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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

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.
Date: Thu, 19 Sep 2019 18:32:25 +0200 (METDST)

Khartoum, Sept 19, 2019 (AFP) - Sudan said on Thursday that the number of cases of cholera reported in the country have surged to 124, most of them in the war-torn state of Blue Nile.   The health ministry said the disease had been reported in the states of Blue Nile and Sinnar.

Of a total of 124 cases reported so far, 101 were in Blue Nile and the remaining in Sinnar, the ministry said in a statement.   Experts from the World Health Organization have been sent to the two regions, the ministry said.   Last week, the ministry reported four cases of cholera in Blue Nile.   It also said that three deaths from acute diarrhoea had also been reported in Blue Nile.   WHO at the time said it was working closely with health authorities in Blue Nile to tackle cholera cases there.

A WHO official in Sudan warned cholera and other diarrhoeal diseases could spread if no action was taken, due to "suboptimal health conditions" as well as poor water and sewage infrastructure, exacerbated by floods.   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.
Date: Tue, 10 Sep 2019 13:02:19 +0200 (METDST)

Khartoum, Sept 10, 2019 (AFP) - Sudan reported four confirmed cases of cholera in Blue Nile Tuesday and said three people had also died of acute diarrhoea in the war-torn state.   Health Minister Akram al-Toum has asked the World Health Organization to send supplies of cholera vaccine immediately, the ministry said.

Ministry and WHO officials have been sent to the affected area.   "There are 37 cases of acute diarrhoea in Blue Nile... There have been three deaths," the ministry said in a statement.   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]
More ...

Iceland

Iceland US Consular Information Sheet
November 17, 2008
COUNTRY DESCRIPTION:
Iceland is a highly developed, stable democracy with a modern economy.
The national language is Icelandic, but English is widely spoken, especially in the ca
ital city of Reykjavik.
Read the Department of State Background Notes on Iceland for additional information.

ENTRY/EXIT REQUIREMENTS:
Iceland is a party to the Schengen agreement.
As such, U.S. citizens may enter Iceland for up to 90 days for tourist or business purposes without a visa.
The passport should be valid for at least three months beyond the period of stay.
For further details about travel into and within Schengen countries, please see our fact sheet.
For further information in English concerning entry requirements for Iceland, please contact the Icelandic Directorate of Immigration via their web site at www.utl.is.

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 have been no terrorist attacks and very few criminal attacks affecting Americans in Iceland.
However, like other countries in the Schengen area, Iceland’s open borders with its Western European neighbors allow the possibility of terrorists or other criminals entering/exiting the country with anonymity.
Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

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

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

CRIME:
Iceland has a relatively low crime rate, but minor assaults, automobile break-ins and other street crimes do occur, especially in the capital city of Reykjavik.
Tourists should be aware that downtown Reykjavik can become especially disorderly in the early morning hours on weekends.
Violent crime is rare, but it does occasionally occur.

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft of a U.S. passport abroad 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.
Iceland maintains a limited crime victim’s assistance program through the Ministry of Justice.
Please contact the U.S. Embassy in Reykjavik for further details.
Those suffering psychological trauma or who are victims of rape may receive psychological assistance by contacting the University of Iceland’s Hospital Psychological Trauma Center at 354-543-2000. For further information about possible U.S. compensation, see our Information for Victims of Crime
The local equivalent to the “911” emergency line in Iceland is:112.
MEDICAL FACILITIES AND HEALTH INFORMATION:
Excellent medical facilities are available in Iceland.
To obtain emergency medical assistance anywhere in the country, dial 112.
To obtain non-emergency medical assistance in the Reykjavik metropolitan area dial 544-4114 during business hours and outside of normal business hours, dial 1770.
The nurse who answers will offer advice on how to handle the problem, suggest that the patient come to an after-hours clinic, or send a physician to make a house call.
For information on after-hours dental care, call 575-0505.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Iceland.
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 web site at http://www.who.int/en.
Further health information for travelers is available at http://www.who.int/ith
MEDICAL INSURANCE:
Most medical services in Iceland, including emergency care, require full payment at the time of service.
Payment to the medical facility must be paid in full before an individual will be able to leave the country.
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.
Additional travel insurance to cover the price of medical evacuations is also strongly recommended.
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 Iceland is provided for general reference only, and may not be completely accurate in a particular location or circumstance.

Less than a third of Iceland’s total road network is paved (2,262 miles of paved road vs. 5,774 miles of gravel or dirt road).
Most of the 900-mile ring road (Highway 1) that encircles the country is paved, but many other roads outside the capital, especially those that run through the center of the country, are dirt or gravel tracks.
Even those roads that are paved tend to be narrow and lack a shoulder or margin.
Most bridges are only one lane wide, requiring drivers to be cognizant of oncoming traffic.
Extreme care should be taken when driving in rural areas during the winter (October through March), when daylight hours are limited and the weather and road conditions can change rapidly.
Many routes in the interior of the country are impassable until July, due to muddy conditions caused by snowmelt.
When driving in the interior, consider traveling with a second vehicle and always inform someone of your travel plans.
For information on current road conditions throughout the country, please call the Public Roads Administration (Vegagerdin) at 1777 or consult its web site at http://www.vegagerdin.is/english/.

For recorded weather information in English, call the Icelandic Weather Office (Vedurstofa Islands) at 902-0600, press 1 for English.

Icelandic law requires drivers to keep headlights on at all times.
Talking on cell phones while driving is prohibited and is subject to a 5000 Icelandic Kronur fine, except when using a hands-free system.
Unless otherwise posted, the speed limit is 50 km/h in urban areas and 30 km/h in residential areas.
In rural areas, the speed limit depends on the type of road.
On dirt and gravel roads, the speed limit is 80 km/h.
On paved highways, the speed limit is 90 km/h.
It is illegal to turn right on a red light.
At four-way intersections, the right of way goes to the driver on the right; in traffic circles, to drivers in the inside lane.
Many intersections in the capital have automatic cameras to catch traffic violators.

The use of seatbelts is mandatory in both the front and rear seats, and children under the age of six must be secured in a special car seat designed for their size and weight.
Drivers are held responsible for any passenger under the age of 15 who is not wearing a seatbelt.
No one who is less than 140 centimeters tall, weighs less than 40 kilograms, or is under the age of 12 is allowed to ride in a front seat equipped with an airbag.

Driving under the influence of alcohol is considered a serious offense in Iceland.
The threshold blood alcohol test (BAT) level is very low.
Drivers can be charged with DUI with a BAT as low as .05%.
Drivers stopped under suspicion of DUI are usually given a ``balloon’’ or Breathalyzer test.
If the test is positive, a blood test is routinely administered.
Under Icelandic law, a blood test cannot be refused and will be administered by force if necessary.
The minimum punishment for a first offense is a fine of 50,000 Icelandic Kronur and the loss of driving privileges for two months.
U.S. citizens spending less than 90 days in Iceland may drive using their U.S. licenses.

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

SPECIAL CIRCUMSTANCES:
Extreme care should be exercised when touring Iceland's numerous nature attractions, which include glaciers, volcanic craters, lava fields, ice caves, hot springs, boiling mud pots, geysers, waterfalls, and glacial rivers.
There are few warning signs or barriers to alert travelers to potential hazards.
Several tourists are scalded each year because they get too close to an erupting geyser, or because they fall or step into a hot spring or boiling mud pot.
High winds and icy conditions can exacerbate the dangers of visiting these nature areas.
Hikers and backpackers are well advised to stay on marked trails, travel with someone, notify a third party about their travel plans and check weather reports, as there are often no means of communication from remote locations.
This is especially important as weather conditions in Iceland are subject to frequent and unexpected changes.
Those planning visits to dangerous or remote locations in Iceland are strongly encouraged to register with the U.S. Embassy before beginning their journey and to leave a travel itinerary with local guides/officials if planning to trek through remote parts of the country.
See below for information on how to register.

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 Icelandic laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use or trafficking in illegal drugs in Iceland are strict, 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.

DISASTER PREPAREDNESS:
Iceland is subject to natural disasters in the form of earthquakes, volcanic eruptions, avalanches, and violent storms.
Travelers should learn how to prepare for and react to such events by consulting the web site of Iceland's National Civil Defense Agency at http://www.almannavarnir.is.
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.

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 in or visiting Iceland 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 Iceland.
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 Laufasvegur 21, tel. +354-562-9100; fax +354-562-9110.
Information about consular services can be found in the Consular section of the Embassy home page at http://iceland.usembassy.gov
* * *
This replaces the Country Specific Information sheet dated May 7, 2008 to update the sections on Information for Victims of Crime and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Sat 13 Jul 2019
Source: Food Safety News [edited]

At least 3 children have developed kidney failure after being diagnosed with _Escherichia coli_ infections that are linked to eating ice cream from a farm. A cluster of infections due to Shiga toxin producing enterohemorrhagic _E. coli_ (EHEC) O26:H11 has been traced to the tourist attraction Efstidalur II farm in Blaskogabyggd in the south of Iceland.

The 17 ill children are aged between 14 months and 12 years. At least 3 of them developed haemolytic uremic syndrome (HUS), a severe condition associated with _E. coli_ infections that causes kidney failure. Around one-third of employees at the farm have also been investigated, but none tested positive for the bacterium.

It was initially suspected that children who fell ill after visiting the farm were infected because of contact with calves, but further investigation found some children had no contact with this animal while 9 had eaten ice cream and the 10th child was infected by a sibling.

Product testing of ice cream did not find the outbreak strain, but samples were not the same as what the children had eaten, as new product was being sold. An investigation found the _E. coli_ strain that infected the children was also detected in faeces from calves.

Officials from the Directorate of Health urged anyone who had visited the farm between 10 Jun 2019 and 4 Jul 2019, and developed diarrhoea within 10 days, to contact a doctor to be tested for the bacterium. "After contact with animals, before eating or preparing food and especially after caring for individuals with diarrhoea, hand-washing with soap and water is strongly recommended. Alcohol-based hand-sanitizer is an optional addition but may not be sufficient on its own against many causes of diarrhoea," added the agency.

The Icelandic Food and Veterinary Authority (Matvaelastofnun) recently detected EHEC in 30% of lamb samples and 11.5% of beef samples it tested. Of 148 samples of Icelandic sheep meat, 44 samples were positive for EHEC, and in the 148 samples of domestic and foreign beef, 17 samples were contaminated.

Symptoms of infections caused by EHEC include abdominal cramps and diarrhoea. The incubation period can range from 3 to 8 days and many people recover within 10 days.  [byline: Joe Whitworth]
=======================
[It may well be that contact with the calves was the initial transmission event and the ice cream eating using unwashed hands facilitated transfer. Alternatively, since the outbreak strain was found in calves, were there milk-producing cows present, and, if the ice cream was made there, was the milk used to make the ice cream pasteurized?

Three of 17 cases developing HUS is a high proportion. Some strains seem to produce a higher risk of HUS, but the use of antimicrobials early in the infection can increase the risk of HUS. In episodes of diarrhoea (with or without blood) with significant abdominal pain and little or no fever, EHEC must be suspected and antimicrobials withheld. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Iceland:
Date: Thu 4 Jul 2019
Source: Outbreak News Today [edited]

Iceland health officials have reported 4 paediatric Shiga toxin-producing E. coli (also called enterohemorrhagic E. coli [EHEC]) cases. Officials say all the children are from the capital of Reykjavik; however, all have probably been infected in Arnessysla county or, more specifically, in Blaskogabyggd.

The source of the infection is unknown at this time. The Icelandic Food and Veterinary Authority and the South Iceland Health Inspectorate are now working to analyse the origin of the infections and stop further spread.

Health officials say individuals who have been in Arnessysla (Blaskogabyggd) in the past 2 to 3 weeks and sickened with bloody diarrhoea are encouraged to seek medical advice so that they can check whether they have been infected with [EHEC].

The symptoms of [EHEC] infections vary for each person but often include severe stomach cramps, diarrhoea (often bloody), and vomiting. If there is fever, it usually is not very high (less than 101 deg F/less than 38.5 deg C). Most people get better within 5 to 7 days. Some infections are very mild, but others are severe or even life-threatening.

The Icelandic Food and Veterinary Authority recently analysed the presence of pathogenic bacteria in meat in the Icelandic market. It was found that [EHEC] bacteria are found in 30% of lamb and 11.5% of beef. In addition, the bacteria can be found in unpasteurized milk.
========================
[The serotype of EHEC involved is not stated, and it is not entirely clear whether the cases are related to the same food or are even the same serotype. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Thu, 14 Mar 2019 18:17:56 +0100

Reykjavik, March 14, 2019 (AFP) - Iceland has blocked the millions of tourists who descend upon the volcanic island each year from visiting a canyon that has been overrun since it was featured in a Justin Bieber music video.   An influx of tourists and a humid winter have disrupted the Fjadrargljufur canyon's fragile ecosystem, so the Environment Agency of Iceland has closed the site to the public until June 1.   "During periods of thaw, the path is completely muddy and is practically unusable for hikers," agency advisor Daniel Freyr Jonsson told AFP on Thursday.   "Because the mud is so thick, visitors step over the fences and walk parallel to the path, which rapidly damages the plant life," he added.

Fjadrargljufur is a gorge about 100 meters (yards) deep and two kilometres (1.25 miles) long, with steep green walls and a winding riverbed. The canyon was created by progressive erosion from water melting from glaciers 9,000 years ago.   The canyon was little known to foreigners until the end of 2015, when Canadian singer Justin Bieber featured the site in his song "I'll Show You".   "Visits to the site have risen by 50 to 80 percent per year since 2016," said Daniel Freyr Jonsson, estimating that around 300,000 people visited the canyon in 2018.   A growing number of tourist sites in Iceland have been closed in a bid to
preserve them.

The popular Reykjadalur valley and its hot springs were temporarily closed in April 2018 and a hiking trail overlooking the Skogafoss waterfall is currently shut.   "The infrastructure is not set up to accomodate so many visitors," said Daniel Freyr Jonsson.    "Tourism in winter and spring, the most sensitive periods for wildlife in Iceland, (was previously) almost unheard of in Iceland."   Since 2010 and the eruption of the Eyjafjallajokull volcano -- which generated a lot of publicity for the island -- the number of visitors has grown by 25 percent per year on average.   Last year, a record 2.3 million people visited Iceland.
Date: Wed, 27 Dec 2017 18:20:14 +0100

Reykjavik, Dec 27, 2017 (AFP) - A coach carrying Chinese tourists visiting Iceland overturned on Wednesday, killing one person and leaving 12 others seriously injured, local authorities said.   The 44 passengers in the coach were all Chinese nationals, a police spokesman told AFP.   The most seriously injured were taken by helicopter to the capital Reykjavik, around 250 kilometres (340 miles) from the scene of the accident in Kirkjubaejarklaustur.

It happened in the heart of the Icelandic winter with harsh weather conditions and icy roads.   The coach crashed into the back of a car carrying Lithuanian tourists, before going off the road and overturning, authorities said in a statement.   Tourism is a growing sector in Iceland, which welcomed a record number of 1.8 million visitors in 2016.   The number of tourists coming from china have tripled between 2014 and 2016 when 67,00O visited the small volcanic island nation of 335,000.
Date: Fri, 31 Mar 2017 17:26:19 +0200

Reykjavik, March 31, 2017 (AFP) - Tourists keen to explore Iceland's natural beauty will have to pay more from next year, after Reykjavik announced a tax hike Friday on the sector, which has exploded in recent years.   The island nation announced the end of an 11 percent reduced rate of value-added sales tax, saying it will make a typical holiday there about 4 percent more expensive.

Tax on hotels, campsites, travel agents' services, pools and spas and such like will rise to the regular rate, which was itself reduced to 22.5 percent.   The government said the reduced rate was no longer justified since tourism in Iceland, which was badly hit by the 2008 global economic near-meltdown, has exploded seven-fold in the last seven years.

Some 1.77 million visitors came last year, with 2.2-2.3 million expected to make the trip in 2017.   "Most types of tourism will be classified under the general value-added tax bracket," said the finance ministry, announcing the end or the lower rate from July 1, 2018.   Reykjavik estimates the move will reduce tourist numbers by 1 or 2 percent, saying that cost was not the decisive factor for visitors to the country.   According to an opinion poll last year by the national tourism office, 83 percent of visitors cited Iceland's natural beauty as a reason they chose to come, against only 19 percent who said low prices were a factor.
More ...

French Polynesia

French Polynesia US Consular Information Sheet
August 13, 2008
COUNTRY DESCRIPTION: French Polynesia is a French overseas territory located in the middle of the Pacific Ocean.
It is made up of several groups of islands, the largest and mos
populated of which is Tahiti.
Tourist facilities are well developed and are available on the major islands.
For more information visit Tahiti’s web site at http://www.go-to-tahiti.com/.
ENTRY/EXIT REQUIREMENTS:
A passport valid for six months beyond duration of stay is required.
Visas are not required for stays of up to one month.
Extensions for up to three months may be granted locally by applying to the border police at the airport or to the Haut Commissionaire (The French High Commissioner).
The application for an extension must be presented with a fiscal stamp, which can be purchased in a post office.
For further information about entry requirements, travelers, particularly those planning to enter by sea, may contact the French Embassy at 4101 Reservoir Road NW, Washington, DC 20007, telephone 202-944-6200, fax 202-944-6212, or visit the Embassy of France's web site at http://www.info-france-usa.org/.
Additional information is available at GIE Tourisme, Fare Manihini, Boulevard Pomare, B. P. 65, Papeete, French Polynesia, Telephone: (689) 50-57-00, Fax: (689) 43-66-19.

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll- free in the U.S. and Canada, or for overseas callers 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:
Although French Polynesia has one of the lowest crime rates within France and its territories, petty crime, such as pick-pocketing and purse snatching, is occurring more frequently.
Visitors should secure valuables at all times.
Common sense precautions should be taken, especially at night, to avoid becoming a target of opportunity.
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 U.S. Consular Agent in French Polynesia at (689) 42- 65-35.
If you are the victim of a crime while overseas, in addition to reporting to local police, please contact the U.S. Consular Agent in French Polynesia for assistance.
The U.S. Consular Agent 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, the Consular Agent 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 French Polynesia is 15 for ambulance and medical emergencies, 18 for fire, and 17 for police.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical treatment is generally good on the major islands, but is limited in more remote or less populated areas.
Patients with emergencies or serious illnesses are often referred to facilities on Tahiti for treatment.
In Papeete, the capital of Tahiti, two major hospitals and several private clinics provide 24 hour medical service.
Serious medical problems requiring hospitalization and/or medical evacuation to the United States can cost thousands of dollars.
Although some doctors and hospitals are beginning to accept credit card and U.S. insurance payments, others still expect immediate cash payment for health services.
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.
The U.S. Department of State is unaware of any HIV/AIDS entry restirictions for visitors to or foreign residents of French Polynesia.

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 French Polynesia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
While most major roads are paved, many secondary roads are not.
In urban areas, traffic is brisk and all types of vehicles and pedestrians jockey for space on narrow streets.
Crosswalks are marked, and the law requires that motor vehicles stop for pedestrians; however, this is not always done.
Tourists should exercise caution when driving, particularly at night.
While extensive sections of the road circumnavigating Tahiti have streetlights, many streets do not.
Pedestrians walk along the sides of darkened roadways and sometimes cross in unmarked areas.
Bicycles and mopeds are frequently driven without headlights and taillights.
Tourists who rent bicycles or mopeds should be particularly attentive to their driving and the driving of others and not underestimate the danger, even on roads with little traffic.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT:
Civil aviation operations in French Polynesia fall under the jurisdiction of French authorities.
The U.S. Federal Aviation Administration (FAA) has assessed the Government of France’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight forofof France’s air carrier operations.
For further information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa/.
SPECIAL CIRCUMSTANCES:
French customs authorities may enforce strict regulations concerning temporary importation into or export from French Polynesia of some items. It is advisable to contact the Embassy of France in Washington, D.C. or one of the French consulates in the United States for specific information regarding customs requirements.
The web site for French customs is http://www.finances.gouv.fr/.
Goods arriving on pleasure yachts must be declared at the first point of arrival in French Polynesia.
Arms, animals, alcohol, cigarettes, cameras, etc., must be included in this declaration.
Please see our Customs Information
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 are readily available.
If detained, U.S. citizens are encouraged to request that the U.S. Consular Agent in French Polynesia be notified.
The cyclone season is November through April.
French Polynesia is located in an area of high seismic activity.
Although the probability of a major earthquake occurring during an individual trip is remote, earthquakes do occur.
General information regarding disaster preparedness is available via the Bureau of Consular Affairs’ web site, and from the U.S. Federal Emergency Management Agency (FEMA) home page at http://www.fema.gov/.
Some visitors to French Polynesia have reported problems using ATMs with certain kinds of credit and debit cards at ATM machines.
Visitors should verify that their cards can be used in French Polynesia.
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 those in the United States for similar offenses.
Persons violating French Polynesia’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession of, use of, or trafficking in illegal drugs in French Polynesia 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 web pages.
REGISTRATION / EMBASSY LOCATION:
There is no U.S. eEmbassy or cConsulate in French Polynesia.
However, there is a U.S. Consular Agent in French Polynesia who can provide assistance.
Americans living or traveling to French Polynesia are encouraged to register with the local U.S. Consular Agent or the U.S. Embassy in Suva, Fiji, or through the State Department’s travel registration web site and to obtain up-to-date information on travel and security within French Polynesia.
Americans without Internet access may register directly with the nearest eEmbassy or cConsulate.
By registering, American citizens make it easier for the eEmbassy or cConsulate to contact them in case of emergency.
To contact the U.S. Consular Agent, call (689) 42 65 35 or fax (689) 50 80 96 or e-mail usconsul@mail.pf.
The U.S. Consular Agency is located at Centre Tamanu Iti, 1er etage, Punaauia, B.P. 10765, 98711 Paea, Polynesie Francaise.
The U.S. Embassy in Suva, Fiji, which oversees the U.S.Consular Agent in French Polynesia, can also provide assistance for U.S. citizens.
It is located in the capital city of Suva at 31 Loftus Street, P.O. Box 218, telephone 679-331-4-466, fax 679-3302-267.
Information may also be obtained by visiting the Embassy’s home page at http://fiji.usembassy.gov/.
*

*

*
This replaces the Country Specific Information for French Polynesia dated February 219, 20087, to update sections on Entry/Exit Requirement, Safety and SecurityInformation for Victims of Crime and , Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

19 Aug 2019

358 indigenous cases and 2 imported cases of dengue 2 have been confirmed since the beginning of 2019, according to the latest Health Watch bulletin. Tahiti is still in an epidemic phase: all communes are affected except Mahaena, Pueu, and Teahupoo. In the islands, Bora-Bora is in epidemic phase (at least 3 cases without epidemiological link): Vaitape and Faanui are affected. Moorea is in an epidemic phase: The communes of Afareaitu, Haapiti, and Paopao are affected. Six islands are in the alert phase: Nuku-Hiva (Taiohae), Fakarava, Raiatea, Rangiroa, Huahine, and Hiva Oa (Atuona). Since dengue type 2 has not circulated in the country since the year 2000, the population is poorly immunized, and the epidemic may be large. People under 20 or arriving in French Polynesia after 2000 are most at risk of becoming infected.

HealthMap/ProMED-mail map of French Polynesia:
- Taihiti (French Polynesia). 13 Apr 2019

DEN-2 confirmation of several autochthonous cases
Date: Mon 12 Feb 2018
Source: MVariety [edited]

The Department of Health Services is informing the public that its syndromic surveillance system shows that Yap has exceeded the threshold for diarrhoea cases. Diarrhoea can be caused by parasites such as amoeba or giardia, bacteria in food poisoning or contamination of water by viruses spread through unsanitary conditions.

Frequent and proper hand-washing is the best way to reduce the chance of spreading infections. Most of these infections are transmitted primarily through the fecal-oral route, either by consumption of faeces-contaminated food or water, or by direct person-to-person spread.
==================
[The aetiology of the gastroenteritis cases here is not stated.  Yap traditionally refers to an island located in the Caroline Islands of the western Pacific Ocean, a part of the Federated States of Micronesia. The name "Yap" in recent years has come to also refer to the state within the Federated States of Micronesia, inclusive of the Yap Main Islands and its various outer islands. The area can be found on a map at <https://en.wikipedia.org/wiki/Yap>. - ProMED Mod.LL]

[The mortality from cholera and most diarrhoeal illnesses is related to non-replacement of fluid and electrolytes from the diarrheal illness.

As stated in Lutwick LI, Preis J, Choi P: Cholera. In: Chronic illness and disability: the pediatric gastrointestinal tract. Greydanus DE, Atay O, Merrick J (eds). NY: Nova Bioscience, 2017 (in press), oral rehydration therapy can be life-saving in outbreaks of cholera and other forms of diarrhea:

"As reviewed by Richard Guerrant et al (1), it was in 1831 that cholera treatment could be accomplished by intravenous replacement, and, although this therapy could produce dramatic improvements, not until 1960 was it 1st recognized that there was no true destruction of the intestinal mucosa, and gastrointestinal rehydration therapy could be effective, and the therapy could dramatically reduce the intravenous needs for rehydration. Indeed, that this rehydration could be just as effective given orally as through an orogastric tube (for example, refs 2 and 3) made it possible for oral rehydration therapy (ORT) to be used in rural remote areas and truly impact on the morbidity and mortality of cholera. Indeed, Guerrant et al (1) highlights the use of oral glucose-salt packets in war-torn Bangladeshi refugees, which reduced the mortality rate from 30 percent to 3.6 percent (4) and quotes sources referring to ORT as "potentially the most important medical advance" of the 20th century. A variety of formulations of ORT exist, generally glucose or rice powder-based, which contain a variety of micronutrients, especially zinc (5).

"The assessment of the degree of volume loss in those with diarrhea to approximate volume and fluid losses can be found in ref 6 below. Those with severe hypovolaemia should be initially rehydrated intravenously with a fluid bolus of normal saline or Ringer's lactate solution of 20-30 ml/kg followed by 100 ml/kg in the 1st 4 hours and 100 ml/kg over the next 18 hours with regular reassessment. Those with lesser degrees of hypovolaemia can be rehydrated orally with a glucose or rice-derived formula with up to 4 liters in the 1st 4 hours, and those with no hypovolemia can be given ORT after each liquid stool with frequent reevaluation."

References
----------
1. Guerrant RL, Carneiro-Filho BA and Dillingham RA. Cholera, diarrhea, and oral rehydration therapy: triumph and indictment. Clin Infect Dis. 2003;37(3):398-405; available at
2. Gregorio GV, Gonzales ML, Dans LF and Martinez EG. Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database Syst Rev. 2009;(2):CD006519. doi: 10.1002/14651858.CD006519.pub2; available at
3. Gore SM, Fontaine O and Pierce NF. Impact of rice based oral rehydration solution on stool output and duration of diarrhea: meta-analysis of 13 clinical trials. BMJ 1992; 304(6822): 287-91; available at
4. Mahalanabis D, Choudhuri AB, Bagchi NG, et al. Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med 1973; 132(4): 197-205; available at
5. Atia AN and Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol. 2009; 104(10): 2596-604, doi: 10.1038/ajg.2009.329; abstract available at
6. WHO. The treatment of diarrhea, a manual for physicians and other senior health workers. 4th ed. 2005; available at
Date: Thu 30 Nov 2017
Source: Tahiti Infos [in French, trans. ProMED Corr.SB, edited]

Three cases of salmonellosis have been officially confirmed in Taravao in addition to the suspected case of a 4th person who died after having shown the symptoms of salmonella infection.

In a statement, released Thursday morning, 30 Nov 2017, the Ministry of Health said: "3 cases of salmonellosis confirmed and a suspected case, occurred in Taravao." These infections were reported to the Bureau de Veille Sanitaire between 20 and 28 Nov 2017. Above all, "one person has died," says this information, while indicating that "the main cause of death remains uncertain."

This person died in the night of 18 to 19 Nov 2017, a few hours after eating an egg dish (Kai Fan). His wife suffered a salmonella infection following this meal. One of 2 other confirmed cases of salmonellosis also consumed a Kai Fan. These takeaway meals were all purchased in the same Taravao business.

"We were not able to take samples from the deceased person," says Dr. Marine Giard. "It is thought that this person also had salmonellosis, but the doctor who observed the death did not remember that the person's episode of gastroenteritis was the direct cause of death. [He] died at home and did not call a doctor during the episode of illness. (...) He had the same symptoms as his wife, who was confirmed with salmonellosis," said the head of the Bureau de Veille Sanitaire, noting that "it is unusual for a healthy person, as it seemed to be his case, to die of salmonellosis, which is why this case is still very surprising. There was no autopsy."

The statement released on Thu 30 Nov 2017 said that an "inspection was conducted in this store by the Center for Hygiene and Public Health." Two types of analyses are in progress, the Ministry of Health said, stating that they are interested in the "remains of the food consumed" and "water withdrawals made due to recent rainy episodes." The sanitary survey is currently underway: "We will try to explore all leads; the dishes sold in this shop are being analyzed, water samples were taken; we are going back to the egg production chain and examining people who were preparing the dishes," says Dr. Giard.

Regarding the salmonellosis found in Taravao: "More than 10 days later, we have had no new cases declared; we have good reasons to assume that the infectious source has dried up," the Bureau de Veille Sanitaire stated.
=====================
[Certainly, undercooked eggs are a well-recognized vehicle for the transmission of salmonellosis. It is unclear whether salmonellosis was the proximate cause of death in the man mentioned, as most fatalities in salmonellosis are in the very young and very older and those with underlying diseases. It is not clear whether the decedent had any substantial risk factors for more severe disease.

Salmonellosis is often thought to be associated with cracked eggs or eggs dirty with faecal matter, a problem controlled by cleaning procedures implemented in the egg industry. It is clearly the case, however, that most of the salmonellosis outbreaks linked to eggs were associated with uncracked, disinfected grade A eggs, or foods containing such eggs. The undamaged eggs become contaminated during ovulation, especially with _S._ Enteritidis_, and thus were contaminated with the bacteria before the egg shell was formed. To avoid this, uncooked eggs should only be used as an ingredient if pasteurized. - ProMED Mod.LL]

[Tahiti, with a population of 183 645 residents in 2012, is the most populous island of French Polynesia, accounting for 68.5 percent of its total population; the small town of Taravao is situated on a short isthmus that connects the larger northwestern portion of Tahiti, where Papeete, the capital of French Polynesia is located, with the much smaller southeastern portion (<https://en.wikipedia.org/wiki/Tahiti>). - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Tahiti, French Polynesia: <http://healthmap.org/promed/p/22997>]
Date: Wed, 20 Sep 2017 05:11:20 +0200
By Alastair HIMMER

Tetiaroa, France, Sept 20, 2017 (AFP) - An exotic island paradise in French Polynesia bought by Marlon Brando in the sixties is using its Hollywood image to tackle environmental issues -- with a little help from its jet-set visitors.   The tiny, palm-fringed atoll of Tetiaroa was once a favourite holiday spot for Tahitian royalty before the late American movie star fell in love with it while filming "Mutiny on the Bounty" in 1961 on islands close by.   Brando married co-star Tarita Teriipaia and the couple raised a family on Tetiaroa, now home to a luxury eco-resort that bears the reclusive actor's name and regularly pampers A-list clientele such as Leonardo DiCaprio, Johnny Depp and Barack Obama.

Guests at "The Brando" help fund research projects by paying up to $10,000 a night to stay in the elegant thatched villas overlooking a turquoise lagoon.   As Pippa Middleton soaks up the rays on honeymoon or Obama seeks inspiration to write his memoirs, scientists quietly go about their work testing ocean acidification to study the effects on coral bleaching.   Behind the butler service and Michelin-star cuisine, the resort has built on Brando's own vision for a sustainable environment, to become one of the most eco-friendly hotels in the world, running on solar power and coconut oil.   Luxury eco-tourism is a growing sector of the travel industry with big name hotel brands such as Alila and Aman investing heavily in ensuring their green
credentials.

Boutique resorts that pride themselves on sustainability and giving back to the local community, such as Song Saa private island in Cambodia, Nihiwatu in Indonesia, and the Soneva hotels in Thailand and the Maldives, are also increasingly in demand.    But Tetiaroa, where legend has it British sailors who seized control of the Bounty in 1789 found vestiges of a pagan sex cult, has the added bonus of old Hollywood glamour.   Brando's granddaughter Tumi grew up on the island, fishing for snapper and grouper in the lagoon, home to juvenile lemon and black tip sharks which glide lazily among the corals as guests snorkel.   The 29-year-old works as the chief communications officer for the non-profit Tetiaroa Society, a scientific organisation devoted to marine wildlife founded by the Brando estate, which owns the atoll.

- Coconut power -
"Our aim is to raise awareness," she told AFP as marine biologists studied shark populations inside the three-mile (4.8 kilometre) wide lagoon, which contains at least 167 species of fish, including parrotfish and spotted eagle rays.   "First among local people, because we want to protect our environment. Maybe America or China -- they come to my mind first because they're the biggest polluters -- can emulate us."   Opened in 2014, the hotel's electricity comes from more than 2,000 solar panels which line the island's tiny runway and generators fuelled by coconut oil. Its air-conditioning is powered by deep seawater -- a brainwave of Marlon Brando's.   Mosquitoes are dying out at the resort where researchers have found a way to sterilise an invasive species capable of carrying dengue and Zika virus.

Brando previously ran a modest eco-lodge after buying Tetiaroa where celebrity buddy Robert De Niro, a guest in the late 1980s, once amused himself by waiting on tables.   Brando died in 2004, but Tetiaroa, located some 2,700 miles south of Hawaii, has been preserved in line with his ecological vision -- resort staff even keep a pet cat called Marlon in homage.   "He was passionate," said Tumi. "He was dragged here by Hollywood, then grandma made him come back."   Following Brando's blueprint, naturalists at the island's research centre monitor its countless tropical birds and turtle sanctuary, ready to rescue clumsy hatchlings before they can become a meal for predators.

- 'Canary in the coal mine' -
Luxury eco-resorts offer high-rollers a chance to offset any guilt they might feel over their carbon-heavy lifestyles.   "You need to look at the full picture of sustainability," said Rochelle Turner, research director at the World Travel and Tourism Council.   "Often these upscale resorts lead the way. They have a much higher profit margin so they're able to do things that make their destinations more protected."    "But they pass on knowledge to the mass market too," she added. "Even backpackers are learning from what is happening at the high end."   Tetiaroa is ideal for ecological research, according to Frank Murphy, executive director of the Tetiaroa Society, to which DiCaprio and Depp donate.   "We're perched here on one the most vulnerable spots on earth. It's kind of the canary in the coal mine for climate change so we better be doing our damnedest to figure out what's going on," he said.   "The El Nino years we've had over the past 20 years gives us a glimpse into what will happen with global warming."
More ...

Liberia

Liberia - US Consular Information Sheet
February 21, 2008
COUNTRY DESCRIPTION: Liberia is a country in West Africa that suffered from years of instability and conflict from 1990 - 2003, with attendant destruction of buildings, roads, and infras
ructure and public institutions.
A comprehensive peace accord ended the conflict in August 2003 and a United Nations peacekeeping force (UNMIL) was deployed to facilitate disarmament and demobilization, help arrange democratic elections and provide for security of the country.
In late 2005, Liberians went to the polls and elected Ellen Johnson Sirleaf as president.
The new government was inaugurated in January 2006, and has made tremendous progress towards restoring security and stability to the country.

