbaijan@azembassy.com.
American citizens should ensure their visas and/or local identification cards, for stays of longer than 30 days, are current and valid, and they carry local identification cards, if applicable, at all times. It is advisable to carry a photocopy of your current passport and valid visa if you do not normally carry your passport as well.
Visit the Embassy of Azerbaijan web site at http://www.azembassy.us/ for the most current visa information.
.
Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
As a result of continuing conflict, travelers are cautioned to avoid travel to the region of Nagorno-Karabakh and the surrounding occupied areas.
Because of the existing state of hostilities, consular services are not available to Americans in Nagorno-Karabakh.
American citizens of Armenian ancestry considering travel to Azerbaijan should remain particularly vigilant when visiting the country, as the Government of Azerbaijan has claimed that it is unable to guarantee their safety.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State‘s Bureau of Consular Affairs web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.

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

CRIME:
Baku has experienced a trend away from casual stealth street crime, such as pick-pocketing, towards more targeted and aggressive attacks.
These attacks tend to be against males, usually involve alcohol, and usually occur late at night.
The attacks typically involve multiple attackers on a lone victim using overwhelming numbers and a quick, violent attack to end resistance or flight.
Violent crimes tend to be more frequent in the winter, despite the presence of fewer tourists and foreigners in general at this time of year.
Many recent attacks have resulted in injuries.
There are also reports of foreigners being held up at knife- or gunpoint at or near ATMs during hours of darkness. Visitors should not walk alone at night.

All incidents of crime should be reported to the local police and U.S. Embassy.
The Police Office of Crimes By and Against Foreigners has an English-speaking officer available at all times who may be reached at (994 12) 490-95-32 or, after hours, at 490-94-52.
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.

The local equivalents of the “911” emergency lines in Azerbaijan are: 101-Fire Brigade; 102-Police; 103-Ambulance; 104-Gas services; and 112-Ministry of Emergency Situations.

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

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Azerbaijan’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Azerbaijan 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.

SPECIAL CIRCUMSTANCES:
The Republic of Azerbaijan's economy is mostly cash-only.
Traveler’s checks and credit cards are accepted only in some hotels and a few restaurants and supermarkets.

Azerbaijani customs authorities may enforce strict regulations concerning temporary importation into or export from Azerbaijan of items such as firearms, religious materials, antiquities including carpets, medications, and caviar, and any amount of currency over USD 1000.
It is advisable to contact the Embassy of Azerbaijan in Washington for specific information regarding customs requirements.
Please see our Customs Information.

MEDICAL FACILITIES AND HEALTH INFORMATION:
A few Western-type medical clinics, the quality of which is comparable to those in Western countries, are operating in Baku.
However, medical facilities outside the capital remain inadequate, unsanitary, and unsafe.
There is often a shortage of basic medical supplies, including disposable needles and vaccines. Bring adequate amounts of prescription medicines for the duration of your visit, as pharmacies often do not carry all brands or doses.

Tuberculosis (TB) is an increasingly serious health concern in Azerbaijan.
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.

Avian Influenza:
In 2006, the World Health Organization (WHO) and Azerbaijani authorities confirmed several human cases of the H5N1 strain of avian influenza, commonly known as "bird flu."
Travelers to Azerbaijan and other countries affected by the virus are cautioned to avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces from poultry or other animals.
In addition, the CDC and WHO recommend eating only fully cooked poultry and eggs.
For the most current information and links on avian influenza in Azerbaijan, see the State Department’s Avian Influenza Fact Sheet or visit the web site of the U.S. Embassy in Baku at http://azerbaijan.usembassy.gov/.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the CDC’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the WHO web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en.

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

MEDICAL INSURANCE:
The U.S. 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 Azerbaijan is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving hazards such as open manholes, debris, sinkholes, and potholes are common in Baku.
Most drivers do not pay attention to traffic regulations, signals, lane markings, pedestrians, or other drivers.
Drivers often travel at extremely high speeds, and accidents are frequent and often serious.
Driving in Baku should be considered extremely hazardous.
Outside the city, even where roads are present, conditions are similar.
Roads are often in poor repair and unlighted, and lack lane markings, traffic signs, and warnings.
Many rural roads are largely unpaved.
Public transportation throughout the country is overcrowded and poorly maintained.
The U.S. Embassy strongly discourages use of the Baku Metro.
Train travel in the Caucasus region is not secure.

Please refer to our Road Safety page for more information.
Visit the web site of the Azerbaijan’s national tourist office and national authority responsible for road safety at http://azerbaijan.tourism.az/
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Azerbaijan, the U.S. Federal Aviation Administration (FAA) has not assessed Azerbaijan’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 Caucasus may experience prolonged delays and sudden cancellations of flights.
In addition to frequent delays, flights are often overcrowded, with passengers without seats standing in the aisle along with excess unsecured cabin luggage.
Even basic safety features such as seat belts are sometimes missing.
Air travel to Azerbaijan on international carriers via Europe is typically more reliable.

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 Azerbaijan are encouraged to register with the U.S. embassy through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Azerbaijan.
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 at Azadlig Prospekt 83; tel. (9-9412) 498-03-35, 36, or 37; (9-9412) 490-66-71; email: ConsularBaku@state.gov; web site at http://azerbaijan.usembassy.gov.
Travelers are encouraged to notify the Embassy before their permanent departure from the country.
*
*
*
*
*
*
This replaces the Country Specific Information for Azerbaijan dated June 19, 2008 to update sections on Entry and Exit Requirements; Safety and Security; and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Fri, 19 Apr 2019 03:13:16 +0200
By Andrea PALASCIANO

Naftalan, Azerbaijan, April 19, 2019 (AFP) - Immersed up to her neck in a dark viscous liquid, Sulfiya smiles in delight, confident that the fetid substance will cure her painful condition.   Sulfiya, a Russian woman in her 60s, has travelled to Azerbaijan's north-western city of Naftalan in the hope that crude oil baths at a local sanatorium will end her years of suffering from polyarthritis, a disease affecting the joints.   "This is so pleasant," she enthuses, despite the reek of engine oil.

Her naked dip in oil heated to just above body temperature lasts 10 minutes, after which an attendant scrapes the brown oil off her skin and sends her into a shower.   The native of Russia's Tatarstan region said she and her friends "have long dreamed of coming" for treatment in Naftalan.   The petroleum spa resort in the oil-rich Caucasus country is a draw for visitors despite its proximity to Nagorny Karabakh, a region disputed between Azerbaijan and Armenia in a long-running armed conflict.

After 10 days of bathing in crude oil Sulfiya says she now feels "much better" and has even reduced her medication for the polyarthritis that she has had for 12 years.   "It is a gift from God," agrees 48-year-old Rufat, an Azerbaijani journalist and opposition party member who is undergoing treatment in the sanatorium called Sehirli, or "magic" in Azerbaijani.   Azerbaijan's vast oil deposits were discovered in the mid-19th century, making what was at the time part of the Russian Empire one of the first places in the world to start commercial oil production.

Oil exports to markets all over the world are the largest sector of Azerbaijan's economy, but the crude that comes from subsoil reservoirs in Naftalan is not suitable for commercial use.   Instead the local oil is used to treat muscular, skin and bone conditions as well as gynaecological and neurological problems.   According to a legend, which spa staff readily tell clients, the healing properties of Naftalan's "miraculous oil" were discovered by accident when a camel left to die near a pool of oil was cured.

The small town of Naftalan some 300 kilometres (185 miles) from the capital Baku became a popular health resort for Soviet citizens in the 1920s.   "In the past, when there weren't any hotels or sanatoriums, people would come to Naftalan and stay with locals," said one of the doctors at the Sehirli sanatorium, Fabil Azizov, sitting in her office under a portrait of strongman President Ilham Aliyev.   "But as time passed, sanatoriums were built and treatment methods developed."

- Controversial benefits -
Some specialists warn the method has dangerous side effects.   "Despite the stories of past cures, the use of crude oil for medicinal purposes has been condemned by Western doctors as potentially carcinogenic," former journalist Maryam Omidi wrote in a 2017 book published in Britain about Soviet-era sanatoriums.

In fact, the oil at Naftalan is almost 50 percent naphthalene, a carcinogenic substance found in cigarette smoke and mothballs that in large amounts can damage or destroy red blood cells.   But doctors and patients at Naftalan brush aside any misgivings and the sanatorium even has a small museum displaying crutches that once belonged to patients who have recovered from their illnesses.

- 'We heard gunshots' -
During its heyday in the 1980s, Naftalan would host more than 70,000 visitors a year.    But in 1988, a bloody war began with neighbouring Armenia for the control of Azerbaijan's separatist Nagorny Karabakh region, which unilaterally proclaimed independence from Baku in 1991.

The conflict claimed the lives of some 30,000 people from both sides and forced hundreds of thousands to flee their homes.   A 1994 ceasefire agreement ended hostilities, but the arch foes have yet to reach a definitive peace deal and there are frequent skirmishes along the volatile frontline.   During the war, the sanatoriums in Naftalan -- a few kilometres from the frontline -- were converted into hospitals for wounded soldiers and temporary accommodation for refugees.

