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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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Uzbekistan

Uzbekistan - US Consular Information Sheet
May 07, 2007
COUNTRY DESCRIPTION:
Uzbekistan gained independence from the Soviet Union in 1991.
While the country has undergone significant change since then, its progress towards democratic
nd economic reform has been halting and uneven.
Corruption is endemic at all levels of society.
Much of the country, particularly areas outside of Tashkent and the major tourist destinations of Samarkand, Bukhara, and Khiva, are remote and difficult to access.
Tourist facilities, when they exist at all, are typically below Western standards, and many goods and services remain difficult to find on a regular basis.
Read the Department of State Background Notes on Uzbekistan for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
Although official invitation letters are not required for American citizens applying for tourist visas, they are required for those planning to visit an individual who resides in Uzbekistan.
Tourist visas cannot be extended in Uzbekistan.
Visas are issued by Uzbek embassies and consulates abroad.
Visitors coming from countries where Uzbekistan does not have diplomatic or consular representation should obtain visas in a third country.
Visas are not available upon arrival at Uzbek airports.
The Embassy has received a number of reports from American citizens who have had problems obtaining Uzbek visas or who received Uzbek visas valid for a very limited period, usually for fewer than three months.
Americans seeking visas are encouraged to apply for their visas well in advance of their travel.

It is important to note that Uzbek visas indicate not only the validity of the visa, but also the period of time a person is allowed to stay in Uzbekistan on a given trip.
A visitor will have to leave the country after the number of days indicated as the duration of stay on the visa.
Therefore, it is important to indicate your intended period of stay when applying for your Uzbek visa.
American citizens who are affiliated with a non-governmental organization (NGO), which has been closed in Uzbekistan, may be prevented from entering the country, even with a valid visa.
All travelers, even those simply transiting Uzbekistan for fewer than 72 hours, must obtain an Uzbek visa before traveling to Uzbekistan.

The Uzbek Government maintains travel restrictions on large parts of the Surkhandarya province bordering Afghanistan, including the border city of Termez. The border crossing point at Hayraton between Afghanistan and Uzbekistan, while open, is tightly controlled.
Foreign citizens intending to travel to this region must obtain a special permission card from the Ministry of Foreign Affairs, the Ministry of Internal Affairs or Uzbek embassies and consulates abroad.
Even with such permission, however, some American citizens transiting to Afghanistan via Termez have been briefly detained and/or fined for not registering in Uzbekistan.

Travel within Uzbekistan by rail or land sometimes requires brief exit into neighboring countries.
Travelers should have multiple-entry Uzbek visas and a proper visa for the neighboring country in order to avoid delays in travel.

Registration after entry:
All travelers present in Uzbekistan for more than three business days must register with the Office of Entry, Exit, and Citizenship, commonly known as “OVIR.”
Hotel guests are registered automatically, but all other travelers are responsible for registering themselves.
Registration fees vary depending on length of stay.
See http://uzbekistan.usembassy.gov/consular for more information.
Visitors without proper registration are subject to fines, imprisonment, and deportation.
The fines range from $500 to $4,000.
Uzbek law mandates that visitors carry a medical certificate attesting that they are not infected with HIV, but this requirement is sporadically enforced.
For more information, see the Department of State's Human Immunodeficiency Virus (HIV) Testing Requirements for Entry into Foreign Countries brochure.

Further visa information is available from the Consular Section of the Embassy of the Republic of Uzbekistan, 1746 Massachusetts Ave., NW, Washington, D.C. 20036; telephone: (202) 530-7291; fax: (202) 293-9633; website: http://www.uzbekistan.org ; or from the Consulate General of Uzbekistan in New York City, 866 United Nations Plaza, Suite 327A, New York, NY 10017; telephone:
(212) 754-7403; fax: (212) 838-9812; website: http://www.uzbekconsulny.org .

See our Foreign Entry Requirements brochure for more information on Uzbekistan and other countries.
Visit the Embassy of Uzbekistan web site at http://www.uzbekistan.org for the most current visa information.

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

SAFETY AND SECURITY:
A Travel Warning remains in effect for Uzbekistan.
The Department of State reminds U.S. citizens of the potential for terrorist attacks or civil disturbance in Uzbekistan, although there have been no violent incidents there since May 2005, and continues to urge Americans in Uzbekistan to exercise caution.
The U.S. Government continues to receive information that indicates terrorist groups may be planning attacks, possibly against U.S. interests, in Uzbekistan.
Supporters of terrorist groups such as the Islamic Movement of Uzbekistan, Al-Qaida, the Islamic Jihad Union, and the Eastern Turkistan Islamic Movement are active in the region.
Members of these groups have expressed anti-U.S. sentiments and have attacked U.S. Government interests in the past, including the U.S. Embassy in Tashkent, and may attempt to target U.S. Government or private American interests in Uzbekistan.
In the past, these groups have conducted kidnappings, assassinations, and suicide bombings.

Increased security at official U.S. facilities over the past year may lead terrorists and their sympathizers to seek softer targets.
These may include facilities where Americans and other foreigners congregate or visit, such as residential areas, clubs, restaurants, places of worship, schools, hotels, outdoor recreation events, and resorts.
The U.S. Embassy in Tashkent continues to employ heightened security precautions.
U.S. citizens should report any unusual activity to local authorities and then inform the Embassy.

Uzbekistan experienced a wave of terrorist violence in 2004.
In July 2004 there were three suicide bombings in Tashkent, including one outside the U.S. Embassy.
The Islamic Jihad Union (IJU) claimed responsibility for the attacks.
The IJU also used suicide bombers in multiple attacks focused on police and Uzbek private and commercial facilities in Tashkent and Bukhara in late March and early April 2004.
In May 2005, armed militants stormed a prison in Andijon, released its prisoners, and then took control of the regional administration and other government buildings in Andijon Province.
Fighting broke out between government forces and the militants, and reports indicated that several hundred civilians died in the ensuing violence.
While there were no reports of U.S. citizens affected by these events, U.S. citizens and other foreigners in Uzbekistan frequently have experienced harassment from authorities and local residents since the 2005 violence.

Depending upon security conditions, travelers can expect restricted personal movement, including the closing of roads to traffic, and frequent document, vehicle, and personal identification checks should be anticipated.
The Uzbek Government has intermittently restricted travel to certain parts of the country in response to security concerns.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s Internet website, where the current Travel Warnings and Public Announcements , including the Travel Warning for Uzbekistan , Worldwide Caution Public Announcement , and the Public Announcement for Central Asia, 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:
Uzbekistan’s rate of violent crime, including against foreigners, has increased in recent years.
In urban areas, travelers are urged to take the same precautions against crime that they would take in a large American city.
If you are traveling at night, please travel in groups, maintain a low profile, and do not display large amounts of cash.

Although using private cars as taxicabs is a common practice in Uzbekistan, Americans, especially women, should not consider this a safe practice.
Americans are encouraged to use clearly marked taxicabs, such as those at hotels.
Also, Americans should avoid riding in taxis alone.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm .

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting the crime 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:
Medical care in Uzbekistan is below Western standards, with severe shortages of basic medical supplies, including disposable needles, anesthetics, and antibiotics.
Elderly travelers and those with pre-existing health problems may be at particular risk due to inadequate medical facilities.
Most resident Americans travel to North America or Western Europe for their medical needs.

Travelers are advised to drink only boiled water, peel all fruits and vegetables, and avoid undercooked meat.
Due to inadequate sanitation conditions, travelers should avoid eating unpasteurized dairy products and most food sold in the streets.

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

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

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

Uzbekistan has a developed but deteriorating traffic infrastructure.
Although main roads in central Tashkent are relatively well maintained, many secondary roads inside and outside Tashkent, and particularly those in the Tien Shan and Fan Mountains, are in poor condition and may be passable only by four-wheel-drive vehicles.
Driving at night can be quite dangerous because only the main roads in Tashkent and a few other major cities have streetlights; rural roads and highways generally are not lit.
Visitors are strongly urged to avoid driving at night outside Tashkent.
The gasoline supply can be sporadic; therefore, travelers should expect occasional difficulty finding gasoline, particularly outside of Tashkent.

Livestock, as well as farm equipment and carts drawn by animals that lack lights or reflectors, are found on both urban and rural roads at any hour.
Local drivers are not familiar with safe driving techniques.
Pedestrians in cities and rural areas cross streets unexpectedly and often without looking for oncoming traffic.
Uzbekistan has a large road police force, which frequently stops drivers for minor infractions or simple document checks.
There have been reports of harassment of foreign drivers by the road police, with reported minor police corruption in the form of solicitation of bribes.

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 Uzbekistan’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Uzbekistan’s air carrier operations.
For more information, travelers may visit the FAA’s Internet web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa .

SPECIAL CIRCUMSTANCES: Travelers to Uzbekistan are subject to frequent document inspections.
Therefore, U.S. citizens are strongly encouraged to carry a certified copy of their U.S. passport and their Uzbek visa with them at all times so that, if questioned by local officials, proof of identity and U.S. citizenship are readily available.
In accordance with the Vienna Convention on Consular Relations and certain bilateral agreements, local authorities must grant a United States Consular Officer access to any U.S. citizen who is arrested.
U.S. citizens who are arrested or detained should ask to contact the U.S. Embassy immediately.

Uzbek customs authorities may enforce strict regulations concerning temporary import to or export from Uzbekistan of items such as armaments and ammunition, space technology, encryption devices, X-ray and isotope equipment, nuclear materials, poisons, drugs, precious and semi-precious metals, nullified securities, pieces of art, and antiques of historical value.
Contact the Embassy of Uzbekistan in Washington, D.C. or the Consulate of Uzbekistan in New York for specific information regarding customs requirements.

Most transactions are conducted on a cash-only, local currency (soum) basis.
Credit cards are accepted only at the main hotels and a few shops and restaurants; travelers’ checks can be cashed into dollars at the National Bank of Uzbekistan.
The commission fee is two percent.
Importation of currency exceeding $10,000 (US) is subject to a one- percent duty.
Foreigners must complete a customs declaration upon entering Uzbekistan and may face fines upon departure if unable to produce certificates verifying legal conversion of foreign currency.
Old U.S. dollar bills (prior to 1990) and/or those in poor condition (with tears, writing or stamps) are not acceptable forms of currency in Uzbekistan.
Although payment in U.S. dollars is required for certain hotel charges, airline tickets, and visa fees, other dollar transactions, as well as black market currency exchanges, are prohibited.
Please see our Customs Information.

Uzbekistan is an earthquake-prone country.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/ .

