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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 ...

Madagascar

Madagascar - US Consular Information Sheet
November 06, 2008
COUNTRY DESCRIPTION:
Madagascar is a developing island nation off the east coast of Africa.
The primary languages are French and Malagasy.
French is less spoken outside
of major cities.
Facilities for tourism are available, but vary in quality.
Travelers seeking high-end accommodations should make reservations in advance.
Read the Department of State Background Notes on Madagascar for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
Visas are available at all airports servicing international flights, but travelers who opt to obtain a visa at an airport should expect delays upon arrival.
Visas obtained at the airport cannot be extended.
Most international flights arrive in Antananarivo, but there are some limited international flights to/from the nearby islands of Comoros, Mayotte and Reunion from airports in Mahajanga, Toamasina (Tamatave), Nosy Be, Tolagnaro (Ft. Dauphin) and Antsiranana (Diego Suarez).
There are also direct flights between Italy and Nosy Be.
Evidence of yellow fever immunization is required for all travelers who have been in an infected zone within 6 months of their arrival in Madagascar.

Travelers may obtain the latest information and details on entry requirements from the Embassy of the Republic of Madagascar, 2374 Massachusetts Avenue NW, Washington, DC
20008; telephone (202) 265-5525/6; or the Malagasy Consulate in New York City, (212) 986-9491.
Honorary consuls of Madagascar are located in Philadelphia, and San Diego.
Overseas, inquiries may be made at the nearest Malagasy embassy or consulate.
Visit the Embassy of Madagascar’s web site at http://www.embassy.org/madagascar 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:
There are random police vehicle checkpoints throughout Madagascar, so all visitors should carry photo identification (i.e., U.S. passport) in the event of police questioning.
These check points are routine in nature, and should not result in vehicle and/or person searches as long as valid identification is shown.
Political demonstrations occur from time to time.
There have been incidents of violence during demonstrations, but these have not been directed against Americans.
Travelers should maintain security awareness at all times and should avoid political gatherings and street demonstrations.
Certain large gatherings such as concerts or scenes of accidents also may pose a threat to foreigners.

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 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:
The major concerns for visitors to Antananarivo are crimes of opportunity such as pick pocketing, purse snatching and residential and vehicular theft.
Although these incidents are generally non-violent, incidents involving violence by assailants do occur and are on the rise, particularly when the victim resists, and especially when multiple persons confront the victim.
The Embassy has received reports of physical attacks against foreigners, including Americans, particularly in coastal tourist areas.
A number of these attacks resulted in serious injuries and in some cases, fatalities.
Criminal elements in Antananarivo and throughout Madagascar are becoming bolder when selecting their victims, and are also committing more crimes in areas that are considered to be “safe” – those that are generally well lit and well traveled by pedestrians and vehicles.

To reduce the risk of being victimized, travel in groups and avoid wearing expensive jewelry or carrying high cost electronic items (iPods, digital cameras, or high end cell phones) with you in public. Valuable items should never be left in an unattended vehicle or at a hotel (unless locked in the hotel safe). Walking at night, whether alone or in a group is not considered safe in urban areas, including in the vicinity of Western-standard hotels, restaurants and night clubs. Visitors are strongly discouraged from traveling outside of Antananarivo after dark due to banditry, lack of lighting, and poor road conditions. In the last six months there have been several incidents involving nighttime criminal activity that targeted vehicles outside of town.
These events have involved villages designing a “trap” of sand, a tree log or some other substance or condition that makes the only viable road impassible.
Local villagers then “assist” the stranded vehicle and expect monetary compensation. Others have involved armed criminals who stage a “breakdown” that blocks the roadway, forcing the victimized driver to slow down, and hence become more vulnerable.

Criminal gangs comprised of felons, ex-military and police from the former regime are known to commit home invasions and kidnappings, sometimes targeting foreigners.
Organized gangs of bandits are known to patrol areas where foreigners, who are perceived to be wealthy, tend to congregate.
Crimes such as burglary and robbery do occur in areas outside the capital and the threat of confrontational and violent crime has increased in rural and isolated areas throughout the last year.
Specifically, Amboasary, a town in the southeast, has experienced a surge in armed robberies targeting not-governmental organizations (NGOs).
However, Americans visiting Madagascar should not expect to experience any hostility or aggression solely because of their citizenship.

In major cities, the National Police is charged with maintaining peace and security. Outside of major cities, the Gendarmerie is primarily responsible for these duties. Due to lack of resources available to both law enforcement agencies, police response to victims of a crime is often limited, slow and ineffective.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to local police and to 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 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.
During an emergency, visitors to Antananarivo can contact local police at telephone numbers 117 and 22-357-09/10 or 22-227-35. See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Standards of healthcare throughout Madagascar are well below U.S. standards.
However, there are foreign physicians in Antananarivo representing a broad range of specialties, but their training is variable and often not to U.S. standards.
The hospitals in Antananarivo vary greatly in standards of care.
Medical care outside of Antananarivo is generally well below the care available in the capital city.
Caution and good judgment should be exercised when seeking hospital and medical services.
The Embassy maintains a list of hospitals and specialists.
A Seventh Day Adventist dental clinic offers emergency procedures and x-ray facilities.
Some medications, generally of French origin, are available in Antananarivo.
If you need to refill a prescription from home, it is important to carry a prescription from your doctor listing the medicine's generic name.
There is limited availability of both prescription and over the counter medications, and outside of Antananarivo, medications may not be available.
Travelers should have a supply of any needed medication sufficient for the entire length of a visit before arriving in Madagascar.
Americans who will be carrying medications with them to Madagascar may wish to contact the Malagasy Embassy in Washington, D.C. regarding any restrictions on imports.

Ambulance services are available in Antananarivo with Polyclinique Ilafy at 22-425-66/69 or 033 11 458 48 / 032 07 409 38; Espace Medical at 22-625-66, 22-219-72, or 032-02-088-16 (cellular); and CDU (Centre de Diagnostic Medical d’Urgences) at 22 329 56 or 032 07 822 28 or 033 11 822 28.
However, due to traffic jams, response times are often dangerously slow.

Malaria is prevalent, particularly in the coastal regions.
Using preventive measures and malaria prophylaxis is strongly recommended.
Rabies is endemic and there are many street dogs.
It is recommended travelers have the pre-exposure vaccination series prior to arrival in Madagascar.
If bitten by an animal, the effected area should immediately be washed with soap and running water for ten minutes.
Seek medical care immediately.
Plague is also endemic to Madagascar.
While the reported HIV prevalence rate is low, particularly by African standards, Madagascar suffers from a very high reported incidence of other sexually transmitted diseases.

The East African Indian Ocean islands have seen a rise in the cases of Chikungunya.
As with Malaria, Chikungunya and Dengue are transmitted by mosquitoes.
Every effort should be made to use repellants, proper clothing and barriers that discourage/prevent mosquito bites.
The CDC web site contains further information on chikungunya at http://www.cdc.gov/ncidod/dvbid/chikungunya/ and dengue at http://www.cdc.gov/ncidod/dvbid/dengue/.
Travelers should drink bottled water or carbonated beverages.
Local water is not generally potable.
Water purification tablets may be used as necessary.
Bottled water is readily available in Antananarivo but is less so outside the city.
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 Madagascar is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
In Madagascar, one drives on the right side of the road, generally yielding the right of way to vehicles coming in from the left.
Some major intersections and traffic circles have police directing traffic.
If a policeman has his back to you at an intersection, you are required to stop.
Laws make seatbelt use mandatory and prohibit cell phone use while driving, even with a hands-free attachment.
Child safety seats and motorcycle helmets are not required in Madagascar.
If you are caught driving under the influence of alcohol, your car will be impounded for a few days and you will have to pay a fine.
If you are involved in an accident involving injuries and/or deaths, there is a mandatory court case.
The losing party of the court case must then pay all costs.

Except for Antananarivo’s main streets and a few well-maintained routes to outlying cities, many roads are in various states of disrepair.
Some may be impassable during the rainy season.
Night travel by private or public transportation outside Antananarivo is strongly discouraged due to poor lighting and road conditions.
Roads tend to be narrow and winding with many one-lane bridges and blind curves.
Most vehicles tend to drive in the center of the road unless another vehicle is present.
It is common to find livestock or human-drawn carts in the middle of the road, even at night.
Local practice is to blow the horn before going around a curve, to let others know of one's presence.
Few pedestrian crosswalks or working traffic signals exist.

Travel within Antananarivo can be difficult with poor road signage, streets congested with pedestrians, bicycles, animal carts, and vehicular traffic, and an abundance of one-way streets.
Taxis are plentiful and are generally reasonably priced.
Bargain for the fare prior to getting into a vehicle.
Most accidents are pedestrian-related, due to narrow roads and lack of sidewalks on many streets.
When traveling between cities, travelers must have clear directions as there are rarely signs indicating where one must turn to reach a destination.
Conditions of rural roads can degrade significantly and with little notice during the rainy season.

Rental cars generally come with a driver who is responsible for maintaining the vehicle and sometimes acts as a tour guide.
Public transportation is unreliable and vehicles are poorly maintained.
Rail services are extremely limited and unreliable.
The Ministry of Public Works, telephone (20) 22-318-02, is Madagascar's authority responsible for road safety.
During an emergency, visitors to Antananarivo can contact local police by dialing 117, 22-227-35, 22-357-09/10.
American citizens can also call the U.S. Embassy at 22-212-57/58/59 if assistance is needed in communicating with law enforcement officials.
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 Madagascar, the U.S. Federal Aviation Administration (FAA) has not assessed Madagascar’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s Internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.
Domestic and international air services operate regularly but are subject to delays and occasional breakdowns.
Air Madagascar often changes in-country flight schedules based on demand; flights that are not full may be cancelled with little or no prior warning to passengers.
Overbooking is also common.
Reconfirmation of tickets prior to flight day is recommended, especially when flying from provincial airports.
SPECIAL CIRCUMSTANCES:
It is advisable to contact the Embassy of Madagascar in Washington or one of Madagascar'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.
Taking photographs of airports or military installations is prohibited.

Madagascar is renowned for its natural resources.
These include a wide variety of gemstones.
The Government of Madagascar recently imposed restrictions on the export of precious gems; before purchasing or transporting any gemstones it is advisable to seek clarification of the applicable laws.

Madagascar is primarily a cash-driven economy.
Although some high-end establishments catering to tourists accept credit cards, normally only Visa-logo cards, most shops and restaurants are cash only.
Although the government changed the local currency from the Malagasy Franc (FMG) to the Ariary several years ago, many Malagasy still think in terms of FMG.
When talking about prices, it is important to quantify whether the price is in Ariary or FMG. (1 Ariary = 5 FMG).
A few ATMs are available in large cities.
Dollars are not widely accepted. 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 Malagasy laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Malagasy 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 as in Madagascar.
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 Madagascar 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 Madagascar.
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 14-16 Rue Rainitovo, Antsahavola, Antananarivo.
The mailing address is B.P. 620, Antsahavola, Antananarivo, Madagascar; telephone [261] (20) 22-212-57; fax [261] (20) 22-345-39.
The Embassy’s web site is located at http://www.antananarivo.usembassy.gov/
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This replaces the Country Specific Information dated June 2, 2008, to update the section on Crime.

Travel News Headlines WORLD NEWS

Date: 9 Aug 2019
Source: RFI [in French, machine trans. edited]

In Madagascar, the plague season has started. The 1st 3 cases of bubonic plague have just been recorded 50 km west of the capital. No deaths have occurred for the moment, but the Ministry of Health is watching. As every year, awareness campaigns have started. The goal: to prevent the spread of epidemics like that of 2017, the black year, which had more than 200 victims and 2400 people infected by the bacterium throughout the Malagasy territory.

"Do not repeat the mistakes of the past" is the stated ambition of the Ministry of Health. Contacted by telephone, the Director General of Preventive Medicine, Dr. Fidiniaina Randriatsarafara, said that "information and awareness activities have started. Radio clips are being broadcast on local radio stations to remind the public that the appearance of swelling, sudden fever, or chest pains require an immediate visit to the nearest health centre. Clinics are sometimes several hours walking distance away, and patients more easily consult traditional healers.

At present, health centres in plague-endemic areas are all expected to be provided with drugs, since treatment exists to treat both forms of plague on the island. However, some clinics are still awaiting them, according to a ministry official.

Another important preventive measure is the requirement for road transport companies to register the name and telephone number of all passengers during the plague season. In 2017, it was a sick traveller who transmitted the pneumonic plague to other passengers, extending the epidemic to Tamatave. However, according to a regional carrier, many companies do not register passengers and are not sanctioned.
=======================
[Plague infections in Madagascar have been relatively quiet since the dramatic outbreak in 2017.

The following paragraph is from Chanteau S, Ratsifasoamanana L, Rasoamanana B, et al. Plague, a reemerging disease in Madagascar. Emerg Infect Dis 1998;4(1):101-4, PMID: 9452403; available at <http://wwwnc.cdc.gov/eid/article/4/1/98-0114_article.htm>:

"Between 1930 and 1990, bubonic plague had 'virtually disappeared' on the island due to efficient pest-control and good health management. However, since 1990, an annual 200 cases are being reported, and bubonic plague takes on epidemic form, especially in the port of Mahajanga, each year. In the capital city of Antananarivo, more cases are being notified each year since 1990. Madagascar (pop. 13 million) has accounted for 45% of all the cases of plague in Africa."

Fatalities related to plague usually are caused by spread of the organism from the bubo (the very painful infected lymph node that drains the area where the flea bite occurred) to the bloodstream. The bacteraemia can cause a coagulopathy, producing the purpura seen in the "black plague," and also may spread to the lungs causing a haemorrhagic pneumonia. It is the pneumonia that can facilitate person-to-person transmission.

Madagascar was the location of the isolation of multi-antimicrobial resistant _Yersinia pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et al. Multidrug resistance in _Yersinia pestis_ mediated by a transferable plasmid. N Engl J Med. 1997;337(10):677-80, PMID: 9278464; available at <http://www.nejm.org/doi/full/10.1056/NEJM199709043371004>). The strain was resistant to chloramphenicol, streptomycin, and tetracycline but sensitive to fluoroquinolones and trimethoprim as well as other aminoglycosides. This was an ominous observation; however, it is not clear whether this naturally occurring strain has persisted or spread. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Antananarivo, Analamanga, Madagascar:
Date: Thu 9 May 2019
Source: UN OCHA, ReliefWeb, UN Children's Fund (UNICEF) report [abridged, edited]

Madagascar: humanitarian situation report, quarter 1 - 2019
-----------------------------------------------------------
Highlights
----------
- Madagascar is facing an unprecedented measles epidemic due to low measles vaccination coverage (58 per cent nationwide). As of 3 Apr 2019 there were 122 840 registered cases, and 1233 reported deaths. The measles epidemic affects 107 out of 114 districts across all 22 regions of Madagascar.

- For the 1st quarter of 2019, UNICEF vaccinated over 1.9 million children under 5 years against measles. UNICEF also prepositioned emergency stocks consisting of medicines and basic equipment in 5 targeted regions.

- The nutritional status of the population of southern Madagascar remains precarious. The October 2018 Integrated Food Security Phase Classification (IPC) results revealed that 970 000 people would be in a food security crisis or emergency between November 2018 and March 2019. From January to March 2019, a total of 6767 severely malnourished children were treated in the UNICEF programme. While, 17 365 mothers were trained in nutrition screening techniques.

- More than 59 166 people gained access to safe water through ongoing water trucking supported by UNICEF and the rehabilitation of 129 boreholes and construction of six new boreholes.

Situation overview and humanitarian needs
-----------------------------------------
Measles
-------
The measles outbreak, which began on 3 Sep 2018, has resulted in 122,840 cases as of 3 Apr 2019. It is a nationwide epidemic, with cases reported across all 22 regions in Madagascar. The epidemic has a national attack rate which is currently 33 042 cases per 1 million inhabitants; demonstrating a high rate of spread. Of concern, measles cases have been exported to Comoros and La Reunion. This epidemic is occurring in a context of poor immunization performance. 2/3 of cases are either unvaccinated or their vaccination status is unknown. There have been 1233 deaths reported among the people with measles. Of these, 640 deaths have been notified in health facilities, and 593 at the community level, of which 191 are measles related and 402 non-classified by the community agents.

In Madagascar, there are basic measures to combat measles as well as good testing expertise, particularly through the Pasteur Institute of Madagascar (IPM). However, due to an overall weak health system, the country does not have the capacity to react to health emergencies of this scale without additional international support.
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[HealthMap/ProMED-mail map of Madagascar:
Date: Thu 28 Mar 2019
Source: Outbreak News Toady from International Federation of Red Cross and Red Crescent Society [abridged, edited]

Number of people to be assisted: 1,946,656 people in the 10 targeted districts
- Direct targets: 524,868 children for immunization
- Indirect targets: 1,421,788 for sensitization

Host National Society presence of volunteers: Malagasy red Cross Society (MRCS) with 12 000 volunteers across the country. Some 1030 volunteers 206 NDRT/BDRTs, 10 full-time staff will be mobilized through the DREF in the 10 districts.

Red Cross Red Crescent Movement partners actively involved in the operation: International Federation of Red Cross and Red Crescent Societies (IFRC), International Committee of the Red Cross (ICRC), German Red Cross, Danish Red Cross, Luxembourg Red Cross, French Red Cross through the Indian Ocean Regional Intervention Platform (PIROI).

Other partner organizations actively involved in the operation:
Ministry of Health, WHO, UNICEF

Situation.
In July 2018, the 1st case of measles was notified in the urban health centre of the district of Antananarivo Renivohitra in Madagascar. According to WHO, from 4 Oct 2018 to 7 Jan 2019, 19 539 measles cases and 39 "facility-based" deaths (case fatality ratio: 0.2%) were reported by the Ministry of Public Health (MoH) of Madagascar. Cases were reported from 66 of 114 total districts in all 22 regions of Madagascar.

In February 2019 (weeks 7-8), an overall 774 new cases were recorded in 3 newly affected districts including Andilamena (145 cases in week 7 and 167 cases in week 8); Mahajanga II (142 cases in week 7 and 241 cases in week 8) and Mahanoro (22 cases in week 7 and 57 cases in week 8). Despite stabilizing in some areas, the above-mentioned spikes show that the epidemic is progressing, and the epidemic is now posing significant risk to remote and hard to reach communities as seen in the table below, which summarizes the rate at which the disease has been spreading, with 7288 new cases in March 2019 (weeks 9-12).

Indeed, from the onset of the outbreak until 20 Mar 2019, some 117,075 cases have been recorded with 638 deaths notified by health facilities, while 567 deaths have been reported within the communities (114 deaths related to measles and 453 unrelated deaths as per community volunteers). As per Ministry of Health (MoH), about 56% of cases are unvaccinated or of unknown vaccine status. Most cases have been reported in children under 9 years old. Some 105 districts are currently in epidemic situation in the overall 22 regions of the country. The increase in cases can be seen in graphs in the pdf listed above.

Madagascar has not suffered any measles outbreaks in the last 13 years (since 2005) and was already on the road to eliminating measles.
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 [See full report in pdf above. - ProMED Mod.LK]
Date: Wed 13 Mar 2019
Source: Outbreak News Today [abridged, edited]

The number of measles deaths has topped 1100 in Madagascar. In an update on the measles epidemic in Madagascar, UN health officials report 6607 cases of measles, including 41 deaths, in the week ending 24 Feb [2019]. Cases are reported in children aged 1 to 14 years. Of 114 districts in all 22 regions, 104 are in the epidemic phase, officials report.
=======================
[The number of cases and deaths from measles in Madagascar is horrifying, even more so since the disease is vaccine-preventable. There is no information on how the health sector in the country is responding, but clearly the clinics are overburdened during this devastating outbreak. - ProMED Mod.LK]

[HealthMap/ProMED-mail map of Madagascar:
Date: Sat 9 Mar 2019
Source: Outbreak News Today [edited]

Plague is endemic in Madagascar, and a seasonal upsurge, predominantly of the bubonic form, usually occurs yearly between September and April. According to the general secretary of the Madagascar Ministry of Health, between 300 and 600 suspected cases are reported each year, with about 30 cases of pulmonary plague and 10 to 70 deaths.

Since August 2018, Madagascar health officials have reported 105 human plague cases. Of these, 91 cases were identified as bubonic plague, while 14 were pneumonic plague. Of the bubonic plague cases reported to date, 19 people have died; 12 of the 14 pneumonic plague cases also perished.

The districts that include confirmed cases of plague are Manandriana, Tsiroanomandidy, Ambositra, Midongy Atsimo, Ambalavao, Befotaka, Ambatofinandrahana, Miarinarivo, Anjozorobe, Faratsiho, Fianarantsoa, Moramanga, Ankazobe, Arivonimamo, Betafo, and Mandoto.

Plague is an infectious disease caused by the bacterium _Yersinia pestis_. It is found in animals throughout the world, most commonly rats but also other rodents like ground squirrels, prairie dogs, chipmunks, rabbits, and voles. Fleas typically serve as the vector of plague. Human cases have been linked to the domestic cats and dogs that bring infected fleas into the house.

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_ [infection] is treatable with antimicrobials if started early enough.
=======================
[Plague infections on Madagascar have been relatively quiet since the dramatic outbreak in 2017.

The following paragraph is from Chanteau S, Ratsifasoamanana L, Rasoamanana B, et al. Plague, a re-emerging disease in Madagascar. Emerg Infect Dis 1998;4(1):101-4, PMID: 9452403; available at <http://wwwnc.cdc.gov/eid/article/4/1/98-0114_article.htm>.  "Between 1930 and 1990, bubonic plague had 'virtually disappeared' on the island due to efficient pest-control and good health management. However since 1990, an annual 200 cases are being reported and bubonic plague takes on epidemic form, especially in the port of Mahajanga, each year. In the capital city of Antananarivo, more cases are also being notified each year since 1990. Madagascar (pop. 13 million) has accounted for 45% of all the cases of plague in Africa."

Fatalities related to plague usually are caused by spread of the organism from the bubo (the very painful infected lymph node that drains the area where the flea bite occurred) to the bloodstream. The bacteraemia can cause a coagulopathy, producing the purpura seen in the "black plague", and also may spread to the lungs causing a haemorrhagic pneumonia. It is the pneumonia that can facilitate person-to-person transmission.

Madagascar was the location of the isolation of multi-antimicrobial resistant _Yersinia pestis_ in 1995 (Galimand M, Guiyoule A, Gerbaud G, et al. Multidrug resistance in _Yersinia pestis_ mediated by a transferable plasmid. N Engl J Med. 1997;337(10):677-80, PMID: 9278464; available at <http://www.nejm.org/doi/full/10.1056/NEJM199709043371004>). The strain was resistant to chloramphenicol, streptomycin, and tetracycline but sensitive to fluoroquinolones and trimethoprim as well as other aminoglycosides. This was an ominous observation; however, it is not clear whether this naturally occurring strain has persisted or spread. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Madagascar:
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Moldova

Moldova - US Consular Information Sheet
October 10, 2008
COUNTRY DESCRIPTION:
Moldova is a republic with a freely elected government. It has been an independent nation since 1991. Its capital, Chisinau, offers adequate hotels and restauran
s, but tourist facilities in other parts of the country are not highly developed, and many of the goods and services taken for granted in other countries are not yet available. Read the Department of State Background Notes on Moldova for additional information.
ENTRY/EXIT REQUIREMENTS: Since January 1, 2007, citizens of the United States, EU member states, Canada, Switzerland, and Japan do not require visas to enter Moldova. For more information on entry requirements, please contact the Moldovan Embassy, 2101 S Street N.W., Washington, D.C. 20008, telephone: (202) 667-1130, (202) 667-1131, or (202) 667-1137, fax: (202) 667-1204, e-mail: moldova@dgs.dgsys.com. Travelers may also wish to consult the Embassy of Moldova’s web site at http://embassyrm.org/en/cons-serv/visas.html for general information on Moldovan visas and for application forms.

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:
The U.S. Government has no information related to the targeting of U.S. citizens, interests or facilities by terrorist organizations in Moldova, and no Americans have been killed or injured as a result of terrorist activity in Moldova. However, the U.S. government remains deeply concerned about the heightened threat of terrorist attacks against U.S. citizens and interests abroad. Americans are reminded to remain vigilant with regard to their personal security and to exercise caution. Because Moldovan Government authorities often ask to see identification on the street, Americans should carry a copy of their passport with them at all times.
There is a separatist regime in control of the Transnistria region that is not recognized by the United States. Consular assistance to American citizens in that region cannot be ensured. Travelers should exercise caution when visiting or transiting Transnistria. Travelers should be aware that there are numerous road checkpoints along roads leading into and out from Transnistria. Taking photographs of military facilities, public buildings, and security forces, including checkpoints along roads leading into and out from Transnistria, is strictly prohibited.

Racially motivated incidents against foreigners and persons of color have occurred in Moldova. Persons of African, Asian, or Arab heritage may be subject to various types of harassment, such as verbal abuse, and denied entrance into some clubs and restaurants. These Americans are also at risk for harassment by police authorities.

In some instances, Americans have become victims of harassment, mistreatment and extortion by Moldovan law enforcement and other officials. Low-level bribery attempts are commonplace in Moldova. These encounters should always be reported to the U.S. Embassy. Moldovan authorities have cooperated in investigating such cases, but those investigations enjoy the greatest chance of success when the officer is identified by name, physical description, or other identifying characteristics. Please note this information if you ever have a problem with police or other officials. Americans who have refused to pay bribes in Moldova generally report no consequences beyond being delayed or inconvenienced.
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: Moldova’s economic difficulties, as well as organized criminal activity and more frequent travel by foreigners to Moldova, contribute to the risk visitors face from street crime, some potentially violent. While this risk is no greater than in most cities in the United States, many Americans have reported theft of money and small valuables from hotel rooms and local apartments. Cases of breaking and entering into homes and offices have occurred. Sexual assault against foreigners is rare. Travelers are wise to exercise the same precautions with regard to personal safety and protection of valuables in Chisinau that they would in any major U.S. city.
Precautions should also be taken when using ATMs in Moldova. Some Americans have reported unauthorized withdrawals from their accounts after using ATMs. Instances have been reported of PIN theft from use of ATMs in Moldova, either by “skimming” devices, which record the ATM card information while in use, or by surreptitious observation.

Train and bus services are below Western European standards and some U.S. citizens have been victims of crimes involving thefts while traveling on international trains to and from Moldova.
Americans who use the Moldovan postal service report frequent losses from international letter and package mail.
Internet Fraud Warning: The Embassy is aware of various confidence schemes that have taken advantage of American citizens, frequently via the Internet. In some cases these involve the purchase or sale of items on the Internet in which the payment or shipment of goods was not completed by a Moldovan counterpart. In the spring of 2006, Moldovan police recovered over $250,000 in jewelry that was sent to “buyers” in Moldova from the United States via fake online escrow companies. Substantial criminal enterprises specializing in this type of crime (Internet auction fraud) have emerged in Moldova. In other cases, American citizens, particularly males, have met potential Moldovan fiancé(e)s on the Internet who have convinced them to send hundreds or even thousands of dollars, but have no intention of a serious relationship. Once the American citizen starts to question the reason for sending the money, the Moldovan fiancé(e)s suddenly ends his/her contact. On occasion, American citizens who come to Moldova to visit someone they have first met over the Internet have reported becoming subject to crimes such as extortion and involuntary detention. American citizens should be aware that any such activity committed by individuals in Moldova is subject to the Moldovan legal system and could prove difficult to prosecute. In the vast majority of cases, there is little that the U.S. Embassy can do to assist American citizens who are defrauded by Moldovans via the Internet.
Please see our information on International Financial Scams.
INFORMATION FOR VICTIMS OF CRIME: The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate. If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, assist you to find appropriate medical care, contact family members or friends and explain how funds could be transferred. Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed.

The local equivalent to the “911” emergency line in Moldova is: 9-0-2 (Police Assistance) or 9-0-3 (Ambulance Assistance)
See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care in Moldova is substandard throughout the country, including Chisinau. In the event of serious medical conditions every effort should be made to go to Western Europe. In the event of emergency, travelers should attempt first to contact the local ambulance service, which is trained to determine which medical facility is most appropriate for treatment and will transport the injured or sick person to that location. Hospital accommodations are inadequate throughout the country and advanced technology is lacking. Shortages of routine medications and supplies may be encountered. Elderly travelers and those with existing health problems may be at particular risk due to inadequate medical facilities. The U.S. Embassy maintains lists of medical facilities and English-speaking doctors, but cannot guarantee or endorse competence. Visitors to Moldova are advised to bring their own supply of both prescription and common over-the-counter medications. Pharmacies are not stocked to Western standards and products are not labeled in English. Poor quality and/or fraudulent medications have been reported.
HIV/AIDS restrictions: Some HIV/AIDS entry restrictions exist for visitors to or foreign residents of Moldova. Short term visitors (periods of less than 90 days) do not require HIV testing. Applicants for residence permits, however, are required to submit to a HIV test and demonstrate that they are HIV negative. Please verify this information with the Embassy of Moldova at www.embassyrm.org before you travel.

Medical Information: Tuberculosis is an increasingly serious health concern in Moldova; the World Health Organization (WHO) has placed it in its “highest risk” category. Travelers planning to stay in Moldova for more than 3 months should have a pre-departure PPD skin test status documented. Given the way TB is transmitted, travelers should consider limiting their exposure to TB by avoiding crowded public places and public transportation whenever possible. Domestic help should be screened for TB. For further information, please consult the CDC's Travel Notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.
Other major health concerns include Hepatitis A (food-borne), Hepatitis B, and Hepatitis C (blood- and body fluids-borne). The incidence of sexually transmitted diseases is as "high" as it is in most developing countries.

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 WHO’s 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 if it will cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.
TRAFFIC SAFETY AND ROAD CONDITIONS: While in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Moldova is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Moldova’s highway infrastructure consists mainly of two-lane roads that often lack markings or signage, are unevenly maintained, and seldom have lighting. Caution should be taken to prevent collisions with agricultural vehicles and/or livestock. Urban roads in Moldova are infrequently maintained and often lack clear signs or lane markings. Travel outside of urban areas before dawn and after dusk should be avoided if at all possible. Drivers and pedestrians should exercise extreme caution to avoid accidents, which are commonplace. Many Moldovan drivers would be considered aggressive or erratic by American standards. Many accidents involve drunk drivers. The quality and safety of public transportation vary widely. Trains, trolleybuses, and buses are often old and may frequently break down. Taxis are available in most urban areas, and vary from old Soviet-era vehicles to newer, Western European or American model vehicles. Emergency services are generally responsive. Police emergency assistance can be called at 902 and emergency ambulance at 903.
Please refer to our Road Safety page for more information. Visit the web site of the Moldova’s national tourist office at http://www.turism.md/
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Moldova, the U.S. Federal Aviation Administration (FAA) has not assessed Moldova’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.
SPECIAL CIRCUMSTANCES: Travelers are advised to register any foreign currency brought into Moldova with customs authorities upon entering the country. It is advisable to contact the Embassy of Moldova in Washington for specific information regarding customs requirements. Please see our Customs Information.
Visas and residency: Current Moldovan Government (GOM) border registration procedures will remain unchanged under the new immigration law. As of January 1, 2007, U.S. and most other foreign nationals arriving in Moldova do not require a visa and are permitted stays of up to 90 days in any given six-month period. At the point of entry (i.e., airport or border), the Border Guard Service enters the traveler’s personal data into a computer program and transfers the data to the GOM’s Population Register. Visitors are not given a paper “registration receipt.” U.S. citizens are able to enter Moldova through Transnistria. However, because they will not have been registered at the border, they will still have to register with the nearest office of the Ministry of Information Development (MID) within three days of arrival in right-bank (western) Moldova.

For stays exceeding 90 days, foreign nationals are required to obtain “immigration certificates” and residence permits from the National Bureau for Migration. Foreign nationals planning to work in Moldova must also obtain a work permit. Immigration, residence and work permits usually need to be extended annually, but may be issued for up to five years.
For more information on registering with Moldovan authorities, U.S. citizens are encouraged to call the Consular section of the U.S. Embassy in Chisinau at (373) (22) 40-83-00.
Requirement to Carry Documentation: As noted above, Moldovan police have the right to request identity documents from any person. Individuals who fail to produce appropriate ID upon request may be subject to detention and fines. Therefore, Americans are advised to carry their U.S. passports (or a copy of their passport’s biographic information page) with registration card, if applicable, or a Moldovan-issued identification document when in public.
Consular Access: Moldovan law enforcement authorities, particularly in the Transnistria region, have an uneven record of reporting the arrest or detention of American citizens to the U.S. Embassy, as required under international agreements. American citizens are therefore advised that if they are detained or arrested by Moldovan authorities, they should immediately request that the U.S. Embassy be contacted. Moldovan authorities have generally respected such requests in a prompt manner.
Photography: Americans who choose to travel in Transnistria should be aware that foreigners have reported being detained or harassed by authorities for taking photographs of military facilities or public buildings. Photography of checkpoints along roads leading into and out from the Transnistria region, or the personnel working there, is prohibited.
Dual Nationality: Recent Moldovan legislation allows dual citizenship. There is no requirement that dual nationals enter Moldova on their Moldovan passports. For further questions, please contact the Moldovan Embassy in Washington, D.C.

Telephone and Postal Services: Outside of Chisinau, travelers may have difficulty finding public telephones and receiving or making international and local calls. Losses have been reported from international letter and package mail, both of which are subject to a customs inspection before delivery. “Express” mail services such as DHL and Federal Express are available in Chisinau, although in most instances prices are high, and shipments arrive from (or reach) the United States in no less than five (5) business days.
Disabled Access: Persons with disabilities should be aware that public facilities and transportation in Moldova are rarely designed or built in a way that allows for wheelchair access. Wheelchair entrances, ramps, lifts or similar accommodations are rare; those that do exist are often below Western standards and/or poorly maintained. Most streets, sidewalks and other public paths are not well maintained and can be hazardous, particularly in poor weather conditions.
Commercial Transactions: Although still generally a cash-only economy, traveler’s checks and credit cards may be accepted in Chisinau, although locations that will accept them outside the capital are still rare. Some vendors require the customer dial in a PIN to authorize a sale by credit card. Caution is advised, however, as some travelers have reported incidents of unauthorized expenditures made on credit cards during or following their use in Moldova, and there have also been reported incidents of fraud and account theft using bank machines (ATMs – see “CRIME” above).
Business in Transnistria: As noted in the Safety and Security section above, a separatist regime controls a narrow strip of land in eastern Moldova known as Transnistria ("Pridnestrovie" in Russian). Individuals considering doing business in Transnistria should exercise extreme caution. The Embassy may not be able to offer consular or commercial services to Americans in Transnistria. Moldovan law requires firms (including those located in Transnistria) to register with the Moldovan Government and to use Moldovan customs seals on their exports. Under a December 2005 agreement between Moldova and Ukraine, Ukrainian customs and border officials require Moldovan customs seals on goods exported from Moldova, including Transnistria, and are enforcing this requirement with EU assistance. Transnistrian firms not legally registered with Moldovan authorities operate in contravention of Moldovan law, which may complicate or prevent the import or export of goods. The Government of Moldova has indicated that it will not recognize the validity of contracts for the privatization of firms in Transnistria that are concluded without the approval of the appropriate Moldovan authorities. A number of Internet fraud schemes have originated in Transnistria.
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 Moldovan laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Moldova are severe, and convicted offenders can expect long jail sentences and heavy fines. Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see 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 Moldova are encouraged to register with the U.S. Embassy through the State Department’s travel registration web site, and to obtain updated information on travel and security within Moldova. 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 in Chisinau, Moldova, Strada Alexei Mateevici 103; telephone: (373)(22) 23-37-72, after-hours telephone: (373)(22) 23-73-45; Consular Section Fax: (373)(22) 22-63-61. The Embassy’s web site is http://moldova.usembassy.gov
* * *
This replaces the Consular Information Sheet dated January 18, 2008, to update sections on Entry/Exit Requirements, Safety and Security, Medical Facilities and Health Information, and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Wed 10 Sep 2014
Source: Jurnal.md [in Romanian, transl., edited]

Cahul: 3 [more] people hospitalized with anthrax
------------------------------------------------
The number of cases of anthrax in the South [of Moldova] increased from day to day. According to the National Center for Public Health, a further 3 people infected with anthrax, cutaneous form, were admitted to the infectious diseases ward in Cahul District Hospital.

Two patients, one woman and her son, were infected from slaughtering a sick sheep. The case was registered for the village of Vadul Isaac, where 6 other people were earlier infected with the same disease after killing [and butchering] a sick calf.

The 3rd patient is a native of the village of Crihana. He became ill after visiting a cattle farm where an animal was slaughtered and butchered in Vad Isaac, which is under quarantine. He was also admitted to the District Hospital in Cahul.

Initially, a man infected with cutaneous anthrax came to the Crihana village hospital. Health of all patients is satisfactory. They are to be discharged after 2 weeks.
-------------------------------------
Communicated by:
Sabine Zentis
Castleview English Longhorns
Gut Laach
D-52385 Nideggen
Germany
======================
[To find Cahul district in south west Moldova on the Romanian border, go to:

So to date we have 9 cases, with one dying. This is probably a sound conservative set of numbers when considering what one sick animal, apparently a "calf", can do. Where more care is taken handling dead animals, the number can be flipped to have one human case for every 10 sick animals butchered or rendered. When there is a bias to only report human cases, it can be a guessing game as to the numbers of animals involved. With thanks, as usual, to Sabine. - ProMed Mod.MHJ]

[A HealthMap/ProMED-mail map can be accessed at:
Date: 5 Sep 2014
Source: Itar-Tass [edited]

A total of 6 workers of a livestock farm in the Cahul district of Moldova have been hospitalized on the suspicion of contracting anthrax, the national Healthcare Ministry said on Friday [5 Sep 2014].

"The patients are in a satisfactory condition, and the illness makes itself manifest mostly in skin lesions, but they have a normal temperature," Viktor Dyatishin, the head doctor of the infectious diseases hospital in Chisinau told reporters. "They will stay at hospital for about 2 weeks until full recovery."

The previous case of anthrax in Moldova was reported last year [2013]. The experts point to the numerous livestock burial sites -- from where anthrax spores can be washed out on to fields and into rivers by rainwater -- as the main source of the incident.

Moldova's sanitary, veterinary and epidemiological services were taking urgent steps on Friday [5 Sep 2014] to localize the dangerous infection.
-----------------------------
communicated by:
Sabine Zentis
Castleview English Longhorns
Gut Laach
D-52385 Nideggen, Germany
******************************
Date: 5 Sep 2014
Source: Press.try.md [edited]

Five people were diagnosed with anthrax yesterday [4 Sep 2014] at the Chisinau infectious diseases hospital. All patients are residents of the Cahul district.

The 1st ill person with symptoms of an open form of anthrax was delivered on Wednesday [3 Sep 2014] to a hospital in the Cahul village of Vadul. He is known to the employee of a private farm in the village.

Under suspicion of doctors were another 4 people. Their relatives say that the 1st symptoms appeared a few days ago, but local doctors gave them the wrong diagnosis. "[He had a fever]; he was sick; his appetite disappeared. [They] gave him headache tablets, but he still complained of feeling unwell."

The woman and her son ate food prepared from contaminated meat. Now they are under the supervision of doctors. "[We bought] half of the cow's head; someone took the other. He has some kind of sore on his leg."

Accidentally or not, one of the men who participated in the slaughter of cattle died. "He died at the hospital. We were not allowed to visit him. The cause of death not reported. He had some sores on his feet."

The mayor of the village said that the owner of the farm knew that the cows were sick but had not reported it to the authorities. "The 1st cases in animals appeared on 9 Aug 2014. Cows died, but the incident was [not] reported to any veterinary service or to the National Centre of Public Health," said the mayor of the village of Vadul.

All 5 were hospitalized in the capital hospital. "The patients are satisfactory; [their] temperature is normal. They will stay with us for about 2 weeks for treatment until they are cured," said the director of the hospital.

Representatives of the agency's food safety say that animals that carry the dangerous disease have not been vaccinated. "The animals were vaccinated. Still, cows were not vaccinated, because they have entered a period of maturation" [whatever that might mean. - ProMed Mod.MHJ], said the head of the agency's food security, Gregory Porchesku.

Epidemiologists went from Chisinau to study the situation on the ground in the Cahul district. Everyone who has been in contact with patients is under the supervision of physicians. A vaccination [campaign] for all the cattle in the village has still to occur.
---------------------------------------------------
communicated by:
Sabine Zentis
Castleview English Longhorns
Gut Laach
D-52385 Nideggen, Germany
==========================
[These Moldovan accounts are confused. The simplest explanation would be that 5 patients are in hospital under treatment doing well and for some reason will be released in 2 weeks time, which is a fair period if they are without a raised temperature. At some point, a 6th person died who had skin lesions. As "suspected" is used in relation to their diseased conditions, it would seem that if any samples were taken for laboratory analysis, the results are not back yet -- that is, the diagnoses were symptomatic, thus the prescription for headache. - ProMed Mod.MHJ]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Sun, 27 Apr 2014 14:12:01 +0200 (METDST)

BRUSSELS, April 27, 2014 (AFP) - Citizens of Ukraine's neighbour Moldova will be granted visa-free travel from Monday to most European Union nations as part of the country's bid to sign an association deal with the EU bloc.

The decision shows that "closer relations with the European Union do bring tangible benefits to all," said the EU's home affairs commissioner Cecilia Malmstroem.   Under the deal, Moldovans carrying a biometric passport will be authorised to travel without a visa for short stays to the Schengen zone, which currently comprises 26 countries, 22 of them members of the 28-nation EU.   Between 50,000 and 55,000 Moldova nationals apply for short-term visas into the EU each year.

Moldova is one of the six former Soviet satellites that the EU hoped to draw into a wide-ranging Eastern Partnership programme on its eastern flank until Armenia, Azerbaijan and Belarus decided to turn back towards Moscow, and Ukraine's ousted leader Viktor Yanukovych too backed out in November at Russia's behest.

Moldova and Georgia however stood firm, initialling the partnership programme in November. They are expected to sign a final association deal with the EU in June.   Wedged between Romania to the west and Ukraine to the east, Moldova's 3.5 million people are Europe's poorest.   In the capital Chisinau there was a mixed response to the new visa-free travel, with a poll showing 50 percent of respondents underwhelmed on the grounds they were either too poor to travel or already owned a Romanian passport opening the door to the EU.
Date: Sun 7 Jul 2013
Source: Liga Novosti [in Russian, trans. ProMed Mod.NP, edited]

The Ministry of Health of Moldova has reported an outbreak of anthrax in the village of Veden, in Soroca district, located in northeast Moldova close to the border with Ukraine. Results of an epidemiological survey of several inhabitants of the village revealed the 4 patients were infected after a meal in which the main dish was freshly cooked beef.

All patients were hospitalized to the Republican Infectious Diseases hospital: one of them is in critical condition and the other 3 are in the moderately severe condition.

Specialists of Ministry of Agriculture of Moldova are providing the measures for the localization of the infection to prevent the spread of infection. [Presumably livestock vaccination and destruction of any contaminated meat. - ProMed Mod.MHJ]
==================
[This outbreak is to the north of the previous report of human cases in Dubasari district (Transnistria) and probably reflects an ongoing problem which gathers few reports.

>From their reports to OIE, anthrax in Moldova is sporadic with few outbreaks. And yet it receives considerable government attention via vaccination. For example, in 2012 vaccination coverage for cattle was 226 871/221 113 (103 percent), sheep & goats 937 421/908 079 (103 percent), horses 40 722/49 319 (83 percent), and pigs 3636/496 634 (0.7 percent). Outbreaks occur among pigs almost as frequently as reported for cattle. The last reported outbreak in sheep and goats was in 2004. With this level of vaccination the disease is clearly of concern, and possibly the problem is of poor reporting and poor usage of the vaccines distributed.

A HealthMap/ProMED-mail interactive map of Moldova can be seen at <http://healthmap.org/r/7ytP>.

To find Soroca district in northeastern Moldova, go to

Our thanks to Natalia for the translation. - ProMed Mod.MHJ]
Date: Tue 18 Jun 2013
Source: EVZ.ro [in Romanian, trans., edited]

A suspected case of anthrax has been recorded in Dubasari in Transnistria, in a private household.  According to Tiraspol press, the results of laboratory tests are currently expected to determine if it really is about the disease "mad cow". [Why is "mad cow" not explained? - ProMed Mod.MHJ]

The Regional Veterinarians normally take preventive measures to avoid the possible spread of the disease. Local media did not specify what it is, and the Dubasari President, Gregory Policinschi, did not know any details.

The last case of anthrax disease of animals in Moldova was registered in March last year [2012, in Riscani], and in 2011, 2 [porcine] cases were reported. Anthrax is a potentially fatal disease caused by the bacterium _Bacillus anthracis_. It occurs in cattle, horses, sheep, and goats.  [Byline: Roxana Roseti]
-----------------------------------------------
Communicated by:
Sabine Zentis
Castleview Pedigree English Longhorns
Gut Laach
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=========================
[As at least one of the 2 cases in Dubasari has died I think we can presume that this report refers to livestock cases, and as they quote "mad cow" probably bovine.  A HealthMap/ProMED-mail interactive map of Moldova can be seen at <http://healthmap.org/r/7pn0>. For the location of Dubasari and Transnistria in a map of Moldova, go to <http://www.lib.utexas.edu/maps/commonwealth/moldova_pol01.jpg>; Dubasari Province is currently under the administration of the breakaway government of the Moldovan Republic of Transnistria. - ProMed Mod.MHJ]
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World Travel News Headlines

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: Sun, 20 Oct 2019 21:29:49 +0200 (METDST)

Paris, Oct 20, 2019 (AFP) - French rail services ground to a halt in parts of the country Sunday as workers walked off the job for a third day in a dispute over train staffing levels, stranding holiday travellers.   Services in the Paris suburbs, the northeastern Champagne-Ardenne region and the southern Occitanie region, which includes Toulouse and Montpellier, were particularly affected.   The state railway company SNCF said most services would return to normal on Monday.

The industrial action began on Friday after a train in north-eastern France slammed into a truck at a level crossing, injuring 11 people.  The train driver was himself among those hurt but being the sole employee of state railway company SNCF on board had to help take care of passengers.   Unions said the incident highlighted understaffing on trains, notably the absence of ticket inspectors on some lines.

Since Friday, staff have been exercising their "right to withdraw" their labour -- a clause that allows workers to walk off the job in case of "clear and present danger to their life or health".   SNCF's management has accused the workers of abusing that right on a busy weekend for train travel, at the start of the mid-autumn school holidays.   It argues that some train lines have not had ticket inspectors for decades.
Date: Sun, 20 Oct 2019 17:53:19 +0200 (METDST)

Frankfurt am Main, Oct 20, 2019 (AFP) - Cabin crew at four Lufthansa subsidiary airlines staged a day-long strike Sunday, causing dozens of cancellations at German airports in a battle for better pay and conditions.   The walkout, called by the UFO cabin crew union, was initially set to last from 5:00 am until 11:00 am (0300-0900 GMT) but a worsening spat with Lufthansa bosses prompted the union to extend the strike until midnight.

The industrial action at Eurowings, Germanwings, SunExpress and Lufthansa CityLine led to over 100 flight cancellations, mainly hitting short-haul journeys at Hamburg airport, Munich, Berlin-Tegel, Cologne and Stuttgart, according to DPA news agency.   Frankfurt airport, the country's busiest, reported "only a few" cancellations, affecting CityLine flights.

In a statement, UFO said it had ramped up the strike after the Lufthansa group told employees the walkouts were "illegal" and "endanger your jobs".   "This is not only wrong, it also signals the next level in the threats against cabin crew colleagues," UFO said. "This behaviour must be stopped."   But the Lufthansa group downplayed the impact of the strike, with a spokesman telling DPA that "more than 90 percent of the crew members showed up on time for their shift".

The union had previously called off plans for Lufthansa workers to join Sunday's warning strike after the company offered a surprise two-percent pay hike to flight attendants at the flagship airline.   But other demands for better conditions have yet to be met and UFO has not ruled out further action, with fresh talks at all five airlines scheduled for Monday.   Bosses at the Lufthansa group believe UFO may no longer have the legal right to speak for workers and have challenged its status in court.   Internal disputes at the union have cost it members and support among cabin crew, some of whom have now turned to other representative organisations.
Date: Sun, 20 Oct 2019 06:45:19 +0200 (METDST)

Niamey, Oct 20, 2019 (AFP) - Floods in southeast Niger have forced 23,000 people to flee their homes since early October, officials said Saturday, threatening a new humanitarian crisis in a region already wracked by Boko Haram Islamist violence.   Heavy rains have caused the Komadougou Yobe river that flows through the semi-desert Diffa region into Lake Chad to burst its banks, inundating villages, flooding fields and damaging crops.   Two villages near the city of Diffa were "completely submerged" and 2,500 households have been forced to move, according to national radio the Voice of the Sahel.

Some 400 families were sheltering in a gym in the city, it added.   "We have been fighting for days to stop the water rising, but it's not working," Amadou Issa, a rice farmer, told AFP. "The sandbags we've been using to keep the water out are completely under water."   Extreme weather events are common in Niger, one of the world's poorest countries.   Between June and September 57 people were killed and more than 130,000 affected by flooding according to government figures.

The capital Niamey was hit badly in September, with the waters of the Niger river -- the third biggest in Africa -- rising to a level not seen in more than 50 years and swamping parts of the city.   Last year, drought and flooding led to food shortages in a crisis which, exacerbated by jihadist violence, left more than 10 percent of the population needing humanitarian aid.   Niger, along with neighbouring Burkina Faso, Chad, Mali and Mauritania is also struggling against escalating attacks by armed Islamists.   According to the UN's human rights agency UNHCR, the Diffa region is home to almost 120,000 refugees and 109,000 internally displaced people.
Date: Fri, 18 Oct 2019 22:45:46 +0200 (METDST)

Washington, Oct 18, 2019 (AFP) - The US moved to further hurt Cuba's vital tourism industry by tightening the ability of the country's airlines to lease aircraft.   The US Department of Commerce said it was revoking existing licenses for US companies leasing aircraft to Cuban carriers, and will deny future applications for aircraft leases.   The move could make it harder for Cuba to service its rapidly growing tourism sector, a key source of foreign revenue for the poor country.

Washington has stepped up pressure on Havana due to its support for the embattled regime of Venezuelan President Nicolas Maduro.   "This action by the Commerce Department sends another clear message to the Cuban regime -- that they must immediately cease their destructive behaviour at home and abroad," Secretary of Commerce Wilbur Ross said in a statement.

It was not immediately clear how many aircraft the move would impact.   Cuba's cash-poor carriers depend on aircraft rented from leasing companies or other airlines, which are often very old.   In May 2018, 112 people died in the crash of a 39-year-old Boeing 737 leased by national carrier Cubana de Aviacion from a small Mexican firm, Global Air.

In June of this year, US President Donald Trump announced a US ban on cruise ship stopovers by Americans on the island, forcing Havana to cut its 2019 tourism target by 15 percent to 4.3 million visitors.   Nearly 900,000 tourists visited the island on cruise ships last year, and almost 40 percent were American, according to official figures.   The announcement Friday also expanded restrictions on imports from Cuba and on products with US content that can be sold to the country.
Date: Fri, 18 Oct 2019 15:43:29 +0200 (METDST)

Accra, Oct 18, 2019 (AFP) - Floods caused by eight days of torrential downpours in north-eastern Ghana have left 28 people dead and displaced hundreds, officials said Friday.     "At the moment the death toll is 28. About 640 people in some six communities have been displaced and we are providing shelters for them," George Ayisi, spokesman for the National Disaster Management Organisation, told AFP.    "We've counted about 286 collapsed houses during this disaster and that is making life difficult for the people."

Relief items were being transported 800 kilometres (500 miles) by road from the capital Accra to the affected region on the border with Burkina Faso as meteorologists warned the rains could last into November.    "We have to just prepare for anything," Ayisi said.   So far this year 46 people have been killed in floods in the West African nation, the disaster relief agency said.   Flooding in northern and other parts of Ghana happens each year during the rainy season.    Last year, 34 people died in northern Ghana during flooding caused by heavy rains and waters spilling from a dam in Burkina Faso.
Date: Fri, 18 Oct 2019 04:33:10 +0200 (METDST)
By Patrick FORT

Bobo-Dioulasso, Burkina Faso, Oct 18, 2019 (AFP) - "They've placed us in the red zone, which means the tourists aren't coming like before. Even the aid workers don't come," said Antoine Atiou, governor of Burkina Faso's Hauts-Bassins region.   The "red zone" refers to the risk of jihadist attacks -- a top-end warning by Western embassies to travellers wanting to visit southwest Burkina and the economic capital, Bobo-Dioulasso, once a popular tourist destination.   The impact has been brutal for local businesses. The city's hotels have emptied, its heritage sites are quiet and the souvenir shops shuttered.    "It's hard, hard, hard!... We haven't seen a tourist for a fortnight," said Sanou Moumouni, a guide at the city's mosque and in the historic Kibidwe district for 22 years.   In the past he could sometimes earn 100,000 CFA francs ($167, 150 euros) in two days, he said, but he has not made 5,000 francs in the last three months.    "I'm living on loans," he said. "We no longer have work because of the murderers. We're sick of it."    The north and the east of the landlocked country in West Africa endure frequent Islamist attacks, which have claimed some 600 lives in the past four years. There have also been some raids in the west.

In December 2018, an Italian man and his Canadian companion were kidnapped on the road from Bobo to the capital Ouagadougou. Last April, the Burkinabe government said it had information that the couple was still alive, but might have been taken to another country.   Bobo-Dioulassou itself has been relatively spared as the jihadist threat expands across poor nations of Africa's Sahel region.   Ministry of tourism statistics from 2017 show that of about half a million annual visitors to Burkina Faso, fewer than 150,000 came from abroad -- down 5.6 percent from 2015.   The number of nights stayed in the country by Westerners fell from 30,000 in 2012 to fewer than 15,000 in 2017. "This trend has probably sped up in 2018 and 2019," a local tour operator said.

- Crafts and wonders -
Renowned for its traditional masks, its batik print textiles and the balafon -- a West African instrument like a xylophone -- Bobo attracted thousands of Western tourists.   The Lonely Planet guide, which notes the security situation currently prohibits travel, says the city's "tree-lined streets exude a languid, semitropical atmosphere that makes it a favourite rest stop for travellers", adding that highlights include a "thriving live-music scene and excellent restaurants". 

The city itself has an array of charms, with its grand railway station, bustling market and striking Great Mosque -- an undulating white-plastered mud structure studded with wooden poles that dominates the historic centre.   Bobo-Dioulasso is a jumping-off point to visit regional highlights like the ruined fortress of Loropeni, a UNESCO World Heritage Site. It was also a base for exploring the Dogon country in Mali, Ivory Coast and Ghana.   "Everyone came through Bobo. We really were a tourist region. Now it's over," said Benjamin Ouedraogo, owner of the Watinoma hotel and president of the professional association of hotel and restaurant owners in High Basins.   He said hotels in the region only do a third of the business they did before the attacks   To avoid closing his hotel, Ouedraogo took on a second job in the building trade. "We asked for help, but state aid is a disaster," he said, explaining that the authorities rejected applications for tax rebates and preferential tariffs on water and electricity.

- 'We subsist' -
In Kibidwe, an old neighbourhood of the city near the mosque, children play in alleys and women wash clothes in the open air, but most of the shops that catered for tourists are now shut.   Sanon Bissiri, an artist, was quick to bring out his batik prints on spotting Western journalists.    "I don't hang them every day any more, that's pointless. Since July, I haven't even sold two. All this because of those jihadists. Now I have to do masonry whenever I'm wanted."   Bissiri used to sell his textiles to an Italian association that made regular visits.   "That's over. We just get by. It's my wife who meets our needs," he said. "I come in to work each day on foot, six kilometres (nearly four miles). I can't afford medicine for my son with his cough."   Bobo's nightlife is not what it was, though the locally-brewed beer is the same.    "There's still a little activity with Burkinabe visitors," said musician Gaoussou Ben Sanou. But "there's less money, fewer dates, fewer gigs. We can't sell records".   Governor Atiou said people were reluctant to go out.   "All that weighs on economic activity. Unfortunately, this is the aim of the terrorists."
Date: Thu, 17 Oct 2019 12:37:14 +0200 (METDST)

Manila, Oct 17, 2019 (AFP) - Five people were killed and dozens were injured after a powerful earthquake hit the southern Philippines, authorities said Thursday.   The 6.4-magnitude quake struck the Mindanao region on Wednesday night, reducing dozens of houses to rubble on the southern third of the Philippines.   On Thursday afternoon, authorities said five people were killed and 53 injured, mainly in a cluster of small farming towns.   Three people were killed in landslides while another was crushed by the collapsed wall of a house. The fifth suffered a fatal heart attack, the National Disaster Risk Reduction and Management Council said.   No fatalities were reported in Mindanao's major cities. Local authorities had earlier told AFP three children were among the dead.   The Philippine seismology office has recorded more than 300 weaker aftershocks in the area since the big quake, but authorities said they do not expect the toll to rise significantly.

The disaster council's spokesman Mark Timbal told local television it had not received any reports of missing people from any of the quake-hit areas.   "People have returned home... They are OK now, unlike last night when they were terrified and slept on roads beside their homes," Zaldy Ortiz, civil defence officer of Magsaysay town, told AFP.   Local school and government holidays were announced in Magsaysay, where the landslides struck, to allow building inspectors to check structures for damage, Ortiz added.   Power was being restored in the bigger cities, but there was substantial damage to some hospitals, government buildings, schools, churches and houses in the small towns, the council said in a report.   In General Santos City, firefighters on Thursday finally put out a blaze that started at a shopping mall shortly after the quake.   The Philippines is part of the Pacific "Ring of Fire", an arc of intense seismic activity that stretches from Japan through Southeast Asia and across the Pacific basin.
Date: Thu, 17 Oct 2019 05:32:08 +0200 (METDST)
By Tom LITTLE

Kulusuk, Denmark, Oct 17, 2019 (AFP) - Kayaking past blue-white icebergs drifting along near a pristine harbour, wandering around colourful houses or trekking in the snow-capped wilderness: July and August are high season for tourists in eastern Greenland.   Many of the 85,000 tourists who visit each year head to the west coast, but eastern Greenland, with its glaciers, wilderness and wildlife starring whales and polar bears, is also drawing visitors.

Sarah Bovet, a 29-year-old Swiss artist, said it's hard to know what to expect.   "Thinking you're going to be surprised, you are even more so in reality," she said standing outside a hostel in the tiny village of Kulusuk.   Bovet was on an artistic residency in Greenland when she visited Kulusuk and its 250 souls.   Although she had imagined a small village before arriving, its stunning views and bright colours still came as a surprise.   With just one supermarket, an airport built in the 1950s by the US military to serve a Cold War radar base, and a harbour surrounded by brightly painted wooden houses, most of the villagers appreciate the extra revenue from tourism.

Justus Atuaq, a young hunter in Kulusuk, takes tourists out on sled tours in March and April -- the spring high season -- earning money that helps him feed and care for the dogs he uses for racing and hunting.   "Now I can take dogsleds for hunting, and sometimes tourists coming from other countries also want to dogsled," he said outside his wooden house.   Tourists also take boat trips during the summer high season from July to August.   Arrivals to the island grew 10 percent year-on-year from 2014 to 2017, and three percent in 2018, according to the tourist board, Visit Greenland.   Many adventure seekers and nature lovers arrive by plane, but cruise ships also bring admirers, hugging the picture perfect coastline.

- Growing strategic importance -
But they are not alone in taking an interest in the world's largest island.   The Danish territory's rich natural resources and growing strategic importance as the Arctic ice sheet melts have attracted the attention of US President Donald Trump.   The Arctic region has untapped reserves of oil, gas and minerals, as well as abundant stocks of fish and shrimp.   In August, Trump offered to buy Greenland, then called off a visit to Copenhagen over its refusal to sell.

Denmark colonised Greenland in the 1700s, granting it autonomy in 1979.    Today, many Greenlandic political parties advocate full independence.   The territory still receives an annual subsidy from Copenhagen, which was 4.3 billion Danish kroner (576 million euros) in 2017, and tourism could help it to become economically self-reliant.   Like many parts of Greenland, Kulusuk has no tarmac roads and visitors must travel by plane or boat.   The growth in tourism could put a strain on the village's infrastructure, and the sector faces unique challenges given Greenland's location, weather and the cost of travelling there.

Day tours of Kulusuk with flights from the Icelandic capital Reykjavik are 97,000 Icelandic kronur ($780, 700 euros).   Jakob Ipsen, a 48-year-old who grew up between Denmark and Greenland's west coast, runs Kulusuk's sole hotel.   The 32-room hotel stands beside a fjord, and from its dining room, guests can watch icebergs drift by during the summer.    But the region's isolation can be problematic, Ipsen admits.    "We have to get all our supplies in with the first ship for the whole summer season, and for the winter season when everything is frozen over, we have to get all our supplies in with the last ship for the whole winter," he said.

- 'They go back as different people' -
Greenland must tackle its infrastructure challenges if it wants to develop tourism, Visit Greenland says.   Government-funded work is under way to extend runways at the capital Nuuk and Ilulissat, both on the west coast, and a new airport is planned in the south.   The tourist body said it would weigh the environmental impact of boosting infrastructure, both on the environment and on local communities.    Ipsen worries about the effects of uncontrolled tourism to the region.   "We want to try to maintain it as it is, so it's not exploding," he said.

Already, said Johanna Bjork Sveinbjornsdottir, who runs tours in Kulusuk for an Iceland-based company, the rise in visitor numbers is making itself felt.   "In the campsites here out in nature where you used to be alone, there's two, three groups at a time," she said.   Like Ipsen, she is also concerned about the effect that rising visitor numbers could have on the wilderness around the village.    "If you want nature to survive that, you have to build up the infrastructure," she said, pointing to the lack of officially designated campsites around Kulusuk, with no rubbish bins or toilets for travellers outdoors and no one supervising the sites.   Despite the concerns, Sveinbjornsdottir hopes visitors will keep coming.   "They go back as different people," she said. "Everything is beyond what you ever imagined."
Date: Tue, 15 Oct 2019 19:33:58 +0200 (METDST)

Beirut, Oct 15, 2019 (AFP) - Lebanon has turned to its neighbours for help battling forest fires that have ravaged homes and killed a volunteer firefighter in the Mediterranean country, its premier said on Tuesday.   Heavy rain fell on parts of the country including Beirut in the evening, after Cyprus dispatched help and as Greece and Jordan vowed to follow suit.   "We have contacted the Europeans who will send means of help," Prime Minister Saad Hariri said earlier in comments carried by national news agency NNA.

Dozens of blazes have hit Lebanon in recent days, fire chief Raymond Khattar told NNA, amid unusually high temperatures and strong winds.   Thick smoke had been seen drifting over the outskirts of Beirut, the mountainous Chouf region to its southeast, and the southern city of Saida.   In the Chouf, an area famed for its forests, a volunteer firefighter lost his life trying to put out the flames, his family said.   In an area south of Beirut, firefighters have for two days been unable to stop the blaze, which has burnt four homes to the ground and caused dozens to suffer breathing difficulties, NNA said.

Interior Minister Raya El-Hassan said nearby Cyprus and Greece had responded to Lebanon's call for help.   "Two Cypriot planes have been working to put out the fires since yesterday," she said on Twitter.   "Greece has responded to our request and will send two planes to help us," she added.   Jordan's army said the king had ordered two firefighting planes to be dispatched.   NNA said the army was working together with helicopters and the Cypriot planes to fight the blaze, with access sometimes impeded by thick smoke and high-voltage power lines.   Personnel from UN peacekeeping force UNIFIL, who usually patrol the country's southern border with Israel, have also joined in the efforts, the agency said.   Lebanese on social media criticised the government's apparent inability to respond fast enough on its own.

In neighbouring war-torn Syria, fires also killed two people, Syrian state media said.   Flames have ripped through parts of the coastal provinces of Latakia and Tartus, as well as the central province of Homs but most have been brought under control, state news agency SANA said.   Two members of the Latakia forestry department were killed while fighting the blaze, it added.   In Tartus, the fires -- mostly stamped out -- coincided with the olive harvest, the governor told SANA.   In Homs, trees were burnt and electricity networks disrupted in mountainous areas, the agency reported.