Over the last two decades, the Azerbaijani authorities have worked hard to re-establish Naftalan's reputation as a health resort.    They resettled refugees in other regions, demolished decrepit Soviet-era sanatoriums and built brand-new tourist facilities.   Modern Naftalan is a blend of kitsch-looking high-end spas where a week's treatment costs some 1,000 euros, and modest sanatoriums where a week's treatment costs around 100 euros.   The simmering Karabakh conflict may be out of sight, but guests can still feel uncomfortably close to the military action.   During one of the deadliest recent bouts of fighting in April 2016, "we heard gunshots," said a member of staff at Naftalan's luxurious Garabag spa, adding quickly that "everyone stayed on."
Date: Fri, 12 Apr 2019 05:49:56 +0200
By Andrea PALASCIANO

Naftalan, Azerbaijan, April 12, 2019 (AFP) - Immersed up to her neck in a dark viscous liquid, Sulfiya smiles in delight, confident that the fetid substance will cure her painful condition.   Sulfiya, a Russian woman in her 60s, has travelled to Azerbaijan's north-western city of Naftalan in the hope that crude oil baths at a local sanatorium will end her years of suffering from polyarthritis, a disease affecting the joints.   "This is so pleasant," she enthuses, despite the reek of engine oil.

Her naked dip in oil heated to just above body temperature lasts 10 minutes, after which an attendant scrapes the brown oil off her skin and sends her into a shower.   The native of Russia's Tatarstan region said she and her friends "have long dreamed of coming" for treatment in Naftalan.   The petroleum spa resort in the oil-rich Caucasus country is a draw for visitors despite its proximity to Nagorny Karabakh, a region disputed between Azerbaijan and Armenia in a long-running armed conflict.

After 10 days of bathing in crude oil Sulfiya says she now feels "much better" and has even reduced her medication for the polyarthritis that she has had for 12 years.   "It is a gift from God," agrees 48-year-old Rufat, an Azerbaijani journalist and opposition party member who is undergoing treatment in the sanatorium called Sehirli, or "magic" in Azerbaijani.   Azerbaijan's vast oil deposits were discovered in the mid-19th century, making what was at the time part of the Russian Empire one of the first places in the world to start commercial oil production.

Oil exports to markets all over the world are the largest sector of Azerbaijan's economy, but the crude that comes from subsoil reservoirs in Naftalan is not suitable for commercial use.   Instead the local oil is used to treat to cure muscular, skin and bone conditions as well as gynaecological and neurological problems.   According to a legend, which spa staff readily tell clients, the healing properties of Naftalan's "miraculous oil" were discovered by accident when a camel left to die near a pool of oil was cured.

The small town of Naftalan some 300 kilometres (185 miles) from the capital Baku became a popular health resort for Soviet citizens in the 1920s.   "In the past, when there weren't any hotels or sanatoriums, people would come to Naftalan and stay with locals," said one of the doctors at the Sehirli sanatorium, Fabil Azizov, sitting in her office under a portrait of strongman President Ilham Aliyev.   "But as time passed, sanatoriums were built and treatment methods developed."

- Controversial benefits -
Some specialists warn the method has dangerous side effects.   "Despite the stories of past cures, the use of crude oil for medicinal purposes has been condemned by Western doctors as potentially carcinogenic," former journalist Maryam Omidi wrote in a 2017 book published in Britain about Soviet-era sanatoriums.

In fact, the oil at Naftalan is almost 50 percent naphthalene, a carcinogenic substance found in cigarette smoke and mothballs that in large amounts can damage or destroy red blood cells.   But doctors and patients at Naftalan brush aside any misgivings and the sanatorium even has a small museum displaying crutches that once belonged to patients who have recovered from their illnesses.

- 'We heard gunshots' -
During its heyday in the 1980s, Naftalan would host more than 70,000 visitors a year.    But in 1988, a bloody war began with neighbouring Armenia for the control of Azerbaijan's separatist Nagorny Karabakh region, which unilaterally proclaimed independence from Baku in 1991.  The conflict claimed the lives of some 30,000 people from both sides and forced hundreds of thousands to flee their homes.   A 1994 ceasefire agreement ended hostilities, but the arch foes have yet to reach a definitive peace deal and there are frequent skirmishes along the volatile frontline.

During the war, the sanatoriums in Naftalan -- a few kilometres from the frontline -- were converted into hospitals for wounded soldiers and temporary accommodation for refugees.   Over the last two decades, the Azerbaijani authorities have worked hard to re-establish Naftalan's reputation as a health resort.    They resettled refugees in other regions, demolished decrepit Soviet-era sanatoriums and built brand-new tourist facilities.

Modern Naftalan is a blend of kitsch-looking high-end spas where a week's treatment costs some 1,000 euros, and modest sanatoriums where a week's treatment costs around 100 euros.   The simmering Karabakh conflict may be out of sight, but guests can still feel uncomfortably close to the military action.   During one of the deadliest recent bouts of fighting in April 2016, "we heard gunshots," said a member of staff at Naftalan's luxurious Garabag spa, adding quickly that "everyone stayed on."
Date: Sun, 27 Aug 2017 12:33:14 +0200

Baku, Aug 27, 2017 (AFP) - Six people were injured Sunday when a fire at a military base in Azerbaijan set off explosions of weapons at a storage depot, officials in the Caucasus nation said.   Residents were evacuated from two villages Gilezi and Shitalchai nearest to the base, about 70 kilometres north of capital Baku, the defence ministry said in a statement.

The ministry said there was a fire at the base "which caused the explosions," without giving details of damages or cause of the fire.   A spokeswoman of the health ministry, Liya Bairamova, told AFP that six people were injured in the fire and blasts, though without clarifying if they were soldiers or civilians.   Earlier emergencies authorities said that first response vehicles could not get close to the base because of ongoing explosions.   A major road from Baku north to the city of Guba and the Russian border was closed due to the incident.
Date: Fri 8 Jul 2016, 14:46
Source: Azeri Press Agency (APA) [edited]

A 10-year-old boy has died of rabies after being bitten by a dog in his head, face, and mouth 20 days ago in the Dayikend village of Azerbaijan's Salyan. Rita Ismayilova, head of the department of epidemiology of especially dangerous infectious diseases of the Republican Anti Plague Station under the Health Ministry, told APA that the boy was admitted to the Salyan district central hospital the same day he was attacked by the dog. However, the child's body failed to create immunity as the incubation period of the disease was short, so it developed into rabies. The child was transferred to Baku and received symptomatic treatment in the children infectious diseases hospital No.1.

Nevertheless, the child could not be saved and he died on 7 Jul 2016. It's well known that there's no treatment for a person who is infected with rabies; it results in death", she said. She added that about 17 000 people bitten by animals every year are healed [see comment]. On rare occasions, the incubation period is very short. "This child's incubation period was 14 days and symptoms had already manifested. The treatment didn't help because the child's body failed to create immunity. Moreover, he had been bitten in dangerous parts -- his face, head, fingers, upper body. These areas are close to the brain and therefore death occurs earlier", she said. Note that this is the 2nd such [event] recorded in 2016. The 1st incident took place in Zagatala in May; P.T. (b. 1969) did not go to hospital after being bitten and died of rabies in Zagatala [See item 2].  [Byline: Konul Kamilqizi]
=====================
[The term "healed" may mislead, suggestive of remedying established rabies disease. The 17 000 people bitten by animals in Azerbaijan have, rather likely, undergone a "post exposure prophylaxis" treatment, preventing the development of disease (which, unfortunately, cannot be healed...). - ProMED Mod.AS]
************************
Azerbaijan, fatal human case
Date: Tue 24 May 2016, 12:31 GMT
Source: News.AZ [edited]

Azerbaijan's Health Ministry on Tue [24 May 2016] confirmed its 1st recorded human rabies case in the country in 2016. Liya Bayramova, spokesperson for the Health Ministry, told APA that P.T., 47, a resident of the Faldar village of the country's Zagatala district, was hospitalized with symptoms of rabies on 22 May 2016. "The woman was bitten by a dog on 1 Apr 2016, but she didn't admit to hospital immediately," Bayramova said.

She noted that in fact, in animal bite cases, people must be vaccinated against rabies within 14 days. "Turajova went to the hospital after 52 days when signs of rabies appeared. Her treatment continued in a hospital in Zagatala, and doctors from Minghachevir and Baku were sent for consultation," she added.

Rita Ismayilova, head of the department of epidemiology of especially dangerous infectious diseases of the Republican Anti Plague Station under the Health Ministry, told APA that a dog bit the index finger of that woman's right hand 2 months ago. "As she was slightly injured, she didn't seek medical aid. The wound healed, but 2 months later she began to exhibit signs of rabies. Symptoms begin with fear of light, water and air. Though the woman was hospitalized, human rabies case often results in death," Ismayilova noted.

She added that it is the 1st case of human rabies recorded in Azerbaijan in 2016. The last case of human rabies was recorded 3-4 years ago.
====================
[The statement of the spokesperson that "in fact, in animal bite cases, people must be vaccinated against rabies within 14 days" does not comply with WHO guidelines for the "post exposure prophylaxis (PEP)" procedures. Such cases require "immediate" post-exposure-prophylaxis treatment. Subscribers are referred to the following WHO's "Top 10 General Considerations in Rabies PEP", updated 2014:

1. Wounds must be immediately washed/flushed for 15 minutes and disinfected.
2. Rabies PEP should be instituted immediately. PEP consists of a course of potent, effective rabies vaccine that meets WHO recommendations and administration of rabies immunoglobulin.
3. PEP must be applied using vaccine regimens and administration routes that have been proven to be safe and effective.
4. PEP does not have contraindications if purified rabies immunoglobulin and vaccine are used. Pregnancy and infancy are not contraindications to PEP.
5. If rabies immunoglobulin is not available on 1st visit, use can be delayed by up to 7 days from the date of the 1st vaccine dose.
6. Initiation of PEP should not await the results of laboratory diagnosis or be delayed by dog observation when rabies is suspected.
7. When suspect rabid animal contacts (excluding bats) occur in areas free of carnivore-mediated rabies and where there is adequate surveillance in place, PEP may not be required. The decision must be based on expert risk assessment.
8. Patients presenting for rabies PEP even months after having been bitten should be treated as if the contact had recently occurred.
9. PEP should be administered even if the suspect animal is not available for testing or observation. However, vaccine and immunoglobulin administration may be discontinued if the animal involved: is a vaccinated dog (cat or ferret) that following observation for 10 days, remains healthy or is humanely killed and declared negative for rabies by a WHO prescribed laboratory test. 10. In areas enzootic for (canine and wildlife) rabies, PEP should be instituted immediately unless adequate laboratory surveillance and data indicates that the species involved is not a vector of rabies.

For the above and further information, see WHO "Guide for Rabies Pre and Post Exposure Prophylaxis in Humans at

The recent case, in a child (item 1), was a "Category III" case ("Bites to the head, neck, face hand and genitals") requiring special treatment.

Subscribers are referred to the excellent paper
"Things-you-may-not-know-about-rabies-but-should", available at
Date: Wed 18 Feb 2015
Source: Azer News [edited]

We are accustomed to hear about food poisoning in summertime and may neglect winter's main danger -- botulism -- which may strike us down. In January 2015, 64 cases of food poisoning were registered in Azerbaijan. The total number of victims of these poisoning cases reached 92 people, said Imran Abdullayev, Head of Hygiene and Epidemiology Center Department of the Health Ministry. Moreover, cases of botulism were registered in January 2015, which harmed 9 people, leaving 1 dead. The poisoning was due to homemade pickled tomatoes.

The Centre of Hygiene and Epidemiology urges people to follow hygiene rules at home and buy food from reliable catering outlets and grocery stores to avoid food poisoning. Special attention should be paid to children's nutrition.

To avoid food poisoning, one must simply follow hygiene rules at home and buy food in reliable catering outlets and grocery stores.

Prevention of botulism is simple: combining a refrigeration temperature with salt content and acidic conditions. This combination stops the growth of the bacterium and production of toxin.  [Byline: Nigar Orujova]
====================
[Pickling food in an acidic medium such as vinegar is one way of preserving the food and minimizing the risk of botulism, since the spores do not germinate below pH 4.6. Inadequate acidification, therefore, may be the issue here, and this has occurred before related to human botulism, as an example, from homemade pickled eggs (CDC: Foodborne botulism from eating home-pickled eggs -- Illinois, 1997. MMWR 2000;49:778-780). - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
More ...

North Korea

Democratic People's Republic of Korea US Consular Information Sheet
April 29, 2008
Prior to departing the United States, U.S. citizens planning to transit China on their visit to North Korea are encouraged to register on line with the U.S. Emba
sy in Beijing; U. S. citizens transiting South Korea to take the Mount Kumgang or Kaesong City tours should register with the U.S. Embassy in Seoul.
U. S. citizens visiting North Korea should also register with the Swedish Embassy in Pyongyang (U.S. Protective Power).
Please see the Registration/Embassy Location section below.

COUNTRY DESCRIPTION: The Democratic People’s Republic of Korea (North Korea or the DPRK) is a highly militaristic Communist state located on the Korean Peninsula between northeast China and the Republic of Korea (South Korea or ROK), with land borders with China, Russia and South Korea.
The DPRK is one of the world’s most isolated countries.
The continuing dispute over North Korea’s development of nuclear programs and nuclear weapons has resulted in tensions in the region and between the United States and the DPRK.
North Korea limits trade and transportation links with other countries and tightly restricts the circumstances under which foreigners may enter the country and interact with local citizens.
Telephone and fax communications are unavailable in many areas of the country and foreigners can expect their communications to be monitored by DPRK officials.
In the past few years, North Korea has experienced famine, flooding, fuel and electricity shortages, and outbreaks of disease.
Many countries, including the United States, have contributed to international relief efforts to assist the people of North Korea.

Foreign tourists are a means for North Korea to earn much needed foreign currency, but an underdeveloped service sector, inadequate infrastructure, and political tensions with surrounding countries have stymied any significant tourist flow.
North Korean efforts to expand tourism have focused primarily on group tours from China, as well as from South Korea primarily to the Mount Kumgang tourist area and the city of Kaesong.

The United States does not maintain diplomatic or consular relations with the DPRK.
The Swedish Embassy located in Pyongyang acts as the United States’ interim consular protective power and provides basic consular services to U.S. citizens traveling in North Korea.
Please refer to Special Circumstances for additional information.

Read the Department of State Background Notes on North Korea for additional information.

ENTRY/EXIT REQUIREMENTS: North Korean visas are required for entry.
The U.S. Government does not issue letters to private Americans seeking North Korean visas, even though in the past such letters have sometimes been requested by DPRK embassies.
Prospective travelers entering and departing North Korea through China must also obtain a two-entry visa for China, as a valid Chinese visa is essential for departing North Korea at the conclusion of a visit or in an emergency.
While the ROK government is attempting to open direct travel routes to the DPRK, routine travel from the ROK to the DPRK is currently prohibited.
Travel across the demilitarized zone (DMZ) is allowed only infrequently for official and government-authorized cultural and economic exchanges, or aid shipments, and for tours limited to Mt. Kumgang and Kaesong City.
There are no regularly operating direct commercial flights from South Korea to North Korea.
U.S. citizens who arrive in North Korea without a valid U.S. passport and North Korean visa may be detained, arrested, fined or denied entry.
Travelers to North Korea report that fees for local travel costs (taxi, tolls, permits and the cost for security personnel assigned to escort foreigner visitors) can be high and arbitrary.

Where to obtain a North Korean visa: There is no DPRK embassy in the United States.
U.S. citizens and residents planning travel to North Korea must obtain DPRK visas in third countries, for example in Beijing, China.
For information about entry requirements and restricted areas, contact the DPRK Mission to the United Nations in New York.
Address inquiries to:

The Permanent Representative of the Democratic
People’s Republic of Korea to the United Nations
820 Second Avenue
New York, NY
10017
Tel: (212) 972-3105
Fax: (212) 972-3154

Americans living abroad can contact the DPRK embassy, if any, in their country of residence.
U.S. citizens traveling to North Korea may obtain their visas at the DPRK Embassy in Beijing, China, which will issue visas only after receiving authorization from the DPRK Foreign Ministry in Pyongyang.
Prior to traveling to the region, travelers may wish to confirm that authorization to issue their visa has been received from Pyongyang.
Americans can call the North Korean Embassy in Beijing prior to their travel by telephone at (86-10) 6532-1186 or (86-10) 6532-1189 (fax: (86-10) 6532-6056).

Information on dual nationality or the prevention of international child abduction can be found on our website.
For further information about customs regulations, please read our Customs Information sheet.
Please see those sections below under Special Circumstances.

SAFETY AND SECURITY: DPRK government security personnel closely monitor the activities and conversations of foreigners in North Korea.
Hotel rooms, telephones and fax machines may be monitored, and personal possessions in hotel rooms may be searched.
Photographing roads, bridges, airports, rail stations, or anything other than designated public tourist sites can be perceived as espionage and may result in confiscation of cameras and film or even detention.
DPRK border officials routinely confiscate visitors’ cell phones upon arrival, returning the phone only upon departure.
Foreign visitors to North Korea may be arrested, detained or expelled for activities that would not be considered criminal outside the DPRK, including involvement in unsanctioned religious and political activities, engaging in unauthorized travel, or interaction with the local population.
For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site
at where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.
Up-to-date information on worldwide security can also be obtained by calling 1-888-407-4747 toll free in the United States 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: The North Korean government does not release statistics on crime.
Violent crime is rare and street crime is uncommon in Pyongyang.
Petty thefts have been reported, especially at the airport in Pyongyang.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and to the Swedish Embassy.
If you are a victim of any crime while in North Korea, in addition to reporting to local police, please contact the Swedish Embassy for assistance (address and phone number below).