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

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

REGISTRATION / EMBASSY LOCATION: Americans living or traveling in Uzbekistan are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration website and to obtain updated information on travel and security within Uzbekistan.
Americans without Internet access may register directly with the U.S. Embassy in Tashkent.
By registering, American citizens make it easier for the Embassy to contact them in case of emergency.
The U.S. Embassy is located at # 3, Moyqorghon Street, 5th Block, Yunusobod District, Tashkent -700093, Uzbekistan.
The main Embassy telephone number, which can also be reached after hours, is (998 71) 120-5450, fax:
(998 71) 120-6335; Consular fax: (998 71) 120-54-48; e-mail address: ConsularTashkent@state.gov; web site: http://uzbekistan.usembassy.gov.
*

*

*
This replaces the Consular Information Sheet dated October 13, 2006, to update the sections on Country Description, Entry/Exit Requirements, Safety and Security, Crime, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Fri, 1 Feb 2019 09:29:10 +0100

Tashkent, Feb 1, 2019 (AFP) - Uzbekistan on Friday granted visa-free entry to citizens of 45 countries to boost tourism, which the government views as vital for economic growth.  The countries benefiting from a 30-day visa waiver that went into force on Friday include the majority of European countries including Britain as well as Australia, Canada, Argentina and Chile. The United States is a notable exception.

The impoverished ex-Soviet country has made tourism a priority to reduce its dependence on commodity exports.   The government is keen to show off the lavish Silk Road heritage of ancient cities such as Bukhara, Khiva and Samarkand.    Earlier this year, Uzbekistan granted a 30-day visa waiver to Germany while France became the first European Union country to benefit from the measure last year.

Uzbekistan's tourism committee said last month that annual visitor numbers for 2018 were 5.3 million, double the figure for 2017.   President Shavkat Mirziyoyev has reversed a number of policies that hampered tourism under his late predecessor Islam Karimov.    Among the restrictions he scrapped was a ban on photography in the capital Tashkent's ornate metro that had led to police detentions of unsuspecting tourists.    Mirziyoyev's bid to boost tourism in the immediate aftermath of Karimov's death in 2016 suffered a false start.

In December that year, he issued an order easing or cancelling visa requirements for visitors from 27 developed countries but this was swiftly reversed before coming into force.   Observers attributed the reversal to resistance within the powerful security apparatus.      Uzbekistan already offers visa-free entry to visitors from Turkey, Israel, Indonesia, South Korea, Malaysia, Singapore and Japan, in addition to long-standing reciprocal visa-free entry for citizens of most former Soviet countries.
Date: Fri, 4 Jan 2019 13:59:14 +0100

Tashkent, Jan 4, 2019 (AFP) - Uzbekistan said Friday it will allow German citizens to visit for up to 30 days visa-free to boost tourism as the ex-Soviet country emerges from long-term isolation.   Germany will be the second European Union country after France to gain visa-free travel to Uzbekistan, which has opened up somewhat since the death of its long-reigning hardline leader Islam Karimov in 2016.    Germans will be able to enter the central Asian nation visa-free from January 15, the Uzbek tourism committee said Friday, three months after authorities granted French citizens the same 30-day visa waiver.

The impoverished country is highly dependent on commodity exports and has made developing tourism a priority.   In particular the government is keen to show off the lavish Silk Road heritage of cities such as Bukhara, Khiva and Samarkand.    According to the Uzbek tourism committee, 18,094 Germans visited Uzbekistan in 2018, almost five times as many as in 2016.   Reform-touting Uzbek president Shavkat Mirziyoyev is set to visit Germany this month after meeting US President Donald Trump and French leader Emmanuel Macron last year.    These high-profile visits are seen as rewards for his steps towards greater openness following the death of  Karimov, under whom Mirziyoyev served as prime minister for 13 years.   The current president has reversed a number of policies that hampered the tourism sector in recent years.

Among the restrictions he scrapped was a ban on photography in the capital Tashkent's ornate metro that had led to police detentions of unsuspecting tourists.    Mirziyoyev's bid to boost tourism in the immediate aftermath of Karimov's death suffered a false start, however.    In December 2016, he issued an order easing or cancelling visa requirements for visitors from 27 developed countries but this was reversed a month later before actually coming into force.   The reversal was attributed to resistance within the powerful security apparatus.      Uzbekistan offers visa-free entry to citizens of Turkey, Israel, Indonesia, South Korea, Malaysia, Singapore, and Japan, in addition to long-standing reciprocal visa-free entry for citizens of most former Soviet countries.
Date: Thu 27 Dec 2018
Source: Vanguard NGR News [edited]

The World Health Organization (WHO) has certified Uzbekistan as malaria-free, confirming the end of the country's half-century-long battle for malaria elimination within its borders. Uzbekistan has become the 2nd country in 2018 to be certified malaria-free -- Paraguay was certified in June -- marking another milestone on the road to ending the disease for good.

"Malaria No More commends the government of Uzbekistan for its resilience and determination to eliminate malaria once and for all. Uzbekistan's decade-long commitment demonstrates the government's recognition that malaria stood in the way of development, and that ridding the country of the disease was critical to improving [the country's] economic outlook and protecting the health of its people," said Martin Edlund, CEO of Malaria No More.

Uzbekistan 1st eliminated malaria in 1961 but struggled to maintain elimination as malaria cases continued to flow in from neighbouring countries. In 2000, recognising the barriers that having malaria within its borders had on the country's economy and overall health of its citizens, the government of Uzbekistan stepped up its investment and implemented a holistic multisectoral approach that went beyond health, with support from other ministries -- agriculture, education and transportation.

Highlighting the critical factors needed to get the job done, the WHO certification committee cited Uzbekistan's decision to maintain its support of the nation's primary health care system -- the backbone of the malaria response -- even during the economic crisis that gripped the country during the 1990s; its use of data to better target malaria interventions where they're need most; and its approach toward early detection, diagnosis and efficacious treatment of malaria patients -- free of charge and irrespective of nationality.

Another critical factor was support from non-governmental organizations and partners, particularly the Global Fund to Fight AIDS, TB and Malaria, which played a vital role in Uzbekistan's achievement by providing financial support to ensure the national malaria program had the full amount of insecticide-treated bed nets, indoor residual spraying equipment, medicines and other tools needed to protect its citizens from malaria.  [Byline: Sola Ogundipe]
========================
[ProMED congratulates Uzbekistan with this important achievement. It is important to note that the achievement included mobilization beyond the health sector alone, applying a "holistic multisectoral approach that went beyond health," and the importance of the "primary health care system -- the backbone of the malaria response."

It is also noted that the malaria-free status would probably not have been achieved without the support of "non-governmental organizations and partners, particularly the Global Fund to Fight AIDS, TB and Malaria." - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Date: Sun, 29 Apr 2018 12:05:35 +0200
By Christopher RICKLETON

Samarkand, Uzbekistan, April 29, 2018 (AFP) - Coiffed, cheerful and multilingual, identical twins Fatima and Zukhra Rakhmatova do not immediately resemble agents of ex-Soviet Uzbekistan's long-feared security apparatus.   But the photogenic 30-year-old pair are frontline members of a newly formed, user-friendly Tourist Police deployed in the famed Silk Road city of Samarkand and other hotspots as a visitor boom sweeps the Central Asian country.

The force, established in January, is viewed as part of a broader opening initiated by Uzbekistan's authoritarian government following a long period of self-enforced isolation.    More than 2.5 million tourists visited Uzbekistan last year, a 24 percent increase on the previous year, according to the UzDaily news site.   "In the past I worked as a teacher and then as a wedding stylist. I even won a national prize as a stylist," recalls Zukhra Rakhmatova, one half of a sister act proficient in English, Russian, Farsi, Turkish and Japanese.   "But our grandfather served in the force and our uncle too," Rakhmatova told AFP. "It was always our dream to serve."

- Change and continuity -
Samarkand -- a former power centre positioned at the epicentre of millennia-old trade routes linking China and Europe -- hosts symbols of authoritarian continuity as well as tentative reform.    A short walk from the ceramic and marble dazzle of the three madrasahs towering over the city's old square is the statue of Islam Karimov, who ruled the country from before independence in 1991 until his death in 2016.    Laid to rest in a grand mausoleum in Samarkand's historic centre, Karimov is criticised by rights groups as the architect of one of the world's most repressive and closed-off police states.

Far from being disavowed, his monument is now yet another photo opportunity for visitors and wedding parties in the city, where he was born in 1938 and remains widely revered.    "Everyone makes mistakes but Islam Karimov is a hero. He worked day and night to protect the Uzbek people," said a 22-year-old bridesmaid posing for pictures by the monument.    The young woman, who did not give her name but said she had travelled to Samarkand from the capital Tashkent, refused to say what "mistakes" she thought Karimov had made.

- Power struggle -
Whether out of political pragmatism or genuine deference to a man he served for 13 years as prime minister, Karimov's successor, 60-year-old Shavkat Mirziyoyev has also continued to honour his mentor in public.   In the aftermath of the former leader's death, new strongman Mirziyoyev likened him to a "father", even as he toned down some of the totalitarian excesses that defined Karimov's 27-year rule. 

Foreign tourism, which grew by around a quarter during Mirziyoyev's first year in office emerged as a key battleground in a power struggle that pitted the new reform-touting president against regime hardliners.   In February for instance, Mirziyoyev ordered the introduction of a 30-day visa-free regime for citizens of seven countries -- Israel, Indonesia, South Korea, Malaysia, Singapore, Turkey and Japan -- and relaxation of registration rules for citizens of 39 others.

In cities like Samarkand, the changes were cheered by a population that endured long stretches of economic stagnation under Karimov.   "(We need to) open up of course!" said Malika Shakhimardonova, a chef at a mutton-grilling teahouse in the shadows of the Bibi-Khanym Mosque, completed on the orders of medieval conqueror Tamerlane in the 15th century.   "Let the tourists arrive to us like brothers and sisters!" said Shakhimardonova, whose kitchen is expanding.

- 'Take photos and share them!' -
Many saw significance in the fact that Mirziyoyev's relaxation of visa restrictions came days after Rustam Inoyatov, 73, who led the notorious national security service for over two decades, was dismissed.   Inoyatov was widely reported to have blocked a previous effort by Mirziyoyev to revamp tourism and to have insisted on retaining long-standing security measures, including a blanket ban on photography in the capital's metro.    Such bans, which occasionally saw visitors detained by police, were "rudiments of the Soviet Union" now consigned to the past, said the country's new 44-year-old tourism chief Aziz Abdukhakimov.

"We want tourists to take as many photos as possible. Put them on Instagram! It is the best advert for the country," he told AFP.     The Rakhmatova sisters, who scoot around Samarkand on two-wheeled, motorised "Segways" and are trained to administer first aid, certainly seem far removed from the grimmer elements of a former communist police state.   But Fatima jokes their dual presence on the tourism beat might sometimes give visitors a different impression.    "Some tourists will see one of us close to one attraction then move on to another and find the other sister standing there," she explained.    "They smile but sometimes give us a strange look. Probably because we are identical they think the police are following them around," she laughed.
Date: Wed, 7 Feb 2018 13:23:32 +0100

Tashkent, Feb 7, 2018 (AFP) - Uzbek authorities are to ease strict rules that bar visitors from taking photos or videos in parts of the country's picturesque capital, in a new bid to encourage tourism.   Uzbek President Shavkat Mirziyoyev has made boosting the tourism sector a priority as his country seeks to emerge from a long period of economic stagnation under late ruler Islam Karimov, who died of a reported stroke in 2016.

But tourists have long been forbidden from capturing on camera the Uzbek capital Tashkent's elaborate metro stations and some government buildings.    Late on Tuesday state media published a presidential decree saying tourists would now be able to take photos of and film public places "without any sort of restrictions" as long as there is no specific legal act to prevent them from doing so.

It was not stated in the February 3 decree whether or not tourists would now be able to take photos of the metro stations.    Two travel agencies told AFP they had not yet received a list of spots that could not be photographed.   The decree also said tourists would be permitted to use drones to take photos and video, which was previously not allowed in the capital Tashkent.     Mirziyoyev, who served as prime minister for 13 years before taking over, has made moves to distance himself from Karimov's authoritarian excesses while also honouring his memory.

The new decree also allows for some foreign nationals to obtain a 72-hour transit visa on arrival in Tashkent airport, providing they can show proof of onward travel.    It was not immediately clear which passport holders this rule would apply to.     Uzbekistan is expected to grant citizens of Israel, Indonesia, South Korea, Malaysia, Singapore, Turkey and Japan visa-free entry into the country starting from Saturday.

In December 2016, the government moved to lift visa restrictions for a longer list of countries but the order was unexpectedly deferred until 2021 weeks later.    Analysts attributed the nixing of the law to the intervention of the country's powerful national security chief, Rustam Inoyatov, whose dismissal after 23 years in power last month was widely seen as paving the way for further reforms.
More ...

World Travel News Headlines

Date: Wed, 22 May 2019 16:52:39 +0200
By Nazeer al-Khatib with Hashem Osseiran in Beirut

Maaret al-Numan, Syria, May 22, 2019 (AFP) - Syrian government air strikes killed 18 civilians, including a dozen people at a busy market, as fierce fighting raged for the jihadist-held northwest, a war monitor said on Wednesday.   Regime forces battled to repel a jihadist counteroffensive around the town of Kafr Nabuda that has left 70 combatants dead in 24 hours, the Syrian Observatory for Human Rights said.   The Hayat Tahrir al-Sham alliance, led by Syria's former Al-Qaeda affiliate, controls a large part of Idlib province as well as adjacent slivers of Aleppo, Hama and Latakia provinces.   The jihadist-dominated region is nominally protected by a buffer zone deal, but the government and its ally Russia have escalated their bombardment in recent weeks, seizing several towns on its southern flank.   At least 12 people were killed and another 18 wounded when regime warplanes hit the jihadist-held Idlib province town of Maarat al-Numan around midnight (2100 GMT) on Tuesday, the Observatory said.

The market was crowded with people out and about after breaking the daytime fast observed by Muslims during the holy month of Ramadan.   The bombardment blew in the facades of surrounding buildings, and ripped through the flimsy frames and canvas of stalls in the market square, an AFP photographer reported.    The bodies of market-goers were torn apart.   "Residents are still scared," stallholder Khaled Ahmad told AFP.   Three more civilians were killed on Wednesday by air strikes in the nearby town of Saraqib, the Observatory said.    Two others were killed in strikes on the town of Maaret Hermeh, it added.    Another civilian was killed in air raids on the town of Jisr al-Shughur, the monitor said.   The Britain-based Observatory relies on a network of sources inside Syria and says it determines whose planes carried out strikes according to type, location, flight patterns and munitions.

- 'Worst fears'-
The strikes came as heavy clashes raged in neighbouring Hama province after the jihadists launched a counterattack on Tuesday.   Fresh fighting on Wednesday took the death toll to 70 -- 36 regime forces and militia and 34 jihadists, the Observatory said.   It said the jihadists had recaptured most of Kafr Nabuda from government forces, who had taken control of the town on May 8.   State news agency SANA on Wednesday however said the army repelled a jihadist attack in the area, killing dozens of insurgents.

Russia and rebel ally Turkey inked the buffer zone deal in September to avert a government offensive on the region and protect its three million residents.   But President Bashar al-Assad's government upped its bombardment of the region after HTS took control in January.   Russia too has stepped up its air strikes in recent weeks.   The Observatory says nearly 200 civilians have been killed in the flare-up since April 30.   The United Nations said Wednesday that Idlib's civilian population once again faced the threat of an all-out offensive.   "A full military incursion threatens to trigger a humanitarian catastrophe for over 3 million civilians caught in the crossfire, as well as overwhelm our ability to respond," said David Swanson, a spokesman for the UN humanitarian office.   Swanson said more than 200,000 people have been displaced by the upsurge of violence since April 28.   A total of 20 health facilities have been hit by the escalation -- 19 of which remain out of service, Swanson said.   Collectively they served at least 200,000 people, he added.

- 'Break the status quo' -
The September deal was never fully implemented as jihadists refused to withdraw from a planned buffer zone around the Idlib region.   But it ushered in a relative drop in violence until earlier this year, with Turkish troops deploying to observation points around the region.   The Syrian government has accused Turkey of failing to secure implementation of the truce deal by the jihadists.   But Turkish Defence Minister Hulusi Akar accused the Syrian regime late Tuesday of threatening the ceasefire deal.   "The regime is doing all that it can to break the status quo including using barrel bombs, land and air offensives," Akar told reporters.   "Turkish armed forces will not take a step back from wherever they may be", he however added.   Earlier, the US State Department said it was assessing indications that the government had used chemical weapons on Sunday during its offensive in Idlib.   HTS accused government forces of launching a chlorine gas attack on its fighters in the northern mountains of Latakia.   But the Observatory said Wednesday it had "no proof at all of the attack".
Date: Wed, 22 May 2019 02:06:35 +0200
By Amelie BARON

Port-au-Prince, May 22, 2019 (AFP) - With no oxygen in intensive care or gloves in the emergency room, residents at Haiti's largest hospital have gone on strike to protest the filthy environment and demand six months of back pay.   "We have almost nothing when we talk about emergency services," said Emmanuel Desrosiers, 24, one of the doctors-in-training at the State University of Haiti Hospital (HUEH) that began the work stoppage Monday.    "When a patient arrives, when we should immediately take charge, we start by listing the things they or their family need to go buy."   The HUEH, known as the "general hospital," is where the most disadvantaged families in this impoverished Caribbean country crowd. Buying the medical supplies themselves is a financial headache, but private clinics are far too expensive.   In crumbling buildings in the center of Port-au-Prince, male and female patients are crowded together in tiny rooms, while trash cans overflow.   "We feel ridiculous when we give hygienic advice to patients," one resident said of the situation.

The residents' selflessness as they work in an unsanitary environment is compounded by the fact that they have not been paid since the start of their residency, nearly six months ago.   After five years of medical studies, the state is required to pay them 9,000 Haitian gourdes (HTG) per month -- only about $100, due to the devaluation of the national currency.   Nothing is being done about the hospital's disrepair, with those in charge waiting for a new building to be completed, according to resident Yveline Michel.   The new HUEH will have two floors and more than 530 beds once it's finished -- but it's unclear when that will be.   The project began after the January 2010 earthquake, which destroyed more than half the hospital. The United States, France and Haiti invested $83 million in a new hospital, which should have been completed by 2016.   Instead, there is little visible activity on the construction site, which can be seen through the windows of the current building.

Due to the heat, the windows are always open, letting in noise and dust from the street. There are only a few fans in the hospital rooms, which do little to combat the humidity or the flies.   "At any moment we could lose patients, but the state isn't doing anything to save their lives," said Michel, 25.   "We're striking for the population, since it should make these demands."   But some locals question the residents' position because the strike prevents the already struggling hospital from functioning.   Since the strike began, the poorest families in the area no longer know where to go for medical emergencies, as the residents are in charge of admitting patients.   "Due to the lack of resources and the unsanitary environment, there are always people dying in the hospital, so it's not the strike causing that," said Michel in response.
Date: Tue 21 May 2019
Source: Le Dauphin [in French, trans., edited]

Lovers of sushi, maki, sashimi, and other raw fish, beware of your stomach! 7 cases of fish tapeworm, better known as tapeworm [ProMED presumes it is Diphyllobothrium latum], have been reported in 2 years by the Rennes hospital in Ille-et-Vilaine [Brittany].

An exceptional number of cases was counted between July 2016 and September 2018, especially since no case had been detected for at least 20 years.

The infection is acquired by "eating raw or marinated fish which contains larvae of this parasite. The larvae will undergo several moults and develop in our digestive tract," explained Professor Florence Robert-Gangneux to our colleagues in France Bleu Armorique.

The parasite can measure up to 20 meters [66 ft] long and live 10 years in the body. The fish tapeworm can cause digestive disorders, deficiencies, although some patients do not notice.

The only solution to eliminate these parasites of the fish is freezing. This is what a 2004 European regulation imposes on restaurant owners serving raw fish. Freezing should be from -20 deg C [-4 deg F] during 24 hours or -35 deg C [-31 deg F] during 15 hours. And to get rid of the worm once ingested, it is necessary to undergo an unpleasant antiparasitic treatment, often on several occasions.
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[We presume it is the fish tapeworm _Diphyllobothrium latum_, which is a tapeworm found in freshwater fish (<https://www.cdc.gov/parasites/diphyllobothrium/index.html>). In saltwater fish the most common parasite is _Anisakis_, but this is not a tapeworm. - ProMED Mod.EP]

[HealthMap/ProMED-mail map of France:
Date: Mon 20 May 2019
Source: El Pais [in Spanish, trans. Mod.TY, edited]

Tarija Departmental Health Services (SEDES) reported a new case of hantavirus [infection] in Padcaya municipality. The number of patients with this illness is within what is expected, because this season is when more people acquire the disease. Epidemiological surveillance is continuing in Arce province. The person who acquired this illness is male and is under medical care until his recuperation.

The head of the Epidemiological Unit of SEDES, Claudia Montenegro, stated that the patient is hospitalized in the San Juan de Dios Regional Hospital in Tarija awaiting his recuperation. The physician said that in Bermejo and Padcaya municipalities, the harvest of citrus fruit and sugar cane for production of sugar has begun, so there is a trend for the cases of this illness to increase. This is due to the large number of families that move to the countryside where the rodent (long tail) is present that transmits this disease [virus].

"In contrast to previous seasons, this year [2019], there were positives for this disease in Gran Chaco province, including fatalities," Montenegro commented. "Epidemiological surveillance there is being implemented, as well as in areas such as Padcaya and Bermejo."

The official explained that in these localities, the rodent that transmits the disease [virus] to families is present, and with agricultural activities, [people] move into places where this animal lives, and so new cases of patients with hantavirus [infections] are registered every year.

In order to prevent this illness, it is recommended that rodent control campaigns be done to reduce their populations, openings in houses be sealed, and that residents reduce the possibility for rodents to make nests within a radius of 30 meters [100 ft] around the house, and eliminate items that could attract these animals near the house (food, grain, garbage). Workers should employ protective measures during agricultural tasks and cleaning work.

Initial symptoms include fatigue, fever and muscle pain, especially in the thighs, hips and back. Also, patients may present with headache, dizziness, chills, nausea, vomiting, diarrhea and abdominal pain. [These symptoms may progress rapidly to respiratory difficulty requiring mechanical ventilation (hantavirus cardio pulmonary syndrome). Death can occur. - ProMED Mod.TY]
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[The hantavirus involved in the above cases is not mentioned. Cases of hantavirus infections in Tarija department are not new. Tarija department is endemic for hantaviruses, and cases occur there sporadically. Last year (2018), there were 11 cases. The previouslyreported 2015 cases of hantavirus pulmonary syndrome (HPS) that occurred in Tarija department were confirmed. As noted in the previous comments, earlier cases of hantavirus pulmonary syndrome have been reported from tropical, lowland areas of Bolivia, including 7 cases in Tarija during 2014. The specific hantaviruses involved in these or previous cases in Bolivia were not given.

In the lowland Amazon Basin of Bolivia, the rodent hosts of the hantavirus that might be involved in these hantavirus pulmonary syndrome (HPS) cases, with their images, include the following: - Laguna Negra virus (_Calomys laucha_ <http://www.faunaparaguay.com/images/Calomys%20laucha%20enciso%2031aug2011.jpg> and _C. callosus_ <https://eee.uci.edu/clients/bjbecker/PlaguesandPeople/Calomyscallosusb.jpg>); - Bermejo (Chaco rice rat _Oligoryzomys chacoensis_ <http://www.faunaparaguay.com/oligorizomyschacoensis.html>); and - Oran (_O. longicaudatus_ <http://calphotos.berkeley.edu/imgs/512x768/0000_0000/0711/1203.jpeg>).

Since previous cases in Tarija department have occurred in Bermejo, perhaps Bermejo hantavirus was involved.

Dr. Jan Clement commented that there is a need to be able to differentiate Seoul (SEOV) as a causative agent, but that is hampered by the fact that most current commercial ELISA or WB formats do not contain (anymore) a SEOV antigen, so that a preliminary presumption of a hantavirus infection can even be missed in non-research laboratories (ibidem, and: Reynes J-M, Carli D, Bour J-B, Boudjeltia S, Dewilde A, Gerbier G, et al. Seoul virus infection in humans, France, 2014-2016. Emerg Infect Dis. 2017;23:973-7;  <https://wwwnc.cdc.gov/eid/article/23/6/16-0927_article>.

SEOV is widely distributed around the world in the brown rat and is likely found in Tarija department. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Tarija, Tarija, Bolivia: <http://healthmap.org/promed/p/12643>]
Date: Tue 21 May 2019
Source: ZBC (Zimbabwe Broadcasting Corporation) [edited]

The Zambezi Parks & Wildlife Management Authority (Zimparks) says it has managed to contain the anthrax outbreak in the Zambezi Valley which claimed 6 elephants, 3 buffalo, a lion and an impala. Zimparks, which has been working together with other stakeholders following the outbreak of anthrax in Zambezi Valley, confirmed that the infectious disease has now been brought under control.

Zimparks Public Relations Manager, Mr. Tinashe Farawo said the authority is pleased to have contained the disease, adding that measures are being put in place to strengthen surveillance mechanisms. "We can confirm that we have managed to contain the anthrax diseases in the Zambezi Valley thanks to efforts by our officers and support from private stakeholders," said Mr. Tinashe Farawo.

The disease killed a number of hippos in Binga last year [2018]. Anthrax is usually transmitted by feed and water contaminated with spores, which can lie dormant in the soil for many years. The primary sign of anthrax in grazing animals is sudden death, often with bloody discharges.
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[So far so good, but I must point out that nature is illiterate and does not read the announcements of senior bureaucrats. She does what she does. Hopefully Mr. Farawo is correct but we should wait a couple of weeks at full alert.

Maps of Zimbabwe can be seen at

For a description of Hwange national park, go to
<https://en.wikipedia.org/wiki/Hwange_National_Park>.

Hwange is in the western part of the country bordering Botswana and Zambia
(<https://en.wikipedia.org/wiki/Hwange>). - ProMED Mod.MHJ]

[HealthMap/ProMED map available at:
Matabeleland North Province, Zimbabwe:
Date: Mon 20 May 2019, 2:49 PM
Source: KDKA [edited]

Pennsylvania's Secretary of Health, Dr. Rachel Levine has announced that the state has declared a hepatitis A outbreak with 171 cases in 36 counties. According to the map provided by the Department of Health, Allegheny and Philadelphia counties are hit the hardest with anywhere between 31-50 cases.

The counties hit hardest by this outbreak are Philadelphia and Allegheny, but we have seen an increase of cases throughout much of the state," Dr. Levine said. "We are taking this action now to be proactive in our response to treating Pennsylvanians suffering from this illnesses and prevent it from spreading. The best way to prevent hepatitis A is through vaccination."
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[Pennsylvania is the latest (now almost half of the states in the USA) to declare a hepatitis A outbreak. As the numbers of cases continue to rise in a number of states, and news of smaller (so far) outbreaks occur in others, the question at the end of ProMED post http://promedmail.org/post/20190104.6241686 by a Kentucky official, "This is a disease of developing countries.

One has to ask: Why are we seeing it in the USA?" is more and more relevant. We are seeing these outbreaks because of the inability to deal with marginalized populations among their midst. The dramatic cutbacks in public health infrastructure in some of these states clearly feed the fire of these outbreaks. They must be addressed by bolstering public health resources and education and directly addressing the needs of these marginalized populations. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Pennsylvania, United States: <http://healthmap.org/promed/p/240>]
Date: Thu 16 May 2019
Source: AllAfrica, The Guardian report edited

A serving medical doctor has been infected with Lassa fever while 2 persons were confirmed dead in Kebbi state. Another medical doctor disclosed this yesterday [15 May 2019] when The Guardian visited the Federal Medical Centre (FMC), Birnin Kebbi. He said that 2 children died last week [week of 6 May 2019] as a result of the Lassa fever while a medical doctor, who was doing his primary assignment treating the patients, was also infected.

"You see, the management of the FMC has opened a special unit called isolated unit for the Lassa fever patients. We still have some patients inside. Also, a medical doctor, who was managing some patients last month [April 2019], has also been infected and he is presently on admission," he said.

Meanwhile, the state's Commissioner for Health, Alhaji Umar Kambaza, who confirmed the incident, said they were aware of the cases in the state but the government is working towards them.  [Byline: Michael Egbejule, Ahmadu Baba Idris]
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[The dates of occurrence of these cases is not given. Presumably, they were hospitalized after 12 May 2019 when the Nigeria CDC update was issued. It is indeed unfortunate that an attending physician became infected in the hospital. Nosocomial infections are not unusual when personal protective equipment and barrier nursing measures are not employed. - ProMED Mod.TY]
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 20 May 2019 08:47 IST
Source: The Hindu [abridged, edited]

The current global resurgence in measles is having its resonance in Kerala too, which has been witnessing a serious surge in the disease since January [2019].

Across the globe, huge local outbreaks have been caused by travel as well as the increase in unvaccinated populations.

In Kerala, however, the majority of the cases are reported from Thiruvananthapuram, which has good vaccination coverage and amongst people who are well-nourished and have received at least one dose of vaccine in their lifetime.

Kerala reports around 600 plus cases of measles every year. This year [2019], as many cases have been reported in the first 4 months itself, with over 50% cases in the 19-40 year age group. There are also cases in the less than 9 months age group, but fewer cases than before in the 1-5 years group.

Immunisation
------------
"When universal routine immunisation in childhood improves and the virus is still in circulation, the disease will naturally move to the older age group who may be unimmunised or whose vaccine-derived immunity has begun to wane. At a time when the state is moving towards measles elimination, adult measles is a major concern," a senior health official said.

Historically, measles has been a childhood disease. The epidemiological shift to older population presents new public health challenges because of the increased severity of the disease, especially in vulnerable populations like pregnant women and immunocompromised patients (HIV, organ transplant recipients on immunosuppressants, cancer patients), who cannot be vaccinated with the live attenuated measles vaccine.

"Earlier, nearly 90% of measles cases could be managed on out-patient basis. This year [2019], most cases are in the 19-35 age group and over 60% of the cases had to be admitted as in-patients, with a good percentage requiring ICU management," said R Aravind, head of infectious diseases at Thiruvananthapuram Medical College.

The changing epidemiology of measles has not just brought forth the several unknowns but also raised important questions on whether adult immunisation should be a policy, on vaccine potency and the adequacy of vaccine immune response.

Though measles vaccine is highly immunogenic, as part of the national measles elimination strategy, a mandatory 2nd dose at 15-18 months was introduced in 2010, so that there is better immune protection. It is fairly certain that those currently in the 18-40 years age group have not had the protection of the 2nd dose and may be one reason for the increase in cases in this age group.

The 1st vaccination age for measles has been fixed at 9 months because till then, the maternal antibodies transferred in utero are supposed to afford protection to the child. If vaccinated earlier, the maternal antibodies might interfere with the immune response to vaccine.

Susceptible
-----------
However, at Rajiv Gandhi Centre for Biotechnology, the director, M Radhakrishna Pillai and team, who are currently studying the efficacy of measles vaccination in South India, have reported that children under the recommended vaccination age of 9 months are highly susceptible to measles.

SAT Hospital too has recently reported the death of an infant younger than 9 months due to measles.

"If the young mothers of the day do not have sufficient antibody protection, how do we protect infants younger than 9 months against measles? Given measles' age shift to older age group, should we move the vaccination age to 12 months for better vaccine response?

"Is a 3rd dose of MMR (mumps-measles-rubella) necessary? And should we recommend that all adults be given a dose of MMR as the virus is still in circulation? These questions need to be looked at from a research perspective by the State/National Technical Advisory Group on Immunisation," a public health expert said.  [Byline: C Maya]
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[HealthMap/ProMED-mail map of Kerala State, India:
Date: Fri 17 May 2019
Source: The Government of Hong Kong Special Administrative Region, press release [abridged, edited]

The Centre for Health Protection (CHP) of the Department of Health (DH) said today (17 May 20-19) that no additional case of measles infection had been recorded as at 4pm today and announced that the outbreak of measles infection at Hong Kong International Airport earlier has concluded.

A spokesman for the CHP said, "A total of 73 cases of measles infection were recorded so far this year [2019], among them 29 cases were associated with the outbreak among airport workers.

Regarding measles control measures implemented at the airport, a total of 23 persons had received measles vaccination at the airport vaccination station as at 6pm today [17 May 2019], bringing the cumulative number of vaccinations given to 8501 since 22 Mar 2019. The airport vaccination station will cease operation from [18 May 2019].

As for the blood test service, the DH earlier provided the measles serology test service to airport staff. A cumulative total of 777 blood samples have been collected. For the pilot service to provide measles serology testing for Filipino foreign domestic helpers working in Hong Kong, a total of 146 blood samples have been collected to date. Participants are notified individually of the serology results.
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[HealthMap/ProMED-mail map of Hong Kong: