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American Samoa

Samoa US Consular Information Sheet
January 23, 2008
COUNTRY DESCRIPTION:
Samoa consists of the two large islands of Upolu and Savai’i and seven small islets. The country has a stable parliamentary democracy with a developing economy. To
rist facilities are accessible by bus, taxi and car and are within walking distance of access roads. Infrastructure is adequate in Apia, the capital, but it is limited in other areas. Nearly all Internet connections use a relatively slow dial-up method. Samoa has two digital telephone service providers, and visitors can easily purchase prepaid phones that cover virtually the entire country. The Samoa Tourism Authority, at http://www.visitsamoa.ws/, provides a wide range of information of interest to travelers. Read the Department of State Background Notes on Samoa for additional information.

ENTRY/EXIT REQUIREMENTS:
U.S. nationals who are not U.S. citizens, and who are resident in American Samoa, must obtain a visitor permit prior to all travel to Samoa. U.S. nationals have not been permitted to travel to Samoa on certificates of identity since May 2005 except on a case by case basis. (U.S. law distinguishes between individuals who are citizens and those who are nationals. The U.S. passport bio-page shows one’s status as either a citizen or a non-citizen national.) As of March 22, 2006, visitor permits to travel to Samoa can be applied for at the new Samoa Consulate General office in Pago Pago, American Samoa. A valid passport and an onward/return ticket are required for all Americans (both citizens and nationals) to travel to Samoa. Visitor permits are not required for U.S. citizens (only for U.S. nationals) seeking to stay in Samoa for up to 60 days. All visitors are required to pay a departure tax of 40 Tala (approximately 17.50 USD) upon leaving the country. Further information about entry requirements and the departure tax may be obtained from the Samoa Mission to the United Nations at 800-2nd Avenue, Suite 400J, New York, NY 10017, telephone (212) 599-6196, fax (212) 599-0797. Visit the Embassy ofSamoa web site at http://www2.un.int/public/Samoa/ 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:
In Apia and many villages, stray dogs wander the streets. Visitors should not approach or feed them; they can become aggressive in the presence of food or if they feel threatened.

Although there have been no major accidents involving the ferry service linking Upolu and Savai’i, vessels are sometimes overloaded. One of the ferries, a multi-deck automobile ferry, sometimes transports passengers on its automobile deck. Americans who choose to use this ferry are encouraged not to remain in the automobile deck during the crossing and to ride only in the passenger compartment in order to avoid injury from shifting vehicles.

Samoa has numerous “blowholes” (lava tubes open to the sea where wave action produces, often spectacular, geysers). These blowholes are popular tourist attractions. The footing around the mouths of most blowholes is very slippery. To avoid being swept in, visitors should not approach too closely and should never stand between the opening of the blowhole and the sea.

Snorkeling and diving in ocean lagoons is a popular activity for many visitors to Samoa. Tide changes can produce powerful currents in these lagoons. Visitors are encouraged to consult local residents and tour operators about hazards and conditions at a particular location before venturing into the water.

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:
Overall, Samoa is considered a low threat environment. Nevertheless, visitors should remain aware of their surroundings, lock their doors at night, and not leave their belongings unattended. Incidents of petty theft/robberies of personal effects are common. Some such incidents have involved residential break-ins. While rare, violent assaults, including sexual assaults have occurred in Samoa. No specific groups have been targeted, nor have there been any racially motivated or hate crimes against Americans. Police responsiveness in Apia is generally good. Because of the very limited police presence elsewhere in Samoa (where order is maintained primarily by local village authorities), police responsiveness elsewhere is problematic.

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:
Health care facilities in Samoa are adequate for routine medical treatment, but are limited in range and availability; complex illnesses and life-threatening emergencies generally need to be treated elsewhere. Dental facilities do not meet U.S. standards, but good dental treatment and some emergency care can be obtained nearby at the LBJ Tropical Medical Center in Pago Pago, American Samoa. The national hospital and a small private hospital are located in Apia, and there are several small district hospitals on Savai'i and in outlying areas of Upolu. There are no hyperbaric chambers on any of the islands for the treatment of scuba diving related injuries. Serious cases of decompression sickness are evacuated to the nearest treatment center in Suva, Fiji, or Auckland, New Zealand. Serious medical conditions and treatments that require hospitalization and/or medical evacuation to the United States can cost thousands of dollars. Travelers should carry emergency evacuation insurance. Doctors and hospitals often expect immediate cash payment for health services. There is no reported incidence of malaria or rabies in Samoa. Occasional outbreaks of typhoid and non-hemorrhagic dengue do occur.

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

Safety of public transportation and rural road conditions in Samoa, are considered fair, while urban road conditions/maintenance is considered good. Taxis in particular are widely available and used by Samoans and visitors alike; buses are slow, generally crowded and uncomfortable, and rarely utilized by visitors. Rental cars can also be obtained. No roadside assistance is available. Most major roads are tar-sealed, but secondary roads are predominantly dirt and gravel and may be overgrown with vegetation. A four-wheel drive vehicle is recommended for travel on these roads. Travelers should be aware that vehicle safety regulations are rarely enforced and traffic violations occur routinely. Roads outside Apia are often narrow, winding, relatively steep, with narrow or no shoulders, and poorly lighted. Pedestrians as well as vehicles and livestock regularly travel these roads. Due to poor and deteriorating road conditions, night driving on unlit rural roads can be dangerous and should be avoided if possible. Roads in Samoa often traverse small streams. Drivers are urged to exercise extreme caution when fording these streams, which can become swollen and dangerous with little warning. Vehicles should never enter a stream if the roadbed is not visible or if the water’s depth exceeds the vehicle’s clearance.

Speed limits in Samoa are 25 miles per hour in the Apia area and 35 miles per hour outside Apia, with certain exceptions. At unmarked intersections, traffic on the left has the right of way. As in the United States, vehicular traffic moves on the right side of the road; although right-hand-drive vehicles (mainly from New Zealand) do exist in Samoa. Importing right hand drive vehicles to Samoa is currently legally forbidden.

Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office at Samoa Tourism Authority at http://www.visitsamoa.ws/.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government ofSamoa’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Samoa’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:
Some overseas treatment centers, known as Behavior Modification Facilities, operate in Samoa. Though these facilities may be operated and staffed by U.S. citizens, the Samoan government is solely responsible for compliance with local safety, health, sanitation and educational laws and regulations, including all licensing requirements of the staff in country. These standards, if any, may not be strictly enforced or meet the standards of similar facilities in the U.S. Parents should be aware that U.S. citizens and non-citizen nationals 14 years of age and older have a right to apply for a passport and to request repatriation assistance from the U.S. government, both without parental consent. Any U.S. citizen or non-citizen enrollee has the right to contact a representative from the U.S. Embassy. For further information, consult the Department of State's Fact Sheet on Behavior Modification Facilities, available via the Bureau of Consular Affairs home page. Parents may also contact the U.S. Embassy in Apia or the country officer in the Office of American Citizens Services, Bureau of Consular Affairs at 202-647-5226.

Financial Transactions:
Although some businesses (especially those in Apia or those frequented by tourists) do accept credit cards, many (including gas stations) do not. Major credit cards (Visa, Master Card, and American Express) are accepted at major hotels and some restaurants and stores. Samoan currency can be obtained from ATMs, which are located in Faleolo Airport and in many locations in Apia. For more information on ATM locations and banking services see ANZ web site at http://www.anz.com/samoa/overview.asp and WESTPAC web site at http://www.westpac.com.ws/pacific/publish.nsf/Content/PFSA+HomePage.

Disaster Preparedness: Samoa is located in an area of high seismic activity. Although the probability that a major earthquake would occur during an individual trip is remote, earthquakes can and will continue to happen. Major cyclones have occurred in the past and are always a concern. Strong winds and very heavy rains are common, especially during the rainy season from November to April. During this period, Samoa receives most of its annual average of over 130 inches of rain. General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency’s (FEMA) web site at http://www.fema.gov/.

Customs: Samoa customs authorities may enforce strict regulations concerning temporary importation into or export from Samoa of items such as firearms, fruits, pets and other animals, and drugs. It is advisable to contact the Samoan Mission to the United Nations at 800 2nd Avenue, Suite 400J, New York, NY 10017, telephone (212) 599-6196 for specific information regarding customs requirements. Please see our Customs Information.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Samoa’s laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Samoa 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:
Samoa is not a member of the Hague Convention on the Civil Aspects of International Child Abduction. 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 Samoa 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 withinSamoa. 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 in the Accident Compensation Board (ACB) Building, Fifth Floor, Apia. The Embassy is open to the public from 8:15 a.m. to 5:00 p.m. Monday - Friday. The Embassy's mailing address is U.S. Embassy, P.O. Box 3430, Apia, Samoa 0815. The telephone numbers are (685) 21436/21631/22696 and 21452. The fax number is (685) 22030. An Embassy officer can be reached after hours in an emergency involving the welfare of a U.S. citizen or non-citizen national at (685) 21514 or (685) 777-1776. Visit the U.S. Embassy’s web site at http://samoa.usembassy.gov/.
* * *
This replaces the Consular Information Sheet (now known as Country Specific Information) dated May 21, 2007, to update sections on Country Description and Crime.

Travel News Headlines WORLD NEWS

American Samoa. 8 Mar 2017.
(susp) as of mid-February 30 cases of Dengue.

A HealthMap/ProMED-mail map showing the location of American Samoa in the Pacific can be accessed at <http://healthmap.org/promed/p/380>
and a map of the island at <http://www.nationsonline.org/maps/tutuila-island-map.jpg>. - ProMED Mod.TY
Date: Sat 20 Sep 2014
Source: Radio New Zealand [edited]

Latest figures from Samoa's Ministry of Health show an increase of suspected and confirmed cases of chikungunya [virus infections] from 400 to 626 since the outbreak of the acute fever, rash and joint pain disease was reported in July [2014].

However, the ministry says so far presentation of the main signs and symptoms of those affected have largely been mild.

The highest number of people affected is recorded in the districts of Vaimauga west in the urban area with 151 cases; Faleata east, 139 cases; and 113 in Faleata west.  The majority of patients is young.

In American Samoa, the chikungunya outbreak is on the wane. Health officials say there are now 823 probable cases of the mosquito-borne illness, with 15 people requiring hospital care.
===========
[The chikungunya outbreak continues to grow in Samoa, from 269 cases reported on 25 Aug 2014 to 433 reported on 8 Sep 2014 and now to 626 cases. One hopes that a prompt and aggressive clean up of breeding sites will reduce the vector mosquito population enough to halt, or at least reduce, transmission.

On 26 Jul 2014, it was reported that American Samoa had about 100 cases, with 3 laboratory confirmed as chikungunya virus infections (see ProMED-mail archive no. 20140727.2638925). This is a sharp outbreak, with over 700 cases in a little over one month, apparently peaking at 823 probable cases reported above. Once introduced into American Samoa, spread of the virus is not surprising, because it has had dengue virus transmission in the past, and the same mosquitoes that transmit dengue viruses can transmit chikungunya virus as well.

A map showing the location of Samoa in the Pacific Ocean can be accessed at <http://www.worldatlas.com/webimage/countrys/oceania/wsnewz.gif>. A HealthMap/ProMED-mail map showing the location of both Samoa and American Samoa in the Pacific Ocean can be accessed at <http://healthmap.org/promed/p/380>. - ProMed Mod.TY]
Date: Mon 9 Sep 2014
Source: Radio New Zealand [edited]
<http://www.radionz.co.nz/international/pacific-news/253977/chikungunya-related-cases-reach-over-700-in-american-samoa

The latest reports from American Samoa reveal that chikungunya-related [febrile] cases have now reached over 700, and there is now one probable case in Ofu, Manua. The virus was discovered in the territory in July 2014, but there have been no reported cases in Manua until now.

Health officials are urging residents not to travel to Manua if they have chikungunya, and testing is being done to determine whether the case in Ofu is due to the virus. Since July 2014, there have been 11 hospitalisations with the virus but no deaths.

Health officials continue to urge those with symptoms to drink plenty of fluids, get a lot of rest, and visit the emergency department if symptoms become serious.
=======================
[On 26 Jul 2014, it was reported that American Samoa had about 100 cases, with 3 laboratory confirmed as chikungunya virus infections (see ProMED-mail archive no. 20140727.2638925). This is a sharp outbreak, with over 700 cases in a little over one month. Once introduced into American Samoa, spread of the virus is not surprising, because it has had dengue virus transmission in the past, and the same mosquitoes that transmit dengue viruses can transmit chikungunya virus as well.

A HealthMap/ProMED-mail map showing the location of American Samoa in the Pacific Ocean can be accessed at
Date: Tue 5 Aug 2014
Source: Radio New Zealand International [edited]

The American Samoan Department of Health says there are now more than 300 confirmed cases of chikungunya or 'chik' virus in the territory.

The Health Director Motusa Tuileama Nua says his department and LBJ hospital have confirmed the outbreak of fever, rashes, and joint pains among people on the main island of Tutuila is due to chikungunya.

He says there have been 343 recorded cases, with 6 patients hospitalised and no deaths, since the beginning of July [2014].

He recommends those who are ill with fever and body aches do not travel off island.
--------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
===============
[CHIKV has been circulating in Pacific islands this year (2014).

Maps showing the location of American Samoa in the Pacific Ocean can be accessed at
<http://healthmap.org/promed/p/380>. - ProMed Mod.TY]
****************************
American Samoa: confirmed
Date: Fri 8 Aug 2014
Source: Samoa News [edited]

The American Samoa Department of Health and the LBJ hospital have created a 24 hour a day hotline for the CHIK virus. The CHIK hotline number is 731-7511.

The Health Alert issued yesterday [7 Aug 2014] confirms chikungunya (CHIK) virus as the cause of fever, rash, and joint pains outbreak on Tutuila and there have been more than 390 recorded cases, with 7 patients hospitalized and no deaths since 1 Jul 2014.

According to the health alert, there is no cure for CHIK virus [infection, and] it can usually be treated at home by drinking lots of fluids, taking pain medicine like Tylenol, ibuprofen, or Aleve as needed but only as much and with cautions as recommended on the package.

The health alert urges not to work while your joints are painful, let them rest and apply ice or cold packs on the joints and this may protect against prolonged joint pain.

DOH notes you should go to the Emergency Room to see a doctor if symptoms persist more than 10 days, or if you have bleeding from any part of the body or bruised skin. Call the hotline "or come to the ER or clinic if you are worried about your condition getting worse."

The alert once again urges that people stay indoors in air-con, behind screens, or under bed nets while you are ill, because if you are bitten by mosquitoes while you are ill, you can spread the disease to your family and neighbors.

For travelers, the DOH urges those who are ill not to travel off island, including to Manu'a. "If you travel and become ill when you arrive, tell the doctor who sees you that you may have been exposed to the CHIK virus."  [Byline: B. Chen]
----------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
-----------------------------------
[Interestingly, the 5 Aug 2014 report above indicated that there were 343 reported cases, and in the subsequent report of 8 Aug 2014 above, that number has increased to 390 cases, indicating that transmission of CHIK virus is continuing. - ProMed Mod.TY]
******
Samoa: suspected cases
Date: Fri 8 Aug 2014
Source: Island Business [edited]

Samoa's Ministry of Health has reported 2 deaths from acute fever and rash, saying it is now an outbreak. A press statement from the Director General, Leausa Toleafoa Dr Take Naseri, says there have been 21 recorded cases as of earlier this week with 4 people hospitalised.

The cases are suspected to be chikungunya virus, similar to dengue fever, but results are yet to be confirmed and 3 children and one man have been admitted to the intensive care unit.

The ministry says collaboration with other government agencies, and media campaigns, aim to raise awareness of the outbreak and help its containment.

Samoa has also sought assistance from the Ministry of Health's development partners including the Secretariat of the Pacific Community and the World Health Organisation.

In neighbouring American Samoa, there have been more than 300 confirmed cases of chikungunya.
======================
[This is the 1st ever ProMED-mail report of a chikungunya outbreak in Samoa. Concerning the current outbreak, it would be unusual to have 2 deaths from chikungunya virus infections of a total of 21 recorded cases. One explanation for the high proportion of fatal cases could be significant underreporting of non-fatal cases. No mention is made indicating that there were contributory underlying medical conditions in these 2 fatal cases. ProMED-mail will be interested in receiving results of the laboratory tests when they become available.

Maps showing the location of Samoa in the Pacific Ocean can be accessed at
at <http://healthmap.org/promed/p/2>. - ProMed Mod.TY]
Date: Wed 14 May 2014
Source: Radio New Zealand International [edited]

Health officials in American Samoa are warning the public about an amoebic dysentery outbreak which has so far affected 26 people, half of which have been admitted to the LBJ hospital. A Pacific Island Health Officers' Association Epidemiologist, Mark Duran, says the department of health is leading an investigation into the source of the parasite.

Dr Duran says amoebic dysentery is spread through contamination of human waste. "It especially attacks the intestines and invades its way into the wall of the intestines; it causes abdominal pain, it causes bloody diarrhoea, fever." Dr Duran says in serious cases the parasite can travel through the body and cause abscesses especially in the liver.
===================
[Maps of American Samoa can be seen at
<http://healthmap.org/promed/p/380>. - ProMed Sr.Tech.Ed.MJ]
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Bouvet Island

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

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

Travel News Headlines WORLD NEWS

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Ethiopia

Ethiopia - US Consular Information Sheet
November 26, 2008
COUNTRY DESCRIPTION:
The Federal Democratic Republic of Ethiopia is a developing country in East Africa.
It is comprised of nine states and two city administrations (Addis Aba
a and Dire Dawa).
The capital is Addis Ababa.
Tourism facilities can be found in the most populous regions of Ethiopia, but infrastructure is basic.
The ruling EPRDF party and Prime Minister Meles Zenawi maintain strong control of the government and economy.
Despite several years of high economic growth, the country remains vulnerable to external economic shocks and recurring drought.

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

ENTRY/EXIT REQUIREMENTS:
To avoid possible confusion or delays, travelers are advised to obtain a valid Ethiopian visa at the nearest Ethiopian Embassy prior to arrival, and must do so if entering across any land port-of-entry.
For example: travelers wishing to enter Ethiopia from Kenya at the land border at Moyale, must obtain an Ethiopian visa first.
Ethiopian visas ARE NOT available at the border crossing point at Moyale.
Travelers should apply for Ethiopian visas at the Ethiopian Embassy in Nairobi or at other Ethiopian embassies in other countries.
Ethiopian visas are available to U.S. citizens upon arrival at Bole International Airport in Addis Ababa.
U.S. citizens may obtain one-month or three month, single-entry tourist visas or 10-day single-entry business visas upon arrival at Bole International Airport.
This service is available only at Bole International Airport and is not available at any other ports of entry in Ethiopia.
The visa fee at Bole International Airport is payable in U.S. dollars.
Such visas can be extended by applying at the Main Immigration Office in Addis Ababa.
Business visas of up to three-months validity can also be obtained at Bole International Airport upon arrival if the traveler has a sponsoring organization in Ethiopia that has made prior arrangements for issuance through the Main Immigration Office in Addis Ababa.
Travelers whose entry visa expires before they depart Ethiopia, must obtain a visa extension and pay a monthly penalty fee of $20 USD per month.
Such travelers may also be required to pay a court fine of up to 4000 ETB (USD $435) before being permitted to depart from Ethiopia.
Travelers are required to pay the penalty fee before they will be able to obtain an exit visa (USD $20) permitting them to leave Ethiopia.

Individuals intending to stay in Ethiopia for a prolonged period of time are advised to contact the Ethiopian Embassy in Washington prior to traveling.
The Ethiopian Embassy is located at 3506 International Drive NW, Washington, DC 20008; telephone (202) 364-1200; fax (202) 587-0195.
For the most current visa information, visit the Embassy’s web site at www.ethiopianembassy.org.
Inquiries by Americans located overseas may be made at the nearest Ethiopian 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:
While Ethiopia is generally stable, domestic insurgent groups, extremists from Somalia, and the heavy military buildup along the northern border pose risks to safety and security, particularly along Ethiopia’s border areas and in the Somali region.
In the past year, there has been an increase in targeted bombings in Addis Ababa and in other parts of Ethiopia.
In November 2008, the Government of Ethiopia issued a warning to its citizens alerting them of the potential for terrorist attacks and subsequently increased security measures to unprecedented levels.

Throughout Ethiopia:
Americans are strongly advised to review their personal safety and security posture, to remain vigilant and to be cautious when frequenting prominent public places and landmarks.
Targeted bombings in Addis Ababa and south eastern Ethiopia in 2008 resulted in numerous injuries and deaths.
Americans are advised to avoid public gatherings and public places, including hotels, if possible, and using public transportation and transportation hubs.
They are advised to beware of unattended baggage or packages left in any location, including in mini-buses and taxis.

Ethiopia/Eritrea Border Area:
Ethiopia and Eritrea signed a peace agreement in December 2000 that ended their border war.
However, the border remains an issue of contention between the governments of Ethiopia and Eritrea.
The border area is a militarized zone where there exists the possibility of armed conflict between Ethiopian and Eritrean forces.
American citizens are advised to avoid travel in the areas along the Eritrean/Ethiopian border (within 50 km/30 miles of the Ethiopian/Eritrean border) because of the dangers posed by land mines and because of the possibility of conflict between Ethiopian and Eritrean defense forces.
Due to abductions and banditry, Americans are advised to avoid travel within 30 miles of the Ethiopian-Eritrean border west of Adigrat to the Sudanese border, with the exception of the town of Axum, and within 60 miles east of Adigrat to the Djiboutian border.
Embassy personnel are permitted to travel in these areas only on a case-by-case basis. Travel to the northern Afar Region towards the Eritrean border is also discouraged.
Embassy personnel are permitted to travel there only on a case-by-case basis.

Somali Region:
Since the mid-1990's the members of the Ogaden National Liberation Front (ONLF) have clashed with Ethiopian government forces near the city of Harar and in the Somali regional state, particularly in the Ogaden zones.
In April 2007, the ONLF claimed responsibility for attacking a Chinese oil exploration installation south of Jijiga, in Ethiopia's Somali region.
The attack resulted in deaths, kidnappings and the wounding of dozens of Chinese and Ethiopian citizens.
In 2008, a hotel in the town of Jijiga was bombed and two hotels in the town of Negele Borena were bombed.

American citizens are reminded that the U.S. Embassy strongly discourages travel to Ethiopia's Somali region and that a Travel Warning for Somalia has been issued that advises against all travel to that country.
Armed insurgent groups operate within the Somali, Oromiya and Afar regions of Ethiopia.
In December 2006, the Ethiopian Government, at the invitation of the Transitional Federal Government of Somalia, began military operations against extremists in Somalia.
As of November 2007, military operations continue in Mogadishu, where an African Union peacekeeping force, AMISOM, is deployed.
In 2008, two staff members of a non-governmental organization (NGO) were abducted in the Somali region.

Gambella Region:
Sporadic inter-ethnic clashes remain a concern throughout the Gambella region of western Ethiopia following outbursts of violence there in 2003 - 2004.
There is a heavy military and police presence in the town of Gambella.
While the security situation in the town of Gambella is calm, it remains unpredictable throughout the rest of the region, and violence could recur without warning.
Travel to this region is discouraged.

Travel in Ethiopia via rail is discouraged due to past episodes of derailment, sabotage, and bombings.
In southern Ethiopia along the Kenyan border, banditry and incidents involving ethnic conflicts are also common.
Travelers should exercise caution when traveling to any remote area of the country, including the borders with Eritrea, Somalia, Kenya and Sudan.
Ethiopian security forces do not have a widespread presence in those regions.

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:
Pick-pocketing, “snatch and run” thefts, and other petty crimes are common in Addis Ababa.
These are generally crimes of opportunity rather than planned attacks.
Travelers should exercise caution in crowded areas and should avoid visiting the Mercato in Addis Ababa, a large open-air market.
Violence in the Mercato has been on the rise.
In 2008 an explosion in the Mercato killed several and wounded more than a dozen individuals.
Also in 2008, there was a shooting in the Mercato.
Travelers should limit the amount of cash they carry and leave valuables, such as passports, jewelry, and airline tickets in a hotel safe or other secure place.
Travelers should keep wallets and other valuables where they will be less susceptible to pick-pockets.
Travelers should be cautious at all times when traveling on roads in Ethiopia.
There have been reports of highway robbery, including carjacking, by armed bandits outside urban areas.
Some incidents have been accompanied by violence.
Travelers are cautioned to limit road travel outside major towns or cities to daylight hours and travel in convoys, if possible.

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.

There is no local equivalent to the “911” emergency line in Ethiopia.
Distress calls should be made to the local police station, the telephone number of which can be obtained by calling directory assistance at 997.
This is the number for directory assistance throughout Ethiopia.
In Addis Ababa, the number for police is 991, for the fire brigade 939, and for an ambulance 907.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Health facilities in Addis Ababa are very limited and are generally inadequate outside the capital.
Even the best hospitals in Addis Ababa suffer from inadequate facilities, antiquated equipment, and shortages of supplies (particularly medicines).
There is a shortage of physicians.
Emergency assistance is limited.
Psychiatric services and medications are practically nonexistent.
Serious illnesses and injuries often require travelers to be medically evacuated from Ethiopia to a location where adequate medical attention is available.
Such “medevac” services are very expensive and are generally available only to travelers who either have travel insurance that covers medevac services or who are able to pay in advance the considerable cost of such services (often in excess of USD 40,000).
See Medical Insurance below.
Travelers must carry their own supplies of prescription drugs and preventive medicines, as well as a doctor's note describing the medication.
If the quantity of drugs exceeds that which would be expected for personal use, a permit from the Ministry of Health is required.
Malaria is prevalent in Ethiopia outside of the highland areas.
Travelers who become ill with a fever or flu-like illness while traveling in a malaria-risk area and up to one year after returning home should seek prompt medical attention and explain to the health care provider their travel history and which anti-malarials they have been taking.
For additional information on malaria, protection from insect bites, and anti-malarial drugs, please visit the CDC Travelers' Health web site at http://www.cdc.gov/malaria/index.htm.
Tuberculosis is an increasingly serious health concern in Ethiopia.
For further information, please consult the CDC's Travel Notice on TB at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx

Ethiopia is a mountainous country and the high altitude may cause health problems, even for healthy travelers.
Addis Ababa is located at an altitude of 8,300 feet.
Travelers may experience shortness of breath, fatigue, nausea, headaches, and inability to sleep.
Individuals with respiratory (including asthma) or heart conditions should consult with a health care professional before traveling to Ethiopia.
Travelers to Ethiopia should also avoid swimming in any lakes, rivers, or still bodies of water.
Most bodies of water have been found to contain parasites.
Travelers should be aware that Ethiopia has a high prevalence of HIV/AIDS.
Ethiopia has had outbreaks of acute watery diarrhea, possible cholera, typhoid, or other bacterial diarrhea in the recent past, and the conditions for reoccurrences continue to exist.
Further information on prevention and treatment of cholera and other diarrheal diseases can be found at the CDC web site at http://wwwn.cdc.gov/travel/contentDiseases.aspx.
Ethiopian authorities are monitoring the possibility of avian influenza following the deaths of poultry and birds; preliminary results are negative.
For additional information on avian flu please visit the CDC website at http://www.cdc.gov/flu/avian/.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Ethiopia.
Please verify with the embassy of Ethiopia before you travel.
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.
Specific medevac insurance, which generally covers evacuation of a patient from Ethiopia to a location where adequate medical attention is available, is often inexpensive and available through a variety of companies that can be accessed online.
Medicare and Medicaid recipients are not covered overseas and are advised to purchase supplemental health and medical evacuation insurances.
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 Ethiopia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
According to the World Health Organization (WHO), Ethiopia has the highest rate of traffic fatalities per vehicle in the world.
Roads in Ethiopia are poorly maintained, inadequately marked, and poorly lighted.
Road travel after dark outside Addis Ababa and other cities is dangerous and discouraged due to hazards posed by broken-down vehicles left in the road, pedestrians walking in the road, stray animals, and the possibility of armed robbery.
Road lighting in cities is inadequate at best and nonexistent outside of cities.
Excessive speed, unpredictable local driving habits, pedestrians and livestock in the roadway, and the lack of basic safety equipment on many vehicles are daily hazards on Ethiopian roads.
While travel during daylight hours on both paved and unpaved roads is generally considered safe, land mines and other anti-personnel devices can be encountered on isolated dirt roads that were targeted during various conflicts.
Before undertaking any off-road travel, it is advisable to inquire of local authorities to ensure that the area has been cleared of mines.
Please refer to our Road Safety page for more information.
AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Ethiopia’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Ethiopia’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/.
The Ethiopian government has closed air routes near the border with Eritrea and has referred to the airspace as a “no-fly zone.”
The FAA currently prohibits U.S. aircraft and U.S. pilots from flying in Ethiopian airspace north of 12 degrees north latitude, the area along the country's northern border with Eritrea.
For complete information on this flight prohibition, travelers may visit the FAA's web site at http://www.faa.gov/airports_airtraffic/air_traffic/publications/notices/2008-11-20/PART3_SEC1.cfm.
SPECIAL CIRCUMSTANCES:
Ethiopia does not recognize dual nationality.
The government of Ethiopia considers Ethiopians who have become naturalized U.S. citizens to be Americans.
Such individuals are not subject to Ethiopian military service.
The Ethiopian government has stated that Ethiopian-Americans in almost all cases are given the same opportunity to invest in Ethiopia as Ethiopians.
Several years ago the government of Ethiopia arrested people of Eritrean origin who initially failed to disclose their U.S. citizenship.
However, this has not occurred in recent years.
Ethiopian officials have recently stated that Eritrean-Americans are treated as U.S. citizens and are not subject to arrest simply because of their ties to Eritrea.
For additional information, see our dual nationality flyer.
Permits are required before exporting either antiques or animal skins from Ethiopia.
Antique religious artifacts, including "Ethiopian” crosses, require documentation from the National Museum in Addis Ababa for export.
Foreign currency should be exchanged in authorized banks, hotels and other legally authorized outlets and proper receipts should be obtained for the transactions.
Exchange receipts are required to convert unused Ethiopian currency back to the original foreign currency.
Penalties for exchanging money on the black market range from fines to imprisonment.
Credit cards are not accepted at most hotels, restaurants, shops, or other local facilities, although they are accepted at the Hilton and Sheraton Hotels in Addis Ababa.
Some hotels and car rental companies, particularly in Addis Ababa, may require foreigners to pay in foreign currency or show a receipt for the source of foreign exchange if paying in local currency.
However, many hotels or establishments are not permitted to accept foreign currency or may be reluctant to do so.

Ethiopian institutions have on occasion refused to accept 1996 series U.S. currency, although official policy is that such currency should be treated as legal tender.
Ethiopian law strictly prohibits the photographing of military installations, police/military personnel, industrial facilities, government buildings, and infrastructure (roads, bridges, dams, airfields, etc.).
Such sites are rarely marked clearly.
Travel guides, police, and Ethiopian officials can advise if a particular site may be photographed.
Photographing prohibited sites may result in the confiscation of film and camera.
There is a risk of earthquakes in Ethiopia.
Buildings may collapse due to strong tremors.
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/
Please see our Customs Information.
CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Ethiopia’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Ethiopia are severe, and convicted offenders can expect long jail sentences and heavy fines.
Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Ethiopia are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website so that they can obtain updated information on travel and security within Ethiopia.
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 Entoto Avenue, P.O. Box 1014, in Addis Ababa; telephone: 251-11-124-2424; emergency after-hours telephone: 251-11-124-2400; consular fax: 251-11-124-2435; web site: http://ethiopia.usembassy.gov/
* * *
This replaces the Country Specific Information for Ethiopia dated April 30, 2008 to update sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, Information for Victims of Crime, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Tue 2 Jul 2019
Source: Anadolu Agency [edited]

Ethiopia has diagnosed 871 people with cholera, an acute infectious diarrheal disease, an official said. "So far, 871 people have been diagnosed with cholera in different areas," the local broadcaster FANA stated, quoting the Director General of Ethiopian Public Health Institute, Getachew Tolera. The cholera cases have spread in Oromia, Amhara, Tigray, Somali and Afar provinces, as well as in 2 major cities of the country. The disease has so far caused deaths of 17 persons, FANA quoted Getachew as saying.

The majority of cases have been reported from Oromia province, with 350 people diagnosed with the infectious disease. As many as 202 people have contracted it in Amhara, 19 in Tigray, 131 in Afar and 33 in Somali regions. Some 125 persons have been diagnosed with the disease in the capital Addis Ababa and one in Dire Dawa city in Eastern Ethiopia. In a bid to control further spread of the disease, 26 quarantine centres have been set up across the nation. Getachew said medicines are being made available to the affected areas. At least 291 000 people have been vaccinated in the West Harerghe zone of Oromia province, according to the local broadcaster.  [Byline: Addis Getachew Tadesse]
Date: Tue 11 Jun 2019
Source: Anadolu Agency [edited]

At least 525 people have been infected with the cholera bacterium in Ethiopia, according to health sources [information released] on [Tue 11 Jun 2019]. The Ethiopian Public Health Institute confirmed that the cause of the death of 16 people by this infectious disease caused by _Vibrio_ bacteria. The deadly epidemic occurred in Oromia, Amhara, Tigray regional states as well as the Addis Ababa city administration.

The majority of the casualties were recorded in Amhara, with 14 people, the local broadcaster FANA quoted, Beyene Moges, the deputy director of the institute, as saying in a press conference. Beyene also cited as saying that 19 samples were examined in a lab to determine the cause. Medicinal supplies were dispatched to the affected areas, according to FANA.

Cholera is an acute epidemic infectious disease and it is characterized by watery diarrhoea, extreme loss of fluid and electrolytes, and severe dehydration.
Date: Thu 23 May 2019 Source: XinHuaNet [edited] <http://www.xinhuanet.com/english/2019-05/23/c_138083427.htm>
An acute watery diarrhoea (AWD) outbreak in Ethiopia's northern Amhara regional state has left 12 people dead, an official said on Thu 23 May 2019. Asaye Gebreselassie, deputy director of Wag Himera zone in Amhara regional state, said the outbreak killed 4 people and sickened 67 others in recent days, according to state media outlet Ethiopia News Agency.
A medical taskforce comprising federal, regional and zonal personnel has been deployed to the affected areas, Gebreselassie said. With the rainy season expected to start in June and continue until mid-September, the government is trying to prevent the spread of the AWD.
Federal and regional health institutions have been combating the diarrhea outbreak by treating unhygienic conditions in factories, health facilities, agricultural areas and eateries.
Date: Sun 19 May 2019
Source: Vax Before Travel [abridged, edited]

The eastern African country of Ethiopia has been reporting measles outbreaks for many years, however, in 2019, new information indicates children are the ones most vulnerable for this infectious disease.

According to reporting by the European Commission, approximately 54% of the 4000 measles cases in Ethiopia reported during 2019 affected children under 5 years of age.

Moreover, over 60% of the children had never received their 1st measles vaccine dose.

This new data estimates that by the end of 2019, about 3.5 million children will be susceptible to the measles virus, mainly because of the failure to achieve the 'herd-immunity' necessary to interrupt transmission.

Moreover, these Ethiopian children are not the only under-vaccinated population.

An estimated 169 million children missed out on the 1st dose of the measles vaccine between 2010 and 2017, or 21.1 million children a year on average, said UNICEF on 25 Apr 2019.

And, the measles virus is one of the leading causes of death among children, particularly in developing countries. An estimated 100,000 measles deaths occurred globally in 2017.

Ethiopia announced it would aggressively confront this under-vaccination issue by integrating the measles vaccine 2nd dose (MCV2) vaccination into the routine immunization program in the 2nd year of life.

The Ethiopian Ministry of Health said about 3 348 363 children will receive measles vaccine 2nd doses.

Dr Chatora Rufaro, World Health Organization (WHO) Ethiopia representative said in a press release, "The introduction of the 2nd dose of measles vaccination in Ethiopia will significantly contribute to a reduction of measles morbidity and mortality as well as the overall child mortality by preventing measles outbreaks."

To notify visitors about Ethiopia's ongoing measles risks, the CDC issued an initial Level 1 Travel Alert in 2015. Since then, the CDC advises all visitors to Ethiopia to ensure they are immunized against the measles virus.  [Byline: Don Ward Hackett]
======================
[HealthMap/ProMED-mail map of Ethiopia:
Date: Mon 13 May 2019
Source: New Business Ethiopia [abridged, edited]

The outbreak of acute watery diarrhoea (AWD) has killed 3 people in the North Gondar Tselemt area in the Amhara region of Ethiopia. The 3 people who were getting medical treatment after acquiring AWD have passed away, according to the state broadcaster ETV. The report indicated that currently 151 people affected by AWD are also identified in 3 locations of Amhara region. Currently in North Gondar, Tselemt area, 90 people infected with AWD have been identified and are being treated. While in Abergele area, 58 people and 4 in Beyeda area are getting treatment after acquiring AWD.

The ETV report indicated that the 152 suspected of acquiring AWD are being treated separately in the 3 localities. It is indicated that a medical team at the national, regional, and zone level is mobilized to contain the outbreak in the areas. In addition, teams from WHO and Doctors Without Borders are also engaged to combat AWD in the areas, according to ETV.

Ethiopia has the poorest sanitation facilities in Africa and has been frequently hit by AWD. In Ethiopia, AWD outbreaks have been reported in different parts at different times. The outbreak in Moyale area in the southern part of the country in 2016 resulted in a total of 268 cases and 2 deaths reported. In 2017, it was also reported that some parts of the Somali region of Ethiopia were also affected by an AWD outbreak resulting in the deaths of many people.
=====================
[Especially in east Africa, AWD is used instead of cholera. - ProMED Mod.LL]

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

Turkey

Geographical Information:
*****************************************
Turkey is officially known as the Republic of Turkey and is bordered on the northwest by Bulgaria and Greece, on the north by the Black Sea and on the south by Syria, Iraq and t
e Mediterranean Sea. The capital is Ankara with a population of about 2.5 million though Istanbul is a much larger city (6.6 million). The population of the country is estimated at 62 million with the majority in the cities and along the costal regions.
Climate:
*****************************************
The Mediterranean and Aegean shores of Turkey have long and hot summers with a milder winter. In Istanbul the average July temperature reaches 230C while in January it can drop to 00C. Throughout the country the annual rainfall is about 29". This is mainly during the months of December and January.

Health Care Facilities:
*****************************************
The level of adequate health facilities vary considerably within the country. Most of the better hotels will have access to English speaking doctors but care may be required if hospital admission is required.
Disease Profile:
*****************************************
Cholera and other water borne diseases are frequently reported from Istanbul. In the southeastern city of Diyarbakir there are regular reports of dysentery, typhoid, meningitis and other contagious diseases.

General Food & Water Hygiene:
*****************************************
There can be little doubt that travellers to Turkey who disregard basic hygiene precautions will run a risk of developing significant illness and a ruined holiday. With simple general care most tourists will remain healthy.

Food Rules:
*****************************************
Always eat in clean restaurants and hotels. Eat freshly cooked hot food. Stay away from cold salads, especially lettuce. Don’t eat any of the bivalve shellfish dishes such as oysters and mussels. Never eat food prepared by street vendors. Always peel your own fruit if at all possible.
Water Rules:
*****************************************
Never use the hotel tap water for drinking or brushing your teeth unless you can easily smell chlorine. Don’t allow ice in your drinks and be wary of the hotel water jug which may be in your room each day. Any of the canned drinks or bottles are usually quite safe. Just check the seal first!
Rabies in Turkey:
*****************************************
This disease is only a particularly risk for travellers who plan to have extended trekking holidays throughout Turkey. Most tourists travelling for a ‘sun’ holiday would be very unfortunate to be exposed but nevertheless care should be taken at all times to ensure that there is no contact with warm blooded animals. This is mainly true for dogs and cats but any infected
warm blooded animal can transmit the disease through its saliva. Any bite, lick or scratch should be treated seriously.
*
Wash out the area
*
Apply an antiseptic
*
Attend for urgent medical attention
Sun Stroke:
*****************************************
The immense strength of the sun in the Middle East can often be underestimated by the Irish traveller. This is especially true for small children and the elderly. Try and stay out of the direct sunlight between 11am to 4pm. Use a wide brimmed hat if possible to protect yourself. Drink plenty of fluid (about 2 or 3 times as much as in Ireland) and remember to increase your salt intake unless this is contraindicated because of high blood pressure or heart disease etc. Any signs of dehydration should be recognised and treated early (dry lips, headache etc.).
Anthrax:
*****************************************
This bacterial disease is sometimes contracted by travellers who purchase untreated leather goods while abroad.
Drug Trafficking:
*****************************************
Remember that Turkey is regarded as a gateway to Europe. Never agree to carry belongings for others unless you are certain of the contents.
Malaria in Turkey:
*****************************************
The risk of malaria in Turkey is very limited and transmission usually only occurs between the months of March to November in the Çukurova / Amikova areas and from mid-March to mid-October in southeast Anatolia. These are mainly away from the standard tourist routes and so prophylaxis will usually not be required. Nevertheless there may be an abundant supply of mosquitoes and other insects around. Travellers should carry insect repellents and wear longer sleeved clothing when at risk.
Vaccinations for Turkey:
*****************************************
There are no compulsory vaccines for entry to Turkey from Ireland. However, travellers are advised to ensure that they are adequately covered against Poliomyelitis, Typhoid, Tetanus and Hepatitis A. Those spending longer in the country or undertaking a trekking holiday may also need to consider vaccination cover against Rabies and Hepatitis B .
Further Information:
*****************************************
Travellers can obtain further health information for overseas travel by contacting either of our offices. Useful web sites for information on Turkey include;

www.WHO.int
www.CDC.gov
www.FCO.gov.uk

Travel News Headlines WORLD NEWS

Date: Mon 5 Aug 2019 20:42 TRT
Source: Daily Sabah [edited]

A group of Turkish scientists has identified 4 rare viruses in Turkey that cause haemorrhagic fever and lead to death due to renal failure, a scientist said [Mon 5 Aug 2019].

A team from the Biology Department of Bulent Ecevit University, led by Professor Mehmet Ali Oktem of Dokuz Eylul University's Medical Virology Department, conducted research on hantavirus types that develop in rodents and small mammals in Turkey and 4 particular subspecies that can cause human disease.

Oktem said he has been doing fieldwork on the hantavirus since 2000, adding that the presence of the virus in rodents was discovered in Turkey for the 1st time in 2004 in the Black Sea region. Meanwhile, the 1st cases in which the viruses developed in humans were reported in 2004 in the Aegean region, and subsequently in Zonguldak and Bartin provinces in the western Black Sea region in 2009.

The newly-identified rare viruses which can be transmitted to humans from rodents, have been named after the provinces or towns they were found in, namely the "Dobrava Hantavirus Igneada", "Dobrava Hantavirus Giresun", "Puumala Hantavirus Bartin", and "Tuula Hantavirus Palandoken."
=====================
[Cases of hantavirus haemorrhagic fever with renal syndrome have been reported in Turkey previously. In January-March 2009 there were 12 laboratory confirmed cases that were serologically positive for Puumala virus subtype.

Reference
---------
Ertek M, Buzgan T; Refik Saydam National Public Health Agency; Ministry of Health, Ankara, Turkey: An outbreak caused by hantavirus in the Black Sea region of Turkey, January-May 2009. Euro Surveill. 2009; 14(20). pii: 19214;  <https://www.eurosurveillance.org/content/10.2807/ese.14.20.19214-en>

Finding Puumala virus in rodents in Turkey is not surprising, since it has caused human cases there in the past. Dobrava-Belgrade orthohantavirus (DOBV) was first isolated from yellow-necked mice (_Apodemus flavicollis_) found in Dobrava village, Republic of Slovenia. It was subsequently isolated in striped field mice in Russia and other parts of Eastern Europe and this rodent occurs in Turkey. The report above indicates that it harbors DOBV in Turkey. It will be interesting to see a genomic comparison of these viruses from Turkey with sequences of these same viruses from other geographic areas. - ProMED Mod.TY]

[HealthMap/ProMED-mail map of Turkey:
Date: Tue 30 Jul 2019
Source: Time Turk [in Turkish, machine trans., edited]
<https://www.timeturk.com/mus-ta-15-kisi-brucella-hastaligina-yakalandi/haber-1150899>

A total of 15 people engaged in animal fattening in the town and highlands of Kirkoy have been infected with brucellosis. A resident of the town said that many small ruminants in the town had suffered a miscarriage during the birth season and that 4 people in one family are now being treated for brucellosis. The patients had been seen at the Elazig Ataturk Research Hospital and "the doctors made the examinations and tests and as a result a brucellosis diagnosis was made. The patients were constantly sluggish and sleepy.

Currently, 15 people are receiving treatment for the same disease, "he said. Mus Provincial Health Director Serdal Turkoglu stated that 119 cases were encountered in Muay in 2019 and that the patients were treated in the hospitals in the province and that they made the necessary studies and tests on the subjects in the field. He reminded that the source of animal products should not be consumed in order to prevent the disease: "cheese, cream, butter, cream, ice cream made from pasteurized or well boiled milk should be preferred. Pickled cheeses should be consumed after waiting for at least 3 months. Frequent abortions and stillbirths should be examined by a veterinarian immediately.

The animals' wastes and the feeds that these wastes come into contact with, should be buried in sealed bags. Animals should be vaccinated against brucella," he said. -- Communicated by: ProMED-mail <promed@promedmail.org> [This infection, a bacterial zoonosis, is classified among the category B biowarfare agents. Natural transmission to humans occurs after occupational exposure or through ingestion of contaminated food products. Although brucellosis has become a rare entity in the United States and many industrialized nations because of animal vaccination programs, this condition remains a significant health problem in many developing countries.

Each species of _Brucella_ has a specific animal reservoir in which chronic disease is present. The bacilli tend to localize in the reproductive organs of the animals, causing sterility and abortions, and are shed in large numbers in the animal's urine, milk, and placental fluid. This localization allows for efficient spread to farmers, veterinarians, slaughterhouse workers, and consumers.

Among the 4 species known to cause disease in humans, _Brucella melitensis_ (from goats, sheep, or camels) may be the most virulent, producing the most severe and acute cases of brucellosis with disabling complications. A prolonged course of illness, which may be associated with suppurative destructive lesions, is associated with _B. suis_ (from feral or commercially raised pigs) infection. _B. abortus_ (from cattle, buffalo, and camels) is associated with mild-to-moderate sporadic disease that is rarely associated with complications. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Turkey:
<http://healthmap.org/promed/p/87>]
19th June 2019
https://www.dailysabah.com/turkey/2019/06/18/heavy-rainfall-floods-parts-of-northeastern-turkeys-trabzon-killing-7

emAA Photo/em

At least seven people were killed in north-eastern Turkey's Trabzon province after heavy rainfall triggered flash floods on Tuesday. Interior Minister Süleyman Soylu had previously announced that four people were killed in the province's Araklı district, while three others were injured and six people were missing. Agriculture and Forestry Minister Bekir Pakdemirli said three bodies were found in the area later on Wednesday, bringing the death toll to seven with three others unaccounted for.  Trabzon Governor Ismail Ustaoğlu said search and rescue efforts had been launched by Disaster and Emergency Management Authority (AFAD) units to locate the missing.

The floods hit Araklı's Çamlıktepe and Yeşilyurt neighbourhoods after a nearby stream overflowed following sudden and heavy rainfall.  Firefighters were immediately dispatched to the scene but had difficulty reaching the affected areas as debris brought by the floods blocked the roads.  AFAD and gendarmerie units were also called in to help with the rescue efforts. The governor said the floods also destroyed four houses and offices in the district.  Finance and Treasury Minister Berat Albayrak offered condolences for those that perished in the disaster and said all available resources were being made available to assist the rescue operation.

Date: Sat 23 Feb 2019
Source: Xinhua [abridged, edited]

Turkey's experts recently warned that epidemic diseases such as measles that have been off the grid for years might come back amid decreasing vaccination rates in the country in the past few years under the influence of anti-vaccine discourse. The anti-vaccination trend started with 183 people in 2011, reaching 980 in 2013 and 5091 in 2015. In 2017, a total of 23 600 families declined compulsory vaccine, professor Mehmet Ceylan, head of paediatric infectious diseases at Ankara's Hacettepe Medical Faculty, said.

The expert warned of an epidemic outbreak if vaccination rates falls under 95 per cent, or some 50 000 people in Turkey. Ceylan said that diseases such as diphtheria and tetanus, which have been off the grid in Turkey for years, might show up again.
 
WHO also voiced concern about the increasing anti-vaccination movement in Turkey. An increasing number of groups were "misleading" the public about the effects of vaccines, harming their trust in getting vaccinated, WHO said.
Turkish health ministry has set up a special website to inform the public about vaccines and to fight false facts. But the anti-vaccination movement is increasingly active on social media, with slogans such as "I have no obligation to vaccinate". A great majority is concerned with the content of the vaccines such as use of mercury or aluminum.

It's obligatory in Turkey that a baby be given a total of 16 different types of vaccination in the 1st 24 months. Parents have to sign an official document holding them responsible, if they reject vaccination. Professor Ata Nevzat Yalcin from Akdeniz University's Faculty of Medicine, Infection Diseases and Clinical Microbiology, warned against the latest trend of increasing measles in Turkey. "The worldwide increase in the disease in 2017 was also observed in our country," he said. There were 572 measles cases in 2014, 342 in 2015, 9 cases in 2016, 69 cases in 2017. In the 1st 9 months of 2018, the number of the cases exceeded 500, he added. Measles arises especially in the spring and winter months, and can cause recurrent epidemics every 2 to 3 years, Yalcin said.

According to the Health Ministry's figures, the measles vaccination rate was 97 per cent in 2015, 98 per cent in 2016, and 96 per cent in 2017. Turkey faced a measles outbreak, which was off the grid for many years, compounded by the arrival of millions of refugees after civil war erupted in neighbouring Syria.

Some 7415 people were diagnosed with measles in Turkey in 2013, but the epidemic was prevented after an intense vaccination program. The number of people diagnosed with measles disease reached 510 in the 1st 9 months of 2018 in Turkey, a recent report of WHO said. According to WHO, the number of global measles cases doubled to 229 068 in 2018, and 82 596 of them were in Europe, mostly caused by stalled vaccination levels.
Date: Wed, 13 Feb 2019 13:01:04 +0100

Beijing, Feb 13, 2019 (AFP) - Beijing has warned its citizens in Turkey to "be more vigilant", as bilateral tensions rise after strong Turkish criticism of China's treatment of its minority Uighur community.   Nearly one million Uighurs and other Turkic-speaking minorities are being held in extrajudicial detention in camps in Xinjiang, according to a UN panel of experts, where most of China's more than 10 million Uighurs live.

Beijing has admitted to placing people in "vocational education centres" to prevent radical Islamism. Critics however allege Uighurs in the camps are being brainwashed in a massive campaign to enforce conformity with Chinese society and abandon Islam.   The northwestern Xinjiang region -- home to some 10 million Uighurs -- has long suffered from violent unrest, which China claims is orchestrated by an organised "terrorist" movement seeking the region's independence.

Turkey, which has its own significant Uighur population, said on Saturday China's treatment of the Uighurs was "a great embarrassment for humanity".   It also called on the international community and the UN "to take effective steps to end the human tragedy in Xinjiang region".   China's embassy to Turkey wrote on its website: "We call once more on Chinese citizens in Turkey and Chinese tourists going to Turkey to be more vigilant and pay attention to their personal security as well as the security of their belongings."

The warning was posted on Sunday, the day after the declarations by the Turkish Ministry of Foreign Affairs.   Violent anti-China protests against the county's treatment of the Uighurs have previously broken out in Turkey. In 2015, militant Turkish nationalists burnt a Chinese flag in front of China's embassy in Ankara.   A popular Chinese restaurant in Istanbul also had its windows smashed and a group of South Korean tourists who were visiting the city was attacked because they were mistaken for Chinese.
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Italy

US Consular Information Sheet Italy, Holy See (Vatican City) and San Marino - January 21, 2009 COUNTRY DESCRIPTION:
Italy is a developed democracy with a modern economy.
The Holy See is a sovereign entity that serves as the ecclesiastical, gove
nmental and administrative capital of the Roman Catholic Church, physically located within the State of the Vatican City inside Rome, with a unique, non-traditional economy.
San Marino is a developed, constitutional democratic republic, also independent of Italy, with a modern economy.
Tourist facilities are widely available. Read the Department of State Background Notes on Italy, the Holy See, and San Marino for additional information. ENTRY/EXIT REQUIREMENTS:
Italy is a party to the Schengen agreement.
As such, U.S. citizens may enter Italy 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 all other purposes, a visa is required and must be obtained from the Italian Embassy or Consulates before entering Italy.
For further information concerning visas and entry requirements for Italy, travelers may contact the Embassy of Italy at 3000 Whitehaven Street NW, Washington, DC 20008, via telephone at (202) 612-4400 or online at http://www.ambwashingtondc.esteri.it/ambasciata_washington, or Italian Consulates General in Boston, Chicago, Detroit, Houston, Los Angeles, Miami, Newark, New Orleans, New York, Philadelphia, or San Francisco, accessible through the Italian Embassy web site. Americans staying or traveling within Italy for less than three (3) months are considered non-residents. This includes persons on vacation, those taking professional trips, students registered at an authorized school, or persons performing research or independent study. As of May 2007, under Italian law (http://www.camera.it/parlam/leggi/07068l.htm), all non-residents are required to complete a dichiarazione di presenza (declaration of presence). Tourists arriving from a non-Schengen-country (e.g. the United States) should obtain a stamp in their passport at the airport on the day of arrival. This stamp is considered the equivalent of the declaration of presence. Tourists arriving from a Schengen-country (e.g. France) must request the declaration of presence form from a local police office (commissariato di zona), police headquarters (questura) or their place of stay (e.g hotel, hostel, campgrounds) and submit the form to the police or to their place of stay within eight business days of arrival. It is important that applicants keep a copy of the receipt issued by the Italian authorities. Failure to complete a declaration of presence is punishable by expulsion from Italy. Additional information may be obtained (in Italian only) from the Portale Immigrazione at http://www.portaleimmigrazione.it and the Polizia di Stato at http://www.poliziadistato.it/pds/ps/immigrazione/soggiorno.htm. Americans staying in Italy for more than three (3) months are considered residents and must obtain a permesso di soggiorno (permit of stay). This includes Americans who will work or transact business and persons who want to simply live in Italy.
An application “kit” for the permesso di soggiorno may be requested from one of 14,000 national post offices (Poste Italiane). The kit must then be returned to one of 5,332 designated Post Office acceptance locations.
It is important that applicants keep a copy of the receipt issued by the post office.
Additional information may be obtained from an Italian immigration website online at http://www.portaleimmigrazione.it/.
Within 20 days of receiving the permit to stay in Italy, Americans must go to the local Vital Statistics Bureau (Anagrafe of the Comune) to apply for residency. It generally takes one to two months to receive the certificate of residence (Certificato di Residenza). 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 occasional episodes of politically motivated violence in Italy, most often connected to Italian internal developments or social issues.
Italian authorities have found bombs outside public buildings, received bomb threats, and were subjects of letter bombs.
Firebombs or Molotov cocktails have been thrown at buildings or offices in the middle of the night.
These incidents have all been attributed to organized crime or anarchist movements.
Americans were not targeted or injured in these instances.
Demonstrations may have an anti-American character.
Even demonstrations intended to be peaceful have the potential to turn into confrontational situations and possibly escalate into violence.
U.S. citizens traveling or residing in Italy should take common sense precautions and follow news reports carefully in order to avoid demonstrations and to be aware of heightened security and potential delays when they occur.
American citizens are encouraged to read the Warden Messages posted on the Embassy’s web site at http://italy.usembassy.gov/acs/demonstration/default.asp. Italy remains largely free of terrorist incidents.
However, like other countries in the Schengen area, Italy’s open borders with its Western European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity. For the latest security information, Americans traveling abroad should regularly monitor the Department of State’s, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found. Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S., or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays). The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad. CRIME:
Italy has a moderate rate of violent crime, some of which is directed towards tourists, principally for motives of theft.
Some travelers are victims of rape and beatings.
There are incidents of drinks laced with drugs being used by criminals to rob, and in some cases, assault tourists.
Many of these incidents occur in the vicinity of Rome’s Termini train station and at major tourist centers such as Campo de Fiori and Piazza Navona, as well as in Florence and Naples.
Criminals using this tactic “befriend” a traveler at a train station, bus stop, restaurant, café or bar in tourist areas, then eventually offer a drink laced with a sleeping drug.
When the tourist falls asleep, criminals steal the traveler’s valuables.
There are also instances where the victim is assaulted, either physically or sexually. Americans are urged to exercise caution at train stations and airports, and when frequenting nightclubs, bars and outdoor cafes, particularly at night, because criminals may make initial contact with potential victims in such settings.
Individuals under the effect of alcohol may become victims of crime, including robbery, physical and sexual assault, due to their impaired ability to judge situations and make decisions.
This is particularly a problem for younger Americans visiting Italy, where the age limit on the sale of alcoholic beverages is lower than in the United States.
If you are a victim of such a crime, please file a police report and contact the U.S. Embassy or nearest consulate.
There are also in-country organizations, which provide counseling, medical, and legal assistance to certain crime victims. Petty crimes such as pick-pocketing, theft from parked cars, and purse snatching are serious problems, especially in large cities.
Pick-pockets sometimes dress like businessmen.
Tourists should not be lulled into a false sense of security by believing that well-dressed individuals are not potential pick-pockets or thieves.
Most reported thefts occur at crowded tourist sites, on public buses or trains, or at the major railway stations: Rome’s Termini; Milan’s Centrale; Florence’s Santa Maria Novella; and Naples’ Centrale and Piazza Garibaldi.
Travelers should also be alert to theft in Milan’s Malpensa Airport, particularly at car rental agencies.
Clients of Internet cafes in major cities are also targeted.
Tourists who have tried to resist petty thieves on motor scooters have suffered broken arms and collarbones. Thieves in Italy often work in groups or pairs.
Pairs of accomplices or groups of street urchins are known to divert tourists’ attention so that another can pick-pocket them.
In one particular routine, one thief throws trash, waste or ketchup at the victim; a second thief assists the victim in cleaning up the mess; and the third discreetly takes the victim’s belongings.
Criminals on crowded public transportation slit the bottoms of purses or bags with a razor blade or sharp knife removing the contents.
Theft of small items such as radios, luggage, cameras, briefcases, and even cigarettes from parked cars is a major problem. Carjackings and thefts are reported by occupants of vehicles waiting in traffic or stopped at traffic lights.
Vehicles parked near beaches during the summer are broken into and robbed of valuables.
Robbers take items from cars at gas stations often by smashing car windows. In a scam practiced on the highways, one thief signals a flat tire to the driver of another car and encourages the driver to pull over.
Often, the tire has been punctured by an accomplice, while in other instances, there may, in fact, be nothing wrong with the vehicle.
When the driver stops, one thief helps change the tire, while the other takes the driver’s belongings.
Use particular caution driving at night on highways, when there may be a greater incidence of robbery attempts.
There are occasional reports of break-ins of rental cars driven by Americans when the precautions mentioned above were not followed during stops at highway service areas. On trains, a commonly reported crime involves one or more persons who pretend to befriend a traveler and offer drugged food or drink.
Also, thieves are known to impersonate police officers to gain the confidence of tourists.
The thief shows the prospective victim a circular plastic sign with the words “police” or “international police.”
If this happens, the tourist should insist on seeing the officer’s identification card (documento), as impersonators tend not to carry forged documents.
Tourists should immediately report thefts or other crimes to the local police. The U.S. Secret Service in Rome is assisting Italian Law Enforcement authorities in investigating an increase in the appearance of ATM skimming devices.
These devices are attached to legitimate bank ATMs, usually located in tourist areas, and capture the account information stored electronically on the card’s magnetic strip.
The devices consist of a card reader installed over the legitimate reader and a pin-hole video camera mounted above the keypad that records the customer’s PIN.
ATMs with skimming devices installed may also allow normal transactions to occur.
The victim’s information is sold, traded on-line, or encoded on another card such as a hotel key card to access the compromised account.
Here are some helpful hints to protect yourself and to identify skimming devices: 1) Use ATMs located in well-lit public areas, or secured inside the bank/business 2) Cover the keypad with one hand as you enter your PIN 3) Look for gaps, tampered appearance, or other irregularities between the metal faceplate of the ATM and the card reader 4) Avoid card readers that are not flush with the face of the ATM 5) Closely monitor your account statements for unauthorized transactions Organized criminal groups operate throughout Italy, but are more prevalent in the south.
They occasionally resort to violence to intimidate or to settle disputes.
Though the activities of such groups are not generally targeted at tourists, visitors should be aware that innocent by-standers could be injured. 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. According to Italian Law (Law 80 of May 14, 2005), anyone caught buying counterfeit goods (for example, DVD’s, CD’s, watches, purses, bags, belts, sunglasses, etc.) is subject to a fine of no less than EUR 1,000.
Police in major Italian cities enforce this law to varying degrees.
Travelers are advised to purchase products only from stores and other licensed retailers to avoid unknowingly buying counterfeit and illegal merchandise. 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.
Lost or stolen credit cards present risk of identity theft and should be cancelled immediately.
Although the investigation and prosecution of the crime is solely the responsibility of local authorities, consular officers can help you to understand the local criminal justice process and to find an attorney if needed. The local equivalent to the “911” emergency line in Italy is: 113. Please see our information on Victims of Crime, including possible victim compensation programs in the United States. CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country’s laws and regulations, which sometimes differ significantly from those of 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 Italian law, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use or trafficking in illegal drugs in Italy are severe and convicted offenders can expect long jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties. SPECIAL CIRCUMSTANCES:
Strikes and other work stoppages occur frequently in the transportation sector (national airlines, airports, trains, and bus lines).
Most are announced in advance and are of short duration.
Information on strikes may be found at http://www.infrastrutture.gov.it/page/NuovoSito/site.php.
Reconfirmation of domestic and international flight reservations is highly recommended. U. S citizens using public transportation while in Italy are reminded they must adhere to local transportation laws and regulations. Travelers must purchase train tickets and validate them by punching them in validating machines usually located near the entrance of train tracks prior to boarding.
Failure to follow this procedure may result in an on-the-spot fine by an inspector on the train. Travelers must purchase bus tickets prior to boarding and validate them immediately after boarding. Tickets may be purchased at tobacco stores or kiosks. Failure to follow this procedure may result in an immediate fine imposed by an inspector on the bus. If the violator does not pay the fine on the spot, it will automatically double and will be forwarded to the violator’s home address. MEDICAL FACILITIES AND HEALTH INFORMATION:
Medical facilities are available, but may be limited outside urban areas.
Public hospitals, though generally free of charge for emergency services, sometimes do not maintain the same standards as hospitals in the United States, so travelers are encouraged to obtain insurance that would cover a stay in a private Italian hospital or clinic.
It is almost impossible to obtain an itemized hospital bill from public hospitals, as required by many U.S. insurance companies, because the Italian National Health Service charges one inclusive rate (care services, bed and board). In parts of southern Italy, the lack of adequate trash disposal and incineration sites has led to periodic accumulations of garbage in urban and rural areas.
In some cases, residents have burned garbage, resulting in toxic emissions that can aggravate respiratory problems. The U.S. Navy initiated a public health evaluation in the Naples area in 2008.
Updates on that evaluation can be found at http://www.nsa.naples.navy.mil/risk.
After finding levels of bacterial and chemical contamination of potential health concern, particularly in samples of area well water, the Navy recommended all personnel living off-base in the Naples area use only bottled water for drinking, cooking, ice-making, and brushing teeth.
For more information on safe food and water precautions, see the CDC’s web site below.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Italy. 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 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 Italy is provided for general reference only, and may not be totally accurate in a particular location or circumstance. Streets in historic city centers are often narrow, winding and congested.
Motor scooters are very popular and drivers often see themselves as exempt from conventions that apply to automobiles. Travelers who rent scooters should be particularly cautious.
Pedestrians and drivers should be constantly alert to the possibility of scooters’ sudden presence.
Most vehicle-related deaths and injuries involve pedestrians or cyclists who are involved in collisions with scooters or other vehicles.
U.S. citizens should remain vigilant and alert while walking or cycling near traffic.
Pedestrians should be careful, as sidewalks can be extremely congested and uneven.
Drivers of bicycles, motorcycles, and other vehicles routinely ignore traffic signals and traffic flows and park and drive on sidewalks.
For safety, pedestrians should look carefully in both directions before crossing streets, even when using a marked crosswalk with a green avanti (“walk”) light illuminated.
Traffic lights are limited, often disobeyed, and a different convention of right-of-way is observed.
Italy has over 5,600 kilometers (3,480 mi.) of Autostrada, or superhighways.
Commercial and individual vehicles travel and pass on these well-maintained roads at very high speeds.
Accidents occur in which contributing factors include excessive speed, alcohol/drug use, and/or sleepiness of long-distance drivers.
Italy has one of the highest rates of car accident deaths in the European Union. In rural areas, a wide range of speed on highways makes for hazardous driving.
Roads are generally narrow and often have no guardrails.
Travelers in northern Italy, especially in winter, should be aware of fog and poor visibility, responsible for multiple-car accidents each year.
Most Italian automobiles are equipped with special fog lights.
Roadside assistance in Italy is excellent on the well-maintained toll roads, but limited on secondary roads.
Use of safety belts and child restraining devices is mandatory and headlights should be on at all times outside of urban areas. U.S. citizens driving in Italy are reminded that they must adhere to the local driving laws and regulations.
Vehicle traffic in some historic downtown areas of cities and towns throughout Italy is limited by a system of permits (called “ZTL” and functioning the same way as an EasyPass system in the United States might on the freeway).
Cameras record the license plates of cars driving in parts of the city that require a permit.
Although most of the automated verification stations are clearly marked, if a driver passes one it is impossible to know at the time that a violation occurred or has been recorded.
Violators are not pulled over or stopped, and there is no personal contact with a police officer.
Whenever possible, the fines imposed for these violations are forwarded to the driver’s home in the United States to request payment.
The fines are cumulative for each time a driver passes a control point.
A similar system of automated traffic control cameras is in place in many parts of the highway system and is used to ticket speeding violations. U.S. citizens driving in Italy should also note that, according to Italian regulation, if a resident of a non-European Union country (e.g. the United States) violates a traffic law, the violator must pay the fine at the time the violation occurs to the police officer issuing the ticket.
If the citizen does not or cannot pay the fine at the time, Italian regulation allows the police officer to confiscate the offender’s vehicle (even if the vehicle is a rental vehicle). For specific information concerning Italian driving permits, vehicle inspection, road tax and mandatory insurance, contact the Italian Government Tourist Board (ENIT) offices via the Internet at: http://www.enit.it, tel: 212-245-4822 or the A.C.I. (Automobile Club Italiano) at Via Magenta 5, 00185 Rome, tel: 39-06-4477.
For information on obtaining international drivers licenses, contact AAA or the American Automobile Touring Alliance. Please refer to our Road Safety page for more information.
Visit the web site of the country’s national tourist office at http://www.italiantourism.com and national authority responsible for road safety at http://www.infrastrutturetrasporti.it. AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) assessed the Government of Italy’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Italy’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. DISASTER PREPAREDNESS:
Several major earthquake fault lines cross Italy.
Principal Italian cities, with the exception of Naples, do not lie near these faults, but smaller tourist towns, like Assisi, do and experience earthquakes.
General information about disaster preparedness is available online from the U.S. Federal Management Agency (FEMA) at http://www.fema.gov.
Detailed information on Italy’s earthquake fault lines is available from the U.S. Geological Survey (USGS) at http://www.usgs.gov Italy also has several active volcanoes generating geothermal events.
Mt. Etna, on the eastern tip of the island of Sicily, has been erupting intermittently since 2000.
Mt. Vesuvius, located near Naples, is currently capped and not active.
Activity at Mt. Vesuvius is monitored by an active seismic network and sensor system, and no recent seismic activity has been recorded.
Two of Italy’s smaller islands, Stromboli and Vulcano in the Aeolian Island chain north of Sicily, also have active volcanoes with lava flows.
Detailed information on volcano activity in Italy is available from the U.S. Geological Survey (USGS) at http://www.usgs.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 AND CONSULATE LOCATIONS:
Americans living or traveling in Italy are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site, so they can obtain updated information on travel and security within Italy.
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 Via V. Veneto 119/A, tel.: 39-06-46741 and fax: 39-06-4674-2217; web site: http://italy.usembassy.gov/english/. The U.S. Consulates are located in: Florence:
Lungarno Amerigo Vespucci 38, tel: 39-055-266-951, consular fax: 399-055-215-550; Milan:
Via Principe Amedeo 2/10, tel: 39-02-290-351, and fax:
39-02-290-35-273; Naples:
Piazza della Repubblica, tel:
39-081-583-8111, and consular fax:
39-081-583-8275. There are U.S. Consular Agents located in: Genoa:
Via Dante 2, tel:
39-010-584-492, and fax: 39-010-553-3033; Palermo:
Via Vaccarini 1, tel:
39-091-305-857, and fax:
39-091-625-6026; Venice:
Viale Galileo Galilei, 30, tel: 39-041-541-5944, and fax: 39-041-541-6654. * * * This replaces the Consular Information Sheet dated June 10, 2008, to update the sections onSafety and Security and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Tue, 6 Aug 2019 20:52:44 +0200 (METDST)

Rome, Aug 6, 2019 (AFP) - Tourists to the Eternal City will no longer be able to catch their breath on the Spanish Steps, after Rome banned people from sitting on the famous monument.   Police could be seen blowing whistles to order people up and off the Steps in the historic centre on Tuesday, an AFP photographer reported.

The marble steps, one of the architectural jewels of the Italian capital, have long been a place for weary sightseers to stop and watch the world go by -- while possibly scoffing down a quick sandwich or slurping a milkshake.   But in an attempt to crack down on slovenly behaviour, the council issued new rules earlier this summer banning all "camping out" or "sitting" on historic monuments, including the Steps and the "boat" fountain at its feet.   Transgressors could be slapped with a fine of up to 400 euros ($448) for everything from sitting, to going shirtless, bathing in fountains and dragging wheeled suitcases down historic steps.

The landmark, made famous in the United States by the 1953 film "Roman Holiday" starring Audrey Hepburn and Gregory Peck, underwent a 1.5-million-euro renovation in 2016 financed by upmarket jeweller Bulgari.   The marble had been discoloured by years of pollution but also caked in chewing gum and stained by wine and coffee spills.

The Steps, designed by architect Francesco de Sanctis between 1723 and 1726 and dominated by the Trinita dei Monti church at the top, are a UNESCO site.   Last month, two German tourists were fined 950 euros for making themselves a coffee on the steps of the famous Rialto bridge in Venice and asked to leave the city.
Date: Sat, 20 Jul 2019 11:45:40 +0200

Rome, July 20, 2019 (AFP) - Italy's Mount Etna, Europe's biggest live volcano, erupted overnight with lava flows and explosive burps, vulcanologists said Saturday.   A heavy emission of ash into the sky forced the closure of two airports in Sicily's second-biggest city of Catania. They partially reopened early Saturday.

The activity followed "lively spattering" recorded by the  National Institute of Geophysics and Vulcanology (INGV) in early June and a previous eruption in December last year.   Eruptions are frequent, and the last major one dated back to early 2009.   The institute said this latest eruption was intermittent and the lava was flowing around 1.5 kilometres (one mile) down a desertic escarpment called the Valle del Bove (Ox Valley) from craters situated on the volcano's southeast face.
Date: Wed, 3 Jul 2019 21:26:25 +0200
By Charles ONIANS

Rome, July 3, 2019 (AFP) - A volcano on the Italian island of Stromboli erupted dramatically on Wednesday, killing a hiker and sending tourists fleeing into the sea.   The volcano is known to be active but on Wednesday there were two particularly powerful explosions.   "Unfortunately one man is dead, there are a few injured, but none seriously," emergency worker Calogero Foti told RAI television.   The dead man was a 35-year-old from Messina in Sicily who was walking with a Brazilian companion who was found dehydrated and in a state of shock, the AGI news agency reported.   They were walking below the 400 metre altitude limit above which a guide is required.

- 'Like being in hell' -
A navy boat has been sent to the 12 square kilometre (five square miles) island for a possible mass evacuation, with 70 inhabitants and tourists already evacuated.   "It was like being in hell because of the rain of fire coming from the sky," Italian news agencies quoted local priest Giovanni Longo as saying.   He said it was not known if there were any hikers on the volcano at the time of the eruption, which caused fires around the village of Ginostra.   Stromboli is topped by an active volcano which is a magnet for tourists from early spring each year.   Italian media reported that some tourists had fled into the sea after the eruption, while others had barricaded themselves into homes.

Italy's National Institute of Geophysics and Volcanology (INGV) said there were two huge explosions on the central-southern side of the volcano's crater at around 1446 GMT Wednesday, one of the biggest explosions ever recorded on the island.   The explosions were preceded by lava spills "from all the active mouths of the crater terrace," the INGV said, prompting a two-kilometre high plume of smoke.   "It's been a long time since we had an eruption of this magnitude," former local councillor Gianluca Giuffre told RAI news.   "My experience and of those who have been living here for generations leads us to believe that the situation will calm down again but we must be cautious," he said.   A firefighting plane could not put out fires in the area because of the amount of smoke, Italian media reported.   The INGV said it was monitoring the situation.

- Cinematic fame -
A previous massive eruption in December 2002 prompted a tidal wave after magma from a particularly violent eruption cascaded into the sea. Six people were injured.   Piers, boats and some buildings were swept away.   Access to the island was forbidden to outsiders for over a month amid the risk of further landslides and scientists set up electronic observation stations to monitor volcanic activity.   Four-fifths of the island's population of around 500 decided to leave for the Aeolian island administrative centre of Lipari, whose schools have taken on Stromboli's children since the disaster.   Stromboli was made famous in the 1950 film of the same name by Roberto Rossellini, starring Ingrid Bergman and is a major tourist attraction with thousands of people visiting its lava-spitting crater each year.   Stromboli is part of the seven-island Eolian Archipelago just off Sicily in southern Italy.
Date: Sat, 1 Jun 2019 21:20:01 +0200

Rome, June 1, 2019 (AFP) - Mount Etna in southern Italy has burst into life, spitting molten lava high into the sky, though cloud cover Saturday ruined the view for those brave enough to venture up the flanks of Europe's highest volcano.

The National Institute of Geophysics and Vulcanology (INGV) said there was "lively spattering" as fire and hot ash spewed high into the sky in an eruption which began Thursday and had slowed slightly by Saturday but still posed a risk to climbers.

The lava came from two eruptive fissures on the north-eastern and south-south-eastern sides of the New Southeast Crater.   The volcano on the island of Sicily previously erupted in December.   The latest lava show was not expected to pose any problems for nearby residential areas or for flights at the closest airport at Catania.
Date: 23 May 2019
Source: ECDC [edited]

Abstract
"In 2018, there was a large West Nile virus (WNV) outbreak in northern Italy. We observed 5 atypical cases of WNV infection that were characterised by the presence of WNV RNA and WNV IgG at the time of diagnosis, but no IgM response during follow-up. Neutralisation assays demonstrated pre-existing Usutu virus immunity in all patients. Besides challenging diagnosis, the immunological crosstalk between the 2 viruses warrants further investigation on possible cross-protection or infection enhancement effects."
=====================
[WNV and Usutu virus (USUV) are genetically related neurotropic mosquito-borne flaviviruses, which are endemic in several European countries. In their transmission cycle, WNV and USUV share the same mosquito vectors and bird populations as amplifying hosts, and often the 2 viruses co-circulate in the same environment. Most WNV infections in humans are asymptomatic or characterised by influenza-like illness, while less than one percent of cases might evolve to severe and potentially fatal neuro-invasive disease, especially in elderly and immunocompromised individuals. USUV appears to be more pathogenic and lethal than WNV for some bird species, while it rarely causes disease in humans; (J Clin Virol. 2018;107:38-47. DOI: 10.1016/j.jcv.2018.08.007 PMID: 30176404).

According to the paper, the 1st human cases of WNV infection were detected in northern Italy in 2008 with subsequent WNV infection outbreaks reported every year. The 1st human cases of USUV infection were detected in northern Italy in 2009 in immunocompromised patients [Euro Surveill. 2009;14(50):19446.PMID: 20070936]. Seroprevalence studies and retrospective investigations suggested that the prevalence of USUV infection in humans could be higher than WNV infection (estimated to range between 0.3 and 3 percent) in areas where both viruses co-circulate [J Med Virol. 2018;90(10):1666-8. DOI: 10.1002/jmv.25230 PMID: 29797606].

The 2018 transmission season recorded a substantial increase in the number of human WNV infections, with approx. 1500 confirmed cases in European Union countries, with Italy as the most affected country [available from: <https://ecdc.europa.eu/en/west-nile-fever>]. The authors infer that the unprecedented high number of WNV infections recorded in 2018 in the Veneto Region (440 confirmed cases) was perhaps the main factor that led to the identification of the cases of WNV infection with an atypical immune response, which is described in the paper, since the diagnostic process was similar to that of the previous years.

The study concludes: "Further investigation including a larger number of cases is needed to better define the clinical and virological features of WNV infection in individuals with pre-existing flavivirus imunity and to understand if USUV infection provides cross-protection against WNV disease or whether it might increase the risk for more severe disease through antibody-dependent enhancement. Infections from closely related flaviviruses, like WNV and USUV, may pose problems not only because of the induction of cross-reactive antibodies that challenge the differential diagnosis, but also because the immunological crosstalk between heterologous viruses may increase the risk of severe disease through a mechanism of antibody-dependent enhancement of infection." - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
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World Travel News Headlines

Date: Tue, 20 Aug 2019 05:21:07 +0200 (METDST)

Bangkok, Aug 20, 2019 (AFP) - At least 13 Chinese tourists were killed and dozens injured when their bus skidded off the road and plunged 30 metres into a ravine in Laos, a police officer said Tuesday.   The bus was carrying more than 40 Chinese nationals heading towards the tourist town of Luang Prabang when the accident occurred late on Monday.   "At this moment, 13 bodies have been recovered... while two are still missing," police officer Xaiyaphon Chitavong told AFP, blaming brake failure for the accident.   He added that 31 people were receiving medical treatment.    Chinese state media showed photos of rescuers wading through ankle-deep floodwaters.

Traffic accidents in Laos, Thailand, Cambodia and Myanmar are common, with safety regulations often flouted and law enforcement low.    The monsoon season from June to October also drenches rural roads with heavy rains creating slippery conditions.   Tourism to communist-run Laos has grown in recent years, and visitors from China increased by 13 percent in the first half of 2019 compared to the year before, according to the state-backed Vientiane Times.
Date: Mon, 19 Aug 2019 20:57:15 +0200 (METDST)

Bukavu, DR Congo, Aug 19, 2019 (AFP) - A child has died from Ebola in DR Congo's South Kivu, health authorities said Monday, the second person to succumb to the virus since the epidemic spread to the eastern province.   The announcement last week of the first confirmed cases in South Kivu revived concerns that the highly contagious disease could cross the porous borders of the central African country, where it has claimed more than 1,900 lives since August last year.   "A seven-year-old child died yesterday (Sunday) of Ebola" in South Kivu's Mwenga region, said Claude Bahizire, communication officer of South Kivu's provincial health division.

The first death in South Kivu was a woman in her twenties who evaded movement controls to travel from the North Kivu town of Beni, the epicentre of the outbreak, to South Kivu's capital Bukavu and then Mwenga.    She died on Wednesday, and her seven-month-old son has been diagnosed with the virus and is receiving treatment.   Bahizire said that "two other suspected cases, two women, have been detected and admitted to Bukavu's transit centre".   The two women "were in contact with the woman who died last week while she was staying in Bukavu on the way to Mwenga," he added.

The outbreak of the haemorrhagic virus began in North Kivu on August 1, 2018 and spread to Ituri province.   The health ministry also announced that "a new health zone had been assigned in North Kivu".   A confirmed case of Ebola has been recorded in North Kivu's Pinga region, in Walikale territory, a source said without providing further details.   According to the latest numbers published on Sunday, 1,934 people have since died, while 862 have been cured.

The latest outbreak is the second-deadliest on record after more than 11,000 people were killed in Guinea, Sierra Leone and Liberia between 2014-2016.   Also on Monday, World Health Organization (WHO) chief Tedros Adhanom Ghebreyesus called on the nine countries that share a border with DR Congo to show solidarity to stop the spread of Ebola.   "We now have an Ebola vaccine that is more than 97 percent effective and treatments that are more than 90 per cent effective if used early enough," he said in Republic of Congo capital Brazzaville.
Date: Mon, 19 Aug 2019 19:48:07 +0200 (METDST)
By Alain JEAN-ROBERT

Paris, Aug 19, 2019 (AFP) - French construction workers wearing protective masks returned to the site of stricken Notre-Dame cathedral on Monday after a three-week pause due to the risk of lead contamination.   Labour Minister Muriel Penicaud was given a tour of the scorched monumet wearing a white protective suit while workers could again be seen surveying the structure which was left damaged and weakened in a massive fire in April.

Restoration of the cathedral has yet to begin with efforts focused entirely on securing the building. The culture ministry has warned it is still at risk of collapse.   Efforts to remove lead from the area around Notre-Dame began last week after alarm grew over the presence of the toxic metal.   Hundreds of tonnes of lead in the roof and steeple melted during the April 15 blaze that nearly destroyed the gothic masterpiece, with winds spreading the particles well beyond the church grounds.

Residents have accused the Paris authorities of underplaying the risk from the lead although the culture ministry insists safety is the top priority.   But prefect Michel Cadot, the government's top official for the Paris region, approved the resumption of the works after visiting the site.   "I saw that the different recommendations of the labour inspectors had been implemented," he said, adding the decontamination work would help keep contractors safe.   Securing the structure is required before the restoration work can start.    The culture ministry said that stones had fallen from the nave vault during a heatwave in July.   "It is only the urgency linked to the persistent risk of a collapse that justifies the rhythm of work undertaken" since the fire, it said in a statement Wednesday.

President Emmanuel Macron has set an ambitious target of five years for the restoration to be finished. But the ministry said the work would not even begin until next year.   Paris prosecutors said in June that a poorly stubbed-out cigarette or an electrical fault could have started the fire and opened an investigation into criminal negligence, without targeting any individual.

French investigative news site Mediapart published a report this week accusing the ministry of repeatedly ignoring warnings by labour inspectors about the dangers posed by the lead until work was finally suspended on July 25.   Critics have accused the city of failing to notify the public about the test results, while an environmental group has filed a lawsuit alleging that officials failed to sufficiently contain the contamination.   The ministry rejected Mediapart's allegations it had failed to pay attention to the risks encountered by workers on the site.
Date: Mon, 19 Aug 2019 13:26:06 +0200 (METDST)

Jalalabad, Afghanistan, Aug 19, 2019 (AFP) - Scores of people including children were wounded Monday after a series of explosions shook the eastern Afghan city of Jalalabad, as the country's independence day was marred by bloodshed.

As many as 10 blasts were reported in and around the city in Nangarhar province, authorities said, and casualty numbers rose as the day wore on.   "The explosions were caused by IEDs in different parts of the city and as groups of people were celebrating independence day," the Nangarhar governor's spokesman Attaullah Khogyani said, referring to improvised explosive devices.   Jalalabad is the scene of frequent bomb attacks, and the surrounding terrain is home to both Taliban fighters and the Islamic State group's local affiliate.

At least 52 people were wounded, Khogyani said. Zaher Adel, a spokesman for a local hospital, said 66 wounded people had been brought in. An AFP correspondent saw children among the victims.   This year's August 19 celebrations mark 100 years of Afghan independence from British influence.   The day was supposed to be one of national pride and unity, but was overshadowed by an IS suicide attack Saturday on a crowded Kabul wedding hall that killed at least 63 people.

In Kabul, locals took to the streets to wave the black-red-and-green Afghan flag, but several public events to commemorate the date were scrapped as Kabul mourns and due to fears of a fresh attack.    "We postponed the celebrations to honour the victims, but we will definitely take revenge for our people," Afghan President Ahraf Ghani said.   "We will avenge the blood of our people, every drop of it."

Mayhem from Afghanistan's war continues to wreak havoc on Afghans every day, even though the US and the Taliban are in final negotiations for a deal that would see US troops begin to quit Afghanistan and could potentially lead to a reduction in violence.
Date: Wed 14 Aug 2019
Source: Universitat Hohenheim [in German, trans. Britta Lassmann, edited]

The University of Hohenheim and the Bundeswehr Institute of Microbiology [IMB] have detected spotted fever in a hyalomma tick, the 1st time such a tick is suspected to have caused disease in a human in Germany.

This tick feeds on humans and can transmit a form of spotted fever in Germany. What were still unanswered questions about the tropical giant tick hyalomma is now certainty. At the beginning of August [2019], it was suspected that for the 1st time, a human in Germany had contracted a disease with the typical symptoms of rickettsiosis from the bite of a hyalomma tick. Experts from the University of Hohenheim in Stuttgart and the IMB in Munich were able to detect the pathogen _Rickettsia aeschlimannii_ in the tick. The number of hyalomma ticks in Germany increased significantly in 2019 compared to the previous year [2018]. In nearly half of the hyalomma ticks, _R. aeschlimannii_ can be detected. The tick researchers continue to ask the population to send them suspicious ticks.

It was probably no coincidence that this 1st case was in a horse owner. Tropical ticks of the genus _Hyalomma_ feed on large mammals. For several years, these ticks have been on the rise in Germany. Now tick researchers report the 1st suspected case of spotted fever transmitted in Germany. "Not only do we now know for sure that the hyalomma tick is also targeting humans," says Prof Dr Med Ute Mackenstedt, a parasitologist at the University of Hohenheim, "but also that there is the urgent suspicion that the transmission of spotted fever by these ticks is actually possible here in Germany."

The case: At the end of July [2019], the horse owner from near Siegen was bitten by a hyalomma tick. He sent the tick to the tick researcher in Hohenheim. He then presented to the hospital only a few days later with severe symptoms. Spotted fever caused by the bacterium _R. aeschlimannii_ was suspected. The tick was sent by courier service to the IMB in Munich, where the pathogen was detected in the tick. Thereafter, the patient received targeted antibiotic therapy, and his symptoms rapidly improved.

"We are talking about a suspected case, because direct detection of the pathogen from the patient was not possible," explains PD Dr Med Gerhard Dobler, medical doctor at the IMB. "The treatment of the patient came 1st. But the preceding tick bite, the typical symptoms
and, above all, the proof of the pathogen in the tick suggest that the case was spotted fever. The fact that the patient responded to targeted antibiotic therapy further supports this."

_R. aeschlimannii_ causes a feverish infection with headache and muscle pain, extreme joint pain, and a burning sensation. Typical for the disease, however, is the rash that gave the disease its name. This classic sign shows mainly on the extremities. The incubation period is about one week.

"If spotted fever is suspected after a hyalomma bite, a swab should be taken from the bite site and sent for examination," advises PD Dobler. "If there are questions, you are welcome to contact us. Ideally, we would also like to examine the tick."

About half of the hyalomma ticks, the researchers say, are infected with rickettsia. Transmission takes place exclusively via tick bite. "The number of hyalomma ticks in Germany is significantly higher this year [2019] than in the previous year [2018]," reports Prof Dr Med Mackenstedt, referencing the publication in which the situation was presented in 2018. The Hohenheim parasitologist not only cooperates closely with the IMB in Munich, but also with the working group of Prof Dr Med Christina Strube at the Veterinary University (TiHo) Hannover. "Together they already have found 50 such ticks in Germany in 2019. Last year [2018] there were a total of 35." Last year, these ticks had survived the winter in Germany for the 1st time.

"Rickettsia are the only pathogens that we have been able to detect so far," explains PD Dr. Dobler. "We have not found the virus that causes the dangerous Crimean Congo hemorrhagic fever, nor the pathogens _Theileria equi_ and _Babesia caballi_, both of which can be transmitted from ticks to horses."

The research team continues to ask the population for support to further explore the spread and potential dangers. In case of a tick bite, it's best to remove the tick with a tick remover, TickCard, or tweezers. Then send the animal in a small, tightly closed container to:
University of Hohenheim
Prof. Dr. Ute Mackenstedt
Department of Parasitology
Emil-Wolff-Strasse 34
70599 Stuttgart

Background: Tick genus _Hyalomma_
_Hyalomma marginatum_ and _Hyalomma rufipes_ are native to the dry and semi-arid areas of Africa, Asia, and southern Europe. Until recently, they did not occur in central and northern Europe. Their striped legs are striking, and they are much larger than the native ixodes ticks.

The adult ticks feed on large animals. They are active hunters and move quickly towards their host. They cover a distance of up to 100 m [328 ft]. Humans can serve as hosts. In contrast, tick larvae and nymphs mainly infest birds and small mammals and can stay up to 28 days with their hosts. Migratory birds can introduce larvae and nymphs to Germany.

In Eurasia, both _Hyalomma_ species are considered transmitters of the Crimean Congo hemorrhagic fever virus and the Arabic hemorrhagic fever virus (Alkhumra virus). They also transmit the bacterium _Rickettsia aeschlimannii_, which causes a form of spotted fever.

Reference:
Chitimia-Dobler L, et al. Imported _Hyalomma_ ticks in Germany in 2018. Parasites & Vectors. 2019; 12 (134).

More information:
Picture and video material [in German]
Press release: Tropical ticks in Germany: University of Hohenheim asks to send conspicuous tick finds [in German]
Press release: Tropical ticks: New immigrant species winters in Germany for the 1st time [in German]
-----------------------------------
communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
====================
[Given that the ticks were found last year (2018) and that they overwintered and were found again this year (2019), it is likely that this genus of tick is becoming established in Germany. Although the species of _Hyalomma_ that infected the man with _Rickettsia aeschlimannii_ was not determined, there is a clear association of this rickettsia with the 2 species of _Hyalomma_ that were tested. The published report cited above states, "35 ticks with an unusual appearance or behaviour were reported to us during summer-autumn 2018. For 17 of them, the description or photos implied that they belong to the hard tick genus _Hyalomma_. The remaining 18 ticks were sent to us and were identified as adult _Hyalomma marginatum_ (10 specimens) or adult _Hyalomma rufipes_ (8 specimens). All ticks tested negative for CCHF virus, _Coxiella burnetii_, _Coxiella_-like organisms, _Babesia_ spp. and _Theileria_ spp. The screening for rickettsiae gave positive results in 9 specimens. The _Rickettsia_ species in all cases was identified as _R. aeschlimannii_." Given that these ticks can be transported by birds migrating from Africa, continued surveillance in Germany for the rickettsia and the other pathogens that were not found currently is prudent. - ProMED Mod.TY]

The first human case of _R. aeschlimannii_ infection was identified in a patient who had fever, rash, and an eschar similar to _R. conori_ infection (Mediaterrian spotted fever) after travel in Morocco (1). _R. aeschlimannii_ infections in humans have been previously confirmed in South Africa, in Algeria, and in Tunisia (2). To our knowledge, the first human case of _R. aeschlimannii_ infection reported in Europe occurred in Greece and was reported in 2013 (3).

1. Raoult D, Fournier PE, Abboud P, Caron F. First documented human Rickettsia aeschlimannii infection. Emerg Infect Dis. 2002; 8: 748-9. doi: 10.3201/eid0807.010480
2. Demoncheaux JP, Socolovschi C, Davoust B, Haddad S, Raoult D, Parola P. First detection of _Rickettsia aeschlimanii_ in _Hyalomma dromedarii_ ticks in Tunisia. Ticks Tick Borne Dis. 2012; 3: 398-402.
3. Germanakis A, Chochlakis D, Angelakis E, Tselentis Y, Psaroulaki A. _Rickettsia aeschlimannii_ infection in a man, Greece. Emerg Infect Dis. 2013; 19: 1176-7.  - ProMED Mod. LL]

[HealthMap/ProMED-mail map of Germany:
Date: Wed 19 Aug 2019, 12:48 PM
Source: Kazakh Telegraph Agency [edited]

A total of 4 anthrax cases have been confirmed in the Akmola region, reports the health care department. "Up to [now] 5 [suspected cases of] anthrax have been recorded; lab tests have confirmed 4. The cause of contamination was cow butchering without a veterinary certificate in a private yard," said the interlocutor.

"Epidemiological situation in the Akmola region and Nur-Sultan is stable," said the department. "The situation is being constantly monitored by the committee," said Ludmila Burabekova, chairfigure of the committee of quality control and goods safety. "Anti-epidemic and anti-epizootic arrangements have been organized in the area," she added.
*****************************
Date: Wed 19 Aug 2019, 12:04 PM GMT
Source: Radio Free Europe [edited]

A village near the Kazakh capital, Nur-Sultan, is under quarantine after lab tests confirmed anthrax infections in several people.

The Health Ministry said on [19 Aug 2019] that 5 residents of the village of Olginka, 100 km [about 62 mi] east of Nur-Sultan, have been hospitalized in recent days with anthrax symptoms, 4 of whom tested positive for _Bacillus anthracis_ -- the bacterium that causes the infectious disease. According to the statement, the situation in the village in the Aqmola region is under the control of the authorities and all necessary measures are being taken to prevent the possible spread of the disease.

In 2016, in nearby Qaraghandy Oblast, 2 people died as a result of anthrax infections.

According to the United States Centers for Disease Control and Prevention (CDC), domestic and wild animals -- such as cattle, sheep, goats, antelope, and deer -- can become infected by inhaling or ingesting spores in contaminated soil, plants, or water. CDC says all types of anthrax infections can cause death if they are not treated with antibiotics.
========================
[Olginka is in north-central Kazajhstan; see:

There is a measure of rural poverty in northern half of Kazakhstan, with the result that sick and moribund animals get butchered and eaten. Fortunately, as this village is within 100 Km [about 62 mi] of the Kazakh capital the affected have had the advantage of hospital care and proper laboratory confirmation. The coincident 5th person may have just shown a fever when the medical authorities were looking for clinical cases or it may be a false negative.

Folk have a habit of self-treating with antibiotics and this would have reduced the number of circulating vegetative cells available to testing. My friend Benyamin Cherkasskyi, the Soviet anthrax expert, used to tell me that only some 30%-40% of cutaneous cases would test positive. You have to know to insert your needle in under the lesion to draw out the fluid there which will contain cells, blood, and toxins. - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Date: Mon, 19 Aug 2019 03:45:54 +0200 (METDST)

Lomo del Pino, Spain, Aug 19, 2019 (AFP) - A raging wildfire on the Spanish holiday island of Gran Canaria forced the evacuation of some 5,000 people, authorities said Sunday, warning it could take days for the blaze to be brought under control.   The fire, which has spread to the mountainous Cruz de Tejeda region popular with tourists for its breathtaking views, is "extremely fierce" and "unstable", said Canary Islands president Angel Victor Torres in a statement.   No fatalities have been reported.

More than 600 firefighters and 14 aircraft battled to contain the flames, hampered by strong winds and high temperatures.   With the temperature set to rise Monday, authorities estimate it could take days before the blaze is brought under control.   "The next few hours will be very important because the weather forecast for the night is not good," Torres said.   The fire broke out days after another wildfire in the same region forced the evacuation of hundreds.

Gran Canaria is the second most populous of the Canary Islands in the Atlantic off the northwest coast of Africa.   The Canary Islands received 13.7 million foreign visitors last year, over half of them from Britain and Germany.   Spain is frequently plagued by huge forest fires because of its arid summer climate.
Date: Sun, 18 Aug 2019 23:01:00 +0200 (METDST)

Lisbon, Aug 18, 2019 (AFP) - Portuguese fuel tanker drivers whose strike has caused fuel shortages at the summer holiday season on Sunday ended their industrial action.   Drivers have been staging a strike since Monday to demand further wage increases in 2021 and 2022, prompting the government to declare an energy crisis.   "Since all the conditions are now in place to negotiate, we decided to end the strike," Pedro Pardal Henriques, spokesman for the National Union of Dangerous Goods Carriers (SNMMP), told reporters.

A meeting is scheduled for Tuesday, the union President Francisco Sao Bento said, adding that the union did not "rule out new strikes being called if Antram (the employers association) adopts an uncompromising attitude".   Police had launched an operation to escort fuel tankers with extra supplies and Portugal also mobilised about 500 members of the security forces to replace the strikers and drive the trucks.   Despite the shortages, Energy Minister Joao Pedro Matos Fernandes said about two-thirds of the country's 3,000 or so petrol stations had not run dry.
Date: Sun, 18 Aug 2019 11:47:26 +0200 (METDST)
By By Emal Haidary and Mushtaq Mojaddidi

Kabul, Aug 18, 2019 (AFP) - Joy and celebration turned into horror and carnage when a suicide bomber targeted a packed Afghan wedding hall, killing at least 63 people in the deadliest attack to rock Kabul in months, officials and witnesses said Sunday.   The massive blast, which took place late Saturday in west Kabul, came as Washington and the Taliban finalise a deal to reduce the US military presence in Afghanistan and hopefully build a roadmap to a ceasefire.   The groom recalled greeting smiling guests in the afternoon, before seeing their bodies being carried out hours later.

The attack "changed my happiness to sorrow", the young man, who gave his name as Mirwais, told local TV station Tolo News.   "My family, my bride are in shock, they cannot even speak. My bride keeps fainting," he said.   "I lost my brother, I lost my friends, I lost my relatives. I will never see happiness in my life again."   Interior ministry spokesman Nasrat Rahimi said at least 63 people had been killed and 182 injured.   "Among the wounded are women and children," Rahimi said. Earlier he stated a suicide bomber carried out the attack.

Afghan weddings are epic and vibrant affairs, with hundreds or often thousands of guests celebrating for hours inside industrial-scale wedding halls where the men are usually segregated from the women and children.   "The wedding guests were dancing and celebrating the party when the blast happened," recounted Munir Ahmad, 23, who was seriously injured and whose cousin was among the dead.   "Following the explosion, there was total chaos. Everyone was screaming and crying for their loved ones," he told AFP from his bed in a local hospital, where he is being treated for shrapnel wounds.

Images from inside the hall showed blood-stained bodies on the ground along with pieces of flesh and torn clothes, hats, sandals and bottles of mineral water. The huge blast ripped parts of the ceiling off.   The wedding was believed to be a Shia gathering. Shia Muslims are frequently targeted in Sunni-majority Afghanistan, particularly by the so-called Islamic State group, which is also active in Kabul but did not immediately issue any claim of responsibility.

Wedding guest Hameed Quresh told AFP the young couple were saying their vows when the bomb went off.    "We fainted following the blast, and we don't know who brought us to the hospital," sobbed Quresh, who lost one brother and was himself wounded.   Another guest told Tolo that some 1,200 people had been invited. With low security, weddings are seen as easy targets.   The attack sent a wave of grief through a city grimly accustomed to atrocities. President Ashraf Ghani called it "barbaric", while Afghanistan's chief executive Abdullah Abdullah described it as a "crime against humanity".

- Withdrawal deal expected -
The attack underscores both the inadequacy of Afghanistan's security forces and the scale of the problem they face. While the police and army claim they prevent most bombings from ever happening, the fact remains that insurgents pull off horrific attacks with chilling regularity.   On July 28, at least 20 people were killed when attackers targeted Ghani's running mate Amrullah Saleh as he campaigned in presidential elections.    The incident showed how even amid tight security and known threats, insurgents can conduct brazen attacks.   The issue also goes to the heart of a prospective deal between the US and the Taliban that would see Washington begin to withdraw its approximately 14,000 soldiers from Afghanistan.

The deal relies on the Taliban providing guarantees they will stop jihadist groups such as Al-Qaeda and IS from using Afghanistan as a safe haven. Saturday's attack suggests any such promise would be tough to keep.   The "Taliban cannot absolve themselves of blame, for they provide platform for terrorists," Ghani said.   Few believe such a deal will bring quick peace.

Many Afghans fear the Taliban could return, eroding hard-won rights for women in particular and leading to a spiralling civil war.   Meanwhile, in the northern province of Balkh, 11 members of the same family were killed when their car hit a roadside bomb, officials said. The provincial governor blamed the Taliban for planting the device.
Date: Sun, 18 Aug 2019 05:28:47 +0200 (METDST)
By Amélie BOTTOLLIER-DEPOIS

Paris, Aug 18, 2019 (AFP) - Seafood lovers who prize the mussel for its earthy taste and succulent flesh may be unaware of its growing potential in the fight against water pollution.   The mussel is the hoover of the sea, taking in phytoplankton for nourishment along with microplastics, pesticides and other pollutants -- which makes it an excellent gauge.

One day, it may also be pressed into service to cleanse water.   "It's a super-filter in the marine world, filtering up to 25 litres of water a day," says marine biologist Leila Meistertzheim.   "It's a real model of bioaccumulation of pollutants generally speaking."   As they pump and filter the water through their gills in order to feed and breathe, mussels store almost everything else that passes through -- which is why strict health rules apply for those destined for human consumption.

Like canaries in a coal mine, mussels have long been used as "bio-indicators" of the health of the seas, lakes and rivers they inhabit.   Little-known pollutants can turn up to join the usual suspects, with increasing attention paid to microplastics containing bisphenol A and phthalates, both thought to be endocrine disruptors.

Meistertzheim heads a study for France's Tara Ocean Foundation using mussels to gauge the health of the estuaries of the Thames, Elba and Seine rivers.   The mussels, placed in fish traps, are submerged in the waters for a month before researchers dissect them to determine what chemical substances lurk in their tissues.   The idea of deploying mussels across the oceans to absorb ubiquitous microplastics is just a dream for now, but for other pollutants, the bivalves are already at work.   "In some places, mussels are used, as well as oysters, to cleanse the sea of pesticides, for example," Meistertzheim notes.

- E. coli busters -
Richard Luthy, an environmental engineer from California's Stanford University, says that, in most cases, mussels harvested from contaminated waters should not be eaten.   But if the contaminant is E. coli, mussels can be thanked for the "removal and inactivation" of the faecal material, he says, calling the service a "public health benefit".   The mussels are edible because they "excrete the bacteria as faeces or mucus," he says.   Mussels living in waterways affected by eutrophication -- often marked by abundant algae -- are also fit for human consumption, researchers say.   The phenomenon is often the result of waste dumped into the waterway containing phosphates and nitrites, such as detergents, fertilisers and sewage.   The nutrients in these substances encourage the proliferation of algae, which in turn starves the water of oxygen, upsetting the ecosystem.

Mussels "recycle" these nutrients by feeding on the algae, says Eve Galimany, a researcher of the US National Oceanic and Atmospheric Administration's Milford Laboratory who has experimented with mussels in the Bronx River in New York.   The recycling principle is already at work in a pilot project titled Baltic Blue Growth in Sweden, Denmark and the Baltic countries which grows mussels to be fed to animals such as poultry, fish and pigs.   "Eutrophication... is the biggest problem of the Baltic Sea, the most urgent one," says project head Lena Tasse. Mussels "could be part of a solution".   Why feed them to animals if they are safe for humans? Because Baltic mussels are too small to be of interest to seafood lovers, says Tasse, adding: "Swedes like big mussels."

Meanwhile, the jury is still out on the effects of microplastics on human health.   A recent report by WWF said that humans ingest an average of five grammes of microplastics a week -- about the weight of a credit card.   A 2018 study published in the journal Environmental Pollution, based on samples from British coastlines and supermarkets, estimated that every 100 grammes (3.5 ounces) of mussels contained 70 tiny pieces of plastic.   Should we be worried? Meistertzheim thinks not.   "I eat them," she says. "A dish of mussels is not necessarily worse than organic hamburger meat wrapped in plastic."