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Persons with medical problems should not travel to North Korea.
For decades, medical facilities in the DPRK have suffered from a lack of resources and electricity, as well as inadequate and often outdated skills among the medical staff.
Hospitals in Pyongyang can perform basic examinations and lifesaving measures but functioning x-ray facilities are not generally available.
Surgery should be avoided.
For accidents outside Pyongyang, transport back to the capital can be a lengthy trip without medical assistance.
Persons requiring regular medication are encouraged to bring sufficient stocks of drugs for personal use since most drugs are impossible to obtain locally.
Hospitals will expect immediate U.S. dollar cash payment for medical treatment.
Credit cards and checks have not been honored in the past, according to diplomatic personnel stationed in the DPRK.
Local DPRK hosts are often not aware of available evacuation options and might claim that no such options exist.
In case of serious medical problems, it is important to insist on immediate contact with the Swedish Embassy.
The Swedish Embassy can arrange a medical evacuation to Beijing within approximately 5-10 hours.

Vaccinations.
All necessary vaccinations should be received prior to traveling to North Korea.
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 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.
Travelers with special dietary requirements are advised to bring food with them to North Korea, as the restaurants available to foreigners may have limited menus that lack variety and nutritional adequacy.

Medical Vaccinations. In the case of a critical illness or accident, the Swedish Embassy will attempt to arrange flight clearances for air ambulances performing emergency medical evacuations.
Medical air evacuation costs vary, but average approximately $40,000 to $50,000 for medical, personnel, aircraft and clearance costs.
Clearances can usually be arranged within one day.
Medical evacuation by regularly scheduled airlines can be arranged, but is limited to the very few flights that operate from Pyongyang to Beijing, Dalian, Shenyang and Macau.
Chinese visas for injured foreigners and any escorts must be obtained prior to the evacuation from North Korea in order to transit China.
Even in the case of a medical emergency, transit visas may take several days to arrange.
Evacuation across the DMZ to South Korea is not allowed.

If an American citizen falls ill or is injured while traveling in the DPRK, accompanying travelers or family members should immediately contact the Swedish Embassy using the phone numbers listed below.

The Embassy of Sweden,
Munsu-Dong District,
Pyongyang, DPRK

Telephone and fax numbers for the Swedish Embassy (U.S. Protective Power) are:
Tel:
(850-2) 3817 485 (Reception)


(850-2) 3817 904, 907(First Secretary)


(850-2) 3817 908, 905 (Ambassador)
Fax:
(850-2) 3817 663
Email:
ambassaden.pyongyang@foreign.ministry.se
Notification also should be made to the U.S. Embassy’s American Citizen Services (ACS) Unit in Beijing, China, using the phone numbers listed below:

U.S. Embassy, Beijing
American Citizen Services
2 Xiushui Dong Jie
Beijing, China 100600
Telephone: (86-10) 6532-3431
Fax: (86-10) 6532-4153.

After hours, please call (86-10) 6532-3431 and ask for the Embassy duty officer.
Americans who wish to contact U.S. consular officials in China can e-mail amcitbeijing@state.gov
Companies that may be able to arrange evacuation services include, but are not limited to those listed below.
Travelers may wish to contact these or other emergency medical assistance providers for information about their ability to provide medical evacuation insurance and/or assistance for travelers to North Korea.

SOS International (www.intsos.com)
U.S. telephone:
(1-800) 468-5232
China telephone:
(86-10) 6462-9111/9118

Medex Assistance Corporation (www.medexassist.com)
U.S. telephone:
(410) 453-6300 / 6301
Toll free:
108888-800-527-0218 (call from China)
China telephone:
(86-10) 6595-8510)

Global Doctor (www.globaldoctor.com.au/default.php)
China telephone: (86-10) 83151914).









(86-24) 24330678 in Shenyang, Liaoning Province

Useful information on medical emergencies abroad, including overseas insurance programs, is provided in the Department of State’s Bureau of Consular Affairs brochure Medical Information for Americans Traveling Abroad , available via the Bureau of Consular Affairs home page.

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 if it will cover emergency expenses such as 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 North Korea is provided for general reference only, and may not be totally accurate in a particular location or situation.

Foreigners not holding a valid DPRK driver’s license are not allowed to drive in North Korea.
Foreigners generally are not allowed to use public buses or the subway.
North Korea has a functioning rail transport system; however delays occur often, sometimes for days.
On occasion, service may cease altogether before a traveler reaches his/her final destination.
Bicycles are unavailable for rental or purchase.
Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service between the United States and North Korea, the U.S. Federal Aviation Administration (FAA) has not assessed North Korea’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s Internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:

Interim Consular Protecting Power: The United States does not maintain diplomatic or consular relations with the DPRK.
The U.S. Government therefore cannot provide normal consular protective services to U.S. citizens in North Korea.
On September 20, 1995, a consular protecting power arrangement was implemented, allowing the Swedish Embassy in the DPRK capital of Pyongyang to provide basic consular protective services to U.S. citizens traveling in North Korea who are ill, injured, arrested or who have died while there.

Consular Access:
There is no United States diplomatic or consular presence in the DPRK.
Americans traveling in the DPRK may receive limited consular services from the Swedish Embassy in Pyongyang.
Please see section above on “Medical Insurance” for address and contact information for the Swedish Embassy in Pyongyang.
U.S. citizens are encouraged to carry photocopies of their passport data and photo pages with them at all times so that, if questioned by DPRK officials, evidence of their U.S. citizenship is readily available. The U.S.- DPRK Interim Consular Agreement provides that North Korea will notify the Swedish Embassy within four days of an arrest or detention of an American citizen and will allow consular visits within two days after a request is made by the Swedish Embassy.
However, consular access has not been readily granted in cases where American citizens have been reported as being detained or held against their will by DPRK officials.
Moreover, delegations with ethnic Korean individuals, or delegations representing Korean-affiliated organizations in the U.S., are handled by DPRK structures that are well beyond the reach of diplomatic missions in Pyongyang.
Hence, in case of a situation requiring consular assistance, the Embassy’s access is even more limited.

Customs Regulations:
DPRK authorities may seize documents, literature, audio and videotapes, compact discs and letters deemed by North Korean officials to be pornographic, political or intended for religious proselytizing.
Persons seeking to enter North Korea with religious materials in a quantity deemed to be greater than that needed for personal use can be detained, fined and expelled.
It is advisable to contact the DPRK Mission to the United Nations or a DPRK embassy or a DPRK consulate in a third country for specific information regarding customs requirements.
Please see our information on customs regulations.

Dual Nationality:
The DPRK does not recognize dual nationality.
U.S. citizens of Korean heritage may be subject to military obligations and taxes on foreign source income.
For further information see our dual nationality flyer.
Additional questions on dual nationality may be directed to Overseas Citizens Services, SA-29, 4th Floor, 2201 C Street NW, Washington, DC
20520 or by telephone at 1-888-407-4747.

U.S. Government Economic Sanctions Against North Korea:
At this time, goods of North Korean origin may not be imported into the United States either directly or indirectly without prior notification to and approval of the U.S. Treasury Department’s Office of Foreign Assets Control (OFAC).
Exports to North Korea may be subject to licensing requirements.
Check with the Commerce Department’s Bureau of Industry and Security.
Most financial transactions between U.S. and North Korean citizens are authorized, provided they meet the criteria outlined in the June 19, 2000, and subsequent amendments to OFAC regulations.
All transactions ordinarily incident to travel to, from and within North Korea and to maintenance within North Korea are authorized, and U.S. travel service providers are allowed to organize group travel to North Korea.
Commercial U.S. ships and aircraft carrying U.S. goods are allowed to call at North Korean ports with prior clearance.
In May 2006, OFAC began prohibiting U.S. persons from “owning, leasing, operating or insuring any vessel flagged by North Korea.”
Full text of the regulation can be found in the Federal Register at http://www.fas.usda.gov/info/fr/2000/061900-a.txt.

The U.S. maintains various export controls and other sanctions on North Korea for counter- terrorism, nonproliferation and other reasons.
Exports of military and sensitive dual-use items are prohibited, as are most types of U.S. economic assistance.
The U.S. also abides by multilateral restrictions and sanctions with respect to North Korea, including those contained in recent United Nations Security Council Resolutions in response to the North Korean missile launches and nuclear test in July and October 2006.

For additional information, consult the U.S. Department of the Treasury, Office of Foreign Assets Control (OFAC) home page on the Internet at http://www.treasury.gov/offices/enforcement/ofac/.

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.
Local laws also may not afford the protections available to U.S. citizens under U.S. law.
Penalties for breaking local laws can be more severe than those in the United States for similar offenses.
Persons violating the law, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession of, use of, or trafficking in illegal drugs are strict, and convicted offenders often face long jail sentences and heavy fines.
North Korean security personnel may view unescorted travel inside North Korea by Americans who do not have explicit official authorization as espionage, especially when the U.S. citizens are originally from South Korea or are thought to understand the Korean language.
Security personnel may also view any attempt to engage in unauthorized conversations with a North Korean citizen as espionage.
Foreigners are subject to fines or arrest for unauthorized currency transactions or for shopping at stores not designated for foreigners.
It is a criminal act in North Korea to show disrespect to the country's current and former leaders, Kim Jong-Il and Kim Il-Sung, respectively.
Foreign journalists have been threatened when questioning the policies or public statements of the DPRK or the actions of the current leadership.

Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see additional 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: There is no U.S. embassy or consulate in North Korea.

U.S. citizens planning to visit North Korea are encouraged to register prior to departing the United States with the U.S. Embassy in Beijing if entering North Korea from China.
U.S. citizens planning to visit the Mount Kumgang tourism area or Kaesong from South Korea should register with the U.S. Embassy in Seoul.
Registration can be done on line through the State Department's travel registration web site
or in person, by telephone or fax, at the U.S. Embassy.

The Embassy of Sweden (U.S. Protective Power).
Americans who have a medical or consular emergency and who wish to contact the Swedish Embassy are reminded first to communicate this need to their North Korean escorts or guides.
Do not attempt to travel to the Swedish Embassy unescorted.
The Swedish Embassy (U.S. Protective Power) is located at Munsu-Dong District, Pyongyang.
The telephone and fax numbers for the Swedish Embassy (U.S. Protective Power) are:

Tel:
(850-2) 3817 485 (reception)
Tel:
(850-2) 3817 904, (850-2) 3817 907 (First Secretary)
Tel:
(850-2) 3817 908, (850-2) 3817 905 (Ambassador)
Fax:
(850-2) 3817 663

U.S. Embassy Beijing.
The American Citizen Services Unit of the U.S. Embassy in Beijing, China, is located at:
2 Xiushui Dong Jie, Beijing.
The Embassy is located near Ritan Park.
Telephone: (86-10) 6532-3431.
Fax: (86-10) 6532-4153.
Email: amcitbeijing@state.gov.
The Embassy Beijing web site is http://beijing.usembassy-china.org.cn/.

For after-hours emergencies please call (86-10)6532-3431 and ask for the Embassy duty officer.
U.S. Embassy Seoul.
The American Citizen Services Unit of the U.S. Embassy in Seoul, South Korea, is located at:
32 Sejong-no, Jongno-gu, Seoul.
The Embassy is located across the street from Sejong Cultural Center and next to the Ministry of Information and Communication/KT Building.

Telephone: (82-2) 397-4114.
Fax: (82-2) 2-397-4101.
E-mail: seoul_acs@state.gov.
The Embassy Seoul web site is http://seoul.usembassy.gov/.

For after-hours emergencies please call (82-2) 721-4114 and ask for the Embassy duty officer.
*
*
*
*
This replaces the Consular Information Sheet dated October 15, 2007, to update the sections on Country Description, Medical Insurance, Special Circumstances, and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon 23 Sep 2019
Source: Chosun [edited]

A paratyphoid fever epidemic has broken out recently in North Korea in the aftermath of Typhoon Lingling. The illness, which causes high fever and diarrhoea, has been spreading in South Hamgyong and South Pyongan provinces since typhoon Lingling hit the North, a source said Sunday [22 Sep 2019]. It is mainly transmitted by dirty water and human feces in the superannuated sewage systems and contaminated water supply.

The regime is reportedly restricting the movement of trains and vehicles to and from the 2 provinces. Meanwhile, the flooding of paddy and other grain fields in Hwanghae and Pyongan provinces is expected to devastate this year's [2019's] harvest.  [Byline: Kim Myong-song]
====================
[Paratyphoid fever is similar to typhoid fever in that both are enteric fever types of disease, although the former can be, but is not necessarily, less severe. The paratyphoid salmonellas are divided into A, B, and, rarely now, C. _Salmonella_ Paratyphi, also referred to as _S. enterica_ serotype Paratyphi, types B and C also have species, now serotypes, Schottmuelleri and Hirschfeldii, respectively. Like typhoid, paratyphoid is generally considered not to be a zoonosis, with [only] humans as the reservoir, but the paratyphoid bacillus has been isolated from domestic animals and fish.

In India, paratyphoid A has become an increasing problem, accounting for up to 45% of cases of enteric fever in 1998 (1). Although initially quite sensitive to antimicrobials, strains have become more resistant to quinolones; in contrast, _S._ Typhi has manifested resistance for some time.

In a report regarding differential risk factors for typhoid and paratyphoid in Indonesia, the authors found that the infections seemed to have distinct routes of transmission (2). Typhoid was associated with factors within a household (recent case in the house, no soap for handwashing, sharing of food from the same plate, no toilet in the house), whereas paratyphoid was associated with sources outside the household such as food from street vendors and flooding.

References
-------
1. Sood S, Kapil A, Dash N, et al.: Paratyphoid fever in India: an emerging problem. Emerg Infect Dis. 1999; 5: 483-4.
2. Vollaard AM, Ali S, van Asten Hagh, et al.: Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia. JAMA. 2004; 291: 2607-15.

A map of North Korea showing the location of these 2 adjacent provinces in the central part of the country can be seen at <http://annamap.com/north-korea/>. - ProMED Mod.LL]

[HealthMap/ProMED-mail maps:
South Hamgyeong Province, North Korea:
South Pyongan Province, North Korea:
Date: Sun, 8 Sep 2019 14:18:07 +0200 (METDST)

Seoul, Sept 8, 2019 (AFP) - North Korean state media said Sunday five people had been killed in a powerful typhoon that destroyed farmland and damaged hundreds of buildings.   Typhoon Lingling, called Typhoon-13 in North Korea, hit the reclusive nuclear-armed state on Saturday afternoon, reported the official KCNA news service.

The impoverished and isolated country is vulnerable to natural disasters, especially floods, due in part to deforestation and poor infrastructure.   "According to data available from the State Emergency Disaster Committee, five persons were dead and three persons injured. The injured persons are now under treatment at hospitals," KCNA said.   More than 460 houses and at least a dozen public buildings were "completely or partly destroyed or inundated" by the typhoon, it said.

Crops were wiped out or damaged in 46,000 hectares (110,000 acres) of farmland -- roughly the area of the small European country of Andorra -- the report said, adding that recovery efforts were underway.   It came after South Korea's disaster agency reported three deaths caused by the same typhoon, according to Yonhap news agency.   On Saturday, KCNA reported that North Korean leader Kim Jong Un had berated officials for their "easygoing" attitude to the approaching storm.   According to that dispatch, Kim had convened an emergency meeting on Friday and said "dangerous circumstances" caused by the typhoon were "imminent", but that many in positions of authority were ill-prepared.
Date: Tue, 18 Jun 2019 06:40:09 +0200
By Sebastien BERGER

Pyongyang, June 18, 2019 (AFP) - On a grey stone column in Pyongyang, a mural shows Chinese and North Korean soldiers rushing into battle against US-led forces in the Korean War. Decades later, the monument is a regular stop for new waves of Chinese going to the North, this time as tourists.   Hundreds of soldiers and workers have been sprucing up the obelisk and its grounds in recent days ahead of a state visit to Pyongyang by Chinese President Xi Jinping this week.   An inscription on it lauds "the Chinese People's Volunteer Army, who fought with us on this land and smashed down the common enemy".   Their "immortal exploits" will "last forever", it proclaims, as will "the friendship forged in blood between the peoples of the People's Republic of China and the Democratic People's Republic of Korea".   Nearly 70 years after Mao Zedong sent millions of soldiers to save Kim Il Sung's troops from defeat as General Douglas MacArthur's men marched up the peninsula, China remains the isolated, nuclear-armed North's key diplomatic backer and main provider of trade and aid.

Now the Friendship Tower, as the monument is known, attracts growing hordes of Chinese tourists -- and the renovations suggest it may also be on Xi's itinerary.   Ordinary Chinese pay travel companies around 2,500 yuan ($360) for a standard three-day trip, arriving overland by train in Pyongyang to tour the capital's highlights, from the Arch of Triumph to Kim Il Sung Square.   The following day they head south to the Demilitarized Zone that has divided the peninsula since the two sides fought each other to a stalemate in 1953, before returning home.   "I'm very interested in North Korea and wanted to come to see what North Korea looks like," said Yu Zhi, a retiree from Anhui province visiting Pyongyang, telling AFP that she had a "special feeling" for the country.   "China is very friendly with North Korea," added her fellow traveller, a woman surnamed Jin. "We have been friends for generations."

- Lips and teeth -
It was not always so. Mao -- whose eldest son Mao Anying was among those killed in what China still calls the "War to Resist US Aggression and Aid the DPRK" -- described the neighbours as "as close as lips and teeth".   Ties then waxed and waned during the Cold War, when founder Kim Il Sung was adept at playing his Soviet and Chinese allies off against each other, and his grandson, the current leader Kim Jong Un, did not visit Beijing to pay his respects for more than six years after inheriting power.   But as he embarked on a flurry of diplomacy last year he made sure that Chinese President Xi Jinping was the first foreign head of state he met, and he has since done so three more times -- more often than Kim has seen any other leader.    Now Xi is going to reciprocate.

At the same time Chinese tourism to the North has reached record highs, according to travel industry sources -- so much so that Pyongyang has imposed a limit on arrivals.   No official figures are available from authorities on either side, but Simon Cockerell, general manager of Koryo Tours, the market leader for Western visitors, said there had been "a huge increase in Chinese tourists".   At peak times 2,000 people a day had been arriving in Pyongyang, he said. "That's far too many because there is no infrastructure to accommodate that many tourists, so problems with train tickets, with plane tickets, hotel space."   As a result North Korean authorities had themselves set a 1,000-a-day cap, he added, although it was unclear whether this applied across the industry or solely to Chinese, who make up the vast majority of arrivals.   "There are issues with just hundreds of people showing up at the same time."

- 'Choices being made' -
China has a proven willingness to use tourism as a geopolitical negotiating weapon -- it banned group tours to South Korea after it deployed a US anti-missile system, THAAD.   With nuclear negotiations at a stalemate the North remains subject to multiple UN Security Council sanctions, and the US imposed a travel ban on its own citizens visiting following the death of student Otto Warmbier, who had been jailed after trying to steal a propaganda poster.   But tourism is not among the sectors targeted by the UN, potentially enabling Beijing to use it as an incentive for its sometimes wayward ally.

The Chinese travel phenomenon is market-driven, rather than prompted by state order -- as well as the market offered by China's huge population, the two countries' border enables cheap overland journeys.   But simply enabling it to take place, said John Delury of Yonsei University in Seoul, meant "We can infer some choices are being made" by Beijing.   "We know it's a lever they can turn on and off," he said.   Even with the diplomatic process at a standstill, he added, "The Chinese think you have to use this window of opportunity to move things forward. There has to be a path on both sides and so something like opening up tourism is a good way to enable that."   At the Monument to the Three Charters for Reunification on the edge of Pyongyang, where two giant stone women form an arch over a road, a secondary school teacher from Shanghai called Peng said: "We are both socialist countries. I feel there are more Chinese coming to visit."
Date: Sun, 7 Apr 2019 11:11:12 +0200

Pyongyang, April 7, 2019 (AFP) - Twice as many foreigners as last year gathered in Pyongyang Sunday for the city's annual marathon, tour firms said, as reduced tensions see visitor numbers rise in isolated North Korea.    The event -- part of the celebrations for the anniversary of founder Kim Il Sung's birth in 1912 -- is the highlight of the North's tourism calendar and offers the chance to run or jog through the streets of the tightly controlled city.

Around 950 Westerners entered the event, according to market leader Koryo Tours, compared to some 450 last year when numbers slumped.   That brought participation almost back to the levels of 2017, before tensions soared as the North carried out a series of missile launches and leader Kim Jong Un traded threats and personal insults with US President Donald Trump.   The same year, Washington also banned its citizens from visiting the North following the death of Otto Warmbier, a US student jailed for trying to steal a propaganda poster who died in a mysterious coma days after his release.

Several other countries subsequently raised their travel warnings, a combination of events that dealt a significant blow to the North's tourism industry.   The US ban remains in place but more Western tourists signed up for the marathon this time, tour operators said, following a year of high-level diplomacy between Trump and Kim.   "As political tensions have subsided, tourism demand has increased," said Elliott Davies, director at Uri Tours, another operator, adding: "You could plot a graph in this direct relationship."

- 'Marathon chasers' -
The vast majority of tourists to the North are Chinese and some 5,000 Westerners a year used to visit the North -- with about 20 percent of those from the US -- seeking unique adventures in one of the most closed countries in the world.   The annual race also attracts so-called "Marathon Chasers" who tick off runs around the world, said Matt Kulesza, a senior tour guide at Young Pioneer Tours.   Angel Arnaudov, a 34-year-old engineer from Macedonia, said Pyongyang came onto his "radar" after finishing more than 30 marathons in cities ranging from Tokyo, New York and Copenhagen.   "I want to experience the life in North Korea myself and see if it is like they say on TV or different," he said, adding he would be posting videos on his YouTube channel.

For third-time participant Jasmine Barrett, the Pyongyang Marathon was an opportunity to interact with ordinary North Koreans who line the streets to cheer on the runners, offering high-fives and posing for selfies.   "I keep coming back because I love to see the smiles on the children's faces," the Australian entrepreneur told AFP.   "I'd definitely recommend it to others because it's a great way to see the city and the people who live there," she added.   Tour operators advise visitors to take extra precautions about "what to do and what not to do" when travelling in the North.   Simon Cockerell, Koryo Tours' general manager, said: "This is vital when visiting North Korea and anyone wanting to travel shouldn't go without a briefing."
Date: Thu, 17 Jan 2019 07:33:49 +0100

Seoul, Jan 17, 2019 (AFP) - A giant beach resort in North Korea is nearing completion, a US monitor said Thursday, with satellite pictures showing rapid progress on the sprawling development, now equipped with a water slide and cinema.   The seaside strip known as the Wonsan-Kalma Coastal Tourist Area is squeezed between a new airport and the country's east coast, in an area that has previously been used for artillery drills and ballistic missile launches.

It is intended as a centrepiece of the isolated country's nascent tourism industry as Pyongyang seeks to develop its economy despite international sanctions imposed over its nuclear weapons programmes.   North Korea receives an estimated 100,000 foreign tourists a year, the vast majority of them Chinese, according to industry sources, but Pyongyang issues no official figures itself.   The site's construction has been closely overseen by leader Kim Jong Un and plans have been announced for a grand opening in October, when the country marks the 74th anniversary of the founding of the ruling Workers' Party of Korea.

The respected 38 North website released satellite images taken as recently as December showing that most buildings previously under construction were "nearing external completion and several new or redesigned buildings were in advanced stages".   Kim, who reportedly spent his childhood summers in the area, visited the site at least three times last year according to state media, sometimes berating officials in charge of the works and issuing detailed orders.

Kim "found that the whole street was not perfect in the artistic aspect", the official KCNA news agency reported after his October inspection.   "He instructed officials to envisage the construction of more hotels and inns with over 30 floors," it added, along with more games arcades, movie theatres and an "all-event stadium", plus a "large water park and funfair".   Satellite photos from December 28 indicated the resort was growing into a "vast beach complex", 38 North said.

- 'Great beaches' -
US President Donald Trump, a former real estate developer turned billionaire, applauded North Korea's tourism potential last year following his landmark summit with Kim in Singapore.   After a four-minute screening of a bizarre Hollywood-style trailer -- apparently part of an overall pitch that the US could help the North advance technologically and economically -- Trump pointed to potential property projects in the cash-strapped nation.   "As an example, they have great beaches," he told reporters.    "You see that whenever they are exploding their cannons into the ocean. I said, 'Boy, look at that view. Wouldn't that make a great condo?'"

Kim mentioned the Wonsan-Kalma project in his key New Year speech and 38 North said the push on the development showed "a desire to demonstrate that North Korea, despite the economic sanctions in place, has an economy that is moving forward and showing signs of prosperity.   "It may also reflect an expectation that as the country improves its external political relations, tourism will follow," it added.

At present the US bans its own citizens from tourism in the North.   Hundreds of thousands of South Koreans used to visit Mount Kumgang near the inter-Korean border every year, travelling to a Seoul-funded tourist resort that was the first major cooperation project between the neighbours.   The trips came to an abrupt end in 2008 when a North Korean soldier shot dead a South Korean tourist who strayed off the approved path and Seoul suspended travel.
More ...

World Travel News Headlines

Date: Mon, 27 Jan 2020 01:07:04 +0100 (MET)

Wuhan, China, Jan 27, 2020 (AFP) - China's central government said on Monday that the nationwide total of confirmed infections from a deadly respiratory virus had risen to 2,744, with 769 new cases coming to light.   However, it said no new deaths were confirmed outside of Hubei province, which had earlier reported 24 new fatalities to bring the national total to 80 dead.
Date: Sun, 26 Jan 2020 22:16:28 +0100 (MET)

Beijing, Jan 26, 2020 (AFP) - Chinese authorities have ordered the extension of a public holiday in an effort to contain an epidemic that has killed 56 people and infected nearly 2,000 worldwide, state-run media reported.   A working group chaired by Premier Li Keqiang to tackle the outbreak decided on Sunday "to reduce population flows" by extending the Spring Festival holiday which had been scheduled to end on January 30, state news agency Xinhua said.   It was not immediately clear how long the extension is.

The group also ordered changes to "the starting dates of schools" and "people to work from home by working online."   "The meeting stressed that the country is at a crucial time in the prevention and control of the novel coronavirus outbreak, urging Party committees and governments at all levels to take more 'decisive, powerful and orderly, scientific and well-planned' measures to effective curb the spread," Xinhua reported.   In a bid to slow the spread of the respiratory virus, the government had previously locked down hard-hit Hubei, a province in central China that is at the outbreak's epicentre, in an unprecedented operation affecting tens of millions of people.

The previously unknown virus has caused global concern because of its similarity to the Severe Acute Respiratory Syndrome (SARS) pathogen, which killed hundreds across mainland China and Hong Kong in 2002-2003.   Originating in Hubei's capital of Wuhan, the virus has spread throughout China and across the world -- with cases confirmed in around a dozen countries including as far away as the United States.   Several countries were making arrangements to evacuate their citizens from Wuhan, where an eery calm pervades as new restrictions prohibit most road traffic in the metropolis of 11 million.
Date: Sun, 26 Jan 2020 21:47:53 +0100 (MET)

Washington, Jan 26, 2020 (AFP) - US health authorities said Sunday there are now five confirmed cases of the coronavirus in the United States and more are expected.   Nancy Messonnier, head of the respiratory disease section at the Centers for Disease Control and Prevention, said around 100 people in 26 states are being investigated for the virus, which originated in the Chinese city of Wuhan.

Of the confirmed cases, all five people had travelled to Wuhan, Messonier said during a conference call with reporters.   "Every case we have had in the United States is someone who has had direct contact in Wuhan," she said.   Messonier said there are two cases in California and one each in Arizona, Illinois and Washington state. Until now the toll was three.   While Chinese officials have launched an extraordinary emergency response, Messonier insisted that the health risk for Americans in general remains low "at this time."
Date: Sun, 26 Jan 2020 13:44:57 +0100 (MET)

Lagos, Jan 26, 2020 (AFP) - Nigerian health authorities have announced stepped-up emergency measures to tackle a rise in Lassa fever cases after 29 people died this month.   "As at 24th of January 2020, 195 confirmed cases and 29 deaths had been reported in 11 states," the Nigeria Centre for Disease Control (NCDC) said in a statement Saturday.   A national emergency operations centre had been activated to coordinate the response "to the increasing number of Lassa fever cases" across the country.

Endemic to Nigeria, Lassa fever belongs to the same family as the Ebola and Marburg viruses, but is much less deadly.   The virus is spread by contact with rat faeces or urine. It starts with fever and can, in worst case scenarios, lead to severe bleeding and organ failure.   Nigeria declared an outbreak of Lassa fever a year ago and around 170 people died from the virus in 2019.

The number of cases usually climbs in January due to weather conditions during the dry season.    Almost 90 percent of the recent confirmed cases have been in Edo, Ondo and Ebonyi states in southern Nigeria, but their have also been deaths in the north.

The NCDC said that compared to the same period last year the fatality rate had dropped from 23.4 percent to 14.8 percent.    It encouraged Nigerians to "practise good hygiene and take measures to protect themselves and their families".   Nigeria, Africa's most populous nation with a population of some 200 million, has five laboratories with the capability to diagnose Lassa fever.
Date: Sun, 26 Jan 2020 12:18:19 +0100 (MET)

Beijing, Jan 26, 2020 (AFP) - Two Chinese provinces and three cities have ordered citizens to wear face masks in public, to help control the spread of a deadly virus.   The measure is required in the provinces of Guangdong in the south and Jiangxi in the centre, plus the eastern city of Nanjing, Ma'anshan city in Anhui province, and Xinyang city in Henan, according to local authorities.   China's industry and information technology ministry has said it would "spare no effort in increasing supply" after demand for masks skyrocketed.
Date: Sun, 26 Jan 2020 04:03:51 +0100 (MET)

Hong Kong, Jan 26, 2020 (AFP) - Hong Kong's Disneyland announced it was shutting its doors on Sunday until further notice over the deadly virus outbreak in central China, a day after city authorities classified the crisis as an emergency.   "As a precautionary measure in line with prevention efforts taking place across Hong Kong, we are temporarily closing Hong Kong Disneyland park out of consideration for the health and safety of our guests and cast members," the park said in a statement.
Date: 26 Jan 2020
Source: MENAFN [edited]

Two more polio cases have surfaced from Landikotal tehsil in Khyber tribal district, after which the number of reported cases in Khyber Pakhtunkhwa has reached 4 this year [2020].

According to the Emergency Operations Centre (EOC), a 2-year-old [male child] from Nekikhel and another child from Torwela have been diagnosed with polio. The samples of these 2 children were sent for laboratory tests in 2019, so these cases will be counted in the tally of 2019, which stands at 141 now.

The 2 cases in Landiktoal were reported 2 days after the emergence of 3 new polio cases in Qambar, Dadu and Sajawal districts of Sindh. Among them, 2 children contracted the crippling disease in 2019, but the cases were confirmed on Friday [24 Jan 2020].

On [21 Jan 2020], the 1st case of polio in Pakistan in 2020 surfaced in Lakki Marwat, the district with the highest number of cases in 2019.

The year 2019 was worse for Pakistan in polio eradication efforts, as 141 cases surfaced in Pakistan, including 96 cases in KP. Most cases in KP surfaced in Lakki Marwat, where 32 children were diagnosed with the crippling disease. In 2018, only 12 cases were reported, while in 2017, 8 cases were reported.

Currently, Pakistan and Afghanistan are the only 2 countries in the world which have not fully eradicated polio. The main cause behind the emergence of so many polio cases is refusal of parents to cooperate with the vaccination teams. According to media reports citing Health Ministry data, over a million parents refused to cooperate with vaccination teams in 2019. Most of the refusal cases were reported in April last year [2019] when rumours spread in Peshawar that many children had fainted after consuming vaccination drops. A total of 1 089 087 parents refused to give vaccination drops to their children in 2019.

The emergence of so many polio cases in Pakistan, particularly in KP, has brought the federal and provincial governments under pressure over their performance and strategy to control the spread of disease.

Experts believe that polio vaccination efforts cannot succeed completely until the refusing parents are convinced to cooperate with vaccination teams.
==================
[The End Polio Pakistan website has not added all of the media reported cases as yet, so it's a bit difficult to follow at times and know which cases were 2019 onset and which were 2020 onset. The above media report clearly states 2019 onset and puts the tally for 2019 as 141 cases, but the media reports from Friday's [24 Jan 2020] report is less clear (see Poliomyelitis update (10): global, Pakistan (BA, SD) http://promedmail.org/post/20200124.6911971).

A good map of Pakistan showing districts and provinces can be found at:
Date: Fri 24 Jan 2020
Source: SciTechDaily [abridged, edited]

Citation: Amman BR, Bird BH, Bakarr IA, et al. Isolation of Angola-like Marburg virus from Egyptian rousette bats from West Africa. Nat Commun. 2020; 11:510.  <https://doi.org/10.1038/s41467-020-14327-8>

Scientists have detected Marburg virus in fruit bats in Sierra Leone, marking the 1st time the deadly virus has been found in West Africa. A total of 11 Egyptian rousette fruit bats tested positive for active Marburg virus infection. Research teams caught the bats separately in 3 health districts.

The presence of Marburg virus, a close relative to Ebola virus that also causes hemorrhagic disease in people, was detected in advance of any reported cases of human illness in Sierra Leone. However, the virus's presence in bats means people who live nearby could be at risk for becoming infected. No outbreaks have been reported to date.

The findings, based on PCR, antibody, and virus isolation data, were officially published today [24 Jan 2020] in the journal Nature Communications. Preliminary findings were announced earlier in December 2018 to ensure rapid notification to the citizens of Sierra Leone and the international health community.

The paper highlights the value of collaborating with government and key stakeholders across human, animal, and environmental sectors to engage at-risk communities about the discovery, address health concerns, and communicate risk-reduction strategies before recognized spillovers occur.

Marburg virus was detected by projects led by the Centers for Disease Control and Prevention, the USAID-funded PREDICT project led by the One Health Institute at the UC Davis School of Veterinary Medicine; Njala University, Sierra Leone; and the University of Makeni, Sierra Leone.

"Finding Marburg virus in bats in Sierra Leone before any known cases in people is a huge success, as public health officials and doctors can now include Marburg virus among the possible causes when diagnosing hemorrhagic fever cases in the region," said Tracey Goldstein, co-principal investigator and pathogen detection lead for the PREDICT project from the UC Davis One Health Institute.

To date, there have been 12 known outbreaks of Marburg virus, with the most recent in Uganda in 2017. The largest and deadliest outbreak occurred in Angola in 2005 when 227 people died. Five of the new strains identified among the Marburg-positive bats in Sierra Leone were genetically similar to the strain that caused the outbreak in Angola. This is the 1st time scientists have detected these Angolan-like strains in bats.

The virus-positive bats were all Egyptian rousette bats, the known reservoir for Marburg virus, which primarily feed on fruit. Infected bats shed the virus in their saliva, urine, and feces. Egyptian rousette bats are known to test-bite fruits, urinate, and defecate where they eat, potentially contaminating fruit or other food sources consumed by other animals or people, particularly children. These bats sometimes serve as a food source for local populations as well. People may be exposed to Marburg virus through bat bites as they catch the bats.

Following the announcement of the preliminary findings by the government of Sierra Leone, the PREDICT team worked with government partners, universities, and other key stakeholders to develop and implement evidence-based public health messaging across national, district, and local community levels in Sierra Leone.  "Over a year ago, we worked with our Sierra Leone government colleagues to inform people across the country as fast as possible of this new health risk and remind people not to harm or come in contact with bats," said Brian Bird from the UC Davis One Health Institute and global lead for Sierra Leone and Multi-Country Ebola operations for PREDICT-USAID. "I'm very proud of that work and our teams now that this full report is available."
----------------------------------------------
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
and
Mary Marshall
===========================
[The initial report of this finding, prior to this publication, was posted by ProMED-mail (Marburg virus disease - Sierra Leone (02): bats, additional information http://promedmail.org/post/20181223.6221436) when the virus was detected for the 1st time in fruit bats in Sierra Leone.

According to the CDC (<https://www.cdc.gov/vhf/marburg/index.html>), Marburg virus was 1st recognized in 1967, when outbreaks of hemorrhagic fever occurred simultaneously in laboratories in Marburg and Frankfurt, Germany, and in Belgrade, Yugoslavia (now Serbia). A total of 31 people became ill, initially laboratory workers followed by several medical personnel and family members who had cared for them; 7 deaths were reported. The 1st people infected had been exposed to imported African green monkeys or their tissues while conducting research. One additional case was diagnosed retrospectively.

The reservoir host of Marburg virus is the African fruit bat, _Rousettus aegyptiacus_. Fruit bats infected with Marburg virus do not show obvious signs of illness. Primates (including humans) can become infected with Marburg virus, and may develop serious disease with high mortality.

Ebola virus is closely related to Marburg virus. "Ebola viral RNA fragments were found in an oral swab from a greater long-fingered bat (_Miniopterus inflatus_), captured in 2016 in Liberia's Sanniquellie-Mahn district, which borders Guinea. The bat, which lives in many parts of Africa, roosts in caves and feeds on insects. Scientists had previously found 2 other Ebola species in a related insect-eating bat, _M. schreibersii_. However, most other evidence has pointed to fruit bats as the carriers of Ebola Zaire, Epstein says [J Epstein, veterinary epidemiologist at EcoHealth Alliance in New York City and a member of the PREDICT consortium]. "What it really says to me is that this is a virus that has multiple hosts, and it might be regionally dependent as to which species carries it."

Supporting the variety of bat hosts for Ebola, the bat implicated in the initiation of the West African Ebola virus outbreak in December 2013 was _Mops condylurus_, long-tailed insect-eating bats, that were previously suspected in an outbreak of the Sudan strain of Ebola virus, which is related to the Zaire strain. - ProMED Mod.LK]

[HealthMap/ProMED-mail map:
Date: Sat, 25 Jan 2020 11:49:16 +0100 (MET)
By Su Xinqi, Jerome TAYLOR

Hong Kong, Jan 25, 2020 (AFP) - Hong Kong on Saturday declared a new coronavirus outbreak as an "emergency" -- the city's highest warning tier -- as authorities ramped up measures to reduce the risk of further infections.   The announcement came as city leader Carrie Lam faced criticism in some quarters over her administration's response to the crisis.

Of the five people who have tested positive for the virus in Hong Kong so far, four arrived via a newly built high-speed train terminal which connects with the mainland.   That led to calls from some medical experts and politicians to limit, or even halt, arrivals from China, the epicentre of the outbreak with 41 people dead.

Lam held emergency meetings with health officials on Saturday morning after returning from Davos.   "Today I declare the lifting of the response level to emergency," she told reporters.   Schools and universities, which are currently on a Lunar New Year break, would remain closed until 17 February, Lam said.   All mainland arrivals to Hong Kong will now need to sign health declaration forms, she added, while public events including a new year gala and next month's marathon, would also be called off.    "We haven't seen serious and widespread infections (in Hong Kong), but we are taking this seriously and we hope to be ahead of the epidemic," Lam said.

- Tragic past -
Hong Kong has a recent experience of deadly viral outbreaks.    Nearly 300 people were killed by SARS in 2003, a tragedy that left a profound psychological impact on one of the most densely populated places on earth.   The city's ability to combat the crisis was hampered by moves in mainland China to cover up and play down the outbreak, leaving a lasting legacy of distrust among many Hong Kongers.   Animosity towards the mainland has intensified in recent years as Beijing tightens political control over the semi-autonomous territory.

The outbreak also comes at a sensitive time for Lam, who currently boasts record low approval ratings after seven months of pro-democracy protests.   "We must stand united so that we can prevent and control the disease," she said, in a nod to the political unrest.   The often violent protests have battered Hong Kong's reputation for stability and helped tip it into recession, with the recent virus outbreak compounding the city's economic woes.

Hospitals are already struggling with the winter flu season, but officials are isolating anyone with a history of travel to central China and those exhibiting respiratory tract infections that look similar to the virus.   So far some 300 people have been tested and monitored for the virus. Quarantine centres have been set up in remote holiday parks for anyone found to have come into close contact with people who tested positive.   On Saturday, officials announced a newly built but still-empty public housing block would be used for medical staff on the frontline who did not want to risk returning to their families.
Date: Sat, 25 Jan 2020 06:46:59 +0100 (MET)
By Mahmut Bozarslan and Fulya Ozerkan in Istanbu

Elazig, Turkey, Jan 25, 2020 (AFP) - A powerful earthquake has killed at least 20 people and injured more than 1,000 in eastern Turkey, as rescue teams searched through the rubble of collapsed buildings for survivors on Saturday.    At least 30 people were missing following the magnitude 6.8 quake on Friday night, which had its epicentre in the small lakeside town of Sivrice in the eastern province of Elazig.   "It was very scary, furniture fell on top of us. We rushed outside," 47-year-old Melahat Can, who lives in the provincial capital of Elazig, told AFP.   President Recep Tayyip Erdogan said all steps were being taken to aid people affected by the quake, which caused widespread fear.   "We stand by our people," Erdogan said on Twitter.

The Turkish government's disaster and emergency management agency (AFAD) said the quake hit Sivrice at around 8.55 pm (1755 GMT). Turkey lies on major faultlines and is prone to frequent earthquakes.    Turkish television showed images of people rushing outside in panic, as well as a fire on the roof of a building.   Interior, environment and health ministers, who were in the quake zone, said the casulties were in Elazig province and in the neighbouring province of Malatya, which lies to the southwest.

At least 20 people died and 1,015 others were wounded, according to AFAD.   "There is nobody trapped under the rubble in Malatya but in Elazig search and rescue efforts are currently under way to find 30 citizens," Interior Minister Suleyman Soylu said on Friday.   Rescue teams were searching for survivors trapped in a five-storey collapsed building in a village some 30 kilometres from Elazig, according to AFP journalists at the scene. One person was pulled alive from the rubble.   Emergency staff and people waiting at the scene lit fires in the streets to stay warm in freezing temperatures.   Sports centres, schools and guest houses had been opened to accommodate quake victims in Malatya.

- 'Everybody is in the street' -
Sivrice -- a town with a population of about 4,000 people -- is situated south of Elazig city on the shores of Hazar lake -- one of the most popular tourist spots in the region and the source of the Tigris river.   The lake is home to a "Sunken City", with archaeological traces dating back 4,000 years in its waters.

The tremor was felt in several parts of eastern Turkey near the Iraqi and Syrian borders, the Turkish broadcaster NTV reported, adding that neighbouring cities had mobilised rescue teams for the quake area.   "Everybody is in the street, it was very powerful, very scary," said Zekeriya Gunes, 68, from Elazig city, after the quakes caused a building to collapse on her street.   "It lasted quite long, maybe 30 seconds," added Ferda, 39. "I panicked and was undecided whether to go out in this cold or remain inside."

The US Geological Survey assessed the magnitude as 6.7, slightly lower than AFAD, adding that it struck near the East Anatolian Fault in an area that has suffered no documented large ruptures since an earthquake in 1875.   "My wholehearted sympathy to President @RTErdogan and the Turkish people following the devastating earthquake that has hit Turkey. Our search and rescue teams stand ready to assist," Greek Prime Minister Kyriakos Mitsotakis wrote on Twitter.   In Athens, the Greek premier's office said later that Mitsotakis had spoken by phone to Erdogan.   "The Turkish president... said Turkish teams had the situation under control for now and that it would be re-evaluated in the morning," his office added.

In 1999, a devastating 7.4 magnitude earthquake hit Izmit in western Turkey, leaving more than 17,000 people dead including about 1,000 in the country's largest city Istanbul.    In September last year, a 5.7-magnitude earthquake shook Istanbul, causing residents to flee buildings in the economic capital.   Experts have long warned a large quake could devastate the city of 15 million people, which has allowed widespread building without safety precautions.