Despite nearly four years of peace and a renewal of economic growth, Liberia is still one of the poorest countries in the world and many basic services (public power, water and sewage, land line phones) are either limited or unavailable.
Facilities for foreign visitors are adequate in the capital, Monrovia, but virtually non-existent in the rest of the country.
The official language of Liberia is English.
Read the Department of State Background Notes on Liberia for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport and a visa are required for entry, as is evidence of a yellow fever vaccination and a physician's letter attesting to absence of communicable diseases.
Visa applicants may also be asked to provide evidence of health insurance.
Immigration officials no longer issue visas at the airport.
Persons arriving without a visa may be deported immediately, without leaving the airport.
Persons arriving from the United States must obtain a Liberian visa before traveling.
There is a US $25 airport tax on departing passengers, although this is usually collected as part of the ticket price.
For the latest information on entry requirements, visa fees and airport tax for Liberia, contact the Embassy of the Republic of Liberia, 5201 16th Street NW, Washington, DC 20011, tel. (202) 723-0437, web site www.embassyofliberia.org.
Overseas, inquiries should be made at the nearest Liberian embassy or consulate.

Information about dual nationality or the prevention of international child abduction can be found on our web site.
For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
The Department of State urges U.S. citizens to plan proposed travel to Liberia carefully and to exercise caution when traveling in Liberia.
Neither public transport nor taxis are available at the international airport, which is located 40 miles outside of Monrovia; therefore, before traveling to Liberia, Americans are urged to make arrangements for transportation from the international airport into the city center.
Americans traveling to Liberia are also urged to ensure that they have confirmed reservations at a reputable hotel, as rooms can be scarce and difficult to find without advance plans.

Americans who travel to or reside in Liberia should realize that Liberia's police force is in the process of being rebuilt.
There is a UN Mission in Liberia (UNMIL), but its mandate is to ensure political stability in Liberia.
Americans who travel around Liberia must realize that the role of UN Police (UNPOL) officers is to serve as advisors to the Liberia National Police. Accordingly, they do not have the authority to arrest or detain, and they are unarmed.
The Liberia National Police, for its part, has a limited presence in Monrovia, and even less of a presence outside of Monrovia.
In addition, police officers can be a source of problems for visitors as well as a source of aid or assistance.
Although problems with corruption have improved, travelers may be detained by police officers who solicit bribes.
Americans are encouraged to carry a photocopy of their passports with them at all times so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available.
If detained or arrested, U.S. citizens should always ask to be allowed to contact the U.S. Embassy.

U.S. citizens in Liberia should be aware of their surroundings at all times and use caution when moving around, especially at night.
The U.S. Embassy recommends that American citizens observe a suggested curfew of 2:00 a.m. – 6:00 a.m.
Travel outside of Monrovia after dark is strongly discouraged as roads are in poor condition and thus dangerous to navigate at night.
U.S. citizens should avoid crowds, political rallies, and street demonstrations and maintain security awareness at all times.
For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet web site, where the current Worldwide Caution Public Announcement, Travel Warnings and Travel Alerts can be found. Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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 in Liberia is rated high and is exacerbated by the high rate of unemployment.
Theft, assault, sexual crimes, and murder are problems, and they occur more frequently after dark.
Foreigners, including U.S. citizens, have been targets of street crime, robbery, and sexual assault.
Women have been attacked on deserted beaches.
Residential armed break-ins occur.
The police are ill equipped and largely incapable of providing effective protection or investigation.
Criminal activity is reported in both urban and rural areas.

Perpetrators of business fraud often target foreigners, including Americans.
Formerly associated with Nigeria, these fraud schemes are now prevalent throughout western Africa, including Liberia, and pose a danger of both financial loss and physical harm.
An increasing number of American citizens have been the targets of such scams.
The best way to avoid becoming a victim of fraud is common sense – if it looks too good to be true, it probably is.
Any unsolicited business proposal originating in Liberia should be carefully checked before committing any funds, providing any goods or services, or undertaking any travel.
There is also an increase in Liberian/American Internet relationships, where there are eventual requests for financial assistance under fraudulent pretenses.
For additional information, please see the Department of State's Bureau of Consular Affairs brochure International Financial Scams.

Petty corruption is rampant; poorly paid government officials are not immune from the temptation to collect fees for doing their job.
The result is that travelers may be asked for bribes and inconvenienced for not paying them.

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:
Hospitals and medical facilities in Liberia are very poorly equipped and are incapable of providing many services.
Emergency services comparable to those in the U.S. or Europe are non-existent, and the blood supply is unreliable and unsafe for transfusion.
Americans with serious medical problems travel or are medically evacuated to the United States, Europe or South Africa.
Medicines are scarce, often beyond expiration dates, and generally unavailable in most areas.
As there is neither an effective garbage removal service nor a functioning sewer system, the level of sanitation throughout urban areas is very poor, which increases the potential for disease.
Upper respiratory infections and diarrhea are common, as well as the more serious diseases, typhoid and malaria.
All travelers to Liberia must be vaccinated against yellow fever and should carry a supply of all prescription medication, plus anti-malaria medication, adequate for their entire stay.
A typhoid vaccination is also recommended.

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.
For travel to Liberia, obtaining separate medical evacuation insurance before arriving in Liberia is strongly recommended.
Please see our information on medical insurance overseas.
SWIMMING HAZARD:
Liberia has many excellent beaches along the Atlantic coastline that tourist and those who live in the country enjoy throughout the year, however American citizens should be aware of the threat of dangerous rip currents better known as rip tides.
These strong currents can occur anywhere on the coast given the right surf conditions.
The Liberia Weather Service does not provide information on where and when these tides form and there are no lifeguards posted on beaches.
American citizens who plan to swim in the Atlantic should read from various sources e about the dangers of rip currents and how to navigate if you find yourself in such a situation; or better still do not swim if you are unfamiliar with swimming in water where very strong rip currents occur.

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 Liberia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Road travel in Liberia can be hazardous.
Potholes and poor road surfaces are common, making safe driving extremely challenging.
Cars, trucks, and taxis are often overloaded with people and goods and make frequent stops without signaling.
Drivers overtake on the right as well as the left.
Many vehicles operate with threadbare tires, and blowouts are frequent.
Public taxis are poorly maintained and usually overloaded.
Intersections must be approached with caution.
The absence of public streetlights makes pedestrians walking in the city streets and those walking on country roads difficult to see at night.
Drivers and pedestrians are cautioned that high-speed car convoys carrying government officials require all other vehicles to pull off the road until they have passed.

Travelers should expect delays at UNMIL security checkpoints, as well as time-consuming detours around the many bridges and roads damaged by war, neglect, or the heavy annual rains, which occur from May to November.
Travelers can expect strict enforcement of border controls by Liberian, Ivorian, Sierra Leonean, and Guinean authorities.
At times border crossings to neighboring countries are closed.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service between the United States and Liberia, the U.S. Federal Aviation Administration (FAA) has not assessed Liberia’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:
Lodging, fuel, transportation, and telephone services are unevenly available in Liberia, and are nonexistent or severely limited in rural areas.
Neither water nor electricity is commercially available in Liberia, including the capital of Monrovia.
Most hotels have utilities available, but not always on a 24-hour basis.
There is no working landline telephone system in Liberia.
Several cell phone companies provide service in Monrovia and some areas outside the capital.
US cellular phones do not always work in Liberia and it is advisable to rent or purchase a local cellular phone.
The postal system is slow and unreliable.
Commercial air courier service is available through UPS, Federal Express (FedEx), and other companies.

The U.S. dollar is readily accepted in Liberia, and there is no limit on the amount of foreign currency that can be transported into and out of the country, provided one follows the specific regulations on how such transfers must be done.
Sums in excess of US $10,000 must be reported at the port of entry and no more than US $7,500 in foreign currency banknotes can be moved out of the country at one time.
Larger sums must be transferred via bank drafts or other financial instruments; persons without a Liberian bank account are limited to two outgoing US $5,000 over-the-counter cash wire transfers per month.
Wire transfers are not widely used and are subject to substantial fees.
ATMs are unavailable and Traveler's checks and credit/debit cards are not accepted anywhere in Liberia.

Photographing military installations, air and seaports, and important government buildings is prohibited.
Visitors should not take photographs of sites or activities that might be considered sensitive, or police are liable to confiscate the camera.

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 Liberian law, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Liberia are severe, and convicted offenders can expect long jail sentences and heavy fines.
The U.S. Embassy does not always receive timely notification of the arrest of U.S. citizens by Liberian authorities.
If arrested, U.S. citizens should ask to be allowed to contact the U.S. Embassy (see the Registration/Embassy Location section below).
Americans should carry a photocopy of their U.S. passport with them at all times.
The consular section of the U.S. Embassy cannot give legal assistance but can provide a list of Liberian attorneys if one is required.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Liberia 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 Liberia.
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 111 United Nations Drive, Mamba Point, Monrovia; telephone 231-77-054-826; fax 231-77-010-370; web site http://monrovia.usembassy.gov.
U.S. citizens who wish to write to the U.S. Embassy in Monrovia may address letters to the Consular Section, 8800 Monrovia Place, U.S. Department of State, Washington, D.C. 20521-8800, or send emails to ConsularMonrovia@state.gov.
*

*

*
This replaces the Consular Information Sheet on Liberia dated June 15, 2007 to include a caution on swimming at local beaches.

Travel News Headlines WORLD NEWS

Date: Mon, 23 Sep 2019 19:35:57 +0200 (METDST)

Monrovia, Sept 23, 2019 (AFP) - More than 10,000 Liberian health workers began a strike Monday to demand salary arrears and regular supplies of medicine and equipment in a country ravaged by civil war and an Ebola epidemic.   Battered two back-to-back civil wars and then in 2014-16 by the worst Ebola epidemic in history, Liberia's health sector is on its knees.   The crumbling infrastructure lacks almost everything -- medicine, beds, equipment, ambulances, even a reliable electricity supply.   "We are striking because we do not have medicines in the hospitals, no materials like gloves to protect ourselves before treating the patients which is dangerous for us, the laboratories are unequipped.... until today most of the workers have not got their July salaries," George Williams, secretary general of the Health Workers Association, told AFP.   "We have realised the exchange rate with the US dollar is so terrible, and these salaries we are making are the same we have been making since eight years, the cost of living has tripled," he said.   State-run hospitals and clinics were closed, sparking protests from patients in Monrovia.   Some 40 pregnant and sick women blocked a road in the northern suburb of Paynesville, shouting slogans.   "I don't have money; I am not rich like the big people, so I cannot afford to go in any private clinic. I am eight months pregnant," Annie Sieh, 35, said.
Date: Mon 2 Sep 2019
Source: Daily Observer [edited]

Just 5 years after containing the deadly Ebola virus disease (EVD), authorities at the Ministry of Health (MoH) have confirmed an outbreak of Lassa fever across the country.  The situation is so serious that Chief Medical Officer (CMO) Dr Francis Nah Kateh, has warned Liberians to take the necessary preventive measures, "even though this is what we have been taking care of all the while. For the disease to spread to Grand Kru County, gives health authorities the cause for concern."  According to MoH data, a total of 92 suspected cases between 1 Jan-25 Aug 2019, including 21 deaths, have been reported.  "Of these, 25 cases have been confirmed by RT-PCR (Nimba-9, Bong-10, Grand Bassa-5, and Grand Kru -1), while 9 remain suspected cases," the release recorded.  The case fatality rate among confirmed cases is 36% (9 deaths out of 25 confirmed cases). Males are mostly affected by the disease (56%) of confirmed cases as compared to females.

The MoH release also said that although Lassa fever is not new to Liberia, it is a deadly viral disease that requires urgent attention. The disease is spread by rodents or rats and through close contact with infected persons.  "We are concerned about the sporadic increase of Lassa fever cases outside the Lassa Belt in Liberia," meaning Nimba, Bong, and Grand Gedeh counties.  "For Lassa fever to affect Grand Kru other than those counties it has previously affected, gives us the fear to raise the alert," Dr Kateh told the Daily Observer via mobile phone on [Fri 2 Sep 2019].

Henceforth, MoH authorities in collaboration with partners and the National Public Health Institute of Liberia (NPHIL), said they are responding to the Lassa fever outbreak in the country.  According to a release issued in Monrovia on 22 Aug 2019, Bong County Health Team notified NPHIL and MoH of the disease's outbreak following the confirmation of one case from Suakoko District, Bong County.  The case concerned the death of a 30-year-old male and a laboratory technician; a health worker, who previously worked with the Phebe Hospital, and a resident of Phebe Airstrip.  "Our hearts are broken, and we express our heartfelt condolences to members of the bereaved family," MoH said in a release on [Fri 30 Aug 2019].  Similarly, on 24 and 25 Aug 2019, the National Public Health Reference Laboratory confirmed 2 additional cases of Lassa fever infection in a 46-year old male as well as a 14-year old female, both residents of Suakoko Town, Bong County.

So far, the release said a total of 30 contacts, including 18 health workers, have been line-listed and are being followed up to the extent that 2 of the contacts have become symptomatic, though one of them have been tested negative. Additionally, 2 cases (one contact) remain in isolation and are undergoing Ribavirin (Lassa) treatment, "because this is the 10th confirmed case being detected from Bong County since [the beginning of] 2019." In response to the outbreak, MoH, NPHIL, World Health Organization (WHO), United States-based Centers for Disease Control and Preventions (CDC), and partners are providing technical, financial, and logistical support to the District Response Teams.  "No epidemiological link has been established between these cases. However, there is a likelihood for these cases to be linked based on history of the source of infection," the release declared.

Health authorities are therefore advising people to "Keep your environment clean; cover your dishes to prevent rats excreting or urinating on them; cover food in tightly-closed containers to prevent rats from playing in food or drinking water; do not eat rats, because you can get the sickness by coming in contact with their blood, [urine, or feces] do not dry food in open places where rats can reach; avoid body contact with infected persons and endemic zone; and visit a health facility immediately when you feel sick."

Meanwhile, NPHIL, MoH, and partners have appealed to the general public to take necessary preventive measures, and kindly report cases of fever (any kind) to the nearest health facility.  "We continue to improve our rapid response teams at county, district, and community levels through the County Emergency Operations Centers (EOCs), and to provide technical, financial and logistical support to the outbreak," the release said.
Date: Mon 6 May 2019
Source: Front Page Africa [edited]

The emergence of a rare skin disease known in Liberia as "Be Serious" has sparked fear amongst residents of Charlie Town in Rivercess County. Residents, mainly parents, say children who are under 15 years of are seriously infected. They are afraid that the disease is contagious and is fast spreading rashes on the bodies of school-going-kids.

They are afraid that the situation will become an emergency, due to lack of adequate medication at the only clinic in the area. Joe Gbessigie, a resident of the town, says he's worried that instead of providing medicines, the clinic only gives patients prescriptions to buy drugs from private pharmacies.

Nathaniel Zoklah, the Township Commissioner, says some kids who are affected by the disease are in school, and he is concerned that the situation poses risk to other pupils. "At this time of the school year, keeping children who are affected with the disease may affect their education, so the kids are in schools with their friends but it is risky also," Commissioner Zoklah said. "They are interacting, eating together and this disease has the ability to spread through contact, so more children risk being affected."

The residents have not been able to state the actual cause of the disease, but some are assuming that it is waterborne. Some of the residents in Charlie Town and its surroundings said the hand pumps that are a major source of drinking water are all damaged, forcing residents to fetch water from creeks.  [Byline: Willie N. Tokpah]
===========================
[The disease referred to in this report and its accompanying photograph is most likely to be scabies.  Scabies is a skin infestation by the scabies mite - _Sarcoptes scabiei_. The infection is found worldwide and is transmitted under poor hygienic conditions. The mite is transmitted by physical contact and poor hygiene is a main risk factor. Outbreaks are seen in refugee camps and nursing homes.

An outbreak is handled by ensuring that the affected people and close contacts at risk have a frequent bath and change clothes daily. The traditional treatment is pyrethroid containing ointments which kill the mites, but ivermectin orally is easier to administer and thus more acceptable and ensures better compliance. Especially in an outbreak in a school the best way to stop the outbreak would be administration of ivermectin to all children. - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Rivercess County, Liberia: <http://healthmap.org/promed/p/42309>]
Date: Tue 23 Oct 2018
Source: The Bush Chicken [edited]

The director for immunization at the Ministry of Health says there are currently 29 reported measles cases in Grand Gedeh, with 7 of those cases confirmed.

Director for immunization at the Health Ministry Adolphus T. Clarke said reports of the outbreak in Tchien district 1st emerged on [Wed 17 Oct 2018]. Speaking to The Bush Chicken in an exclusive interview, Clarke said out of the 29 cases reported, health officials in the area realized that 11 children under 5 years of age were affected by the disease. The other children were older than 5.

"The 29 cases identified were managed at the Martha Tubman Memorial Hospital in Zwedru, and the affected children fully recovered with no death reported."

With support from the Ministry of Health, Clarke said the county responded quickly with vaccinations. "The exercise has concluded, and health officials were able to reach a total of 1551 children not less than 5 years," he said. "So I can say that the county responded swiftly to the outbreak of the disease and recorded zero deaths."

However, things did not go smoothly. Due to the poor road conditions in the south-eastern region, Clarke said some health officials who left Monrovia with vaccinations for Grand Gedeh endured difficulties during the journey. "Others had to travel through neighbouring Ivory Coast to reach the country," he said.

The director indicated that, due to the challenge in attaining high vaccination coverage, health authorities in the country knew that, at some point in time, there would be sporadic outbreaks of the disease in the county.

Clarke said the current outbreak was not severe, because the ministry has dealt with sporadic outbreaks of measles in the past. He noted that health officials in Grand Gedeh have now been encouraged to carry out vaccination campaigns in affected and nearby communities as the dry season approaches.

"We have encouraged mothers to make use of the health facilities in the county and ensure that their children are vaccinated against all the diseases the ministry is preventing," Clarke said.  [Byline: Zeze Ballah]
Date: Thu 27 Sep 2018
Source: Front Page Africa [edited]

The National Public Health Institute of Liberia (NPHIL) in collaboration with the Ministry of Health (MoH) and partners is investigating a suspected case of yellow fever in Grand Kru County.

According to a release issued in Monrovia, the suspected case is a 2-year-old female from Farina Town, Barclayville Health District. There has been no death or new cases reported. The suspected case has been managed and is in good health.

A blood specimen has been collected and sent to the National Public Health Reference Laboratory (NPHRL) for confirmation. According to the release, health authorities in the county are conducting an active case search, risk assessment, and planning for a possible reactive vaccination exercise, pending the laboratory result.

Since January 2018, this is the 2nd reported suspected case from Grand Kru County. The 1st was a 29-year-old female from Dorbor District.

There have been no confirmed cases of yellow fever in the country since the 2009 nationwide preventive vaccination campaign. The release also noted that a total of 94 suspected cases of yellow fever have been recorded across the country since the beginning of 2018.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The symptoms include fever, headache, jaundice, muscle pain, nausea, vomiting, and fatigue. Communities have been advised to report unexplained deaths for safe and dignified burials as measures to prevent infection. Community engagement and response activities have been intensified in the area.

Meanwhile, the public is advised to take the following public-health measures:
- Keep your environment clean
- Visit a health facility immediately when you feel the symptoms of yellow fever
- Continue sleeping under treated bed nets

Yellow fever is not transmitted through body touch or body fluids.
=====================
[Yellow fever (YF) cases have occurred sporadically in Liberia, although the last YF ProMED-mail post was in 2009. The 94 suspected YF cases this year (2018), including the most recent one above, is a cause for serious concern. It is important to have a timely laboratory diagnosis and well-developed contingency plans should YF be confirmed. YF can quickly spread if a significant proportion of the human population is unvaccinated and the vector mosquitoes are abundant. The above report does not indicate the number of unvaccinated individuals nor the status of the vector mosquito population. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Grand Kru County, Liberia: <http://healthmap.org/promed/p/32407>]
More ...

Namibia

Namibia US Consular Information Sheet
August 16, 2007
COUNTRY DESCRIPTION: Namibia is a southern African country with a moderately developed economy.
Facilities for tourism are good and generally increasing in quality.
The capital is
indhoek.
Read the Department of State Background Notes on Namibia for additional information.
ENTRY/EXIT REQUIREMENTS: A passport and visa are normally required.
Bearers of U.S. passports who plan to visit Namibia for tourism for less than 90 days can obtain visas at the port of entry and do not need visas prior to entering the country.
Travelers coming for work or study, whether paid or voluntary, must obtain a work or study permit prior to entering Namibia.

All travelers traveling to or from Namibia via South Africa are strongly encouraged to have several unstamped visa pages left in their passports.
South Africa requires two unstamped visa pages, and Namibia usually also requires an unstamped page to stamp a visa upon arrival.
Visitors who do not have enough free visa pages in their passport risk being denied entry and returned to the U.S. at their own expense.

Travelers should obtain the latest information from the Embassy of Namibia located at 1605 New Hampshire Avenue, NW, Washington, D.C. 20009, telephone (202) 986-0540 or from the Permanent Mission of Namibia to the U.N. at 135 E. 36th St., New York, NY 10016, telephone (212) 685-2003, fax (212) 685-1561.
Overseas, inquiries should be made to the nearest Namibian embassy.
See our Foreign Entry Requirements brochure for more information on Namibia and other countries.
Visit the Embassy of Namibia's website at http://www.namibianembassyusa.org/ for the most current visa information.
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:
American citizens wishing to cross into Angola from Namibia should do so only at official border crossing areas and should consult the State Department's Consular Information Sheet for Angola.
American citizens should avoid street demonstrations.
However, such events are rare in Namibia.
American citizens traveling in Namibia are urged to contact the consular section of the U.S. Embassy in Windhoek for the latest safety and security information.
For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site, where the current Worldwide Caution Public Announcement, Travel Warnings and Public Announcements can be found.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State's pamphlet A Safe Trip Abroad.
CRIME: Crime is a serious concern in Namibia, but visitors who employ common-sense preventive measures normally enjoy an incident-free stay.
Incidents of violent crime directed specifically against Americans or other foreigners are rare, but the number of overall incidents continues to increase.
The most common crimes are property-motivated crimes of opportunity, including pick pocketing, purse snatching, vehicle theft, and vehicle break-ins.
Taxi drivers have robbed several American passengers; if taxis must be used, radio taxis that display the NABTA logo (Namibia Bus and Taxi Association) are the most reliable.
Violent crimes are less frequent than non-violent incidents.
Common sense measures such as being alert to one's surroundings, avoiding isolated areas of town, not leaving valuables in parked cars, keeping car doors locked and windows up while driving, safeguarding purses, wallets and especially cellular phones are the best deterrents against becoming a victim.
Drivers should exercise caution at rest stops outside of towns or away from gasoline stations.

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

See our information on Victims of Crime.
MEDICAL FACILITIES AND HEALTH INFORMATION: Windhoek has a small number of private medical hospitals and clinics capable of providing emergency care and performing many routine procedures.
Doctors, both general practitioners and specialists, as well as dentists, generally have training and facilities that are comparable with U.S. standards.
Facilities outside the capital vary widely.
Several large towns have well-equipped facilities similar to those available in Windhoek, while smaller towns generally do not.
Malaria is prevalent only in the north of the country.
Malaria prophylaxis is not required in Windhoek but is suggested for travel to the north.
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); fax 1-888-CDC-FAXX (1-888-232-3299), 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 Namibia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
In Namibia, driving is done on the left-hand side of the road.
Many of Namibia's rural roads are gravel.
Although these roads are generally well maintained, controlling a vehicle on gravel is significantly more difficult than on pavement.
Drivers should not drive in excess of 80km per hour (45 mph) on gravel roads, should reduce speed significantly for curves or turns, and should heed all warning signs.
Hitting a sand patch or driving around a curve too fast can easily result in a rollover or spinout.
Many accidents on gravel roads occur when tourists exceed safe speeds on corners or in areas recently damaged by rains.
Visitors are reminded that motor vehicle accidents are one of the primary causes of injury and death in Namibia, and drivers are therefore strongly urged to drive with caution.

For those driving outside of the capital, distances between cities can be considerable, and often gasoline is only available at a few service stations along a route.
Fuel availability can be impacted by power outages as well.
All travelers are encouraged to plan their route to ensure a sufficient supply of fuel, and are recommended to bring five liters of water per person when traveling on dirt roads to guard against dehydration if an accident should occur.
Turning on a red traffic light is not permitted in Namibia.
Seat belts are required for all vehicle occupants.
Motorcyclists are required by law to wear protective helmets.
While child car seats are not required, they are recommended.
To drive legally while in Namibia, visitors staying more than a few weeks need an international driving permit.
International driving permits must be obtained prior to leaving the U.S. and are available from either the American Automobile Association or the American Automobile Touring Alliance.
Short-term visitors do not need an international driving permit; a valid U.S. driver's license is sufficient.
Roads in Namibia are generally well maintained.
However, few have shoulders or “pull-off” lanes for broken vehicles.
Wildlife wandering on roads is a special driving hazard in Namibia, especially at night.
An encounter at high speeds with antelope or cattle can be fatal.
The salt-surfaced roads at the coast can also be deceptively dangerous, especially when they have been made slick by morning or evening mist.
Robbery has occurred at roadside "rest stops" and motorists are advised to take rest breaks in towns and/or at gasoline stations.
Most major roads are undivided with one lane in each direction.
Drivers should remain alert for passing vehicles and exercise caution when passing slow moving vehicles.
Accidents involving drunk drivers are an increasing problem on major roads where there are high speed limits.
Driving under the influence is illegal in Namibia.
A charge of culpable homicide can be made against a driver involved in an accident resulting in death.
Roadside assistance and emergency medical services outside of Windhoek may be unreliable or non-existent.
Assistance on main roads that link Namibia's larger towns, however, is generally good due to quality cell phone networks.
Emergency services contact numbers vary from town to town.
The Namibian telephone directory has a list of emergency contact numbers at the beginning of each town listing.
It is recommended that Americans maintain a list of contact numbers for the area in which they plan to drive.
Telephone numbers may change, and 24-hour availability of these numbers is not guaranteed.
Public transportation is not widely available outside of the capital.
Taxis and municipal buses are the only forms of public transportation in Windhoek.
Schedules and routes are limited.
Car rentals or radio taxis are generally the best means of transport but may be relatively expensive.
The Embassy has received reports of foreign citizens being robbed by drivers of taxis hailed on the streets of Windhoek.
The Embassy has not received any such reports regarding radio taxis.
Flashing of high beams and similar signals could mean anything from a friendly greeting to a warning.
When encountering a motorcade, motorists are encouraged to make way immediately and follow promptly any instructions given by the officials present.
Because of the possibility of intoxicated and/or reckless drivers, the poor mechanical condition of some motor vehicles, and the high incidence of single-vehicle rollover accidents, Americans are urged to avoid hitchhiking in Namibia.
Please refer to our Road Safety page for more information.
Visit the website of the country's national tourist office and national authority responsible for road safety: http://www.met.gov.na/default.htm
AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service between the United States and Namibia, the U.S. Federal Aviation Administration (FAA) has not assessed Namibia'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 www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES: Wild animals may pose some danger.
Travelers are advised that, even in the most serene settings, animals are wild and can pose a threat to life and safety.
Travelers are cautioned to observe all local or park regulations and heed all instructions given by tour guides.
In addition, tourists are advised that potentially dangerous areas sometimes lack fences and warning signs.
Appropriate caution should be used in all unfamiliar surroundings.

Namibia does not recognize dual citizenship for adults over the age of 18.
Therefore, despite the fact that these individuals possess U.S. citizenship, they must enter and exit Namibia bearing a Namibian passport.
Namibia recognizes dual citizenship up until the age of 18; however, such children must enter Namibia on their Namibian passport and may face questioning by an immigration officer before being permitted entry.
Please see our information on customs regulations.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offences.
Persons violating Namibian laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Namibia 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.
Americans should avoid purchasing diamonds and other protected resources outside of licensed retail establishments.
The penalty for illegal dealing in diamonds in Namibia is stiff -- up to U.S. $20,000 in fines or five years in prison -- and the courts generally impose the maximum sentence.
The purchase and exportation of other protected resources, such as elephant ivory, may also be prohibited by Namibian, international, and/or U.S. law.
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 Namibia 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 Namibia.
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 14 Lossen Street, Ausspannplatz, Windhoek, telephone (264-61) 295-8500, fax (264-61) 295-8603.
You can reach the Consular Section at extension 8551; i.e., (264-61) 295-8551 or via e-mail consularwindho@state.gov.
The mailing address for the Embassy is Private Bag 12029, Windhoek, Namibia.
The U.S. Embassy Windhoek website is http://windhoek.usembassy.gov/.
* * *
This replaces the Consular Information Sheet dated August 1, 2006, to update the sections on Entry/Exit Requirements, Crime, Medical Facilities and Health Information, Traffic Safety and Road Conditions and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Mon 23 Sep 2019
Source: News Ghana, via XinhuaNet [edited]

Hepatitis E cases in Namibia have risen to over 6305 cases in the entire country, health officials said Monday [23 Sep 2019]. Health Ministry director of research Phelomena Ochurus said there is a need for the country to be concerned, as cases are being reported on a weekly basis.

According to statistics Ochurus provided, there have so far been 52 fatal cases since 2017, with pregnant women topping the list of deaths.

"Pregnant women are more susceptible, because when they are pregnant, their immune system is compromised," she said. She added that males are topping the number of cases reported, with 60% of them affected in a specific age group of between 20 and 39 years old.

"In the Khomas and Erongo regions, people affected are living in areas with limited water and sanitation facilities, especially in the informal settlements where there are no proper facilities," she said. Khomas region has so far recorded 3865 cases, while Erongo region has recorded 1358 cases.

Namibia experienced the 1st hepatitis E outbreak in 1983 in Rundu, where 9 cases were confirmed, and the last outbreak was experienced in 1995-1996, also in Rundu.
========================
[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, whereas genotype 3 is usually seen in developed countries and does not cause outbreaks. Acute epidemic hepatitis E is attributable to infection with hepatitis E virus genotypes 1 and 2. Many of the deaths are in pregnant women, characteristic of genotype 1.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Mon 1 Jul 2019
Source: Informante [edited]

During the month of June 2019, hepatitis E virus (HEV), which has spread like wildfire through Namibia's sewer-deep informal settlements, carried on unabated, with 113 cases reported countrywide. So far, 45 [persons] have perished since [the outbreak started] in September 2017. From the 45 lives lost, 20 maternal deaths have been reported, signifying the much-extended grave impact that the disease has on Namibia, with new-born babies and children being orphaned due to insatiable spread of the virus. To date, more families are in peril, with 300 more suspected cases of pregnant women with hepatitis E having been reported.

According to the report dated 24 Jun 2019, the 113 cases reported during the month show a significant spike in the spread of the disease, with only 56 cases reported during the prior month (May 2019). Cumulatively, as of 16 Jun 2019, a total of 5423 HEV cases were reported, including 1041 confirmed, and total of 3694 people suspected to have come into close contact with those infected. The majority of cases are reported from Khomas (61%), Hardap (16%), Erongo (15%), Omusati (7%), Omaheke 6 (5%) while Oshana, Ohangwena and Kavango reported 1 (0.9%) case each.

Ministry of Health and Social Services spokesperson, Manga Libita, stated that the National Health Emergency Management Committee (NHEMC) and the response team continued to engage partners, particularly UNDP, City of Windhoek (CoW), and Ministry of Information, Communication and Technology (MICT) to support awareness raising for individuals and collective responsibility, including coordination in fighting HEV in the country. Libita added that UNICEF and partners have expressed readiness to support the CoW and other municipalities to implement Community-Led Total Sanitation (CLTS) tailor-made to suit the urban setting, without compromising the standards of cities.

When they occur, the signs and symptoms of hepatitis E are similar to those of other types of acute viral hepatitis and can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, and jaundice and dark urine. Persons experiencing these symptoms are advised to seek medical counsel at their nearest health facility.  [Byline: Zorena Jantze]
==========================
[Hepatitis E is found worldwide, and different genotypes of the hepatitis E virus determine differences in epidemiology. For example, genotype 1 is usually seen in developing countries and causes community-level outbreaks, whereas genotype 3 is usually seen in developed countries and does not cause outbreaks. Acute epidemic hepatitis E is attributable to infection with hepatitis E virus genotypes 1 and 2. Many of the deaths are in pregnant women, characteristic of genotype 1.

The highest seroprevalence rates (number of persons in a population who test positive for the disease) are observed in regions where low standards of sanitation increase the risk for transmission of the virus. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Tue 18 Jun 2019
Source: The Namibian [edited]

Oyster and black mussel production at Walvis Bay has been halted due to another outbreak of diarrheal shellfish poisoning (DSP), which can be harmful to humans. The Ministry of Fisheries and Marine Resources issued a notice yesterday [17 Jun 2019], warning people not to eat oysters or mussels from Walvis Bay. This comes 3 months after the last outbreak, which was cleared shortly thereafter.

According to the fisheries biologist, contamination is a seasonal occurrence -- mainly during summer from October to April. The recent outbreak could put a dent in the shellfish industry's economy as most exports are to Asia.

The worst affected area is at Walvis Bay's central production sector called "aquaculture production area 1", which is situated near Pelican Point. Once 2 negative results of tested samples are issued, the alert would be withdrawn, and harvesting, consumption and exports would be cleared again. The samples should be taken at 48-hour intervals, the statement from the ministry noted. Marine biotoxins are not destroyed by cooking or freezing.

The statement indicated that DSP symptoms in humans who may have been poisoned might include, as the name suggests, diarrhea, although nausea, vomiting and stomach cramps are also common. These symptoms could manifest themselves after about half an hour of eating the infected shellfish, and could last a day. No deaths have been recorded from DSP to date, the statement indicated. People who show such symptoms should immediately consult a doctor or healthcare centre.  [Byline: Adam Hartman]
=======================
[It is not clear if the term outbreak refers to in the shellfish or in humans.  Diarrheal shellfish poisoning (DSP) (<http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20020>) is a gastrointestinal illness caused by the consumption of shellfish contaminated with algal toxins produced by marine dinoflagellates belonging to the genera _Dinophysis_ spp. (_D. fortii_, _D. mitra_, _D. rotundata_, _D. tripos_, _D. acuta_, _D. norvegica_, and _D. acuminata_) and _Prorocentrum_ spp. (_P. lima_, _P. maculosum_, _P. concavum_, and _P. hoffmannianum_).

The DSP toxins, including okadaic acid (OA) and its analogues dinophysistoxin-1 (DTX-1), dinophysistoxin-2 (DTX-2), and dinophysistoxin-3 (DTX-3), belong to the larger group of lipophilic toxins that also includes the azaspiracid, yessotoxin, and pectenotoxin group toxins.

The term diarrhectic (usually diarrhetic) shellfish poisoning (DSP) was used in this report, but this moderator prefers to use diarrheal shellfish poisoning to avoid any confusion between the almost homophones of diarrhetic and diuretic.

DSP is often mistaken for norovirus-like disease. It is treated with rehydration, and affected individuals usually recover in 1 to 2 days. DSP is most commonly found in shellfish in Europe and Japan but can appear anywhere and bears consideration with the appropriate epidemiology. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Sat, 15 Jun 2019 16:27:09 +0200

Windhoek, June 15, 2019 (AFP) - Drought-hit Namibia has authorised the sale of at least 1,000 wild animals -- including elephants and giraffes -- to limit loss of life and generate $1.1 million for conservation, the authorities confirmed Saturday.   "Given that this year is a drought year, the [environment] ministry would like to sell various type of game species from various protected areas to protect grazing and at the same time to also generate much needed funding for parks and wildlife management," environment ministry spokesman Romeo Muyunda told AFP.

The authorities declared a national disaster last month, and the meteorological services in the southern African nation estimate that some parts of the country faced the deadliest drought in as many as 90 years.    "The grazing condition in most of our parks is extremely poor and if we do not reduce the number of animals, this will lead to loss of an animals due to starvation," Muyunda said.

In April, an agriculture ministry report said 63,700 animals died in 2018 because of deteriorating grazing conditions brought on by dry weather.   Namibia's cabinet announced this week that the government would sell about 1,000 wild animals.   They include 600 disease-free buffalos, 150 springbok, 65 oryx, 60 giraffes, 35 eland, 28 elephants 20 impala and 16 kudus -- all from national parks.   The aim is to raise $1.1 million that will go towards a state-owned Game Products Trust Fund for wildlife conservation and parks management.

The government said there were currently about 960 buffalos in its national parks, 2,000 springbok, 780 oryx and 6,400 elephants.   The auction was advertised in local newspapers from Friday.   Namibia, a country of 2.4 million people, has previously made calls for aid to assist in the drought emergency that has already affected over 500,000 people.   In April the government announced that it will spend about $39,400 (35,200 euros) on drought relief this year to buy food, provide water tankers and provide subsidies to farmers.
Date: Tue 21 May 2019
Source: Outbreak News Today[edited]

The Ministry of Health and Social Services of Namibia officially declared an outbreak of Crimean-Congo hemorrhagic fever (CCHF) on [6 May 2019] after reporting a number of cases from different regions of the country.

As of 15 May 2019, 7 suspected cases of CCHF were reported from 5 regions, including one laboratory confirmed case out of 7 samples tested and one death (case fatality ratio 14 percent).

The Ministry of Health and Social Services detail the cases/locations in the following press statement.

The World Health Organization says CCHF outbreaks have been recurrent in Namibia in the past 2 years, with cases reported from Omaheke, Omusati, and Kharas regions. The last recorded outbreak occurred in March 2018 in Kharas region, where one fatal confirmed case was reported.

The current outbreak arises in the context of a national drought emergency that can intensify the risk of transmission and geographical spread of the disease, with livestock movements from arid to less dry areas, if mitigating measures are not implemented in a timely manner.

Crimean-Congo hemorrhagic fever is a widespread disease caused by a tick-borne virus (_Nairovirus_) of the Bunyaviridae family. The CCHF virus causes severe viral hemorrhagic fever outbreaks, with a case fatality rate of 10-40%.

Animals become infected by the bite of infected ticks and the virus remains in their bloodstream for about one week after infection, allowing the tick-animal-tick cycle to continue when another tick bites. Although a number of tick genera are capable of becoming infected with CCHF virus, ticks of the genus _Hyalomma_ are the principal vector.

The CCHF virus is transmitted to people either by tick bites or through contact with infected animal blood or tissues during and immediately after slaughter. The majority of cases have occurred in people involved in the livestock industry, such as agricultural workers, slaughterhouse workers and veterinarians. Human-to-human transmission is possible.
============================
[HealthMap/ProMED-mail map of Namibia:

Crimean-Congo haemorrhagic fever (CCHF) is the most widespread, tick-borne viral disease affecting humans. The disease is endemic in many regions, such as Africa, Asia, Eastern and Southern Europe, and Central Asia. Ixodid ticks, especially those of the genus _Hyalomma_, are both a reservoir and a vector for the virus. _Hyalomma_ ticks favour dry climates and arid types of vegetation, in areas with abundant small and large mammals that can support haematophagy and the different stages of the tick life-cycle. Environmental factors (such as climate) and human behaviour are critical determinants for the establishment and maintenance of CCHF endemicity within an area.

Given the wide distribution of the _Hyalomma_ vector, the numerous animals that can serve as hosts, and the favourable climatic and ecologic conditions in several European countries bordering the Mediterranean Sea, and African countries , it is possible that the incidence of CCHF may increase geographically over the region in the future (<http://dx.doi.org/10.1016/j.ijid.2017.02.018>).

In healthcare settings, implementation of standard IPC (infection prevention and control) measures (standard, droplet, and contact precautions) with additional precautions to avoid aerosols can minimize transmission along with isolation and cohorting of patients. Effective risk communication remains central to prevent primary infection, especially among animal handlers, slaughter-house workers, and agriculture farmers. While there are examples of best practice, there is an urgent need to standardize risk communication with messages that are evidence-based and do not encourage stigma or unnecessary panic. - ProMED Mod.UBA]
More ...

World Travel News Headlines

Date: Wed, 16 Oct 2019 18:45:39 +0200 (METDST)

Manila, Oct 16, 2019 (AFP) - A child was killed in a strong 6.4-magnitude quake that hit the southern Philippines on Wednesday, a local mayor said, as houses collapsed, power was knocked out and a shopping mall burst into flames.   Residents evacuated homes and buildings across the Mindanao region including a mall that caught fire in the city of General Santos shortly after the quake struck in the evening, officials said.   The child died in a house collapse in the town of Datu Paglas, while four residents of nearby Tulunan town were injured when at least two other houses fell down, Tulunan Mayor Reuel Limbungan told AFP.   "The child was crushed by a collapsed house wall" and pronounced dead in hospital, Limbungan said, adding that he had visited the medical facility and spoken to its director.

Rescue and local officials said there were no immediate reports of deaths elsewhere in Mindanao, and rescue official Anthony Allada told local television that 20 people were treated for injuries in the town of Magsaysay, near the epicentre.   Three other people were hurt in the town of M'lang, added its vice-mayor, Joselito Pinol.   The quake was 14 kilometres (8.7 miles) deep and was followed by at least two aftershocks, according to the United States Geological Survey (USGS).   "It was the most powerful earthquake I have ever experienced," Sara Duterte, mayor of the largest Mindanao city of Davao, and daughter of President Rodrigo Duterte, told local television.

- Falling debris -
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.   An elderly man was treated for injuries after being struck by a falling object during the evacuation of a Davao mall, local TV reported.   Jerome Barranco, civil defence officer for the region, said several people were also injured in the city of Kidapawan "as a result of falling debris".   In General Santos, television footage showed firemen battling a blaze that engulfed the three-storey Gaisano shopping mall.   It was not known if there were still people inside the building, which was evacuated as the quake struck.   The blaze was still raging more than three hours later despite the efforts of nearly 100 firemen, fire officer Redentor Batulan told AFP.

Coastal residents of Davao fled their homes in fear of a tsunami, but rescue workers were trying to convince them to return as no warning was issued, city civil defence chief Rodrigo Bustillo told local television.   "Our volunteers are out to calm the people and tell them there is no tsunami," Bustillo added.   Chief Philippine government seismologist Renato Solidum said there was no risk of a tsunami because the quake occurred inland, but he advised residents to check their homes for possible damage.   "We ran out of the police station, and we also let the inmates at the municipal jail out," patrolwoman Celina Sarte told AFP by telephone from the town of Bansalan.   She said the 10 prisoners were put in handcuffs outside moments later.
Date: Tue, 15 Oct 2019 20:35:37 +0200 (METDST)

Addis Ababa, Oct 15, 2019 (AFP) - Rescue workers on Tuesday used excavators to dig out bodies after a landslide in southern Ethiopia washed away homes and killed more than 20 people, a local official said.    The landslide in the remote district of Konta occurred Sunday following 10 hours of heavy rains, said the official, Takele Tesfu.   "There are 22 people dead and we have only been able to dig up 17 using manpower and machine power," Takele told AFP.   "So far, we cannot get the others, so tomorrow we will continue to dig."     He said the victims included nine women and six children.

While the district -- located in Ethiopia's Southern Nations, Nationalities, and Peoples' Region -- sees landslides with some regularity, Takele said this was the deadliest he could remember.    "The area where this occurred is very mountainous, and this means the landslide was very dangerous," he said.    Ethiopia is nearing the end of its rainy season, but security forces are nonetheless relocating some families for fear that more rain in the coming days could lead to similar disasters, Takele said.
Date: Tue, 15 Oct 2019 10:00:23 +0200 (METDST)

New Delhi, Oct 15, 2019 (AFP) - New Delhi banned the use of diesel generators on Tuesday as pollution levels in the Indian capital exceeded safe limits by more than four times.   Every winter, New Delhi is enveloped in a noxious blanket of smog of car fumes, industrial emissions and smoke from stubble burning at farms outside the megacity of 20 million people.   The ban on generators is part of the Graded Response Action Plan (GRAP) that entered into force on Tuesday.   Other measures that will come into effect as smog levels rise, particularly following the Diwali festival in late October, include banning trucks and setting up a "war room".

From November 4-15, a road-rationing scheme will come into force, meaning cars with odd and even plates would be allowed on alternate days in that period.   "We will hand out anti-pollution masks to schoolchildren next week but the date is yet to be decided," the official told AFP.   Indian authorities have also sought to reduce the burning of stubble by farmers in areas surrounding Delhi.   According to government data, concentrations of particles measuring less than 2.5 microns across -- which can penetrate the lung barrier and enter the blood -- hit 108 icrograms per cubic metre on Tuesday.   This was more than four times the recommended World Health Organization safe daily maximum of 25. In previous years, the level has regularly exceeded 400.   Last year, a UN report found 14 of the world's 15 most polluted cities were in India, with one US study saying it kills a million people prematurely every year.
Date: Tue, 15 Oct 2019 09:50:21 +0200 (METDST)
By Kyoko HASEGAWA

Tokyo, Oct 15, 2019 (AFP) - Rescuers in Japan were working around the clock Tuesday in an increasingly desperate search for survivors of a powerful weekend typhoon that killed nearly 70 people and caused widespread destruction.   Hagibis slammed into Japan on Saturday night, unleashing fierce winds and unprecedented rain that triggered landslides and caused dozens of rivers to burst their banks.   By Tuesday afternoon, local media put the toll at nearly 70, with around a dozen people missing. The government's tally was lower, but it said it was still updating information.   Prime Minister Shinzo Abe said there was no plan to slow rescue operations, with around 110,000 police, coast guard, firefighters and military troops involved.   "Currently in damaged areas rescue work and searches for the missing are continuing around the clock," Abe told parliament.   "Where rivers flooded, work is ongoing to fix spots where banks broke, and water is being pumped out where floods occurred," he added.   The prime minister's office said more than 3,000 people have been rescued in the wake of the disaster, which affected 36 of the country's 47 prefectures.   The defence ministry has called up several hundred reserve troops in addition to active duty soldiers for the first time since the 2011 earthquake and tsunami.

- Rain prompts new warnings -
Government officials warned that more rain was expected throughout the day Tuesday in several parts of the country affected by the typhoon.   "We ask people not to drop their guard and to remain fully alert," chief cabinet secretary Yoshihide Suga. told reporters.   Hagibis crashed into land packing gusts up to 216 kilometres (134 miles) per hour, but it was the storm's heavy rain that caused the most damage.   At least 176 rivers burst their banks, including in central Nagano, where a levee breach sent water from the Chikuma river gushing into residential neighbourhoods and submerging bullet trains in a depot up to their windows.   Deaths were reported across many prefectures and included a man whose apartment was flooded, a municipal worker whose car was caught in rising waters and at least seven crew aboard a cargo ship that sank in Tokyo bay on Saturday night.   By Tuesday morning, some 34,000 households were still without power, and 133,000 homes had no water.   Tens of thousands of people spent Monday night in government shelters, with many unsure when they would be able to return home.   "My frightened daughter can't stop shaking. We want to go home quickly," Rie Nishioka, 39, told Kyodo News agency in Miyagi prefecture.

- Government pledges aid -
The government pledged financial support to affected regions without specifying how much aid it would set aside.   "Support for the victims of the disaster is an urgent task," Abe said.   "There are concerns that the impact on daily life and economic activities may be long-lasting."   Another area affected by the storm was Fukushima, where several bags containing soil and plants collected during nuclear decontamination efforts were washed away.   "Ten bags out of 2,667 were swept into a river during the typhoon, but six of them were recovered yesterday," environment ministry official Keisuke Takagi told AFP, adding that the remaining four bags had been found and would be collected soon.   "Residents must be worried about the environment, but there are no reports that the bags were broken, so there will be nothing to worry about once they have been recovered safely," he said.   Hagibis caused transport chaos over a holiday weekend in Japan, grounding flights and halting train services.   By Tuesday, things were largely back to normal, though some flights were cancelled and train services partially disrupted where tracks or train stock were damaged by the storm.   The typhoon also caused disruption to sporting events, delaying Japanese Grand Prix qualifiers and forcing Rugby World Cup organisers to cancel three matches.   A crunch fixture pitting the hosts against Scotland went ahead on Sunday night, with Japan winning its first-ever quarter final spot.
Date: Mon, 14 Oct 2019 17:55:47 +0200 (METDST)

Harare, Oct 14, 2019 (AFP) - Striking Zimbabwe doctors on Monday defied a court order to return to work, saying a pay rise offered by the government failed to meet everyday costs.   Doctors remained home for a 43rd consecutive day, striking for better pay after their salaries were eroded by the country's spiralling inflation.   Zimbabwe's labour court ruled the action "unlawful" on Friday and ordered the medics back to their wards within 48 hours.

The Zimbabwe Hospital Doctors Association (ZHDA) announced Sunday it would appeal to the Supreme Court.    "We noted the court order but unfortunately we don't have the means by which to comply," said ZHDA spokesman Masimba Ndoro on Monday.   "We remain incapacitated... There is nothing we can do when we don't have the means to go to work and to meet our basic needs," he told AFP.   The doctors say the value of their pay shrank 15-fold over the past year -- a legacy of hyperinflation caused by economic mismanagement under ex-president Robert Mugabe.   His successor Emmerson Mnangagwa has so far failed to redress the situation.    Fuel prices have increased by more than 400 percent since the start of the year, and the ZHDA said that doctors had to use their savings just to show up to hospital each morning.

Negotiations with the government have been deadlocked since the ZHDA rejected a 60-percent salary rise offer.   With pay slips worth less than the equivalent of $100 (91 euros) in some cases, they are demanding doctors' salaries be pegged to the US dollar and have appealed to international bodies to supplement their wages.   "While doctors would want nothing more than to return to work in service of their patients, they continue to be incapacitated and lack the resources to comply with the Labour Court judgement," the ZHDA said in a statement on Sunday.   Nurses joined in the action last week.   "We have reduced the number of days we are coming to work initially to three days a week now we are down to two days," Zimbabwe Nurses Association spokesman Enoch Dongo told AFP.   "If the issue of salaries is not urgently addressed we will soon have a situation where nurses will no longer be able to come to work," he said, adding that nurses were "taking turns" in coming to hospital.      Rural teachers also embarked on strike action on Monday with a stay-at-home protest "against underpayment".   "We urge the government to respect our right to engage in job actions and peacefully protest demanding a living wage," the Amalgamated Rural Teachers Union of Zimbabwe posted on Twitter.
Date: Mon, 14 Oct 2019 16:33:26 +0200 (METDST)
By Daniel BOSQUE

Barcelona, Oct 14, 2019 (AFP) - "I feel fury and a sense of powerlessness," said Joan Guich, a 19-year-old student protesting in Barcelona after Spain's Supreme Court jailed nine Catalan leaders jailed over a failed independence bid.   "They have been convicted for an ideology which I agree with."   Within minutes of the ruling demonstrators had poured onto the streets of the Catalan capital, waving flags and blocking traffic over the conviction of the separatist leaders who organised a 2017 referendum banned by Madrid.   "We have to mobilise and stick up for them ... in a way that has an impact, closing airports, stations, but always avoiding violence," Guich said. "Or at least, it won't be us that provokes it."

Workers rallied outside their offices, university students walked out of classes and regional lawmakers demonstrated inside Catalonia's parliament, where most of the defendants had held a senior role.   "Today is going to be historic, you can feel it in the atmosphere. Serious things are happening, we can't stay home," said Oscar Quiles, a 47-year-old real estate entrepreneur.   News of the verdict reached him as he arrived at the office and he immediately called his mother to join him at a protest in Plaza Cataluna in the centre of Barcelona.   By noon the square was packed with thousands of demonstrators, many waving yellow, red and blue Catalan separatist flags or banners reading "We would do it again" and "Freedom for political prisoners".   The protesters then set off walking towards Barcelona's airport, Spain's second busiest, in the hope of blocking it, just as pro-democracy activists have done recently in Hong Kong.

- 'Weeks of mobilisation' -
Tension gripped Barcelona on Monday morning ahead of the ruling, with a heavy police presence outside the courts, the airport and the city's main train station, as a helicopter flew overhead.    Democratic Tsunami, a group advocating more active forms of civil disobedience, had urged demonstrators to hit the streets as soon as the verdicts were announced.   "Tomorrow everyone ready! When the verdict is out, the response will be immediate," said the group in a message to its roughly 150,000 followers on mobile messaging service Telegram.   Juli Cuellar, a 44-year-old office worker, said he believed the verdict was politically motivated.    "Now all we have left is a life of civil and institutional disobedience," he told AFP, predicting "weeks of mobilisation".   The Catalan National Assembly (ANC) and Omnium Cultural, the region's two biggest grassroots pro-independence groups, have also called supporters to attend an evening rally. They have organised some of the largest separatist protests in recent years.   Several more protests are scheduled over the next few days across Catalonia, as well as a general strike on Friday.

- 'Felt like crying' -
Democratic Tsunami, the group that called the gathering in Plaza Cataluna, only emerged in recent weeks. It says it does not depend on Catalan separatist parties or civil associations for support.   Its leaders remain unknown, keeping in touch with each other through encrypted messaging apps such as Wire.   But supporters tend to be kept in the dark until the last minute.   "We don't know exactly what we have to do," said Arnau Font, a 22-year-old shop assistant who took the week off to protest.   "We have to get involved. Right now I feel really powerless in light of the verdicts," he told AFP.    "When I found out, I felt like crying."   The uncertainty was over a few minutes later when a Telegram message arrived urging everyone to "go to the airport", a 15-kilometre (nine-mile) walk from the city centre.    "The time has come to make our voice felt around the world. The goal: stop the activity of Barcelona's airport," it said.   Spain's airport operator Aena said no flights were disrupted, but many passengers got stuck in traffic jams leading to the airport.
Date: Mon, 14 Oct 2019 14:09:03 +0200 (METDST)

Frankfurt am Main, Oct 14, 2019 (AFP) - German cabin crew union UFO urged members Monday to walk off their jobs at airline giant Lufthansa on October 20, although the carrier contests its right to represent workers.   "We call on all cabin crew... not to show up to work" between six and eleven am (0400 to 0900 GMT) at Germany's two busiest hubs Frankfurt and Munich, Ufo chairman Daniel Flohr said in a video message to staff.   At least five of the Lufthansa group's airlines -- Lufthansa, Eurowings, Germanwings, Cityline and Sunexpress -- would be hit by strikes for higher pay in the coming weeks, Flohr added.

Lufthansa told AFP it would "maintain its entire timetable", calling UFO's call to strike "illegal".   Bosses at the airline 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.   Berlin daily Tagesspiegel on Monday called UFO a "half-dead" outfit.   "UFO is battling for its life," agreed business daily Handelsblatt.   "With its far-reaching call for strikes, it wants to show members it remains capable of acting and is representing cabin crew interests."   Lufthansa could also contest before a court whether UFO has the right to initiate a strike -- potentially leaving the worker representatives on the hook for any resulting costs.
Date: Mon, 14 Oct 2019 11:08:10 +0200 (METDST)

Manila, Oct 14, 2019 (AFP) - Parents lined up from sunrise holding sleeping infants as the Philippines launched a campaign on Monday to vaccinate millions of children against polio, which has re-emerged nearly two decades after the nation's last cases.   Years of falling vaccination rates, made worse by the botched rollout of a dengue vaccine, culminated in an outbreak of the preventable disease in September.   "This is for the welfare of my child," Ruth Miranda told AFP after the vaccine was squirted into her child's mouth at the Manila slum they call home.

Miranda's child is among scores who are unprotected in the capital of about 13 million people, where vaccination rates of young children plunged from 77 percent in 2016 to a mere 24 percent in June.   The atmosphere at the event in Manila was festive -- with ice cream vendors and music -- but the stakes for the campaign are high.

Polio, which can cause paralysis and can be fatal in rare cases, has no cure and can only be prevented with several doses of oral and injectable vaccines.   Two cases were detected in September, the first polio infections in the Philippines since 2001, adding to the woes of a country already hit by deadly measles and dengue epidemic.   The risk of the disease spreading within the Philippines is high, according to World Health Organization, due to low immunisation coverage partly blamed to a dengue vaccine scandal.

The Philippines was the first nation to use Dengvaxia in a mass programme in 2016, but a botched rollout led to claims that children had died after being vaccinated.   A dramatic drop in vaccine confidence followed, with trust plunging from 93 percent in 2015 to 32 percent in 2018, according to a study led by the London School of Hygiene and Tropical Medicine.   The Philippines polio outbreak has been traced back to the weakened form of the virus used in vaccines, which is excreted by people for a time after they receive it.   According to the WHO, that form can mutate and spread in the surrounding community when immunisation rates get too low.
Date: Mon, 14 Oct 2019 10:25:38 +0200 (METDST)
By Shingo ITO, Sara HUSSEIN

Tokyo, Oct 14, 2019 (AFP) - Tens of thousands of rescue workers in Japan battled on Monday to find survivors of a powerful typhoon that killed at least 43 people, as fresh rain threatened to hamper efforts.   Typhoon Hagibis crashed into the country on Saturday night, unleashing high winds and torrential rain across 36 of the country's 47 prefectures, and triggering landslides and catastrophic flooding.   "Even now, many people are still unaccounted for in the disaster-hit area," Prime Minister Shinzo Abe told an emergency disaster meeting on Monday.   "Units are trying their best to search for and rescue them, working day and night," Abe said.

But even as rescuers, including troops, combed through debris, the country's weather agency forecast rain in central and eastern Japan that it warned could cause further flooding and new landslides.   "I would like to ask people to stay fully vigilant and continue watching for landslides and river flooding," Chief Cabinet Secretary Yoshihide Suga told a news conference.   In Nagano, one of the worst-hit regions, rain was already falling and was expect to intensify.   "We are concerned about the impact of the latest rain on rescue and recovery efforts," local official Hiroki Yamaguchi told AFP.   "We will continue operations while watching out for secondary disasters due to the current rain."

- 43 dead, 16 missing: NHK -
By late Monday afternoon, national broadcaster NHK said the toll had risen to 43 dead, with 16 others missing and over 200 people injured. The government gave lower figures but was continuing to update its information.   The dead included a municipal worker whose car was overcome by floodwaters and at least seven crew from a cargo ship that sank in Tokyo Bay on Saturday night, a coast guard spokesman said.   Four others, from China, Myanmar and Vietnam, were rescued when the boat sank and the coast guard was still searching for a last crew member.   While Hagibis, one of the most powerful storms to hit the Tokyo area in decades, packed wind gusts of up to 216 kilometres (134 miles) per hour, it was the heavy rains that caused most damage.

A total of 142 rivers flooded, mainly in eastern and northern Japan, with river banks collapsing in two dozen places, local media said.   In central Nagano, a levee breach sent water from the Chikuma river gushing into residential neighbourhoods, flooding homes up to the second floor.   As water slowly receded Monday, television footage showed patients being transferred by ambulance from a Nagano hospital where some 200 people had been cut off by flooding.   Elsewhere, rescuers used helicopters to winch survivors from roofs and balconies, or steered boats through muddy waters to reach those trapped.

- Japan dedicates rugby win to victims -
By Monday afternoon, some 75,900 households remained without power, with 120,000 experiencing water outages.   The disaster left tens of thousands of people in shelters, with many unsure when they would be able to return home.   "Everything from my house was washed away before my eyes, I wasn't sure if it was a dream or real," a woman in Nagano told NHK.   "I feel lucky I'm still alive."   The storm brought travel chaos over the holiday weekend, grounding flights and halting commuter and bullet train services.

By Monday, most subway trains had resumed service, along with many bullet train lines, and flights had also restarted.   The storm also brought havoc to the sporting world, forcing the delay of Japanese Grand Prix qualifiers and the cancellation of three Rugby World Cup matches.   But a crucial decider pitting Japan against Scotland went ahead, with the hosts dedicating their stunning 28-21 win to the victims of the disaster.   "To everyone that's suffering from the typhoon, this game was for you guys," said Japan captain Michael Leitch.
Date: Sun, 13 Oct 2019 23:31:57 +0200 (METDST)

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

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

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