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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: 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:
Date: Sat 18 May 2019
Source: Food Safety News [edited>

Two cases of foodborne botulism linked to hummus have been confirmed by Argentinian health authorities. The National Administration of Drugs, Foods and Medical Devices (ANMAT) reported that an investigation confirmed the botulism cases and results of an epidemiological survey determined illness was associated with a hummus product. Hummus was sold under the brand Tsuki Macro Vegan, which is based in Palermo, Buenos Aires.

The general directorate of hygiene and food safety and ANMAT inspected the processing establishment where the product was made and imposed a ban on processing and marketing. It was also detected that the product did not have the relevant sanitary authorization. The processing firm was asked to carry out an immediate withdrawal from the national market of all units of the implicated branded hummus.

ANMAT advised the public to refrain from consuming the product and to keep the containers closed and separated from other foods. The agency also told those who sell the products to stop marketing it.

Botulism is a rare but life-threatening condition caused by toxins produced by _Clostridium botulinum_ bacteria. In foodborne botulism, symptoms generally begin 18-36 hours after eating a contaminated food. However, they can start as soon as 6 hours after, or up to 10 days later. Botulism can cause symptoms including general weakness, dizziness, double vision, and trouble with speaking or swallowing. Difficulty in breathing, weakness of other muscles, abdominal distension, and constipation may also occur. People experiencing these problems should seek immediate medical attention.

The latest incident follows a different outbreak in Rancul, a town in the La Pampa province of Argentina, at the start of May 2019 with 4 suspected cases. Health authorities in La Pampa reported that 4 people older than 57 years old were in a serious condition and needed hospital treatment. The poisoning was a result of a meal shared by 7 friends in Rancul. The suspected source is preserves such as peppers that were prepared in a homemade way by one of the people who fell ill.
===================
[Hummus is an unusual source of botulism but has been reported, also from a commercially produced product.

Mad'arova L, Dorner BG, Schaade L, et al.: Reoccurrence of botulinum neurotoxin subtype A3 inducing food-borne botulism, Slovakia, 2015. Euro Surveill. 2017 Aug 10; 22(32): pii: 30591. doi: 10.2807/1560-7917.ES.2017.22.32.30591.

Abstract
--------
A case of foodborne botulism occurred in Slovakia in 2015. _Clostridium botulinum_ type A was isolated from 3 nearly empty commercial hummus tubes. The product, which was sold in Slovakia and the Czech Republic, was withdrawn from the market, and a warning was issued immediately through the European Commission's Rapid Alert System for Food and Feed (RASFF). Further investigation revealed the presence of botulinum neurotoxin (BoNT) subtype BoNT/A3, a very rare subtype implicated in only one previous outbreak (Loch Maree in Scotland, 1922). It is the most divergent subtype of BoNT/A with 15.4% difference at the amino acid level compared with the prototype BoNT/A1. This makes it more prone to evading immunological and PCR-based detection. It is recommended that testing laboratories are advised that this subtype has been associated with foodborne botulism for the 2nd time since the 1st outbreak almost 100 years ago, and to validate their immunological or PCR-based methods against this divergent subtype. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
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Sudan

Sudan US Consular Information Sheet
August 29, 2008
COUNTRY DESCRIPTION:
Sudan is a diverse, developing country in northeastern Africa. The capital city is Khartoum. The civil war between the northern and southern regions, which began in 1
83, ended in 2005. A multi-party conflict continues in the west in Darfur, and the armed Ugandan group known as The Lord’s Resistance Army is present in the south. Security conditions are adverse in these and some other regions. Transportation networks and other forms of infrastructure are poor and do not meet western standards. Even where available, water and electric services suffer frequent outages. Read the Department of State Background Notes on Sudan for additional information.

ENTRY/EXIT REQUIREMENTS: The Government of Sudan requires all travelers to present a passport and an entry visa. Most travelers must obtain the entry visa before arrival; only American citizens who also possess a Sudanese national identification document (such as a Sudanese passport or national identification card) may apply for an entry visa at Khartoum International Airport. The Government of Sudan routinely denies visas to travelers whose passports contain visas issued by the Government of Israel or other evidence of travel to Israel such as exit or entry stamps.

Travelers must obtain an exit visa before departure from Sudan as well as pay any airport departure tax not included in the traveler’s airline ticket. Visitors may obtain the latest information and further details from the Embassy of Sudan, 2210 Massachusetts Avenue NW, Washington, DC 20008, tel.: 202-338-8565.

Travel permits issued by the semi-autonomous Government of Southern Sudan (GOSS) or by the South Sudan Relief and Rehabilitation Commission (SSRRC) are not adequate for entry to the country, although travelers may find these documents useful to present to local authorities when in the south. Personal baggage, including computers, is routinely searched upon arrival to and departure from Sudan. The authorities will seize material deemed objectionable, such as alcohol or pornography, and may detain or arrest the traveler. Travelers intending to bring electronic items should inquire about entry requirements when they apply for a visa; restrictions apply to many devices, including video cameras, satellite phones, facsimile machines, televisions, and telephones. Travelers are not allowed to depart Sudan with ivory, some other animal products, or large quantities of gold.

All visitors must register with the authorities within three days of arrival. Travelers must register within 72 hours of arrival in Sudan at the Ministry of Interior. All foreigners traveling more than 25 kilometers outside of Khartoum must obtain a travel permit from the Ministry of Humanitarian Affairs in Khartoum. This applies to all travel, including private, commercial, and humanitarian activities. Americans risk detention by Sudanese authorities when traveling more than 25 kilometers outside of Khartoum without a travel permit issued by the Ministry of Humanitarian Affairs. Travelers must register again with the police within 24 hours of arrival. The government requires a separate travel permit for travel to Darfur. These regulations are strictly enforced and even travelers with proper documentation may expect delay or temporary detention from the security forces, especially outside the capital. Authorities expect travelers to strictly respect roadblocks and other checkpoints.

Travelers who wish to take any photographs must obtain a photography permit from the Government of Sudan, Ministry of Interior, Department of Aliens.

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:
On January 1, 2008, unknown assailants shot and killed two U.S. Embassy employees - an American USAID officer and a Sudanese national driver. Terrorists are known to operate in Sudan and continue to seek opportunities to carry out attacks against U.S. interests. Terrorist actions may include suicide operations, bombings, or kidnappings. U.S. citizens should be aware of the risk of indiscriminate attacks on civilian targets in public places, which include tourist sites and locations where westerners are known to congregate, and commercial operations associated with U.S. or Western interests. Terrorists are known to have targeted both official facilities and residential compounds. Anti-American sentiment is prevalent and Americans should exercise utmost caution at all times.

The U.S. Embassy’s ability to provide consular services in Sudan, including emergency assistance, is severely limited. Many areas outside the capital of Khartoum are extremely difficult to access.

Travel in many parts of Sudan is hazardous. Outside the major cities infrastructure is extremely poor, medical care is limited, and very few facilities for tourists exist.

Conflict among various armed groups and government forces continues in western Sudan, in the states of North Darfur, South Darfur, and West Darfur. Banditry and lawlessness are also common in the west. Many local residents are in camps for internally-displaced persons, and receive humanitarian assistance for basic needs such as food, water, and shelter. Expatriate humanitarian workers have been the targets of carjackings and burglaries.

Land mines remain a major hazard in southern Sudan, especially south of the city of Juba. Visitors should travel only on main roads unless a competent de-mining authority such as the UN has marked an area as clear of mines. The armed Ugandan group known as The Lord’s Resistance Army is present along the southern border and reportedly has announced it will target Americans.
Occasional clashes between armed groups representing communal interests continue to occur in the centrally-located states of Upper Nile, Blue Nile, and Bahr al Ghazal. Banditry also occurs.
Sudan shares porous land borders with nine other countries, including Chad, the Central African Republic, Uganda, Democratic Republic of Congo, Ethiopia, and Eritrea. Conflict in these countries occasionally spills over into Sudan.

Americans considering sea travel in Sudan's coastal waters should exercise caution as there have been incidents of armed attacks and robberies by unknown groups in recent years, including one involving two American vessels. Exercise extreme caution, as these groups are considered armed and dangerous. When transiting in and around the Horn of Africa and/or in the Red Sea near Yemen, it is strongly recommended that vessels convoy in groups and maintain good communications contact at all times. Marine channels 13 and 16 VHF-FM are international call-up and emergency channels, and are commonly monitored by ships at sea. 2182 Mhz is the HF international call-up and emergency channel. Wherever possible, travel in trafficked sea-lanes. Avoid loitering in or transiting isolated or remote areas. In case of emergency, contact the nearest U.S. Embassy or Consulate. In the event of an attack, consider activating Emergency Position Indicating Radio Beacons.

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 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: Crime is on the increase throughout Sudan. Additional security measures should be taken at places of residence to protect life and property. Anti-American sentiments can be found throughout the country. Americans should exercise caution by avoiding crowded public areas and public gatherings. Americans should avoid traveling alone. Report all instances of anti-American acts and crime targeting westerners to the American Embassy, and report incidents of crime to the Sudanese Police.

Americans should guard their backpacks or hand luggage. When traveling by air, travelers should maintain constant contact with their baggage and assure that they do not contain illicit items, such as alcohol or military ordinance. Americans have been removed from international airlines and detained when suspect items have been detected in checked baggage.

Carjacking and armed robbery continue to occur in western and southern Sudan. Sexual assault is more prevalent in the areas of armed conflict. Travelers who do not use the services of reputable travel firms or knowledgeable guides or drivers are especially at risk. Travel outside of Khartoum should be undertaken with a minimum of two vehicles so that there is a backup in case of mechanical failure or other emergency. Solo camping is always risky.

The Sudanese mail system can be unreliable. International couriers provide the safest means of shipping envelopes and packages, although anything of value should be insured.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Individuals with medical conditions which may require treatment are discouraged from traveling to Sudan. Medical facilities in Khartoum fall short of U.S. standards; outside the capital, very few facilities exist and hospitals and clinics are poorly equipped. Travelers must pay cash in advance for any medical treatment. Ambulance services are not available. Medicines are available only intermittently; travelers should bring sufficient supplies of needed medicines in clearly-marked containers.

Malaria is prevalent in all areas of Sudan. The strain is resistant to chloroquine and can be fatal. Consult a health practitioner before traveling, obtain suitable anti-malarial drugs, and use protective measures, such as insect repellent, protective clothing, and mosquito nets. Travelers who become ill with a fever or a flu-like illness while in Sudan, or within a year after departure, should promptly seek medical care and inform their physician of their travel history and the kind of anti-malarial drugs used. For additional information about malaria and anti-malarial drugs please see the Center for Disease Control travelers’ health web site, http://www.cdc.gov/malaria/index.htm.

Officially, people with HIV are not granted a visa and are not permitted to enter Sudan. A negative HIV test result must be presented at a Sudanese embassy or at Khartoum airport in order to obtain a visa. However, anecdotal reports indicate this requirement is not enforced in practice. Please confirm this requirement with the Embassy of Sudan at www.sudanembassy.org.

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

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Sudan is provided for general reference only, and may not be accurate in a particular location or circumstance.

Road conditions throughout Sudan are hazardous due to erratic driver behavior, pedestrians and animals in the roadways, and the lack of basic safety equipment on many vehicles. Only major highways and some streets in the cities are paved; many roads are narrow, rutted, and poorly maintained. Local drivers do not observe conventions for the right-of-way, stop in the road without warning, and frequently exceed safe speeds for road, traffic, and weather conditions. Driving at night is dangerous and should be avoided if possible; many vehicles operate without lights.

In the north and west, dust storms and sand storms, known locally as haboobs, greatly reduce visibility when they occur. Roads in these areas can be quickly covered with shifting sand at any season of the year. Roads in southern Sudan often are impassable during the rainy season, from March to October.
U.S. citizens are subject to the laws of the country in which they are traveling, including traffic laws. In Sudan vehicles have the steering wheel on the left side and drivers use the right side of the road.

Traffic from side streets on the right has the right-of-way when entering a cross street, including fast-moving main streets. Traffic on the right has the right-of-way at stops. Right turns on a red light are prohibited. Speed limits are not posted, but the legal speed limit for passenger cars on inter-city highways is 120 kph (about 70 mph), while in most urban areas the limit is 60 kph (about 35 mph.) The speed limit in congested areas and school zones is 40 kph (about 25 mph).

Many local drivers carry no insurance despite the legal requirement that all motor vehicle operators purchase third-party liability insurance from the government. Persons involved in an accident resulting in death or injury must report the incident to the nearest police station or police officer as soon as possible. Persons found at fault can expect fines, revocation of driving privileges, and jail sentences, depending on the nature and extent of the accident. Persons convicted of driving under the influence of alcohol face fines, jail sentences, and corporal punishment.

Americans may use their U.S. driver's licenses for up to 90 days after arrival in Sudan, and then must carry either an International Driving Permit (IDP) or a Sudanese driver's license. There are no restrictions on vehicle types, including motorcycles and motorized tricycles.

Public transportation is limited to within and between major urban areas. Passenger facilities are basic and crowded, especially during rush hours and periods of seasonal travel. Schedules are unpublished and subject to change without notice. Vehicle maintenance does not meet U.S. standards. There is routine passenger train service on the route from Khartoum to Wadi Halfa (on the border with Egypt) and to Port Sudan (on the Red Sea.) Bus service between major cities is regular and inexpensive. Intra-city bus service in the major urban areas is regular, but most buses and bus stops are privately-operated and unmarked. Taxis are available in the major cities at hotels, tourist sites, and government offices. The motorized rickshaws in common use in Khartoum are unsafe. Travelers are encouraged to hire cars and drivers from reputable sources with qualified drivers and safe vehicles. Irregularly-scheduled mini-buses provide some public transit to rural communities; many areas lack any public transportation.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Sudan, the U.S. Federal Aviation Administration (FAA) has not assessed Sudan’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.

Enforcement of aviation safety standards in Sudan is uneven; civil aviation in Sudan continues to experience air incidents and accidents, including 5 crashes with at least 64 fatalities between November 8, 2007, and June 30, 2008. Incidents included engine failures, collapsed landing gear, and planes veering off the runway. Whenever possible, Americans traveling to Sudan despite the ongoing travel warning are advised to travel directly to their destinations on international carriers from countries whose civil aviation authorities meet international aviation safety standards for the oversight of their air carrier operations under the FAA’s International Aviation Safety Assessment (IASA) program. Adverse seasonal weather conditions, such as dust or sand storms in the north between April and June and severe rain storms in the south between March and October, cause frequent flight cancellations.

Two hijackings originated in Sudan in 2007; no passengers were harmed.

SPECIAL CIRCUMSTANCES: In November 1997, the U.S. imposed comprehensive financial and commercial sanctions against Sudan, prohibiting U.S. transactions with Sudan. Travelers intending to visit Sudan despite the Travel Warning should contact the Department of the Treasury, Office of Foreign Assets Control (OFAC), Office of Compliance, telephone 1-800-540-6322 or 202-622-2490, regarding the effect of these sanctions.

Travelers must be prepared to pay cash for all purchases, including hotel bills, airfares purchased locally, and all other travel expenses. Major credit cards, including Visa, MasterCard, or American Express, cannot be used in Sudan due to U.S. sanctions. Sudan has no international ATMs. Local ATMs draw on local banks only.

Travelers, including journalists, must obtain a photography permit before taking any photographs. Even with a photography permit, photographing military areas, bridges, drainage stations, broadcast stations, public utilities, slum areas, and beggars is prohibited.

Sudan is a conservative society, particularly in the capital and other areas where the Muslim population is the majority. Alcohol is prohibited by law and modest dress is expected. Loose, long-sleeved shirts and full-length skirts or slacks are recommended attire for women visitors. Women who are not Muslim are not expected or required to cover their heads. Men may wear short-sleeved shirts but short pants are not acceptable in public.

Please see our information on 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 Sudanese laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in alcohol or illegal drugs in Sudan 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 as well in Sudan.

Sudan’s Public Order Courts have continued to serve as the state mechanism for morality enforcement since the early 1980's. Today the court still issues punishments ranging from fines, to lashings, to lengthy prison sentences for offences such as drinking alcohol, wearing inappropriate clothing, or associating with unmarried women.

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 Sudan are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Sudan. 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 Sharia Ali Abdel Latif, Khartoum, Sudan; tel: 249 1 83 774-701, http://sudan.usembassy.gov/.
* * *
This replaces the Country Specific Information dated March 12, 2008, to update sections on Entry/Exit Requirements, Medical Facilities and Health Information, Aviation Safety Oversight, and Criminal Penalties.

Travel News Headlines WORLD NEWS

Fri 11/10/2019 14:43
WorldHealthOrganizationNews@who.int

Attributable to the Federal Ministry of Health in Sudan, WHO and UNICEF

KHARTOUM, 11 October 2019 -  "Sudan has launched an oral cholera vaccination campaign in response to the ongoing outbreak of cholera. More than 1.6 million people aged one year and above in the Blue Nile and Sinnar states will be vaccinated over the coming five days.  “The announcement of the Federal Ministry of Health in Sudan on the cholera outbreak last month allowed national and state authorities, and health partners, to act quickly and respond to the outbreak.

“Since the announcement on 8 September, 262 cases of suspected cholera and eight related deaths have been reported as of 9 October in the Blue Nile and Sinnar states. No cholera-related deaths have been reported since mid-September. “The vaccines were procured and successfully shipped using funding from Gavi, the Vaccine Alliance. In addition, Gavi is providing nearly US$ 2 million to cover operational costs for the campaign.

“We joined efforts to respond as quickly as possible to contain the current outbreak of cholera and prevent it from spreading further in Sudan. The vaccination campaign kicking off today in combination with other measures including scaling up water, sanitation and hygiene activities, enhancing surveillance, prepositioning supplies and case management, will help protect people who are at highest risk.

“The first round of the campaign will conclude on 16 October and will be followed by a second round in four to six weeks to provide an additional dose to ensure people are protected for at least the next three years.  “As part of the campaign, over 3,560 vaccinators, more than 2,240 social mobilizers, and almost 70 independent monitors have been trained and deployed to the two affected states.”
Date: Wed 9 Oct 2019
Source: Dabanga [edited]

Arbaat in El Ganeb locality in Sudan's Red Sea state reported 10 new cases of suspected Rift Valley fever* on Monday and Tuesday [7 and 8 Oct 2019], bringing the total number of registered cases to 5, and 3 deaths.  Doctor Ahmed Dereir told Radio Dabanga about the spread of the disease in 8 villages in the area of Arbaat, pointing out that the cases were transferred to Port Sudan for treatment. He explained that the governor formed an emergency room of 35 people representing various government agencies, medical committees, and members of the Forces for Freedom and Change.

Ali Bayrak, head of the Community Support Committee for the residents of Arbaat called on the government for the explicit announcement of the results of laboratory testing of samples.  The state Ministry of Health committed to provide 2 doctors to the villages of the Arbaat Administrative Unit and training 10 medical staff, and 3 midwives, in addition to the distribution of water chlorination tablets and the provision of 3 spraying vehicles.

As reported by Radio Dabanga on Sunday [6 Oct 2019], one man and more than 20 head of cattle died in Arbaat on Thursday and Friday [3 and 4 Oct 2019], and that to date, so far, 3 people and 420 cows have died of the disease, now suspected to be Rift Valley fever, that hit the area of Arbaat, north of Port Sudan, over the past weeks, medical doctor Ahmed Dereir told Radio Dabanga.

According to the UN World Health Organisation (WHO) Rift Valley fever (RVF) is a viral zoonosis that primarily affects animals but also has the capacity to infect humans. Infection can cause severe disease in both animals and humans. The disease also results in significant economic losses due to death and abortion among RVF-infected livestock.

RVF virus was 1st identified in 1931 during an investigation into an epidemic among sheep on a farm in the Rift Valley of Kenya, and most cases occur in Sub-Saharan Africa.

Key facts:
- Rift Valley fever (RVF) is a viral zoonosis that primarily affects animals but can also infect humans.
- The majority of human infections result from contact with the blood or organs of infected animals.
- Human infections have also resulted from the bites of infected mosquitoes.
- To date, no human-to-human transmission of RVF virus has been documented.
- The incubation period (the interval from infection to onset of symptoms) for RVF varies from 2-6 days.
- Outbreaks of RVF in animals can be prevented by a sustained programme of animal vaccination.
==================
[On Wed 9 Oct 2019, villages in the area of Arbaat in El Ganeb locality in Red Sea state reported 9 new cases suspected to be Rift Valley fever, bringing the total number of reported cases to 65 (<https://www.dabangasudan.org/en/all-news/article/nine-more-cases-of-rift-valley-fever-in-sudan-s-red-sea-state>). In addition to the Red Sea state outbreak mentioned above, a separate report indicates that Rift Valley fever is occurring in Sudan's River Nile state (see Rift Valley fever - Sudan: (RS,NR) human, animal, alert, OIE Archive Number: http://promedmail.org/post/20191014.6726088). These 2 Sudan states mentioned above are adjoining, so it is not surprising that suspected or confirmed Rift Valley fever (RVF) outbreaks are occurring there simultaneously. The Ministry of Health is investigating the outbreaks in both states. Not only are these outbreaks a human health problem, they are clearly an animal health problem as well, with 420 cattle reported dying of the disease. A One Health response is urgently needed, with participation of physicians, veterinarians and entomologists. There was evidence of RVF virus in the neighbouring Central African Republic this year (2019). Last year (2018), human and animal cases occurred in neighboring South Sudan (see Valley fever - South Sudan (09): (EL) human, animal, WHO http://promedmail.org/post/20180410.5735975).

If focal geographic areas of transmission are identified in this Sudan situation, increased surveillance of people and livestock should be initiated and livestock vaccination considered. RVF-infected livestock can pose a significant risk to humans in contact with them, often livestock owners and veterinarians. Abortions in livestock with a loss in productivity present an economic problem for many ethnic groups that depend on them for livelihoods.

The above report mentions abortion storms in a River Nile state outbreak that could have had serious economic, social and public health consequences. It is likely that RVF virus will persist in this area in transovarially infected eggs of _Aedes_ mosquito vectors. These eggs can remain viable for long periods and hatch when flooded during future rain events, with subsequent emergence of infected females ready to transmit the virus. This risk provides justification for maintaining livestock of the area well vaccinated into the future. - ProMED Mod.TY]

[A media (radio) report on an event of human and animal disease, in Sudan's area of Arbaat, north of Port Sudan, Red Sea state, caused by an "unknown fever" killing 3 people and 420 cows, was posted by ProMED-mail on 6 Oct 2019 as "undiagnosed," RFI (http://promedmail.org/post/20191006.6712623). The commentary suggested RVF as possible etiology, requesting further information. According to Sudan's official OIE report, dated 13 Oct 2019, an event of RVF has been diagnosed in "Arabaata dam area, Alghunub Wa Alolaib, Red Sea state" (http://promedmail.org/post/20191014.6726088), the animals affected being goats, which are thus considered, in this event, the virus' primary victims and main source of human infection, directly or through vectors. The samples from the goats were found RVF-infected by ELISA. In difference with the earlier media (radio) report, the OIE report indicated that there are "no cattle and sheep in this area." A media report dated 12 Oct 2019 (<https://khartoumstar.com/en/2019/10/12/ministry-of-health-rift-valley-fever-in-northern-sudan/>) reported RVF "emerging" in Sudan's River Nile state, naming the locations Berber, north of Bawqa, Ftouar, Joule and Sulaimaniya, and the Artoli region of the East Bank. The report cited Hatem Fadl, an official in the epidemiology and emergency department at the Federal Ministry of Health, saying that "4 cases of Rift Valley fever were diagnosed among 17 samples taken last week, [which] were sent to the Central Laboratory in Khartoum." Hatem pointed out that the Federal Minister of Health commissioned a team to investigate the injuries, [which] arrived in the villages of Artoli, Al-Bawqa, and Fatwwar [Fri 11 Oct 2019], before the disease was officially announced (12 Oct 2019). Additional data were included in the same media source on 13 Oct 2019 (<https://khartoumstar.com/en/2019/10/13/attempts-to-control-rift-valley-fever-in-the-nile-river-state/>). No details on animal cases in River Nile state have become available, nor specific lab results of the human samples. Additional information from Sudan, and clarification on the discrepancies between the media reports as far as animal species are concerned, will be welcomed. - ProMED Mod.AS]

[A map showing the location of the 2 states mentioned above can be accessed at:

HealthMap/ProMED map available at:
Date: Thu 19 Sep 2019
Source: Dabang Sudan [edited]

The Ministry of Health has reported 22 suspected cases of haemorrhagic fever in Kassala in eastern Sudan.

In a press statement, the director of emergencies and epidemics, Emtiaz Ata, told reporters that the ministry is examining suspected cases to make sure of the suspicion and to find out more about the disease.

The director-general of the Ministry of Health, Nureldin Hussein, said that the health situation in Kassala is not reassuring, and there must be measures and considerable precautions to adequately address the health issue and avoid epidemics.
========================
[It is not clear what is the cause of these suspected cases of hemorrhagic fever or whether epidemiological investigations have been carried out, laboratory tests conducted, the clinical course of the illness determined, or any specific response measures taken. Any updates from the public health personnel and physicians on the ground will be highly appreciated. - ProMED Mod.UBA]

25 September, 2019 – A shipment of 36 tons of cholera treatment medicines and supplies have arrived in Khartoum and are being prepared for distribution as part of the World Health Organization’s response activities supporting the Federal Ministry of Health in Sudan to contain and halt a cholera outbreak.

The shipment includes 5000 rapid diagnostic tests (RDTs) for immediate detection and screening of cholera patients at health facilities and high-risk areas. RDTs are an essential part of early detection and response activities as their use ensures timely management and reporting of cholera cases.

The shipment also contains medicines that can treat 2500 severely dehydrated patients, and which will be distributed to cholera treatment centres in Blue Nile and Sinnar states, where cases have been confirmed, as well as in the neighbouring at-risk states of White Nile, Kassala, Gedaref and Khartoum.

“Even with the rapid depletion of our resources, we are accelerating our coordinated response, including delivering more medicines and supplies,” said Dr Naeema Al Gasseer, WHO Representative in Sudan. “We are working around the clock with the Federal Ministry of Health, state authorities and partners to control the outbreak and prevent more deaths.”

As of 24 September, a total of 184 cholera cases have been reported, including 128 cases from Blue Nile State and 56 cases in Sinnar state. Eight cholera-related deaths have been recorded by the Federal Ministry of Health, including 6 in Blue Nile State and 2 in Sinnar State.

Open defecation, lack of clean water outside the capital city and a dilapidated health sector are serious threats in a country of about 40 million people. Cholera, a bacterial disease usually contracted from contaminated water supplies, can be fatal if not treated early.

As part of an overall integrated cholera response plan, WHO is working with the Ministry, state-level health ministries, United Nations agencies and nongovernmental organizations on surveillance of cases to monitor and control spread of the disease; maintain clean water, sanitation and nutrition; and raise awareness among at-risk communities.

To date, WHO has deployed international experts to support the ongoing response activities and has trained and deployed 9 rapid response teams, each consisting of at least 3 members, for assessment and surveillance of high-risk areas. 18 health volunteers have also been trained and deployed to conduct water quality assessments in the 2 affected States. WHO is also actively disseminating awareness messages on health and sanitation through focus group discussions with community leaders, especially women, and training workshops are ongoing for volunteers on conducting house-to-house and community visits to deliver relevant health messages.
Date: Thu, 26 Sep 2019 11:57:24 +0200 (METDST)

Khartoum, Sept 26, 2019 (AFP) - Eight people have died from cholera in Sudan including six in the war-torn state of Blue Nile, according to the World Health Organisation, amid a surge in the number of reported cases.   A total of 184 cases of cholera have been reported in the northeast African country over the past month, including 128 cases from Blue Nile and 56 in Sinnar state, WHO said in a statement late Wednesday citing health ministry records.

"Eight cholera-related deaths have been recorded by the federal ministry of health, including six in Blue Nile state and two in Sinnar state," WHO said.   "We are working around the clock with the federal ministry of health, state authorities and partners to control the outbreak and prevent more deaths," WHO Sudan head Naeema al-Gasseer said in the statement.

WHO said a shipment of 36 tonnes of cholera treatment medicines and supplies have arrived in Khartoum and are being prepared for distribution as part of the organisation's response activities.   The shipment also contains medicine to treat 2,500 severely dehydrated patients, which is set to be distributed to cholera treatment centres in Blue Nile and Sinnar states, as well as other neighbouring high-risk states.

Cholera, a bacterial disease usually contracted from contaminated water supplies, can be fatal if not treated early.   Open defecation, lack of clean water outside Khartoum, and a dilapidated health sector further increases the threats from such diseases in a country of about 40 million people.   Dozens of people died from acute diarrhoea in Sudan in 2016 after thousands of cases were reported nationwide.   Blue Nile state, which has a large ethnic minority population, has been the focus of a rebellion by the Sudan People's Liberation Army-North since 2011.   The army declared a ceasefire after the overthrow of veteran president Omar al-Bashir earlier this year.
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Guatemala

Guatemala - US Consular Information Sheet
October 13, 2006
COUNTRY DESCRIPTION:
Guatemala has a developing economy, characterized by wide income disparities.
Hotels and other tourist facilities in the principal tourist sites most freq
ented by visitors from the United States are generally good to excellent.
A peace accord, signed in 1996, ended a 36-year armed conflict.
Violent crime, however, is a serious concern due to endemic poverty, an abundance of weapons, a legacy of societal violence, and dysfunctional law enforcement and judicial systems.
Read the Department of State Background Notes on Guatemala for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid U.S. passport is required for all U.S. citizens, regardless of age, to enter Guatemala and to depart Guatemala for return to the U.S.
Even if dual nationals are permitted to enter Guatemala on a second nationality passport, U.S. citizens returning to the United States from Guatemala are not allowed to board their flights without a valid U.S. passport.
Guatemalan authorities do not accept Certificates of Naturalization, birth certificates, driver's licenses, and photocopies as alternative travel documents.
While in Guatemala, U.S. citizens should carry their passports, or a photocopy of their passports, with them at all times.

An exit tax must be paid when departing Guatemala by air.
The exit tax (currently $30) is generally included in an airline ticket price, but may be charged separately.
There is an additional airport security fee (20 Quetzales, approximately $2.50) that all travelers must pay at the airport.

Minors under 18 traveling with a valid U.S. passport need no special permission from their parents to enter or leave Guatemala.
U.S. citizens do not need a visa for a stay of 90 days or less (that period can be extended for an additional 180 days upon application to Guatemalan immigration).

A U.S. citizen whose passport is lost or stolen in Guatemala must obtain a new passport at the U.S. Embassy as soon as possible and present it, together with a police report of the loss or theft, to the Dirección de Migración (Guatemalan immigration agency), Sub-director de Control Migratorio (Sub-director for Migratory Control), to obtain permission to depart Guatemala.
The agency is located in Guatemala City at 6 Avenida 3-11, Zone 4, Guatemala City.
Office hours are weekdays from 8:00 a.m. to 4:00 p.m.; telephone 2411-2411.
No fee is charged by Guatemalan immigration for this service.

In June 2006, Guatemala entered a "Central America-4 (CA-4) Border Control Agreement" with El Salvador, Honduras, and Nicaragua.
Under the terms of the agreement, citizens of the four countries may travel freely across land borders from one of the countries to any of the others without completing entry and exit formalities at Immigration checkpoints.
U.S. citizens and other eligible foreign nationals, who legally enter any of the four countries, may similarly travel among the four without obtaining additional visas or tourist entry permits for the other three countries.
Immigration officials at the first port of entry determine the length of stay, up to a maximum period of 90 days.
Foreign tourists who wish to remain in the four country region beyond the period initially granted for their visit are required to request a one-time extension of stay from local Immigration authorities in the country where the traveler is physically present, or travel outside the CA-4 countries and reapply for admission to the region.
Foreigners "expelled" from any of the four countries are excluded from the entire "CA-4" region.
In isolated cases, the lack of clarity in the implementing details of the CA-4 Border Control Agreement has caused temporary inconvenience to some travelers and has resulted in others being fined more than one hundred dollars or detained in custody for 72 hours or longer.

See our Foreign Entry Requirements brochure for more information on Guatemala and other countries.

For further information regarding entry, exit and customs requirements, travelers should contact the Guatemalan Embassy at 2220 R Street, NW, Washington, DC 20008; telephone (202) 745-4952, extension 102; fax (202) 745-1908; e-mail at info@guatemala-embassy.org; Internet web site - http://www.guatemala-embassy.org or contact the nearest Guatemalan consulate (Chicago, Denver, Houston, Los Angeles, Miami, New York, or San Francisco).

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

SAFETY AND SECURITY:
Violent criminal activity has been a problem in all parts of Guatemala for years, including murder, rape, and armed assaults against foreigners.
The police force is inexperienced and under-funded, and the judicial system is weak, overworked, and inefficient.
Well-armed criminals know that there is little chance they will be caught and punished.
Traditionally, Guatemala experiences increases in crime before and during the Christmas and Easter holiday seasons.
Large demonstrations occur throughout Guatemala, often with little or no notice, and they can cause serious traffic disruptions.
Although most demonstrations are peaceful, they can turn violent, and travelers should avoid areas where demonstrations are taking place.
The use of roadblocks and/or blocking of public facilities, including the international airport, has increased and demonstrators may prevent tourists caught behind the blockades from leaving.

Due to uncontrolled drug and alien smuggling, the Guatemalan border with Mexico is a relatively high-risk area, in particular in the northern most Peten Department.
The most dangerous area in that region is on the northwestern border of the Peten, in the area including the Sierra de Lacandon and Laguna del Tigre National Parks.
Extra precautions are required when travel by U.S. Government personnel to the region is required.

In October 2005 Hurricane Stan caused widespread flooding and landslides on Guatemala's Pacific coast and in many parts of the Highlands, affecting a number of tourist destinations frequented by foreign travelers.
All major highways and tourist destinations reopened by the end of the month, and most secondary routes are also fully open.
Temporary repairs are still in place; some have already been washed out and others will likely fail during the current rainy season (May through October).
The following recommendations will help residents and visitors alike to increase their safety:

Avoid gatherings of agitated people.
Guatemalan citizen frustration with crime and a lack of appropriate judicial remedies has led to violent incidents of vigilantism, including lynching, especially in more isolated, rural areas.
Attempting to intervene may put you at risk of attacks from mobs.

Avoid close contact with children, including taking photographs, especially in rural areas.
Such contact can be viewed with deep alarm and may provoke panic and violence.
Rumors of foreigners stealing children surface periodically and can provoke a violent response towards strangers.
Foreign tourists have been attacked by mobs and some years ago one was killed while photographing children.

Keep informed of possible demonstrations by following the local news and consulting hotel personnel and tour guides.
Avoid areas where demonstrations are occurring.

Strong currents, riptides, and undertow along Guatemala's Pacific Coast beaches pose a serious threat to even the strongest swimmers.
Signs warning of treacherous surf are rare and confined mostly to private beaches owned by hotels.
Lifeguards are rarely present on beaches.

Tourists planning to climb Pacaya and Agua volcanoes during Guatemala's rainy season (May through October) should plan their climb for the morning hours, when it is less likely that thunderstorms will occur.
Climbers should monitor the weather situation and return to the base of the volcano as quickly as safely possible if thunderstorms gather.
In 2003, a Canadian tourist was killed by lightning while climbing Pacaya.
INGUAT, the Guatemalan Tourist Institute, has organized an active community-based tourism program in San Vicente Pacaya to minimize the risk of armed robbery on Pacaya.
Climbing in groups is still highly advisable for any volcano climb to reduce the risk of assault.

Security escorts for tourist groups and security information are available from the Tourist Assistance Office of INGUAT (the Guatemalan Tourist Institute) at 7a Avenida 1-17, Zona 4 Centro Cívico, Ciudad de Guatemala.
INGUAT's 24 hour/seven days per week direct telephone numbers for tourist assistance and emergencies are (502) 2421-2810 and (502) 5578-9836 and the fax is (502) 2421-2891.
INGUAT may be reached by its toll free number within the United States at 1-888- 464-8281.
You may also simply dial 1500 in Guatemala to reach INGUAT Tourist Assistance.
The e-mail address is asistur@inguat.gob.gt.
Travelers may also wish to visit INGUAT's website, http://visitguatemala.com.
Tourist groups are advised to request security escorts from INGUAT, Attention: Coordinator of the National Tourist Assistance Program.
There have been no incidents of armed robbery of groups escorted through the Tourist Protection Program.
The request should be submitted by mail, fax or e-mail and should arrive at INGUAT at least three business days in advance of the proposed travel, giving the itinerary, names of travelers, and model and color of vehicle in which they will be traveling.
Travelers should be aware that INGUAT might not be able to accommodate all requests.

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

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

The Department of State urges 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 number of violent crimes reported by U.S. citizens and other foreigners has remained high in recent years.
Incidents include, but are not limited to, assault, theft, armed robbery, carjacking, rape, kidnapping, and murder.
Criminals often operate in groups of four or more and are confrontational and violent.
Gangs are a growing concern in Guatemala City and rural Guatemala.
Gang members are often well armed with sophisticated weaponry and they sometimes use massive amounts of force.
Emboldened armed robbers have attacked vehicles on main roads in broad daylight.
Travel on rural roads always increases the risk of a criminal roadblock or ambush.
Widespread narcotics and alien smuggling activities can make remote areas especially dangerous.
Though there is no evidence that Americans are particularly targeted, criminals look for every opportunity to attack, so all travelers should remain constantly vigilant.

Most tourists and visitors travel throughout Guatemala without mishap.
However, violent criminal activity on the highways continues, and tourists, among others, have been targeted.
Many of the robbery attempts have occurred in daylight hours on main highways.
Carjacking incidents and highway robberies are often violent.
Four Americans were killed in highway robbery attempts in 2002 and three killed and one wounded in 2003.
In 2004 one American tourist was murdered, and women and children were raped in highway assaults.
Several highway assaults of American citizens also took place in 2005, but without serious injury to the victims.
In some cases, assailants have been wearing full or partial police uniforms and have used vehicles that resemble police vehicles, indicating that some elements of the police might be involved.
Armed robberies have occurred within minutes of the tourist's vehicle being stopped by the police.
U.S. Embassy personnel continue to observe heightened security precautions in Guatemala City and on the roads outside the capital city.
U.S. tourists are urged to be especially aware of safety and security concerns when traveling on the roads in Guatemala.
Rather than traveling alone, use a reputable tour organization.
Stay in groups; travel in a caravan consisting of two or more vehicles; and, stay on the main roads.
Ensure that someone not traveling with you is aware of your itinerary.
Resist the temptation to stay in hotels that do not have adequate security.
Travel after dark anywhere in Guatemala is extremely dangerous.
It is preferable to stay in the main tourist destinations.
Do not explore back roads or isolated paths near tourist sites.
Pay close attention to your surroundings, especially when walking or when driving in Guatemala City.
Refrain from displaying expensive-looking jewelry, large amounts of money, or other valuable items.
Finally, if confronted by criminals, be aware that resistance may provoke a more violent response.

Additional information:
In recent months there has been an increasing number of carjacking incidents and armed robberies near the airport, most frequently between 6:00 and 10:00 am (see list of Recent Crime Incidents Involving Foreigners on the Embassy website for more specifics).
In the most common scenario tourists or business travelers who land at the airport around 7:00 am are held up by armed men as their vehicle departs the airport.
Private vehicles, taxis and shuttle buses have been attacked.
Typically, the assailants steal money, passports, and luggage, and in some but not all cases, the assailants steal the vehicle as well.
Victims who did not resist the attackers were not physically injured.
The Embassy advises its own employees to seek alternative routes for exiting the airport.

Pickpockets and purse-snatchers are active in all major cities and tourist sites, especially the central market and other parts of Zone 1 in Guatemala City and the city of Antigua.
In a common scenario, an accomplice distracts the victim, while an assailant slashes or simply steals a bag or backpack while the victim's attention is diverted.

As in other countries, criminals also use a number of scams to steal money and possessions from tourists in Guatemala.
In one popular scam, robbers place a nail in a parked vehicle's tire.
The vehicle is then followed by the robbers who pose as "good Samaritans" when the tire becomes flat and the victims pull to the side of the road.
While "help" is being rendered, the contents of the car are stolen, often without the knowledge of the victims.
However, in some cases, the robbers have threatened the tourists with weapons.
Parking areas in and around the Guatemala City International Airport are particularly prone to this crime.
In another scam, victims are approached in a hotel, restaurant or other public place by an individual claiming there is some sort of problem with his or the would-be victim's automobile in the parking lot.
On the way to investigate the "problem," usually in a remote or concealed area near the parking lot, the robber pulls a gun on the victim demanding cash, credit cards and other valuables.
A third popular scam involves various attempts to acquire a victim's ATM card and PIN number.
Some sophisticated criminals have even placed boxes outside ATM kiosks that record PIN numbers when unsuspecting victims believe they must enter their PIN number to gain entry to the ATM foyer.
After recording PIN numbers, robbers then steal the owner's ATM card to complete their crime.
There are dozens of techniques scammers can use to rob victims of money and possessions.
While most people mean no harm, always be cautious when strangers approach you for any reason or make unusual requests.

Parents adopting children in Guatemala have also been victimized in public places and at their hotels by police (or individuals dressed as police) who have threatened to arrest foster mothers and turn adoptive children over to orphanages, but released them in exchange for significant payments, often approaching $1000.
Such threats have no basis in Guatemalan law, and should be immediately reported to the Embassy.

For security reasons, the Embassy does not allow U.S. government employees to stay in hotels in Zone 1 in Guatemala City and urges private travelers to avoid staying in this area.

Avoid low-priced intra- and inter-city buses (recycled U.S. school buses); they are often attacked by armed robbers and are poorly maintained and dangerously driven.
The use of modern inter-city buses somewhat improves security and safety.
There have been, however, several attacks on travelers on first-class buses on highway CA-2 near the border areas with both Mexico and El Salvador and on highways CA-1 and CA-9 near the El Salvador border and in the highlands between Quetzaltenango and Solola.
Be cautious with personal items such as backpacks and fanny packs while riding buses, because tourists' possessions are a favorite target of thieves.

Do not hail taxis on the street in Guatemala City.
Use radio-dispatched taxis or taxis from major hotels instead.
The main road to Lake Atitlan via the Inter-American Highway (CA-1) and Solola is safer than the alternatives, though attacks in recent years have made traveling in a caravan highly recommended, even on the Inter-American Highway.
Robbery and assault have been frequently reported on secondary roads near the lake with the highest number of incidents occurring on the RN-11 (Las Trampas road) parallel to the east side of the lake.
Robbers have used mountain roads advantageously to stop buses, vans and cars in a variety of ways.

Armed attacks have occurred on roads from Guatemala City to the Peten.
Visitors to the Mayan ruins at Tikal are urged to fly to nearby Flores and then travel by bus or tour van to the site.

Violent attacks have occurred in the Mayan ruins in the Peten, including in the Cerro Cahui Conservation Park, Yaxha, the road to and inside Tikal Park, and in the Tikal ruins.
Tourist police (POLITUR) patrols inside the park have significantly reduced the violent crime incidents inside the park, but travelers should nevertheless remain in groups and on the principal trails leading to the Central Plaza and the Temple IV complex, and avoid remote areas of the park.

POLITUR (a joint police/Guatemalan Tourism Institute initiative) is present in all major tourist destinations.
They should be contacted in case of any criminal incident in such areas, even if minor.

Foreign residents of Guatemala have special concerns.
Twenty American citizen residents and five American citizen tourists have been murdered since December 1999, and suspects have been convicted in only two cases.
There have been "express" kidnappings in recent years, primarily in Guatemala City, in which a relatively small ransom that can be quickly gathered is demanded.
U.S. citizens have been kidnapped in recent years.
At least one incident of a random kidnapping, in which the victim was grabbed off the street in an affluent neighborhood of the city, occurred in December 2003 and resulted in a physical and sexual assault.

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

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: A full range of medical care is available in Guatemala City, but medical care outside the city is limited.
Guatemala's public hospitals frequently experience serious shortages of basic medicines and equipment.
Care in private hospitals is generally adequate for most common illnesses and injuries, and many of the medical specialists working in them are U.S. trained and certified.

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

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Guatemala is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Driving in Guatemala requires one's full attention, and safe drivers must take extraordinary efforts to drive defensively to avoid dangerous situations.

Traffic rules are only casually observed.
Many drivers do not use their turn signals to alert other drivers.
Instead, a common custom is for a driver or passenger to stick a hand out the window and wave it to indicate that they will be taking an unspecified action.
Speed limits, lane markings and stop signs are frequently ignored.
Passing blindly on winding and/or steep mountain roads, poorly designed surfaces, and unmarked hazards, including frequent landslides and precarious temporary highway repairs, present additional risks to motorists.

Common public transportation is by local recycled school busses, which serve every town in the country.
Criminal activity and frequent fatal accidents, however, make the low-priced inter-city buses particularly dangerous.
Modern inter-city buses offer some security from highway violence, but armed attacks are increasing, showing that all buses are vulnerable.
(See additional information in the CRIME section.)

Although city streets are lit, secondary and rural roads have little to no illumination.
Driving outside of urban areas at night is dangerous and not recommended.
The Inter-American Highway (CA-1) and the road from Guatemala City to the Caribbean coast (CA-9) are especially dangerous due to heavy traffic, including large trucks and trailers.
There are no roadside assistance clubs, however a roadside assistance force (PROVIAL) patrols most of the major highways in the country.
PROVIAL can be contacted by calling 2422-7878.
Their vehicles are equipped with basic tools and first aid supplies, and their services are free.
Police patrol the major roadways and may assist travelers, but the patrols are sporadic and may be suspended due to budget restraints.
For roadside assistance, travelers may call the police by dialing 120 or the fire department by dialing 122 or 123.
Cellular telephone service covers most areas frequented by tourists.

Valid U.S. driver's licenses are accepted for the first 30 days of a visit, and international driving permits are accepted in Guatemala for extended stays.
Guatemala's road safety authorities are the Department of Transit and the Joint Operations Center of the National Police.
Drivers use the right-hand side of the road in Guatemala, and speed limits are posted (in kilometers) depending on the condition of the road.
Speed limits are different in rural and urban areas, but are rarely enforced.
Drivers often drive at the absolute maximum speed possible for the particular vehicle at the time.
These drivers share the road with slow vehicles, some barely able to manage 20 miles per hour, creating a hazardous mix of velocities.
Turning right on red is not permitted unless otherwise posted, and drivers must yield when entering a traffic circle.
Seat belts must be worn in Guatemala, but there are no laws regarding the use of child safety seats.
It is against the law for drivers to operate cellular phones while driving.

People found driving under the influence of alcohol or other drugs are arrested and may serve jail time.
In an accident resulting in injury or death, every driver involved is taken into custody and the vehicle(s) impounded until a judge determines responsibility in a re-enactment of the accident.

Please refer to our Road Safety page for more information.
Visit the website of Guatemala's national tourist office and national authority responsible for road safety at http://www.inguat.gob.gt or via e-mail at asistur@inguat.gob.gt or info@inguat.gob.gt.

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Guatemala's Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Guatemala's air carrier operations.
For more information, travelers may visit the FAA's Internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
A major renovation of the international terminal at La Aurora International Airport in Guatemala City is currently under way.
Until completion in late 2006 or early 2007, there is a temporary reconfiguration of arrival and departure vehicle traffic and major construction works inside the terminal.

Guatemalan customs authorities may enforce strict regulations concerning temporary importation into or export from Guatemala of items such as antiquities and other cultural property.
It is advisable to contact the Embassy of Guatemala in Washington or one of Guatemala's consulates in the United States for specific information regarding customs requirements.
In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products are illegal and bringing them back to the United States may result in forfeitures and/or fines.

Please see our Customs Information.

Non-Guatemalan citizens who wish to marry in Guatemala are required to provide proof of identity and civil status (indicating whether they are single or divorced).
Prior notice of the marriage must be given in the Diario de Centro America (Guatemala's Official Record) and any large circulation daily newspaper for fifteen days.
The marriage must take place within six months of the publication of the notice.

DISASTER PREPAREDNESS:
Guatemala is a geologically active country.
Visitors should be aware of the possibility of earthquakes at any time and the need for contingency plans.
There are also four active volcanoes.
Volcanic activity, such as that of Fuego Volcano near Antigua in January 2003, and again in January 2006, has on occasion forced evacuations of nearby villages; the January-February 2000 activity of Pacaya Volcano near Guatemala City also briefly closed Guatemala City's international airport.
Both the Caribbean and Pacific coasts of Guatemala are also vulnerable to hurricanes and tropical storms from June through November.
Mudslides and flooding during the May to November rainy season often kill dozens of people and close roads.
In October 2005 Hurricane Stan caused widespread flooding and landslides on Guatemala's Pacific coast and in many parts of the Highlands.
Over 1000 Guatemalans died, and many highways across the affected regions were closed for days.
All highways have now reopened.
Temporary repairs are still in place; some have already been washed out and others will likely fail during the current rainy season.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.

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

CHILDREN'S ISSUES:
For information on international adoption of children and international parental child abduction, see the Office of Children's Issues website.

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Guatemala are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website and to obtain updated information on travel and security within Guatemala.
Americans withoutInternet 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 latest security information is available from the Embassy, including its website, http://guatemala.usembassy.gov
The Consular Section is open for citizen services, including registration, from 7:30 a.m. to 12:00 noon and 1:00 p.m. to 3:30 p.m. Monday through Thursdays and 7:30 a.m. to 11:30 a.m. Fridays, excluding U.S. and Guatemalan holidays.
The second and last Friday of each month are reserved for administrative matters; therefore, routine citizen services are not provided.
Emergency services are available at all times.
The U.S. Embassy is located in Guatemala City at Avenida La Reforma 7-01, Zone 10; telephone (502) 2-326-4000 during Embassy business hours (8:00 a.m. to 5:00 p.m.), or (502) 2-331-2354 for emergencies during non-business hours; fax (502) 2-332-4353; Internet web site - http://guatemala.usembassy.gov.
* * *
This replaces the Consular Information Sheet dated June 13, 2006 to update the Entry and Exit requirements section.

Travel News Headlines WORLD NEWS

Date: Sat, 9 Mar 2019 23:07:09 +0100

Guatemala City, March 9, 2019 (AFP) - The parents of a British tourist who has been missing in Guatemala for the past five days launched an emotional appeal for her return Saturday as authorities continued their investigation.   Catherine Shaw, 23, was last seen Monday at a hotel in San Juan La Laguna near the country's fabled Lake Atitlan, about 75 kilometres (45 miles) west of the capital Guatemala City.   The area is famous for its lakes beneath towering volcanoes. Lake Atitlan is one of Guatemala's main tourist attractions.

Her parents put up a video appeal on the Twitter account of the Lucie Blackman Trust, a British charity that provides support to the families who have relatives missing, murdered or in a crisis abroad.   "Hello Catherine, we've been out of touch for five days and we, your family and your friends, need to know you're happy and that you're well. So please get in touch, get in touch with us, and we really you home," said her mother, who did not provide her name on the video.   "We need you, please come home, sweetheart," added her father.

Shaw was described as being five feet seven inches tall (170 centimetres) and of slim build, with blonde hair, blue eyes and piercings in her nose, lip and ears.   She had been traveling in Guatemala for two weeks having previously been in Mexico and California, leaving home in England in September 2018, according to the charity.   Eduardo Smith, the British embassy spokesman, told Prensa Libre that embassy staff were working with Guatemalan police on the case.
Date: Tue, 20 Nov 2018 02:54:29 +0100

Guatemala City, Nov 20, 2018 (AFP) - Guatemalan authorities declared a red alert and evacuated around 4,000 people Monday after the Fuego volcano erupted for the fifth time this year, sending bursts of ash and lava down the mountain before its activity decreased and then stopped.   Memories are still painfully fresh of the volcano's eruption in June, which swept away villages and left nearly 200 people dead and 235 missing.   The Institute of Volcanology's director Pablo Oliva said the volcano's activity level had dropped significantly by late Monday.

A spokesman for Guatemala's disaster management agency CONRED had earlier said it decided to evacuate the municipality of Escuintla and two other districts. Some 4,000 people were taken to temporary shelters as a precaution.   The spokesman, David de Leon, said the eruption became increasingly violent after it began Sunday morning, leading to fears for the safety of the thousands of people who live on the slopes of the 3,763 meter-high (12,246 feet) mountain.

A column of ash rose about 1,000 meters above the crater and areas west of the volcano -- 35 kilometers (22 miles) from Guatemala City -- were under a barrage of gas ash and fiery rocks, CONRED said.   As the volcano's activity fell back to normal parameters, evacuees were asked for the sake of cautiousness to return home on Tuesday by bus.

A previous eruption on October 12-13 was characterized by increasingly loud booms and lava flow. On that occasion, 62 people were evacuated from their homes as a precaution and a highway around the mountain was closed.   Many of those evacuated on Monday said they had feared a repeat of the deadly June eruption.   "We were scared and that's why we evacuated," said Miriam Garcia, from the village of El Rodeo which was largely spared the deadly eruption.

Oscar Juarez from El Rodeo said: "You have to get out as soon as possible because when that (volcanic material) comes close, you no longer have time to leave, even if you run, because it comes very fast."   Activity inside Guatemala's two other volcanoes, Pacaya and Santiaguito, has increased in recent months but they have not entered the eruptive phase.
Date: Mon, 19 Nov 2018 11:28:44 +0100

Guatemala City, Nov 19, 2018 (AFP) - Guatemalan authorities on Monday declared a red alert after the Fuego volcano erupted again, forcing about 200 residents to flee.   A fiery glow rose from the crater of Fuego which is erupting for the fifth time this year, one month after the last one and following a June 3 rain of rocks, ash and toxic gases that left almost 200 people dead and 235 missing.   A spokesman for Guatemala's disaster management agency CONRED, David de Leon, said 214 residents who live on the slopes of Fuego, mostly in the southern municipality of Escuintla, were moved to safe zones and more will follow.

He said about 2,000 people in total have been asked to leave the area of the 3,763-meter (12,246-foot) volcano, 35 kilometres (22 miles) from Guatemala City.   Since the eruption began Sunday morning, lava rises 500 meters above Fuego's crater, while the ash column exceeds one kilometre above the volcanic cone and is causing a rain of particles, the Institute of Volcanology said.   The previous eruption lasted from October 12-13 with loud booms and lava flow. It caused the evacuation of 62 people and closed a highway.
Date: Fri, 12 Oct 2018 18:54:16 +0200

Guatemala City, Oct 12, 2018 (AFP) - Guatemala's deadly Fuego volcano erupted anew early Friday, unleashing a 600-meter flow of lava and sending clouds of ash spiralling into the sky.   Increased volcanic activity over the last 24 hours could release tons of fiery volcanic material and force evacuations of mountain villages, warned Guatemala's disaster management agency CONRED.

A powerful June 3 eruption of the Fuego volcano -- located 35 kilometres (22 miles) southwest of the capital -- rained rocks, ash and toxic gases on several villages and left 190 people dead and 235 missing.   CONRED had yet to issue evacuation orders for mountain communities early Friday, but spokesman David de Leon said: "Considering how the volcano is behaving some communities could make decisions to evacuate to safe areas."

Authorities shut down a nearby highway as a precaution and vulcanologists warned the civil aviation agency of an ash cloud to the west and southwest of the volcano.   Scientists monitoring the 3,763-meter (12,346-foot) volcano reported increased activity from late Thursday. However, activity intensified on Friday with loud booms and lava flows, the Institute of Vulcanology said.   Some 2,900 displaced victims of the earlier disaster remain in temporary shelters as government promises to build a 1,000 permanent homes on a state farm have been held up by irregularities.
Date: Tue 6 Feb 2018
Source: Cooperativa.cl [in Spanish, machine trans., edited]

The Ministry of Public Health and Social Welfare of Guatemala reported [Tue 6 Feb 2018], that the number of people intoxicated by an outbreak of salmonellosis detected in a bakery in the country's capital has risen to 115. A source from the portfolio confirmed that, although initially reported of 54 affected, the number has risen to 115 and added that no further details of this case can be given as it is under investigation.

Health Minister Carlos Soto had previously indicated that the 1st 54 people infected after eating at this establishment, located in zone one of the capital, had already received medical discharge. In addition to _Salmonella_, the authorities detected in the establishment the bacterium _E. coli_ and during the investigations they verified that the workers did not have sanitary cards.

The bakery had until last [Fri 2 Feb 2018], to present the proof of release in this case, but asked for an extension at which time theHealth portfolio will make the decision to close or sanction the establishment.
====================
[The source of the salmonellosis outbreak linked to the bakery is not clear.

A map of (Guatemala): <http://healthmap.org/promed/p/13>. - ProMED Mod.LL]
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Greece

Background
Greece offers a great variety of attractions for the international traveller. A beautiful climate linked with great beaches, a vibrant nightlife and historical monuments to rival any other location throughout the world. All of this located
within western Europe and a short flight away from many of the cooler northern destinations - like Ireland. Travellers from these regions descent on Greece in very significant numbers each year and for the vast majority of them they will have a splendid and healthy time. However for some this may not be the case and serious illness and accidents are regularly reported. Following some commonsense rules would go a long way to avoiding disaster and ensuring that this trip is truly one to be remembered for all the right reasons.
Climate
Situated in southern Europe the country enjoys mild winters but very hot summers. There may be occasional cool breezes (meltemia) but these can serve only to fool the traveller into thinking that they are unlikely to burn. Rain is very uncommon during the height of summer (July and August) and all travellers should be advised to use very adequate sun-block lotion at all times.
Slip, Slop, Slap
Following the Australian mantra of Slip, Slop and Slap makes perfect sense. Slip on a shirt, slop on sunscreen and slap on a hat when out and about during the day and this should help protect against the intense suns rays. Nevertheless, despite all their best intentions, travellers get burnt. This is particularly a problem in the first few days after their arrival when they do not realise the intensity of the suns rays and how easily they can be exposed. Falling asleep beside the hotel's swimming pool or on the beach is a very common problem and must be avoided against. The tips of the ears, shoulders (especially along the bra-strap line, ankles and behind the knees are commonly exposed and forgotten areas.
After Sun care
To treat significant sunburn it is important to increase fluid intake but also to take extra salt on your food (unless medically contraindicated for some specific condition like high blood pressure etc). Soothing water soluble lotions (especially ones containing a mild anaesthetic and/or steroid cream) are probably best but certainly avoid any of the ones which paste the skin with a thick layer - which is almost impossible to remove without causing serious pain! The more severe sunburn cases may need medical care and even hospitalisation which really ruins a holiday.
Food & Water
As a European destination Greece has a good level of food and water hygiene. Unfortunately this can vary - especially as you move away from the main tourist destinations and also as the summer temperatures rise and food goes 'off' more quickly. Eating hot food, avoiding cold foods (side-salads, lettuce etc) and never eating undercooked bivalve shellfish (mussels, oysters, clams etc) makes perfect sense. Eating food or taking fruit juice drinks from street vendors is a risk just not worth taking.
Insect bites
There may be both mosquitoes and sandflys about so having good repellents (DEET based ones) is worthwhile. The biggest problem will be early in the morning and towards the end of the daylight hours. However sitting in the shade while having lunch may be nice and cool but it is also often a place where these insects tend to hover looking for their next meal. Just don't allow that meal to be the blood in your unguarded ankle!
Seeing the Monuments
As mentioned previously Greece is covered with ancient monuments and these attract many thousands of tourists each year. The ruins are often not the most hospitable places for sun-sensitive tourists so taking care against the suns rays is essential - especially while standing carefully listening to the tour guide explain some complicated piece of history while the back of your legs get roasted! The other issue, for those trekking through the ruins, is the distinct possibility of a nasty twisted ankle.
Laser Night shows
Many of the ancient sites have beautiful night shows which depict something of the past splendour and are definitely worth seeing. However it is wise to wear good shoes as stumbling across loose stones is a particular problem at night and also bring a small torch, if possible, to guide your way. Getting separated from your travelling companions, or not being able to find your return bus, can lead to some understandable panic so listen carefully to any instructions and look out for some land marks before you get too far away into the night time crowd.
Animal bites
Some tourists may forget that rabies is a problem in many countries throughout the world and, even though Greece is regarded as rabies-free', there is always a problem if someone should get bitten. The possibility that this animal could have been recently smuggled into the country cannot be out ruled and so many would advise full post exposure treatment should this contact occur. Children may be at particular risk due to their inquisitive nature.
Swimming
Sunburn and swimming go hand in hand but drowning can also occur all too frequently within this region. Strong currents, swimming after meals (or alcohol) and the ever popular romantic midnight swim are all serious risk factors. Also children running around the deep end of the pool may lose their footing and topple in without warning. Unfortunately a very small child sinks instantly with very little sign of the emergency to those close by. Parents need to keep aware of this risk at all times.
The summer working holiday
Many of our students head towards Greece for 2 to 3 months during the summer to work. The attractions are obvious but commonsense and sensible life-style choices are needed throughout their stay to lessen the risk of illness or them returning home with an infection they had not bargained for. Unfortunately many return home with life-long illnesses which have been contracted from a single unprotected sexual contact.
Vaccinations for Greece
As a general rule the usual travel vaccines are not recommended for most short-term travellers to this region. However for the student planning to spend a more prolonged period it would be sensible to consider cover against both Hepatitis A and Hepatitis B and also to check that their Tetanus cover is up-to-date.
Summary
This is still one of the most popular destinations for northern European travellers and, in the vast majority of cases, they will have a fantastic time with only good memories. Unfortunately some less prepared folks will end up with serious sunburn and other illnesses or diseases which perhaps are frequently associated with their own lack of care and protection rather than anything specific to this beautiful country.

Travel News Headlines WORLD NEWS

Date: Wed, 2 Oct 2019 12:31:30 +0200 (METDST)

Athens, Oct 2, 2019 (AFP) - Greek workers staged a fresh 24-hour strike Wednesday against government plans to deregulate the labour market, paralysing road and rail transport, closing banks and shutting down news outlets.   Buses and trams stayed in their depots, the Athens metro was shut down and ferries serving islands on both sides of Greece stayed in port. The action also hit rail services, including to Athens airport.   Banks were closed Wednesday and Poesy, the journalists' union, said there would be no news bulletins over the 24-hour strike period.

The strike caused long traffic jams in Athens as the GSEE, the largest union representing private-sector workers, organised a rally in the city centre to protest the planned legislation.    It denounced "the suppression of collective conventions" and what it said was an assault on the unions.   This was the second strike in a week against the planned reforms of conservative Prime Minister Kyriakos Mitsotakis, which he argues will open the way to investment and encourage growth of more than two percent.   A strike last week hit transport, hospitals, schools and the courts.   The unions say the proposed reforms will undermine collective agreements and make it harder to organise strikes.

The proposed law would require a more-than 50 percent turn-out of the workforce in any strike vote for it to be valid.   Union leaders have also denounced a law passed in August which they say makes it easier to sack people in the private sector.   Adedy, the federation of public-sector unions, which organised last week's strike, called on its members to join Wednesday's action.   Mitsotakis came to power in July, replacing the left-wing government of Alexis Tsipras.
Date: Thu 12 Sep 2019, 7:54 PM
Source: Ekathimerini [edited]

The death toll from the West Nile virus since June this year has risen to 20, according to this week's report by the National Health Organization (EODY).

Up until [12 Sep 2019], authorities had diagnosed a total of 176 cases of the mosquito-borne virus. Of these, 109 developed illnesses affecting the central nervous system such as encephalitis or meningitis.

EODY is urging the public to spray insect repellent on bare skin and clothing, to install mosquito nets and screens, to remove stagnant water from basins, vases and gutters, to regularly mow lawns and to water plants in the morning.
=============================
[The first report mentions 20 fatal human cases as compared to the latest ECDC update that mentions 19 and the total case number is 176 versus 171 (ECDC report).

West Nile fever is a disease caused by West Nile Virus (WNV), which is a _Flavivirus_ related to the viruses that cause St. Louis encephalitis, Japanese encephalitis, and yellow fever. It causes disease in humans, horses, and several species of birds. Most infected individuals show few signs of illness, but some develop severe neurological illness which can be fatal. West Nile Virus has an extremely broad host range. It replicates in birds, reptiles, amphibians, mammals, mosquitoes and ticks <https://www.oie.int/doc/ged/D14013.PDF>.

The reservoir of the virus is in birds. Mosquitoes become infected when they bite an infected bird ingesting the virus in the blood. The mosquitoes act as carriers (vectors) spreading the virus from an infected bird to other birds and to other animals. Infection of other animals (e.g. horses, and also humans) is incidental to the cycle [as also evident in the ECDC update above] in birds since most mammals do not develop enough virus in the bloodstream to spread the disease.

Key to preventing the spread of West Nile fever is to control mosquito populations. Horses should be protected from exposure to mosquitoes. Likewise, people should avoid exposure to mosquitoes especially at dusk and dawn when they are most active, use insect screens and insect repellents, and limit places for mosquitoes to breed. - ProMED Mod.UBA]

[HealthMap/ProMED maps available at:
Date: Sun, 15 Sep 2019 15:38:29 +0200 (METDST)

Athens, Sept 15, 2019 (AFP) - More than 160 firefighters on Sunday battled to contain a large fire near Athens blazing for a second day amid gale force winds, officials said.   And in another emergency, authorities evacuated dozens of people from two villages and a hotel on the island of Zakynthos after a new fire broke out on Sunday.

The fire department said the blaze near Athens burned in the mountains above Loutraki, a coastal resort some 60 kilometres (35 miles) west of Athens.   "The fire is burning near the top of the mountain," Stefanos Kolokouris, the fire department's deputy chief of operations, told state TV ERT.   "We are trying to create a perimeter but the terrain is very difficult, with ravines," he said.   Four water bombers and six helicopters were participating in operations. Given a lack of roads in the area, two squads of firefighters had to be carried to the mountaintop by Super Puma helicopter, state agency ANA said.   Officials had already evacuated 50 people from a local monastery when the fire broke out on Saturday, but stressed that other inhabited areas were not in danger.

On Zakynthos, officials ordered the evacuation of the villages of Agalas and Keri in the south of the island. Some 120 tourists were also relocated to a safe area.   The Greek fire department on Sunday said it had been called to nearly 80 fires over the past 24 hours.   It has already faced more than 9,600 rural and urban fires this year.
Date: Tue, 13 Aug 2019 11:40:19 +0200 (METDST)

Athens, Aug 13, 2019 (AFP) - Dozens of firefighters Tuesday battled a major wildfire that forced the evacuation of a monastery on the Greek island of Evia as smoke from the blaze reached as far as Athens, authorities said.   Authorities also placed on alert two villages threatened by the blaze on the island, Greece's second largest after Crete and located northeast of Athens.   The fire started at about 3 am (0000 GMT) at the side of a road and was quickly spread by strong winds through the dry and dense vegetation in the centre of the island, the semi-official news agency ANA said.

The monastery of Panagia Makrymallis was evacuated as a precaution and residents of the villages of Kontodespoti and Stavros were told to be ready to leave also, TV SKAI said.   "Everything is ready in case it is necessary to evacuate the villages. The evacuation can be done in a few minutes. We are totally prepared," Fani Spanos, the governor of central Greece who was coordinating the operations, told SKAI.   He warned the fire was not yet under control and was spreading in an area that was inaccessible overland.

Around 80 firefighters were fighting the blaze backed by some 40 fire trucks and two water-bombing helicopters and a plane.   The strong winds blew the smoke from the blazing pine forest north toward the Magnesia region and south to the Attica peninsula and Athens.   ANA said the pine forests on Evia are part of the "Natura 2000" European network of protected areas and habitats.   Greece has been hit by a spate of wildfires since the weekend amid gale-force winds and temperatures of 40 degrees Celsius (104 F).

On Monday, a major forest fire threatening homes in Peania, an eastern suburb of Athens, was brought under control. At least two houses were burned but there were no reports of injuries.   On Sunday, a fire on the small island of Elafonissos, in the Peloponnese region, was brought under control after a two-day battle.   Two more fires were doused on Saturday in Marathon, close to Mati, the coastal resort where last year 102 people died in Greece's worst fire disaster.
Date: Sun, 11 Aug 2019 14:32:21 +0200 (METDST)

Athens, Aug 11, 2019 (AFP) - A French man was charged in Greece on Sunday over a boat accident that left two dead and another person seriously injured, state TV ERT reported.   The 44-year-old was charged with negligent manslaughter by a prosecutor and given 24 hours to prepare his defence, ERT said.  The man's lawyer Nikos Emmanouilidis had earlier told reporters that his client "will assist in every way any request by the Greek authorities."

The suspect has admitted to driving a 10-metre (32-foot) speedboat which struck a smaller wooden fishing boat on Friday evening near the Peloponnese resort of Porto Heli, 170 kilometres (105 miles) southwest of Athens.   The collision killed two elderly Greek men on board. A 60-year-old Greek woman, reportedly their sister, was seriously injured and taken to Athens for treatment.

The suspect could not be located for several hours after the incident before turning himself in on Saturday.   He has denied trying to evade arrest, and claims he was also injured in the incident and had sought first aid.   The suspect has said he did not see the fishing boat, which may have had insufficient lighting, state news agency ANA reported.   He has taken a blood alcohol test, with the results to be available on Monday.   "The first indications point to excessive speed by the powerboat driver," Merchant Marine Minister Yiannis Plakiotakis told ERT on Saturday.

Ten other French nationals who were also on the speedboat -- two men, three women and five children aged three to 14 -- were initially taken to Porto Heli for questioning after helping to bring the injured woman and one of the bodies to shore, the coastguard said.   They were all released on Saturday.   Speedboat accidents involving swimmers or other boats are common in Greece during the busy summer holiday season.

Another speedboat on Friday injured a 32-year-old swimmer at the Athens coastal suburb of Glyfada. The driver was arrested.   In 2016, four people including a four-year-old girl were killed when a speedboat sliced into their wooden tourist vessel near the island of Aegina.   Nobody was sanctioned as the prime suspect, an elderly Greek man, died a year after the accident.
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Angola

Angola - US Consular Information Sheet
June 20, 2008
COUNTRY DESCRIPTION:
Angola is a large, developing country in south-west central Africa.
The capital city is Luanda.
Portuguese, the official language, is widely spoken through
ut the country.
Despite its extensive oil and mineral reserves and arable land suitable for large-scale production of numerous crops, Angola has some of the world's lowest social development indicators.
Development was severely restricted by a 27-year long civil war that broke out upon independence in 1975, which destroyed the majority of the country's infrastructure.
Since the conflict's conclusion in 2002, the government has initiated extensive infrastructure reconstruction and development projects, and there are growing signs of economic recovery.
However, Angola still faces challenges with its infrastructure and with providing government services, especially in basic social services, aviation and travel safety, accommodation availability and quality and communications. Facilities for tourism, particularly outside the capital of Luanda, are often rudimentary. Read the Department of State Background Notes on Angola for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required and must be obtained in advance.
An International Certificate of Vaccination is required.
Visitors should allow several weeks for the processing of their visa application.
Angola does not issue airport visas.
Persons arriving without visas are subject to arrest or exclusion.
Travelers may also encounter delays if they do not have at least one completely blank visa page in their passports for entry stamps.
As of November 1, 2007, Angola no longer requires travelers to have an exit visa.
Travelers whose international immunization cards do not show inoculations against yellow fever within the past ten years may be subject to exclusion, on-the-spot vaccination, and/or heavy fines.
Visitors remaining in Angola beyond their authorized visa duration are subject to fines and arrest.
It is illegal to attempt to carry local currency out of Angola and persons found attempting to carry local currency out of Angola are subject to having this currency confiscated by customs officers.
Current information on entry requirements may be obtained from the Embassy of Angola at 2100-2108 16th Street NW, Washington, DC, tel. (202) 785-1156, fax (202) 785-1258. See our information on dual nationality, the prevention of international child abduction and customs regulations.
SAFETY AND SECURITY:
The overall security situation in Angola has improved markedly since the end of the civil war; however, Americans should still exercise caution when traveling in Angola.
Although the war has ended, ground travel throughout Angola can be problematic due to land mines, which were used extensively during the war.
Travelers should not touch anything that resembles a mine or unexploded ordinance.
Frequent checkpoints and poor infrastructure contribute to unsafe travel on roads outside of the city of Luanda.
Police and military officials are sometimes undisciplined, but their authority should not be challenged.
Travel in many parts of Luanda is relatively safe by day, but car doors should be locked, windows rolled up, and packages stored out of sight.
Visitors should avoid travel after dark, and no travel should be undertaken on roads outside of cities after nightfall.

Americans located in, or planning to visit, the northern province of Cabinda should be aware of threats to their safety outside of Cabinda city.
In 2007 and 2008 armed groups specifically targeted and attacked expatriates in Cabinda; these armed attacks resulted in the rape, robbery and murder of a small number of expatriates working in Cabinda.
Those responsible have declared their intention to continue attacks against expatriates.
Occasional attacks against police and Angolan Armed Forces (FAA) convoys and outposts also continue to be reported.
These incidents, while small in overall numbers, have occurred with little or no warning.
American citizens are, therefore, urged to exercise extreme caution when traveling outside of Cabinda city and limit travel to essential only.

Americans are advised to undertake only essential travel to Lunda North and South provinces.
As the government of Angola is sensitive to the travel of foreigners in the diamond producing areas of the provinces, proper permission and documentation is required to frequent these areas.
One can be subject to restriction or detention.
There have been reports of crime or banditry in these areas, especially on roads leading into these areas.

Visitors to Angola are advised not to take photographs of sites and installations of military or security interest, including government buildings, as this can result in fines and possibly arrest.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s web site, where the current Travel Warnings and Public Announcements, including the Worldwide Caution, can be found.
Up-to-date information on security can also be obtained by calling 1-888-407-4747 toll free in the U.S., 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 AM to 8:00 PM Eastern Standard Time, Monday through Friday (except on U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
Crime is a serious problem throughout Angola.
While most violent crime occurs between Angolans, foreigners have occasionally been attacked as well.
Street crime is a regular occurrence in Luanda.
The most common crimes are pick-pocketing, purse-snatching, vehicle theft, and vehicle break-ins.
Armed muggings, robberies, and carjacking involving foreigners are not frequent but do occur.
Americans are advised to avoid Roque Santeiro and Rocha Pinto, and to only travel the “Serpentine Road” in front of the U.S. Embassy by car.
In general, movement around Luanda is safer by day than by night.
Touring after dark should be avoided.
Police and military officials are sometimes undisciplined, but their authority should not be challenged.
Air travelers arriving in Luanda are strongly advised to arrange reliable and secure ground transportation in advance; there is no regular taxi service.
American citizens are advised to avoid the use of the public transportation known as “candongueiros” or “taxistas”; these multi-passenger vans are largely unregulated and often dangerous.

Motorists should stop at all police checkpoints if so directed.
Police officers may solicit bribes or request immediate payment of "fines" for alleged minor infractions.
American citizens asked for bribes by the police should politely ask the traffic police to write them a ticket if the police allege a moving violation.
If the police officer writes the ticket, then the motorist would pay the fine at the place indicated on the ticket.
If no moving violation is alleged and the officer is asking for a bribe, the motorist should, without actually challenging the officer's authority, politely ask the officer for his/her name and badge number.
Officers thus engaged will frequently let motorists go with no bribe paid if motorists follow this advice.
Motorists are reminded to have all proper documents in the vehicle at all times (i.e. vehicle registration, proof of insurance, and driver's license), as the lack of documentation is a violation and can also be a reason an officer would solicit a bribe.
Local law requires that every driver in Angola have the proper permission to drive.
Further information on driving in Angola can be obtained from the Embassy of Angola.
Police are not always responsive to reports of crime or requests for assistance.
Most police are on foot and are assigned to designated stationary posts.
The Rapid Intervention Police (PIR) unit is frequently seen patrolling various areas of the city.
This unit, which is well trained and organized, will respond to major criminal incidents.

There have been police operations against illegal aliens and private companies resulting in deportation of illegal resident foreign nationals and loss of personal and company property.
Independent entrepreneurs in Angola should carry relevant immigration and business documents at all times.

Travelers should be alert to fraud occasionally perpetrated by Luanda airport personnel.
Immigration and customs officials sometimes detain foreigners without cause, demanding gratuities before allowing them to enter or depart Angola.
Airport health officials sometimes demand that passengers arriving without proof of current yellow fever vaccination accept and pay for a vaccination at the airport.
Travelers are advised to carry their yellow fever vaccination card and ensure their yellow fever vaccine is up-to-date.
If travelers forget to bring their yellow fever vaccination card and do not wish to receive the vaccine offered at the airport, they should be prepared to depart the country on the next available flight.
Searches of travelers' checked baggage is common; travelers are advised to take precautions against this possibility.
Travelers should also be aware that criminals sometimes attempt to insert items into baggage at the airport, particularly for flights from Luanda to South Africa.
It is important that travelers maintain control of their carry-on baggage at all times, and if they believe something has been inserted into their baggage, they should report the incident immediately to airport authorities.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, to contact family members or friends, and explain how funds could be transferred.
Although the investigation and prosecution of crimes are solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

In addition to reporting crime to local police and the U.S. Embassy in Angola, victims of crime who are residing in Angola are also encouraged to report the crime to the security department of their employer.
Short-term visitors are encouraged to report the crime to the management of the hotel where they are staying if the crime occurred in or near the hotel.
The local equivalent to the “911” emergency line in Angola for police is 113; for fire fighters: 115, and for ambulance services: 112.
Please be advised that the emergency numbers listed may or may not have an English speaking operator available.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities and services are available in Angola, but are limited and often do not meet U.S. standards.
Adequate care for medical emergencies is limited to Luanda, where there are some good private clinics that usually have a 24-hour service provided by a general practice physician and with specialists on call.
A list of such facilities can be found at http://angola.usembassy.gov/medical_information.html.
Routine operations such as appendectomies can be performed.
Local pharmacies provide a limited supply of prescriptions and over-the-counter medicines/drugs.
Travelers are, therefore, urged to carry with them an adequate supply of properly-labeled medications they routinely require for the duration of their projected stay in Angola.
Malaria is endemic in most areas of Angola.

An outbreak of Marburg hemorrhagic fever, a severe and often fatal disease, occurred in Uige province in the spring of 2005; however, on November 7, 2005, the Ministry of Health of the Republic of Angola and the World Health Organization (WHO) declared that the Marburg outbreak in Angola had ended.
This announcement came after 45 consecutive days without a new case of the illness.

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

MEDICAL INSURANCE:
The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States.
The information below concerning Angola is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Since the end of the civil war in 2002, overland access to the interior has increased.
However, fighting in most of the country damaged or destroyed many roads and bridges, and services for motorists outside urban areas cannot be counted on.

Road travel can be dangerous, especially during the rainy season (October - March), which can cause large potholes and erosion and due to the presence of landmines.
Road conditions vary widely outside the capital from acceptable paved surfaces to virtually impassable dirt roads, particularly secondary routes.
Many secondary roads, including secondary roads in urban areas, are impassable during the rainy season.
Overloaded, poorly marked, and disabled vehicles, as well as pedestrians and livestock, pose hazards for motorists.
Ground travel in rural areas should be undertaken during daylight hours only.
Landmines also pose a continuing hazard to travelers.
Many areas were heavily mined during the war, including roads, bridges, and railroad tracks.
Areas with suspected landmines are generally clearly marked and travelers should heed these warnings.
Primary roads are considered to be landmine free in most provinces, but travelers should not venture far from the margins of the road.
Extensive government, commercial, and NGO demining projects continue throughout the country.

Traffic in Luanda is heavy and often chaotic, and roads are often in poor condition.
Few intersections have traffic lights or police to direct vehicles.
Drivers often fail to obey traffic signals and signs, and there are frequent vehicle breakdowns.
Itinerant vendors, scooters and pedestrians often weave in and out of traffic, posing a danger to themselves and to drivers.
Most public transportation, including buses and van taxis, should be avoided as the vehicles are generally crowded and may be unreliable.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Angola, the U.S. Federal Aviation Administration (FAA) has not assessed Angola’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 www.faa.gov/safety/programs_initiatives/oversight/iasa/. The U.S. Embassy in Luanda prohibits its employees from using TAAG, Angola’s national airline, for domestic or international flights due to concerns regarding safety and maintenance.
SPECIAL CIRCUMSTANCES:
Customs Regulations:
Angolan customs authorities may enforce strict regulations concerning temporary importation into or export from Angola of sensitive items including firearms, antiquities, and currency.
It is advisable to contact the Embassy of Angola in Washington, DC or one of Angola's consulates in the United States for specific information regarding customs requirements.

Financial Transactions:
Angola is generally a cash-only economy; neither traveler’s checks nor credit cards are used outside the capital of Luanda.
In Luanda, credit cards are accepted in extremely limited circumstances, namely large hotels.
Although, in April 2007 a major campaign was launched to expand credit card acceptance this effort has yet to expand beyond the capital city.
In general, Automated Teller Machine’s (ATM’s) are only accessible to those individuals who hold accounts with local banks.
Dollars are generally accepted in all provincial capitals; travelers should carry a sufficient supply of U.S. dollars with them.
Only the newer series U.S. dollar bills (with large faces) are accepted.
U.S. dollars can be converted to local currency at exchange businesses authorized by the Angolan government.
Angolan currency (the Kwanza) may not be taken out of the country and travelers, who attempt to carry currency out of Angola, are subject to having the currency confiscated.

Personal Identification: U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available.
The Consular Section of the U.S. Embassy in Luanda can prepare copies of American passports at no charge for individuals who register with the Embassy.
To avoid the risk of theft of or confiscation of original documentation, the U.S. Embassy recommends that Americans keep their passport in a secure place and carry a copy to avoid the possibility of authorities confiscating identity and travel documents.

Labor Disputes: American performers traveling to Angola to perform in concerts and/or other events should be aware that there have been several serious allegations made against talent agencies making arrangements for foreign performers.
These allegations include, among other things, several charges of breach of contract and the forcible retention of passports and persons.
Performers should assure themselves of the reputation of any agency they may contract with before traveling.
Many find it useful to contact performers who have previously worked in Angola and are familiar with agencies in Angola.
Persons experiencing any incidents of this nature in Angola should report these to the local Angolan police and the U.S. Embassy.

Long Delays in Renewal of Visas: U.S. citizens who opt to renew their work or other visa while in Angola should expect delays of 2-10 weeks or more, during which time the Angolan immigration authorities will retain one's passport and one will not be able to travel.
U.S. citizens are advised to plan accordingly, and if travel during this time cannot be avoided, one should apply for a second U.S. passport PRIOR to turning over the primary passport to Angolan authorities for visa renewal.
To apply for a second U.S. passport, you must write a letter explaining the need for the second passport, as well as meet all the requirements for a normal application for passport renewal, including being able to show a current valid passport.
Receiving a second passport will take 7-10 business days.
Expatriates who stay beyond their visa expiration date are subject to steep fines.

Hotel Availability:
Hotels are limited in Angola, and demand for the limited number of rooms is high.
Hotels are often booked months in advance, especially in the capital city of Luanda.
Only a few large hotels in Luanda accept credit cards; hotels in the provinces generally do not accept credit cards.
Adequate hotels are found in most provincial capitals, but some provide limited amenities.
Please see our information on Customs Regulations.

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

Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Angola are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, and to obtain updated information on travel and security within Angola.
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 Consular Section is located at the American Embassy Complex, Rua Houari Boumedienne #32, in the Miramar area of Luanda, P.O. Box 6468, tel. (244) 222-641-000,
(244) 222-447-028, (244) 222-445-481, (244) 222-446-224; 24-hour duty officer (244) 923-404-209; fax (244) 222-641-259.
The Consular Section may be contacted by e-mail at consularluanda@state.gov.
Further information on travel to Angola is also available at the Embassy web site at http://angola.usembassy.gov/.
*

*

*
This replaces the Consular Information Sheet dated April 29, 2008, to update the Country Description, Entry/Exit Requirements, Safety and Security, Crime, Traffic Safety and Road Conditions, Aviation Safety Oversight, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Thu 9 May 2019 19:02 WAT
Source: Diario de Noticias [in Portuguese, machine trans., abridged, edited]

The measles outbreak in the Angolan province of Lunda Sul has caused 47 deaths since the start of the year [2019], among almost 1300 registered cases, Angola's national director of Public Health told Lusa today [9 May 2019].

Isilda Neves [Director, Program in Technical Assistance to the MOH] told Lusa that a vaccination campaign to identify children who are not yet immunized against the disease, will start at the weekend [11 May 2019], lasting for 10 days.

Along with this campaign, the vaccination intensification in the districts of Saurimo, capital of Lunda Sul, and in the other municipalities of the province, has been underway since the 2nd week of April [2019].

"At the end of the week we are going to make a big intervention: We are training the teams to go all out. We have at least 100 teams, each with 4 elements -- 2 coaches, one support team for the mobilization, and another to register the vaccinated children," she said.

The campaign, according to the national public health official, takes place first in Saurimo, followed by the remaining 3 municipalities in the province.

"Since the beginning of the year [2019], there were 1297 cases and 47 deaths, mostly in Saurimo," added Isilda Neves.

Health authorities are trying to control the situation, in which more than 90% of cases are being registered in children who have not been vaccinated, she said.

"One of the problems we identified is that many children who have passed the age of measles vaccination have not been vaccinated. Since there are a large number of children in the same household, we are also finding cases in children under 9 months and this is our concern too," she said.
======================
[HealthMap/ProMED-mail map of Lunda Sul province, Angola:
26th December 2018

Angola (Cunene province). 29 Nov 2018. (reported) 25 cases of microcephaly. Samples sent to the central laboratory in Luanda to determine if they are Zika virus related. There were no cases of microcephaly during the same period in 2017.

[HealthMap/ProMED-mail map Angola:
Date: Sat 11 Aug 2018
Source: World Health Organization [edited]
<http://www.who.int/neglected_diseases/news/Surveillance-presence-of-dracunculiasis-in-Angola/en/>

Disease surveillance confirms the presence of dracunculiasis in Angola. The World Health Organization (WHO) has received confirmation of a human case (29 Jun 2018) of dracunculiasis (guinea worm disease) in Angola -- a country not known to have had any cases in the past. "The patient is an 8 year old girl from Cunene Province.

Signs of worm emergence in April this year [2018] were characteristic of guinea worm disease and the worm appeared identical to _Dracunculus medinensis_," said Dr Maria Cecília de Almeida of the Angolan Guinea Worm Eradication Programme and who is also director of Control Programmes for Neglected Tropical Diseases, Ministry of Health. "The case-management protocol was observed, including the preservation of the worm specimen, and we are investigating further to determine the extent of transmission and burden of the disease." The case was detected through a nationwide guinea worm case search during the national immunization campaign against measles and rubella.

The specimen was sent to the WHO Collaborating Center for Dracunculiasis Eradication at the US Centers for Disease Control and Prevention, where a polymerase chain reaction (PCR) [1] test confirmed the worm as _Dracunculus medinensis_ [2]. "This is the first confirmed case of human infection in Angola. The discovery is part of measures taken by the Ministry of Health, following a WHO evaluation mission to Angola in 2016 to assess the country's level of readiness to finalize its dossier requesting a WHO certification," said Dr Dieudonné Sankara, team leader of WHO's guinea worm eradication programme.

After the evaluation mission of 2016, the International Commission for the Certification of Dracunculiasis Eradication recommended that Angola should use all available opportunities to gather robust evidence of absence of guinea worm disease in the country before submitting its certification request. WHO is supporting Angola through all 3 of its operating levels -- Country Office, Regional Office and Headquarters -- to implement its roadmap for certification of dracunculiasis-free status. "With the discovery of this new case, measures are being put up to strengthen surveillance, reporting and investigation of all suspicious cases through the country's Integrated Disease Surveillance and Response," said Dr Nzuzi Katondi, field officer, WHO Country Office, Angola. "Intelligence and alerts are being reported and rumours are being followed up and investigated."

Efforts are also being made through the country's broader mapping exercise of other neglected tropical diseases. To achieve global certification of dracunculiasis eradication, WHO must formally certify every individual country even if no transmission has ever taken place in that particular country. Confirmation of the 1st case in Angola comes as the global guinea worm eradication programme is tackling _Dracunculus medinensis_ infection in both humans and dogs, mainly in Chad. From 1 Jan to 31 May 2018, Chad reported 3 human cases and 534 infected dogs. Ethiopia and Mali, 2 other countries with recent cases, reported zero human cases.

South Sudan, which reported its last human case in November 2016, declared interruption of dracunculiasis transmission in March 2018. The latest confirmation from Angola brings the global total, so far this year [2018], to 4 human cases. Dracunculiasis is a crippling parasitic disease caused by a long threadlike worm. The infection is transmitted mostly when people drink water contaminated with parasite-infected water fleas. When the eradication campaign began in 1986, there were an estimated 3.5 million cases.  PCR is a technique used in medical and biological research laboratories. It is used in the early stages of processing DNA for sequencing, for detecting the presence or absence of a gene to help identify pathogens during infection, and when generating forensic DNA profiles from tiny samples of DNA.  _Dracunculus medinensis_, a nematode (worm), is the causative agent of guinea worm disease.
============================
[According to the latest guinea worm update from WHO (Weekly Epidemiology Report 2018;32:409-16. 10 Aug 2018; <http://apps.who.int/iris/bitstream/handle/10665/273782/WER9332.pdf>) the reported numbers for other countries in 2018 are Chad, 5544; Ethiopia, 5044; Mali, 91; Sudan, 0. South Sudan did not file a report. Even though this is just a single case, the finding indicates that there is a focus. - ProMED Mod.EP]

[Cunene province is in the south of Angola bordering Namibia (<https://en.wikipedia.org/wiki/Cunene_Province>).

HealthMap/ProMED map available at: Angola: <http://healthmap.org/promed/p/165>.]
Date: Tue 8 May 2018
Source: AllAfrica.com [edited]

A total of 21 positive cases of sleeping sickness were diagnosed in the last 2 weeks in the municipality of Banga, Kwanza Norte province, during the prospecting campaign held by the Provincial Department of the Institute of Combat and Control of Trypanosomiasis (Icct).

Angelino Francisco Correia, the supervisor of the campaign, said that 2800 had been examined, and 21 cases were diagnosed, of which 5 were confirmed as sleeping sickness patients.

The official called the active participation of the population in the campaigns of prospection of the disease.
=====================
[A review of human trypanosomiasis (sleeping sickness) in Africa (Fevre EM, Wissmann Bv, Welburn SC, Lutumba P (2008) The Burden of Human African Trypanosomiasis. PLoS Negl Trop Dis 2(12): e333. <https://doi.org/10.1371/journal.pntd.0000333>) found that Angola is a highly endemic country with more than a 1000 cases annually. For background information on human trypanosomiasis in Africa see the ProMED posting "Trypanosomiasis - Angola http://promedmail.org/post/20110709.2081".

A map of Kwanza Norte Province, Angola:
Monday 16th April 2018

- Ndalatando. 11 Apr 2018. At least 78 suspected cases recorded in the period 4-9 Apr 2018 in northern Cuanza Norte Province.
More ...

Albania

Albania US Consular Information Sheet November 04, 2008

 COUNTRY DESCRIPTION

Albania is a parliamentary democracy that is transforming its economy into a market-oriented system. Albania's per capita income is among the lowest in Eu

ope, but economic conditions in the country are steadily improving. Tourist facilities are not highly developed in much of the country, and though Albania's economic integration into European Union markets is slowly underway, many of the goods and services taken for granted in other European countries are not yet available. Hotel accommodations are limited outside of major cities. Read the Department of State Background Notes on Albania for additional information.

ENTRY/EXIT REQUIREMENTS

 A passport is required. All travelers entering or exiting Albania must have six months or more validity on their passport. Customs officers strictly enforce this law. U.S. citizens do not require a visa prior to entering Albania, but those traveling without a visa will be charged a fee for an entry stamp at the point of entry, which is valid for a stay of up to 90 days. This fee is currently 10 Euros, or the equivalent in any easily convertible currency, including U.S. dollars. Travelers without a visa who intend to stay in Albania for more than 90 days should be aware that Albanian law allows a traveler without a visa to remain in Albania for 90 days only within a specific 180-day period. That 180-day period is defined from the first day of entry. For example, a traveler entering without a visa on January 1 may remain in Albania for 90 days total during the period of time between January 1 and June 28. Departing Albania during this time period does not "restart the clock." Travelers attempting to reenter Albania without a visa and within 180 days of a previous entry and after an aggregate stay of 90 days may be denied entry. For stays exceeding 90 days within a 180-day period, those interested must apply for a Residency Permit at the police station with jurisdiction over the city of residence. Information on how to apply for a residency permit is available on the Embassy of Albania web site at http://www.embassyofalbania.org/. There is also a departure fee of ten Euros, or the equivalent in any easily convertible currency, including U.S. dollars. Visit the Embassy of Albania web site at http://www.embassyofalbania.org/consular.html#visa for the most current visa information. Dual Nationality: The Albanian government considers any person in Albania of Albanian parents to be an Albanian citizen. In addition to being subject to all Albanian laws affecting U.S. citizens, dual nationals may be subject to Albanian laws that impose special obligations. Male Albanian citizens are subject to compulsory military service regulations. If such persons are found guilty of draft evasion in Albania, they are subject to prosecution by the Albanian court. Those who might be affected should inquire at an Albanian Embassy or Consulate outside Albania regarding their status before traveling. In some instances, dual nationality may hamper U.S. Government efforts to provide protection abroad. Information about dual nationality or the prevention of international child abduction can be found on our web site. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY

Although the overall security situation in Albania has improved in recent years, organized criminal activity continues to operate in all regions, and corruption is pervasive. US Government employees need permission to travel to the northern administrative districts of Shkoder, Malesi E Madhe and Tropoje (with the exception of the route along the national road to Montenegro and the city of Shkoder) and to the southern town of Lazarat, with such travel restricted to secure vehicles with escort. Travel restrictions for U.S. Government employees have been lifted for overnight stays in the city of Shkoder. In most cases, police assistance and protection is limited. A high level of security awareness should be maintained at all times. Photographing anything that authorities regard as being of military or security interest may cause travelers problems. All gatherings of large crowds should be avoided, particularly those involving political causes or striking workers. 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 U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.

CRIME

In the latest State Department assessment, Albania’s crime rating is “medium.” Crime against foreigners is rare in Albania, as targeting foreigners is often viewed as too risky. Visitors should maintain the same personal security awareness that they would in any metropolitan U.S. city. Caution should be exercised in bars in Tirana where violent incidents, some involving the use of firearms, have occurred in the past, particularly in the early morning hours. Within the last years there have been fewer cases of carjacking compared with previous years. Anyone who is carjacked should surrender the vehicle without resistance. Armed crime continues to be more common in northern and northwestern Albania than in the rest of the country. Street crime is fairly common in Albania, particularly at night. Criminals do not seem to deliberately target U.S. citizens or other foreigners, but do seek targets of opportunity, and select those who appear to have anything of value. Vehicle theft is still one of the biggest problems in Albania. Pick-pocketing is widespread; U.S. citizens have reported the theft of their passports by pick-pockets. 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 equivalent to the “911” emergency line is 129, though coverage is inconsistent at best. See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION

Medical facilities and capabilities in Albania are limited beyond rudimentary first aid treatment. Emergency and major medical care requiring surgery and hospital care is inadequate due to lack of specialists, diagnostic aids, medical supplies, and prescription drugs. Travelers with previously diagnosed medical conditions may wish to consult their physicians before travel. As prescription drugs may be unavailable locally, travelers may also wish to bring extra supplies of required medications. Recent electricity shortages have resulted in sporadic blackouts throughout the country, which can affect food storage capabilities of restaurants and shops. While some restaurants and food stores have generators to properly store food, travelers should take care that food is cooked thoroughly to reduce the risk of food-borne illness. Water in Albania is not potable. Visitors should plan to purchase bottled water or drinks while in country. The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Albania. Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx. For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en. Further health information for travelers is available at http://www.who.int/ith/en

MEDICAL INSURANCE

The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS

While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Albania is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Major roads in Albania are often in very poor condition. Traveling by road throughout Albania is the most dangerous activity for locals and tourists. Vehicle accidents are the major cause of death, according to police statistics. Electricity shortages have resulted in sporadic blackouts throughout the country that can happen any hour of the day or night. Such outages affect traffic signals and street lights, making driving increasingly treacherous at any time of day. Travel at night outside the main urban areas is dangerous and should be avoided due to deplorable road conditions. During the winter months, travelers may encounter dangerous snow and icy conditions on the roads throughout mountainous regions in northern Albania. Buses travel between most major cities almost exclusively during the day, but they are often unreliable and uncomfortable. Many travelers looking for public transport prefer to use privately owned vans, which function as an alternate system of bus routes and operate almost entirely without schedules or set fares. Please note that many of these privately owned vans may not have official permission to operate a bus service and may not adhere to accepted safety and maintenance standards. Persons wishing to use privately owned vans should exercise caution. There are no commercial domestic flights and few rail connections. Please refer to our Road Safety page for more information. Visit the website of the country’s national tourist office at www.albaniantourism.com.

AVIATION SAFETY OVERSIGHT

As there is no direct commercial air service to the United States by carriers registered in Albania, the U.S. Federal Aviation Administration (FAA) has not assessed Albania's Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For further information, travelers may visit the FAA's web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa SPECIAL CIRCUMSTANCES: Albania's customs authorities may enforce strict regulations concerning temporary importation into or export from Albania of some items. It is advisable to contact the Embassy of Albania in Washington, D.C. or one of Albania's Consulates in the United States for specific information regarding customs requirements. As noted previously, the Albanian government considers any person in Albania of Albanian parents to be an Albanian citizen. In addition to being subject to all Albanian laws affecting U.S. citizens, dual nationals may be subject to Albanian laws that impose special obligations. Male Albanian citizens are subject to compulsory military service regulations. See our information pertaining to dual nationality. Albania is a cash economy. Credit cards and travelers checks are not generally accepted, except at the major new hotels in Tirana and some international airline offices. Travelers' checks can be changed at banks in larger towns. Automated Teller Machines (ATMs) are available in most cities. 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 Albania’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Albania 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. Under Albanian law, police can detain any individual for up to 10 hours without filing formal charges. U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times to show proof of identity and U.S. citizenship if questioned by local officials.

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 Albania are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within Albania. 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 Rruga Elbasanit 103, tel. (355)(4) 2247285; fax (355)(4) 2232222. The U.S. Embassy web site is http://tirana.usembassy.gov/ * * * This replaces the Consular Information Sheet dated June 10, 2008, to update sections on Entry and Exit Requirements, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Sat, 21 Sep 2019 20:39:17 +0200 (METDST)

Tirana, Sept 21, 2019 (AFP) - Albania was rattled by its strongest earthquake in decades Saturday, officials said, sending people fleeing into the streets in several cities, damaging buildings and triggering power cuts in the capital.   The epicentre of the shallow 5.6-magnitude quake, was near Durres, less than 40 kilometres (25 miles) west of the capital Tirana, according to the US Geological Survey.

Albania's defence ministry said it was the "strongest earthquake in the country in the last 20 to 30 years".   "There are no deaths," defence ministry spokeswoman Albana Qajaj said.   Some 80 people sought medical help in both Tirana and Durres, 21 of whom were hospitalised due to injuries caused by falling objects or parts of walls as well as for panic attacks, Health Minister Ogerta Manasterilu said.   Qajaj told AFP that houses and buildings in Tirana had been damaged but were still standing and that the ministry was accessing damage in other towns and villages.   Prime Minister Edi Rama cancelled his scheduled trip to the United States following the quake, which cut electricity and telephone lines in Tirana and a number of other towns and villages.

Many people remained outside their homes for several hours in the capital, fearful of aftershocks.   "I fear to return because such a strong earthquake could be followed with others," Drita Lohja, a resident in her fifties, told AFP.    Falling debris pulverised parked cars in parts of the city.   AFP reporters and witnesses saw windows broken and deep fissures in the facades of buildings in Durres, as well as in the capital.   Media reported that a large building in Tirana was seriously damaged and that residents were being evacuated.   A University of Tirana building was also damaged, witnesses said.

According to local media reports, at least two people were lightly injured and a dozen houses collapsed in the village of Helmes, 10 kilometres from Tirana.   Two other earthquakes followed the strong one that occurred at around 4:00 pm (1400 GMT) and was felt in neighbouring Montenegro and Italy, but also on the Greek island of Corfu according to some Twitter users.
Date: Fri, 9 Mar 2018 16:28:50 +0100

Tirana, March 9, 2018 (AFP) - The military has been deployed in northern Albania to help hundreds of people trapped by floods following heavy rainfall, authorities said on Friday.   More than 9,230 hectares (22,800 acres) of agricultural land is underwater in the Shkodra region, including villages where the only means of transport is by boat, the defence ministry said.

Army personnel are evacuating residents and securing food supplies in the affected areas, 100 kilometres (60 miles) north of the capital, Tirana.   The torrential rain in recent days has caused landslides damaging dozens of homes and flooding roads, said the transport ministry.   The rain has also forced the Albanian authorities to release excess water from a hydroelectric plant, which has added to the flooding in northern areas of the country.   Weather forecasters say the rain is likely to ease from Saturday.
Date: Sun, 3 Dec 2017 12:29:40 +0100

Tirana, Dec 3, 2017 (AFP) - Thousands of police and soldiers have been deployed in Albania to rescue stranded residents after heavy rainfall triggered major flooding, and caused the death of a utility worker, officials and the power company said Sunday.   The victim, Sabri Vlinga, died while he was working on a electricity pole at Roskovec in the flooded south of the country, the power company said in statement.   Two other people were injured in similar accidents. it added.   Some 6,400 police and soldiers have been sent to help rescue people stranded by the floods, Prime MInister Edi Rama said Saturday, calling the situation "very critical".

Around 1,500 people in the affected areas have been rescued, while several thousand homes were without electricity as many utility poles have been swept away by mudslides, said Shemsi Prenci, head of civil protection.   More than 7,874 hectares (19,450 acres) of farm land as well as 3,193 homes are under water and several roads in the south remained impassable.

Army forces have built a temporary bridge at Darezeze, about 70 kilometres (44 miles) from the capital Tirana, to come to the aid of 2,000 residents stranded by the floods, the defence ministry said.    In neighbouring Macedonia, the heavy rains have also caused flooding as several rivers include the main Vardar river have burst their banks, the MIA news agency reported.
Date: Sat 5 Aug 2017
From: Edmond Puca <edmond_puca@yahoo.com> [edited]

Here in Albania, we have 2 imported cases of haemorrhagic fever with renal syndrome (HFRS), one imported from the north of Greece and another from Macedonia in a village near the border with Albania.

The patient from Macedonia is 25 years old. He presented in the emergency room on 31 Jul [2017]. Right now, he is in good condition and will survive. He presented with fever, nausea and vomiting, abdominal pain, and lower back pain.

The other patient from Greece had been in our service for the previous 2 weeks and now is at home in good condition.

The disease is caused by Dobrava-Belgrade virus infection.
---------------------------------
Dr Edmond Puca
Infectologue
Department of Infectious Disease
UHC "Mother Teresa"
Tirana, Albania
===================
[ProMED-mail thanks Dr Edmond Puca for sending in this report.  This and the previous report are the 1st reports of hantavirus infections in Macedonia that ProMED-mail has posted. There is also evidence of HFRS in Greece, although ProMED-mail has not posted reports previously. Sero-epidemiological investigations conducted in several Balkan countries revealed an overall seroprevalence of 4 per cent in Greece (<http://www.sciencedirect.com/science/article/pii/S0168170213004887#>). There doubtless have been Dobrava-Belgrade virus infections in Greece and the Balkans over the years, given that this virus is known to circulate widely in the Balkans.

The yellow-necked field mouse (_Apodemus flavicollis_) is the principle vertebrate host for Dobrava-Belgrade virus. - ProMED Mod.TY]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Mon, 6 Feb 2017 04:30:32 +0100
By Briseida MEMA

Tirana, Feb 6, 2017 (AFP) - Emira Sela covers her face with her hand to hide a disfiguring abscess, the traumatic result of unregulated cosmetic treatments now rampant across Albania.   The 31-year-old began to worry when wrinkles appeared on her face. Sela's hairdresser told her that a simple injection, costing around 60 euros ($65), would banish the signs of ageing.   "She assured me that I would not risk anything. She even listed well-known names" of women who had undergone such treatment, said Sela.   "I did not think twice, I trusted her without asking questions," said the blonde woman with green eyes, her voice trembling.

Albanian hair and beauty salons lacking expertise and medical supervision are offering such cosmetic treatments, unregulated in a legal vacuum, much to the alarm of qualified doctors.   A single injection of a product whose content and dosage Sela knew nothing about was enough to ruin her life in late August.    Despite antibiotics she has permanent pain, fever and nausea, while the abscess on her right cheek forces her eye to half-close and her face is nearly paralysed.   "I am so disfigured that I tried to commit suicide," said Sela, who lost her job in a bank. Her only hope now is corrective surgery at an Italian hospital, scheduled for this month.

- Desiring Kardashian look -
"There are more and more impostors with syringes," said Panajot Papa, a plastic surgeon at a private clinic in Tirana.   "The problem is also the products... Forbidden in Europe, they enter illegally from Turkey or China."    Eriona Shehu, a dermatologist at Tirana's university hospital, said these unregulated synthetic products, such as injected liquid silicone and acrylamide, were being offered at temptingly low prices.

"Cosmetic interventions have become a lucrative industry. The patient is only a customer, exposed to a number of risks."   Shehu said the desire to look like voluptuous US reality television star Kim Kardashian was "destroying the lives of young Albanian girls looking for beauty".   Albanian doctors say the typical age of clients for such procedures is between 16 and 28.    In the country of about three million people, the demand for cosmetic interventions rose more than 50 percent in 2015, according to a study published by Albania's economic magazine Monitor.

Promotional offers can be seen everywhere, such as a beauty salon advertising 20 percent reductions for three people coming together for treatment during the holiday season.   Papa says he has treated a dozen young women aged between 20 and 27 who suffered complications after having their lips and cheekbones swollen with injected liquid silicone for 40 to 50 euros.    The product has been banned for cosmetic use in countries such as Italy and France for more than 15 years.   Papa said such botched interventions left these women prone to particularly bad swellings during their menstrual period, requiring further treatment -- and he warned they may suffer such symptoms for life.

- Closing legal gap -
Albanian doctors are worried about foreign practitioners who come from Italy, Turkey and Greece to work just for a weekend.   "They may not have a diploma, qualification or licence for these kind of interventions or for assuming the responsibility of a patient's medical follow-up," said Besim Boci, head of the otolaryngology department at Tirana's university hospital.   Due to legal loopholes, the judiciary cannot step in.    A spokesman at Tirana's tribunal, Alba Nikolla, admits that it is currently impossible to "open investigations and prosecute based only on complaints" against practitioners.

But authorities are set to tackle this with a draft law to control cosmetic products and beauty salons, which is due to be introduced in parliament in the next few months.   The law complies with the requirements of the European Union, which Albania aspires to join, and will enable authorities to shut down rogue establishments using synthetic products.    When health is adversely affected, practitioners could be imprisoned for three to 10 years.    Such regulations could go some way to easing the trauma of women like Elisa Lura, a 22-year-old economics student.   She underwent a laser treatment to restore her natural look after paying 50 euros to a neighbourhood salon for permanent eyebrow tattoos, which went wrong. But the laser made things much worse.   "Everything is spoiled!" she said of her face now covered with painful scars.
More ...

Congo, Democratic Republic

Democratic Republic of the Congo US Consular Information Sheet
23rd September 2008
COUNTRY DESCRIPTION: The Democratic Republic of the Congo (Congo-Kinshasa) located in central Africa, is the third largest country on the continent. The capital
s Kinshasa. French is the official language. Years of civil war and corruption have badly damaged the country's infrastructure. Read the Department of State Background Notes on the Democratic Republic of the Congo (DRC) for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport, visa and evidence of yellow fever vaccination are required for entry. Some travelers arriving in the DRC without proper proof of yellow fever vaccination have been temporarily detained, had their passports confiscated, or been required to pay a fine. Information about yellow fever vaccination clinics in the U.S. may be found at http://www2.ncid.cdc.gov/travel/yellowfever/.
Visas must be obtained from an embassy of the DRC prior to arrival.
Travelers to the DRC frequently experience difficulties at the airport and other ports of entry, such as temporary detention, passport confiscation and demands by immigration and security personnel for unofficial “special fees.”
All resident foreigners, including Americans, are required to register at the office of the Direction General de Migration (DGM) in the commune of their place of residence.
Visitors who wish to travel in any mining areas must first obtain government approval from various government agencies or ministries, an often cumbersome and time consuming process.
Dual nationals arriving in the DRC should carefully consider which passport they use to enter the DRC. For departure from the DRC, airlines will require a valid visa for all destination countries before they will issue a ticket or allow a passenger to board. Airlines also require that the passenger have the correct entry stamp in the passport they wish to use to exit the country. Passengers who are unable to leave the country on the passport they used to enter the DRC may not be able to continue on their travel itinerary.
Additional information about visas may be obtained from the Embassy of the Democratic Republic of the Congo, 1726 M Street NW, Washington, DC 20036, tel. (202) 234-7690, or the DRC's Permanent Mission to the UN, 866 United Nations Plaza, Room 511, New York, NY 10017, tel. 212-319-8061, fax: 212-319-8232, web site http://www.un.int/drcongo. Overseas, inquiries should be made at the nearest Congolese 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:
See the Department of State’s Travel Warning for the Democratic Republic of the Congo.

Though the DRC is now significantly more stable than it has been over the past decade, security remains problematic. The first democratic elections in more than forty years were held in 2006, and a new government is now in place. Post-election disturbances occurred as recently as March 2007 in Kinshasa, resulting in deaths of civilians and military personnel. During civil disturbances in 2007 there were incidents of hostility towards U.S. citizens and other expatriates.

Both inside and outside Kinshasa, there can be roadblocks, especially after dark. Vehicles are often searched for weapons and valuables, and travelers are checked for identity papers. Security forces regularly seek bribes. If confronted with such a situation, it is suggested that U.S. citizens remain courteous and calm. If detained, report the incident to the U.S. Embassy in Kinshasa as soon as possible.

The United Nations has its largest peacekeeping operation in the world in the DRC. Known by its French acronym of MONUC, it has close to 17,000 peacekeepers deployed in the country – primarily in the east. Violence nevertheless persists in the eastern DRC due to the presence of several militias and foreign armed groups, with sporadic outbreaks occurring in North Kivu, South Kivu, and northern Katanga provinces, as well as in the Ituri District of Orientale province. Members of the Lord’s Resistance Army entered into northeastern DRC from Sudan in 2005, and have camps in an isolated region of the DRC, Garamba National Park, where they killed eight MONUC peacekeepers in January 2006.

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 U.S. and Canada, or for overseas callers, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.
CRIME:
In the DRC, poor economic conditions continue to foster crime, especially in urban areas. Travel in many sections of Kinshasa, Kisangani, Lubumbashi and most other major cities, is generally safe during daylight hours, but travelers are urged to be vigilant against criminal activity which targets non-Congolese, particularly in highly congested traffic and areas surrounding hotels and stores. Outlying, remote areas are less secure due to high levels of criminal activity and the lack of adequate training, supervision, and salary payments to the security forces present.

Vehicle thefts, burglaries, and armed robbery occur throughout the country; there have been recent reports of after-dark carjackings, resulting in deaths in the North Kivu area. It is recommended to drive with doors locked and windows closed at all times. If confronted by members of the military or security forces, visitors should not permit soldiers or police officers to enter their vehicles nor get into the vehicle of anyone purporting to be a security official. It is recommended that in such instances U.S. citizens remain courteous and calm and, if threatened, not resist. All incidents should be reported to the U.S. Embassy in Kinshasa.

Consistency in administering laws and regulations is notably absent. Travelers should note that in cases of theft and robbery, legal recourse is limited. Therefore, valuable items may be safer if kept at home or another secure location.

Security officials and/or individuals purporting to be security officials have detained and later robbed American citizens and other foreigners in the city of Kinshasa. This type of crime has increased in recent months, but generally occurs more frequently during the Christmas and New Year's holidays.

Travelers using public transportation or visiting high pedestrian traffic areas of any type are advised to be vigilant against robbery and pick-pocketing which is a persistent problem in all major cities in the DRC. The presence of “street children”, who can be persistent and sometimes aggressive, remains a problem particularly in Kinshasa.
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance.
The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
In the DRC, medical facilities are severely limited, and medical materials are in short supply. Travelers should carry properly labeled prescription drugs and other medications with them and should not expect to find an adequate supply of prescription or over-the-counter drugs in local stores or pharmacies. Payment for any medical services required is expected in cash, in advance of treatment.

Malaria is common throughout the DRC and outbreaks of cholera, typhoid, yellow fever, the Ebola virus, and hemorrhagic fever occur.
Travelers should take appropriate precautions to prevent the spread of HIV/AIDS.
Tuberculosis is an increasingly serious health concern in the DRC.
For further information, please consult the CDC's Travel Notice on TB at: http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of the DRC.

Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC’s web site at http://wwwn.cdc.gov/travel/default.aspx.
For information about outbreaks of infectious diseases abroad consult the World Health Organization’s (WHO) web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith/en
MEDICAL INSURANCE:
For planning purposes, the minimum estimated cost of medical air evacuation to the nearest suitable health care facility (in South Africa) is $35,000.

The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their policy applies overseas and whether it will cover emergency expenses such as a medical evacuation.
Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS:
While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning the DRC is provided for general reference only, and may vary according to location or circumstance.

Inter-city roads are scarce, and throughout the DRC roads are generally in poor condition, and often impassable in the rainy season. When driving in cities, keep windows up and doors locked. At roadblocks or checkpoints, documents should be shown through closed windows. In the event of a traffic incident involving bodily injury to a third party or pedestrian, do not stop to offer assistance under any circumstances. Proceed directly to the nearest police station or gendarmerie to report the incident and request official government intervention. Attempting to provide assistance may further aggravate the incident, resulting in a hostile mob reaction such as stoning or beating.

Presidential and other official motorcades pose serious risks to drivers and pedestrians in Kinshasa. When hearing sirens or seeing security forces announcing the motorcade's approach, drivers should pull off the road as far as possible, stop their vehicles, and extinguish headlights. Vehicles should not attempt to move until the entire motorcade has passed by; the security forces will physically indicate when this has occurred. Failure to comply may result in arrest, and/or vehicle damage with possible personal injury.

Public transportation of all forms is unregulated and is generally unsafe and unreliable. Taxis, mini-buses, and trains are in poor mechanical condition and are invariably filled beyond capacity.

Visitors who wish to travel in any mining areas must first obtain government approval from various government agencies or ministries, an often cumbersome and time consuming process.

Drivers should stop their cars and pedestrians should stand still when passing a government installation during the raising and lowering of the Congolese flag. This ceremony occurs at roughly 7:30 a.m. and 6:00 p.m.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of the DRC’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of the DRC’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
Civil aviation in the DRC continues to experience air incidents and accidents; more than a dozen crashes and in-flight accidents resulted in more than 300 fatalities between 2000 and August 2008. Incidents included hard landings, engine failures, collapsed landing gear, and planes veering off the runway.
In-country air travel schedules are unreliable and planes are frequently overloaded with passengers and/or cargo.
The U.S. Embassy in the DRC has prohibited official travel by U.S. government employees and contractors on all DRC-owned and -operated commercial air transportation services due to concerns regarding safety and maintenance.
International flights on foreign-owned and -operated carriers are not affected by this notice.
SPECIAL CIRCUMSTANCES:
Photography: Travelers should note that photography in public places in Kinshasa and around any public or government building or monument in the DRC is strictly forbidden. Persons caught photographing such sites will likely have their photographic equipment confiscated and risk detention and possible arrest.

Travel to and from Congo-Brazzaville (Republic of Congo): Ferry service to and from Kinshasa and Brazzaville stops running in the late afternoon, does not operate on Sundays, and may close completely with minimal notice. If ferry service is functioning, a special exit permit from the DRC's Immigration Service and a visa from the Republic of the Congo (Congo-Brazzaville) are required for U.S. citizens to cross the Congo River from Kinshasa to Brazzaville.

Ferry and riverboat service to the Central African Republic is suspended due to rebel control of the Ubangui River.
Phone Service: In the DRC, cellular phones are the norm, as other telephone service is unreliable. Depending on the type of phone, it may be possible to locally purchase a SIM card to use an American-compatible cell phone in the DRC.

Currency: U.S. currency is widely accepted in the urban areas, but most vendors and banking institutions will accept only Series 1996 bills or newer, with the large, off-center portraits, that provide stronger protection against counterfeiting. In addition, bills must be in near perfect condition; even those with minor stains or small tears will be rejected. One dollar bills are rarely accepted, even if in mint condition. U.S. bills should be examined before they are accepted to ensure that they are legitimate, as counterfeit currency is widely circulated. It is recommended that currency exchange be conducted at reputable banks and not on the street where several schemes exist to either short-change the unwitting customer or to pass counterfeit bills.

CRIMINAL PENALTIES:
While in any 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. 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.

Penalties for breaking the law can be more severe in the DRC than in the United States for similar offenses.
Persons violating Congolese laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in the DRC are severe, and convicted offenders can expect long jail sentences and heavy fines. Accusations of engaging in crimes against the security of the State, which are loosely defined, often result in detention for prolonged periods without being formally arrested. The DRC’s justice system remains plagued by corruption and uneven application of the law. Attorney fees can be expensive and are expected to be paid in advance of services rendered.

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 the DRC 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 the Congo. Americans without Internet access may register directly with the U.S. Embassy.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy is located at 310 Avenue des Aviateurs; tel. 243-081-225-5872 (do not dial the zero when calling from abroad). Entrance to the Consular Section of the Embassy is on Avenue Dumi, opposite the Ste. Anne residence. The Consular Section of the Embassy may be reached at tel. 243-081-884-6859 or 243-081-884-4609; fax 243-081-301-0560 (do not dial the first zero when calling from abroad).
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This replaces the Country Specific Information for the Democratic Republic of the Congo, dated April 29, 2008, to update sections on Entry/Exit Requirements and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Mon 14 Oct 2019 17:11
Source: Africa News [edited]

Bat consumption is still a vibrant culture among Congolese despite numerous warnings by health practitioners against the practice.  Several homes do serve bats, also locally known as "ngembo" in Lingala language, as part of their meals.

The process of preparing a bat is not hectic as elaborated by one of the consumers.  "We start by cutting its wings after burning the hair in the fire. It is then cleaned with warm water, then cut into 2 and everything is put into the pot in which we add a little salt, oil, and other ingredients", [EM] told Africanews correspondent Rosie Pioth in Brazzaville. After one hour of cooking, someone has to taste just to be sure if it's delicious enough to be served. It is then served with cooked cassava.  To get bat meat, one has to go to the market. On the shelves, prices vary between USD 1 to USD 2.5.

Several health practitioners have warned against dangers of consuming bat meat. They have consistently claimed that bats can act as hosts to Ebola virus. "Today, we can say that a bat is a frugivore. A bat can keep a certain number of viruses, today the most dangerous virus is the Ebola. So bat meat can contain this virus and therefore transmit it to human", explained Josaphat Depaget, a nutritionist in Brazzaville.  "You have a very delicious meat, which is very good but by consuming it, you have the risks of being contaminated with the Ebola virus. Therefore, it is not good for consumption."

Cheap and highly appreciated for its meat, the debate on the consumption of bat meat is still raging in Congo. Those who defend it see it as a source of nutrition, while others see it as a contaminant.  [Byline: Michael Oduor]
====================
[Bats are well-recognized reservoirs of zoonotic pathogens, in particular viruses. Agents that can spill over from bats to humans caused emerging zoonoses that affected humans and domestic animals -- such as filoviruses (Ebola and Marburg virus), henipaviruses (Hendra and Nipah virus) and coronaviruses (including severe acute respiratory syndrome coronavirus, SARS-CoV). In DRC the pathogen of main concern is Ebola virus. Ebola outbreaks there have been linked to bat consumption (for example, <http://dx.doi.org/10.1089/vbz.2008.0167>). It has to be taken into account that although the cooking procedures can inactivate the virus, there is inevitable exposure to viral particles before it happens. - ProMED Mod.PMB]

[Bushmeat comes from a variety of wild animals of which bats are just one prized example. Nonhuman primates, cane rats (grasscutters), and duiker (antelope) are also favored, according to the CDC. Generally, Ebola is not spread during the act of eating these animals following roasting. Rather, human infections have been associated with hunting, butchering, and processing meat from infected animals. Also see ProMED-mail 16 Oct 2019 regarding danger of eating dead gorillas. - ProMED Mod.LK]

[HealthMap/ProMED-mail map of DR Congo:
Date: Tue 15 Oct 2019
Source: Outbreak News Today [edited]

In an update on the plague cluster in Ituri Province in the north-eastern Democratic Republic of the Congo (DRC), UN officials report a total of 31 cases and 8 deaths since the beginning of 2019.

The 1st 5 cases were reported during week 10 in the Aungba health zone, which is in an endemic area. Two other cases were reported during week 13 (Aru health zone) and 14 (Aungba health zone). The latest cluster of cases was reported between week 39 (7 cases and 3 deaths) and 40 (14 cases) from Aru health zone in Ituri Province.

Plague is an infectious disease caused by the bacterium, _Yersinia pestis_. It is found in animals throughout the world, most commonly in rats but also in other rodents like ground squirrels, prairie dogs, chipmunks, rabbits and voles. Fleas typically serve as the vector of plague.

People can also get infected through direct contact with an infected animal, through inhalation and, in the case of pneumonic plague, person to person.  _Y. pestis_is treatable with antimicrobials if started early enough.  There are 3 forms of human plague; bubonic, septicemic and pneumonic.
======================
[Most cases are due to bubonic plague following the bite of an infected rodent flea causing a swollen and very tender lymph gland. The swollen gland is called a bubo. Bubonic plague should be suspected when a person develops a swollen gland, fever, chills, headache, and extreme exhaustion, and has a history of possible exposure to infected rodents, rabbits, or fleas. A person usually becomes ill with bubonic plague 2 to 6 days after being bitten.

When bubonic plague is left untreated, plague bacteria invade the bloodstream. As the plague bacteria multiply in the bloodstream, they spread rapidly throughout the body and cause a severe and often fatal condition. Infection of the lungs with the plague bacterium causes the pneumonic form of plague, a severe respiratory illness. The infected person may experience high fever, chills, cough, and breathing difficulty and may expel bloody sputum. If plague patients are not given specific antibiotic therapy, the disease can progress rapidly to death. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Date: Fri 11 Oct 2019
Source: WHO AFRO [abridged, edited]

HM and his wife, NM, were among the 1st parents to arrive for the measles vaccination at Nzombi Health Centre in Masi Manimba, a village 400 km [approx. 250 mi] south of Kinshasa. They brought their 3-year-old triplet girls. The children had missed out on being vaccinated for measles at the designated age of 6 months and are in serious danger of infection.

HM and his wife are among the hundreds of thousands of parents across the Democratic Republic of the Congo who rushed to have their children vaccinated following the launch of a measles campaign by the Government, the World Health Organization (WHO) and partners.

A few streets from the health centre, community mobilizer Mundumusi Lipsa bellows through his megaphone, calling on parents to take children who are not vaccinated to the health centres offering the vaccination. His colleague, Lula Pwati, and a WHO epidemiologist are going from house to house to make sure no child is left behind.

According to preliminary reporting on coverage, the 9-day vaccination campaign that reached the triplets of HM and NM most likely will go beyond the targeted 825 000 children in what has become the world's largest and fastest-moving outbreak. To date, the number of suspected cases has gone beyond 203 000 (6276 confirmed), with more than 4000 deaths, nearly all of them children. This vaccination campaign is the 3rd emergency intervention targeting children aged 6--59 months.

"Measles is a disease that not only kills but also has very serious complications. Health workers must always remind parents to take the children for the shot on time," says Dr. Helene Chenge, a WHO epidemiologist.

The campaign is funded by the United Nations Humanitarian Pooled Fund, with contributions from the WHO Contingency Fund for Emergencies and from the Measles and Rubella Initiative.

A 5-day follow-up immunization campaign in 7 provinces is slated to begin on [22 Oct 2019] to provide supplemental doses to children aged 9-59 months and thus reach those who were not vaccinated through the routine immunization programme.
Date: Sun, 13 Oct 2019 23:31:57 +0200 (METDST)

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

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

The J&J vaccine had been rejected by DRC's former health minister Oly Ilunga, who cited the risks of introducing a new product in communities where mistrust of Ebola responders is already high.   But Ilunga's resignation in July appears to have paved the way for approval of the second vaccine. He currently faces charges that he embezzled funds intended for the fight against Ebola.   In his letter of resignation Ilunga said "actors who have demonstrated a lack of ethics" want to introduce a second vaccine, but did not elaborate.    Muyembe, who took over the Ebola fight in the DRC in July, said "The Johnson & Johnson vaccine has the most science-based data."
Date: Wed, 9 Oct 2019 22:01:17 +0200 (METDST)

Kinshasa, Oct 9, 2019 (AFP) - Six people were killed in the Democratic Republic of Congo after torrential rains hit the capital Kinshasa, flooding several neighbourhoods. a local official said.    The bodies were found between Tuesday night and Wednesday morning.    Five people were killed in the capital's Selembao municipality where around 30 houses collapsed, local mayor Augustin Mankesi told Top Congo radio station.   One woman died in the Pelende district after she was electrocuted, he added.    "Our community is stricken," Mankesi added, calling on the Congolese authorities for help.   Fatal floods and rains are frequent in Kinshasa. In January last year 48 people were killed in landslides, floods and after houses collapsed, according to authorities.    Residents told AFP the road from the sea port district of Matadi to the Kinshasa turnoff has been closed due to erosion caused by the rain.    The passage is Kinshasa's main supply route for imported goods and also serves as an exit point for exports.
More ...

World Travel News Headlines

Date: Tue, 22 Oct 2019 13:43:23 +0200 (METDST)

Capriata d'Orba, Italy, Oct 22, 2019 (AFP) - A taxi driver has drowned in Italy during violent storms in the north which flooded towns and destroyed a bridge, the fire service said Tuesday.   Farmers in the sweltering south meanwhile sounded the alarm over a draught expected to hit crops hard.   Over 100 people were evacuated Monday across the Alessandria province in the Liguria region, while firefighters carried out 900 operations across the north from Milan to Genoa, as rising waters surged across roads and railways.

The taxi was swept away in the town of Capriata d'Orba, where a bridge had also given way as the river burst its banks.   "There's water everywhere", driver Fabrizio Torre, 52, told his bosses before his phone line cut out, media reported.   His passenger managed to escape the vehicle and survived by clinging to a tree, the reports said.   Two men, aged 61 and 84, were found alive by firefighters after going missing in another part of the storm-hit region.   Rescue workers also pulled young children, their grandmother and the family's dog out of a house submerged by a landslide.   The Po river rose by more than 3.5 metres (11 feet) over a 24-hour period, according to Coldiretti, Italy's main agricultural association.   Lake Maggiore was also nearing a historic level.

Italy has seen "over three storms a day since the start of autumn, 18 percent more than the same period last year," it said.   "And while the north is under rain clouds... in the south, record heat and lack of rainfall has triggered a drought alarm."   Italy was seeing "the effects of climate change, with exceptional weather events becoming the norm".   It noted a "clear endency to tropicalisation" in the Mediterranean country, which was experiencing "a crazy autumn that ranks in the top ten of the hottest since 1800, with a temperature of 1.27 degrees above the average".   The high frequency of violent events was expected to continue, with the north pummelled by rains while farmers in the south risk losing crops.
Date: Tue, 22 Oct 2019 09:57:15 +0200 (METDST)
By Tupad POINTU

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

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

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

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

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

A new mandate would keep him in power until 2025.   As leader of his Movement for Socialism Party (MAS), Morales points to a decade of economic stability and considerable industrialization as his achievements, while insisting he has brought "dignity" to Bolivia's indigenous population, the largest in Latin America.   He has come under severe criticism this year as wildfires in August and September ravaged Bolivia's forests and grasslands, with activists saying his policies encouraged the use of blazes to clear farmland.
Date: Tue, 22 Oct 2019 06:44:29 +0200 (METDST)

Papeete, Oct 22, 2019 (AFP) - A French tourist has been seriously injured in a rare shark attack in the palm-fringed Pacific islands of Polynesia, emergency services said Tuesday.   The 35-year-old woman was swimming during a whale-watching trip on Monday in the French overseas territory when the oceanic whitetip shark tore into her chest and arms.   "Luckily for her, there were two nurses on the scene who could deliver first aid," firefighter Jean-Jacques Riveta told AFP.   The woman lost both hands and a lot of blood in the attack and was airlifted to hospital, he said.
Date: Tue, 22 Oct 2019 05:13:16 +0200 (METDST)

Wellington, Oct 22, 2019 (AFP) - A huge fire at a construction site sent clouds of acrid black smoke billowing over Auckland on Tuesday, forcing large parts of the downtown area to be cordoned off as firefighters battled the blaze.   The fire broke out on the roof of the SkyCity convention centre site shortly after 1:10pm (0010 GMT) and quickly spread, Fire and Emergency NZ said.   Office workers were warned to stay inside and turn off air conditioning as a thick pall of smoke engulfed the centre of New Zealand's largest city, but there were no reports on injuries.   Unconfirmed reports said the fire was started by a construction worker using a blowtorch on the building, which is one of the venues for the 2021 APEC summit being held in Auckland.
Date: Mon, 21 Oct 2019 18:48:23 +0200 (METDST)

Harare, Oct 21, 2019 (AFP) - At least 55 elephants have died in a month in Zimbabwe  due to a lack of food and water, its wildlife agency said Monday, as the country faces one of the worst droughts in its history.   More than five million rural Zimbabweans -- nearly a third of the population -- are at risk of food shortages before the next harvest in 2020, the United Nations has warned.

The shortages have been caused by the combined effects of an economic downturn and a drought blamed on the El Nino weather cycle.   The impact is being felt at Hwange National Park, Zimbabwe's largest game reserve.   "Since September, we have lost at least 55 elephants in Hwange National Park due to starvation and lack of water," Zimbabwe National Parks spokesman Tinashe Farawo told AFP.   Farawo said the park was overpopulated and that food and water was scarce "due to drought".

Africa's elephant numbers have dropped from around 415,000 to 111,000 over the past decade, mainly due to poaching for ivory, according to the International Union for Conservation of Nature (IUCN).   But Zimbabwe, like other countries in the southern African region, is struggling with overpopulation.   "Hwange was meant for 15,000 elephants but at the moment we are talking of more than 50,000," Farawo said.   "The situation is dire. We are desperately waiting for the rains."   An adult elephant drinks 680 litres (180 gallons) of water per day on average and consumes 450 kilogrammes (990 pounds) of food.

Hungry elephants have been breaking out of Zimbabwe's game reserves and raiding human settlements in search for food, posing a threat to surrounding communities.   Farawo said 200 people have died in "human-and-animal conflict" in the past five years, and "at least 7,000 hectares (17,300 acres) of crop have been destroyed by elephants".   The authorities took action earlier this year by selling nearly 100 elephants to China and Dubai for $2.7 million.   Farawo said the money had been allocated to anti-poaching and conservation projects.   Botswana, Namibia, Zambia and Zimbabwe have called for a global ban on elephant ivory trade to be relaxed in order to cull numbers and ease pressure on their territories.
Date: Mon, 21 Oct 2019 13:34:35 +0200 (METDST)

Santiago, Oct 21, 2019 (AFP) - Chile, reeling from its worst social unrest in decades, has since the 1990s been considered a Latin American hub of political stability and economic growth after 17 years of dictatorship.   Here is some background.

- From dictatorship to democracy -
In 1973 General Augusto Pinochet toppled Socialist President Salvador Allende in a military coup. Allende committed suicide in the presidential palace as troops closed in.   Pinochet imposed a right-wing dictatorship that lasted for 17 years, during which at least 3,200 people were killed or disappeared as a result of political repression. Around 38,000 were tortured.   In 1988 he lost a plebiscite on remaining in power and handed over to democratically elected Patricio Aylwin in 1990, remaining head of the armed forces until 1998.    Pinochet died in 2006 without standing trial for atrocities under his regime.   In 2006 Socialist Michelle Bachelet became Chile's first female president. Re-elected in 2013, she was barred constitutionally from standing again immediately and appointed UN right commissioner in 2018.   The 2017 elections were won by conservative billionaire Sebastian Pinera, who had already been president in 2010-2014.

- Model economy -
Pinochet applied neo-liberal free-market methods, privatising healthcare, education and pensions.   Chile turned to exports and in the 1980s became the preferred Latin American host for foreign investors.   With this economic model still largely in place, growth reached a strong 4% in 2018. The country of 18 million people also has the highest per capita income of Latin America at $20,000.   GDP, however, fell to 1.8% in the first half of 2019 -- due to a challenging external context, adverse climatic conditions and a delay in reforms -- and is expected at 2.5 percent for the year.   Despite slashing poverty from 30% in 2000 to 8.6% in 2019, the country has high social inequalities including in healthcare, education and pensions.   It is the world's biggest producer of copper, with lithium, timber, fisheries, gold, silver, avocados and oil also driving exports.

- Paedophile priests scandal -
The staunchly Roman Catholic country has been rocked by allegations of sexual abuse within the church going back decades.   In May 2018 Pope Francis summoned all 34 Chilean bishops to Rome over the crisis and all tendered their resignations, although only a handful have been accepted.   Since 2000 about 80 priests have been reported to authorities in Chile for alleged sexual abuse, including of children and adolescents.   Prosecutors said in August 2018 they were investigating 158 members of the church, both priests and lay people.   Ultra-conservative Chile allowed divorce only from 2004 and legalised abortion in certain cases in 2017.

- World's most seismic -
Bordered by the Pacific Ocean to the west and the Andes mountain range to the east, long and narrow Chile is the world's most seismic country.   In 1960 it was struck by the most powerful earthquake ever registered which measured 9.5 and struck at Valdivia. More than 5,700 people were killed.   In 2010 a 8.8-magnitude quake in the south and centre unleashed a tsunami that swept away entire villages, leaving around 520 people dead.

- Astronomy heaven -
Benefitting from a totally clear sky for most of the year, northern Chile is home to some of the world's most powerful telescopes.   The construction of the planet's biggest telescope was launched in May 2017 in the Atacama desert by ESO, the European Organisation for Astronomical Research in the Southern Hemisphere.
Date: Sun 20 Oct 2019
Source: Pakistan today [edited]

The death toll from a mysterious throat virus has reached 9 children in Seerani and its surrounding localities in Badin district as one more child infected by the virus died, affected people said on [Sun 20 Oct 2019].

A child, R, son of RM, died after contracting the disease. The most affected areas are reported to be Seerani and its surrounding localities. Teams of the health department and other organizations reached Seerani and took blood samples of at least 30 children who were infected by the virus. The blood samples will be sent to Islamabad for the tests.

The people of the area are worried about this new throat viral disease and have demanded authorities to provide immediate health cover to them.
====================
[There is little information to go on other than the throats of children are affected and the case fatality rate is high (10 of at least 30). No other symptoms are provided, nor is the basis for concluding that a virus is involved or what the epidemiological data are (dates, ages, sex of children involved, and local conditions). ProMED-mail would welcome additional information. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: 21 Oct 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/polio-cases-reported-in-zambia-chad-and-togo-73820/>

Circulating vaccine-derived polio virus (cVDPV) type cases have been confirmed in 10 African countries through [16 Oct 2019] this year [2019]. Now, the World Health Organization (WHO) is reporting 3 additional countries from the continent that more recently reported circulating vaccine-derived polio virus type 2 (cVDPV2) cases: Zambia, Chad and Togo.

Zambia
The Ministry of Health of Zambia reported last week on a confirmed case of circulating vaccine-derived polio virus type 2 (cVDPV2) in a 2-year-old child in Chienge district, Luapula province on the border with Democratic Republic of the Congo. This is the 1st case of cVDPV2 reported from Zambia in 2019. [Date of onset of paralysis reported to be 16 Jul 2019 according to another media report <https://www.lusakatimes.com/2019/10/21/polio-case-has-been-recorded-in-zambias-luapula-province/>.

In addition to the initial case-patient, 34 stool samples were collected from healthy contacts, and 2 samples tested positive for VDPV2, which were genetically linked to the case-patient. No established links have so far been found with the ongoing outbreak of cVDPV2 in Democratic Republic of the Congo, where 37 cases have been reported in 2019. The last recorded case of indigenous polio in Zambia was in 1995, while between 2001 and 2002, 5 cases of wild polio virus were identified among Angolan refugees in the Western province of the country.

Chad
Last week, WHO was informed about cVDPV2 in Chad. A cVDPV2 was isolated from a 13-month-old case of acute flaccid paralysis (AFP), with onset of paralysis on [9 Sep 2019] in Chari Baguirmi province, bordering Cameroon. The isolated virus has 32 nucleotide changes from Sabin 2, and is genetically linked to a cVDPV2 detected in Borno, Nigeria and is part of the Jigawa emergence. The last indigenous wild poliovirus cases were reported in 2000 in Chad.

Togo
In addition, last week WHO was informed about cVDPV2 in Togo. A cVDPV2 was isolated from a 30-month-old case of AFP with onset of paralysis on [13 Sep 2019] in Plateaux province, bordering Benin and Ghana. The isolated virus has 32 nucleotide changes from Sabin 2 and is genetically linked to a cVDPV2 detected in Irewole state, Nigeria and is part of the Jigawa emergence as well. The last indigenous wild poliovirus case was reported in 1999 in Togo.
======================
[Three more countries are joining the list of cVDPV outbreak countries, all with cVDPV2 isolates. Two of the 3 countries (Togo and Chad) have viruses related to the Jigawa, Nigeria cVDPV2 outbreak. The case in Zambia is suspected to be associated with the ongoing cVDPV2 transmission in the Democratic Republic of the Congo (DR Congo), but genetic testing is presumably still pending or has been negative. See my comments below after the following section, as they are relevant to what is ongoing globally with respect to cVDPVs.

Below are the HealthMap/ProMED map links to countries where cVDPV cases/outbreaks have occurred in the past 12 months, a total of 20 countries.

Angola: <http://healthmap.org/promed/p/165>
Benin: <http://healthmap.org/promed/p/59>
Cameroon: <http://healthmap.org/promed/p/65>
Central African Republic: <http://healthmap.org/promed/p/66>
Chad: <http://healthmap.org/promed/p/57>
China: <http://healthmap.org/promed/p/155>
Democratic Republic of the Congo: <http://healthmap.org/promed/p/194>
Ethiopia: <http://healthmap.org/promed/p/95>
Ghana: <http://healthmap.org/promed/p/53>
Indonesia: <http://healthmap.org/promed/p/184>
Kenya: <http://healthmap.org/promed/p/174>
Mozambique: <http://healthmap.org/promed/p/177>
Myanmar: <http://healthmap.org/promed/p/148>
Niger: <http://healthmap.org/promed/p/58>
Nigeria: <http://healthmap.org/promed/p/62>
Papua New Guinea: <http://healthmap.org/promed/p/188>
Philippines: <http://healthmap.org/promed/p/158>
Somalia: <http://healthmap.org/promed/p/125>
Togo: <http://healthmap.org/promed/p/64>
Zambia: <http://healthmap.org/promed/p/170> - ProMED Mod.MPP]
Date: Fri 18 Oct 2019 07:32 PM EDT
Source: WSPA [edited]

North Carolina health officials say a 4th person has died from an outbreak of legionnaires' disease linked to a hot tub display at the North Carolina Mountain State Fair, which is held at the Western North Carolina Agricultural Center.

We've also learned another person, who did not attend the NC Mountain State Fair, was diagnosed with legionnaires' after attending a quilt show that was held inside the same building as the hot tub exhibit. That building is the Davis Event Center.

7 News spoke with folks who have been impacted by the outbreak. "We were like 'Oh no, I hope nobody gets sick,'" [LP] said. He attended the North Carolina Mountain State Fair-an event tied to at least 140 cases of legionnaires'. He said 2 people he knows, including his uncle, got sick after the fair. "They didn't actually have legionnaires', but they had respiratory problems that did come out of it," he said. [Perhaps Pontiac fever?] Even so, [LP] was back at the WNC Agricultural Center on [Fri 18 Oct 2019] to help host his club's annual Antique Tractor Show.

And while everything appeared to be business as usual, [LP] was concerned as another person was just diagnosed with the disease and didn't attend the fair. Instead, they were at a quilt show held at the WNC Agricultural Center 2 weeks later. "Anytime there's an outbreak of something, it's always going to have a thing in the back of your mind that says, 'I don't know if I want to do this or not,'" he said.

The Davis Event Center has since been closed; but health officials say it's possible the source for the newest case of legionnaires' may not have been at the WNC Agricultural Center. "There are other possible exposures that this person had, so it's hard. At this point, we can't pinpoint," Jennifer Mullendore with Buncombe County Health and Human Services said.

According to a statement by the WNC Agricultural Center, the hot water system in the Davis Event Center, and every other building on the grounds, went through a disinfecting process as a precautionary measure. "They did some cleaning and doing some real hot high-powered water through the water system here, and so we do have a clean bill of health," Phillips said.  It's unclear at this time when the Davis Event Center will re-open.  [Byline: Scottie Kay]
========================
[The latest status, as of 18 Oct 2019, of the legionellosis outbreak associated with the Mountain State Fair that was held in western North Carolina between 6 and 15 Sep 2019 at the Western North Carolina Agricultural Center (WNC Ag Center) in Fletcher, a town in Henderson County, can be found at <https://epi.dph.ncdhhs.gov/cd/legionellosis/outbreak.html>.

The source of the outbreak has still not as yet been confirmed. However, hot tub displays in one of the buildings (Davis Event Center) has been linked to the outbreak. A site map of the WNC Ag Center that shows the location of the Davis Event Center building can be found at <https://www.wncagcenter.org/p/mountainstatefair/competitions/map>.

One more case and an additional death have been reported since the last ProMED-mail post on this outbreak, but no cases linked to the outbreak had a symptom onset date more than 2 weeks after the end of the fair, that is, within the incubation period for legionnaires' disease (<https://www.cdc.gov/legionella/clinicians/clinical-features.html>). The latest case of legionnaires' disease didn't attend the fair, but instead attended a quilt show held 2 weeks later at the Davis Event Center, but the source for this case is thought possibly to have not been at the WNC Agricultural Center. The Davis Event Center has since been closed.

The number of confirmed cases of legionellosis by county are as follows: Buncombe, 49; Burke, 1; Caswell, 1; Cherokee, 1; Gaston, 1; Granville, 1; Haywood, 12; Henderson, 34; Jackson, 3; Madison, 6; McDowell, 5; Mecklenburg, 5; Mitchell, 2; Polk, 1; Rutherford, 3; Transylvania, 3; Union, 1; Watauga, 1; and Yancey, 1. 10 cases occurred out of state (in South Carolina). Total cases: 141. A map showing the location of the North Carolina counties can be found at <https://geology.com/county-map/north-carolina.shtml>.

Male, 82 (59%)*; female, 58 (41%)*. Median age in years (range): 61 (24-91). Hospitalizations: 94 (69%)*; deaths 4. *Some cases reported with unknown gender or hospitalization status.

A total of 133 (94%) have legionnaires' disease, the pneumonic form of the infection, and 8 (6%) have Pontiac fever, the non-pneumonic form of the infection.

The species of _Legionella_ detected in patients is not specified; however, the usual pathogen in the USA is _L. pneumophila_ serogroup 1 and one sample of water collected from the women's restroom in the Davis Event Center was previously reported to be positive for _L. pneumophila_. Genotyping clinical and environmental isolates will help identify clusters of cases with a common source and identify the source responsible for infection in these clusters. - ProMED Mod.ML]
 
[HealthMap/ProMED-mail map of North Carolina, United States:
Date: Sun 20 Oct 2019 12:52 AM IST
Source: Deccan Chronicle [edited]

The respite from cases of dengue, notwithstanding, the city [Hyderabad] is now caught in the grip of viral encephalitis, or brain fever. There is an alarming increase in the number of viral encephalitis cases being reported across city hospitals. This is ironic as October is medically termed as 'fair-weather' season. The rise in the number of cases has been worrisome and those getting inflicted include children and elders.

Many are complaining of fever of the brain with body temperature touching [106-107 deg F/41.1-41.6 deg C].

According to doctors, at least 3 cases are reported each week in the tertiary hospitals of which 7 major ones are in the city.

Dr Shyam Jaiswal, neurologist at Care Hospitals, explains, "Of late, we have been admitting viral encephalitis-affected children in the hospital. Most fall sick because of the body's low immunity. Immediate hospital care is a must as most complain of severe headache, delirium, and in some cases even loss of memory. The treatment takes between 2-3 days."

It is a medical nightmare that some elders are suffering from both chikungunya and viral encephalitis.

Dr Hari Kishan B, general physician with Apollo Hospitals, explains, "The combination of chikungunya and viral encephalitis has been noted earlier too. These are rare cases but do occur from time to time. The viral infections have been very high this year [2019] and those suffering from diabetes, hypertension, and other cardiovascular ailments, will suffer more when infected with these viruses."  [Byline: Kaniza Garari]
=====================
[This report does not provide total case numbers, nor indicate how long 2-3 cases per week have been occurring. The virus suspected or confirmed as the etiology of these cases is not mentioned, but the comment that October is termed "a fair weather season" suggests that Japanese encephalitis virus may be involved with the usual transmission season declining in October. No mention is made of acute encephalitis syndrome, a clinical designation with a variety of suggested Aetiologies in other cases in north-eastern India. - ProMED Mod.TY]

[Maps of India: