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Burundi

Burundi US Consular Information Sheet
April 21, 2008
COUNTRY DESCRIPTION:
One of the poorest countries in the world, Burundi is a small, densely populated central African nation bordering Lake Tanganyika, Rwanda, Tanzania and the Democrati
Republic of Congo. After more than 12 years of civil and ethnic strife, an electoral process deemed free and fair resulted in the installation of a democratic government in 2005. Years of fighting have devastated a historically fragile economy that depends largely on subsistence agriculture. Poor public health and education, weather disasters such as drought and floods, crop diseases and lack of infrastructure exacerbate the effects of conflict and delay recovery. Facilities for tourism, particularly outside the capital, are limited. Read the Department of State Background Notes on Burundi for additional information.

ENTRY/EXIT REQUIREMENTS: A passport, visa and evidence of immunization against yellow fever are required for entry. Travelers with an expired visa are not permitted to leave the country without acquiring an exit visa prior to departure. The latest information about visas may be obtained from the Embassy of the Republic of Burundi, Suite 212, 2233 Wisconsin Avenue NW, Washington, DC 20007, telephone (202) 342-2574, or from the Permanent Mission of Burundi to the United Nations in New York at telephone (212) 499-0001 thru 0006.
For information about dual nationality or the prevention of international child abduction, please refer to related web pages at http://travel.state.gov. For further information about customs regulations, please read our Customs Information sheet.

SAFETY AND SECURITY:
See the Department of State’s Travel Warning for Burundi.
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 personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s pamphlet A Safe Trip Abroad.

CRIME: Crime, often committed by groups of armed bandits, poses a high risk for foreign visitors to Bujumbura and Burundi in general. Common crimes include mugging, purse-snatching, pick pocketing, burglary, automobile break-ins and carjacking. Many criminal incidents involve armed attackers. Armed criminals often ambush vehicles, particularly on the roads leading out of Bujumbura. Criminals in Bujumbura often operate in pairs or in small groups involving six or more individuals. Due to insufficient resources, local authorities in any part of Burundi are often unable to provide timely assistance in case of need.
U.S. Government personnel are prohibited from walking on the streets during the hours of darkness and using local, public transportation. Foreigners, whether in vehicles or at home, are always potential crime targets. Americans should exercise common sense judgment and take the same precautions as one would in any major city.

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 the local police, please contact the nearest U.S. Embassy or Consulate for assistance. The Embassy/Consulate staff can, for example, help 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 facilities in Burundi generally do not meet Western standards of care. Travelers should carry an ample supply of properly-labeled prescription drugs and other medications with them, as certain medications and prescription drugs are unavailable or in short supply. Sterility of equipment is questionable, and treatment is unreliable. Ambulance assistance is non-existent. Hospital care in Burundi should be considered in only the most serious cases and when no reasonable alternatives are available.
Malaria prophylaxis is recommended for travel to all parts of Burundi.

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 companies prior to traveling abroad to confirm whether their policies apply overseas and/or cover emergency expenses such as a medical evacuation. Please see our information on medical insurance overseas.

TRAFFIC SAFETY AND ROAD CONDITIONS: When in a foreign country, U.S. citizens may encounter road conditions that differ significantly from those in the United States. The information below concerning Burundi is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
While travel on most roads is generally safe during the day, travelers must maintain constant vigilance. There have been regular reports of violent attacks on vehicles traveling the roads throughout the country outside of Bujumbura. U.S. Government personnel are required to travel upcountry via two-vehicle convoys and have their trips pre-approved by the Regional Security Officer. The Embassy recommends that Americans not travel on the national highways from dusk to dawn. Drivers without valid permits, and the ease with which a driver's license can be acquired without training, make Burundian drivers less careful, predictable, or mindful of driving rules than Western drivers may expect.
There are no traffic signals in Bujumbura, and virtually nothing of the kind elsewhere in the country. Roadways are not marked, and the lack of streetlights or shoulders makes driving in the countryside at night especially dangerous. Additionally, drivers may encounter cyclists, pedestrians, and livestock in the roadway, including in and around the capital. Mini-vans used as buses for 18 persons should be given a wide berth as they start and stop abruptly, often without pulling to the side of the road.
Large holes or damaged portions of roadway may be encountered anywhere in the country, including in Bujumbura; when driving in the countryside, it is recommended that travelers carry multiple spare tires. During the rainy season, many side roads are passable only with four-wheel drive vehicles. Burundi’s supply of gasoline and diesel fuel are imported predominantly from Kenya and Tanzania, and are relatively expensive due to high transportation costs. Service stations are rare outside of the major cities.

Third-party insurance is required, and it will cover any damages (property, injury, or death). If you are found to have caused an accident, you automatically will be fined 10,000 Burundian francs (approximately $10 U.S.) and your driver's license will be confiscated until the police investigation is completed. Although the law provides for the arrest of drunk drivers, in practice, the police do not act on this law. In the city of Bujumbura, the number for police assistance is 22-22-37-77; there is no comparable number outside the capital. If you are involved in an accident causing death, it is advised that you leave the scene of the accident and proceed to the nearest police station.

Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Burundi, the U.S. Federal Aviation Administration (FAA) has not assessed Burundi’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
There are no ATMs located in the country and most Burundian hotels and businesses do not accept credit cards. Many hotels in Bujumbura accept payment in U.S. dollars or Euros from non-Burundians. Travelers should be aware that Burundian banking practices prohibit acceptance of U. S. currency printed before the year 2003.
The Embassy recommends that visitors do not photograph airports, military installations, or other government buildings, and obtain permission from individuals before taking their photographs. 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 Burundian laws, even unknowingly, may be expelled from the country, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Burundi 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 intercountry adoption and international parental child abduction see our Office of Children’s Issues web pages

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Burundi are encouraged to register with the U.S. Embassy through the State Department’s travel registration website so that they can obtain updated information on travel within Burundi and the Embassy’s current security policies, including areas that are off-limits to U.S. Government personnel for security reasons. Americans without Internet access may register directly with the U.S. Embassy. By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy is located on Avenue des Etats-Unis, telephone (257) 22-22-34-54, fax (257) 22-22-29-26. The Embassy's web site is http://burundi.usembassy.gov/.
* * *
This replaces the Country Specific Information for Burundi dated July 18, 2007, to update sections on Country Description, Entry/Exit Requirements, Medical Facilities and Health Information, and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Thu 8 Jan 2020
Source: Outbreak News Today [edited]

In a follow-up on the malaria situation in Burundi in 2019, the World Health Organization reports a progressive increase in cases in the past year across all 46 districts of Burundi.

Since the beginning of the year [2019], 8 392 921 malaria cases, including 3113 deaths have been reported. The population in the landlocked country in Southeast Africa is estimated at 11.53 million in 2019.

Malaria has been a scourge in Burundi in recent years. In fact, World Vision International reports since 2015, more than 19.7 million cases of malaria have been recorded in Burundi through 2017. With a population of 11.5 million, that's the equivalent of nearly every Burundian getting malaria twice in those 2 years.
=======================
[Please see our extensive comment to the malaria situation in Burundi in the ProMED posting http://promedmail.org/post/20190808.6611871 from the 8 Aug 2019. - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Date: Wed, 14 Aug 2019 17:49:51 +0200 (METDST)

Nairobi, Aug 14, 2019 (AFP) - The World Health Organization (WHO) said Wednesday that Burundi had begun vaccinating frontline workers against Ebola at its border with the Democratic Republic of Congo, where an outbreak of the virus has killed close to 1,900 people.   The campaign to vaccinate at-risk staff against the deadly hemorrhagic fever started Tuesday at Gatumba, the main crossing point from Burundi to its much-larger neighbour, WHO said.

Burundi has received doses of the rVSV-ZEBOV vaccine, an unlicensed product that has been shown to be effective against the Zairian strain of the virus raging in DR Congo.   It would be administered to those at greatest risk such as health workers along the border, laboratory staff and burial teams, WHO said.   "The vaccination of health and frontline staff is a significant step forward in preparing for the response to this disease," said Dr Kazadi Mulombo, WHO representative in Burundi. 

The vaccine, developed by US pharmaceutical group Merck, proved "highly effective" in a trial conducted in Guinea in 2015 during the Ebola epidemic in West Africa, he added.    The vaccination campaign will be overseen by WHO and Burundi's health ministry.   The Ebola outbreak in eastern DR Congo is the second-worst in history. A total of 1,892 deaths have been recorded since the outbreak began on August 1 2018.   No cases of Ebola have been recorded so far in Burundi, a tiny nation of 11 million.    But its border with DR Congo is 236 kilometres (147 miles) long and considered highly porous, and the whole region is on high alert.

In June, three people from one family died in Uganda from Ebola after returning from DR Congo via an unofficial crossing point.   Burundi also shares a border with Rwanda and Tanzania.   The Congo outbreak is the first where vaccines have been rolled out on a large-scale.   The rVSV-ZEBOV vaccine has already been administered to some 170,000 people, especially frontline workers, in DR Congo.   This week, US researchers announced that two prototype drugs being tested among Ebola patients in eastern DR Congo boost chances of surviving the disease.
Date: Thu 8 Aug 2019 05.00 BST
Source: The Guardian [edited]

A serious outbreak of malaria in Burundi has reached epidemic proportions, killing almost as many people as the Ebola crisis in the nearby Democratic Republic of the Congo.  The outbreak in the tiny Great Lakes country has infected almost half the total population, killing about 1800 people since the beginning of the year [2019].  According to figures gathered by the World Health Organisation, almost 6 million cases have been recorded since the 1st week of January to the end of July [2019], with infections reaching crisis levels in May. The figures look on course to outstrip the epidemic of 2017, when more 6 million cases were recorded for the whole year. The situation has continued to worsen as the government of Burundi has refused to declare an emergency.

The scale of the outbreak was described in the latest report for the UN's office for the Coordination of Humanitarian Affairs, which warned that the outbreak had reached "epidemic" proportions.  "The national malaria outbreak response plan, which is currently being validated, has highlighted a lack of human, logistical, and financial resources for effective response," reported the organisation.  The organisation and other experts have blamed a number of issues for the crisis, including low use of preventative measures and a vulnerable population with low levels of resistance. Experts have also noted an increase in drug resistant strains of the disease in common with other parts of the world.

The climate crisis has been cited as a contributing factor. Mosquitoes, which spread the disease, are reaching higher altitudes in the mountainous country, and have displayed behavioural changes including more aggressive feeding habits.  The country's agricultural policies have also encouraged an increase in rice production that has seen farmers encroach on mosquito-infested areas.  While Burundi has long struggled with malaria, the figures for the current outbreak suggest a 50% increase compared to the equivalent period last year [2018]. The UN organisation noted bleakly that the number of health districts that have passed the epidemic threshold had continued to increase.

Although Burundi declared a national health emergency in 2017 after 1.8 million cases and 700 deaths were recorded, it has declined to declare one for the current outbreak, apparently concerned of the potential impact ahead of elections slated for next year [2010]…  [Byline: Peter Beaumont]
========================
[The WHO profile of malaria in Burundi can be found at

In 2017, the entire population of an estimated 10.9 million people lived in _Plasmodium falciparum_ high-endemic areas. In 2017 the annual incidence of _P. falciparum_ was estimated at 800 cases per 1000 population (WHO 2017 as above).

In 2017 there was an estimated 2.1M [range: 1.3M, 3.4M] cases with an estimated number of deaths of 5300 [range: 4300, 6200] (WHO). The 1st line treatment is artesunate-amodiaquine (AS-AQ) introduced in 2003. Malaria control relies on insecticide treated nets (ITN) but only around 30% of the population used a net the previous night one survey found (WHO 2017 as above) and it was also found that 80% of the mosquitoes were resistant to pyrethroids, the usual class of insecticides used for impregnating nets.

In 2005 the annual incidence was estimated at less than 50 cases per 1000 population (WHO 2017 as above) illustrating that since then the national malaria control programme has failed to improve the situation.

It is particularly worrying that the report above mentions treatment failure and possible drug resistance. With artemisinin resistance spreading in southeast Asia (see ProMED post http://promedmail.org/post/20190723.6583616) any signs of a slow parasite clearance need to be followed up by molecular analysis looking for mutations in key genes. No studies have looked at mutations in key genes predicting reduced susceptibility to the artemisinins or the 4-aminoquinolones (amodiaquine).

Since Burundi's independence in 1962, 2 genocides have taken place in the country: the 1972 mass killings of Hutus by the Tutsi-dominated army (<http://www.preventgenocide.org/edu/pastgenocides/burundi/resources/>), and the mass killings of Tutsis in 1993 by the Hutu majority. Both were described as genocides in the final report of the International Commission of Inquiry for Burundi presented in 2002 to the United Nations Security Council (<https://en.wikipedia.org/wiki/Burundi>). - ProMED Mod.EP]

[HealthMap/ProMED-mail map of Burundi:
Date: Tue, 6 Aug 2019 10:38:45 +0200 (METDST)

Nairobi, Aug 6, 2019 (AFP) - Malaria has killed more than 1,800 people in Burundi this year, the UN's humanitarian agency says, a death toll rivalling a deadly Ebola outbreak in neighbouring Democratic Republic of Congo.   In its latest situation report, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) said 5.7 million cases of malaria had been recorded in Burundi in 2019 -- a figure roughly equal to half its entire population.   Of those cases, a total of 1,801 died from the mosquito-born disease in Burundi between January 1 and July 21, OCHA said.

The tiny country of 11 million people in the African Great Lakes region has still not declared a national emergency, despite OCHA saying the outbreak crossed "epidemic proportions" in May.   "The national malaria outbreak response plan, which is currently being validated, has highlighted a lack of human, logistical and financial resources for effective response," OCHA said in its latest weekly bulletin on humanitarian emergencies.   "All stakeholders, including the national authorities and partners are called upon to provide the requisite resources to mount a robust response to this event before it escalates."   A lack of preventative measures like mosquito nets, climatic changes and increased movements of people from mountain areas with low immunity to malaria were driving the crisis, OCHA said.

- 'Many crises' -
An OCHA official told AFP that "the decision to declare an epidemic is the sovereignty of the Burundian state".   The country declared a malaria epidemic in March 2017, when the country had recorded 1.8 million cases and 700 deaths, but was resisting doing the same now.   A senior government official, who declined to be named, said the government did not want to admit weakness with elections set for 2020.   "We are less than a year away from the presidential election. (President Pierre) Nkurunziza, who is facing many crises, does not want to recognise what could be considered a failure of his health policy," the official told AFP.   Burundi has been in crisis since 2015, when Nkurunziza ran for a third term and was re-elected in elections boycotted by most of the opposition.

At least 1,200 people were killed and more than 400,000 displaced in violence the UN says was mostly carried out by state security forces.   Nkurunziza announced in 2018 that he would not stand again, confounding critics who accused him of working to extend his grip on power.   UN investigators said in July that "drastic" steps were needed to boost democratic freedoms in Burundi if the government wanted the elections to be considered credible.

Burundi, one of the poorest countries in the region, abuts DR Congo, where the second-worst Ebola outbreak in history has killed more than 1,800 people amid fears the infectious fever could spread beyond its borders.   But malaria is a much bigger killer on the continent.   The World Health Organization recorded nearly 220 million cases of the parasitic illness in 2017, with an estimated 435,000 deaths. More than 90 percent of malaria cases and deaths were in Africa.
Date: Fri, 16 Mar 2018 14:39:07 +0100

Nairobi, March 16, 2018 (AFP) - Nine workers at a construction site outside Burundi's capital Bujumbura were killed in a landslide on Friday, police said.   Heavy seasonal rains caused the hillside next to the Gasenyi river, east of the city, to collapse burying the workers who were building a channel to redirect the river's floodwaters.   Police said in a statement that nine bodies had so far been found, while rescue efforts continue.
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Nigeria

Nigeria US Consular Information Sheet
June 02, 2008
COUNTRY DESCRIPTION:
Nigeria is a developing country in western Africa that has experienced periods of political instability. It has the largest population on the continent, estimated at
44 million people, and its infrastructure is not fully functional or well maintained. Read the Department of State’s Background Notes on Nigeria for additional information.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. The visa must be obtained in advance from a Nigerian Embassy or Consulate. Visas cannot be obtained on arrival at the airport. Promises of entry into Nigeria without a visa are credible indicators of fraudulent commercial schemes in which the perpetrators seek to exploit the foreign traveler's illegal presence in Nigeria through threats of extortion or bodily harm. U.S. citizens cannot legally depart Nigeria unless they can prove, by presenting their entry visas, that they entered Nigeria legally. Entry information may be obtained at the Embassy of the Federal Republic of Nigeria, 3519 International Court NW, Washington, DC 20008, telephone (202) 822-1500, or at the Nigerian Consulate General in New York, telephone (212) 808-0301. Overseas, inquiries may be made at the nearest Nigerian embassy or consulate.

Visit the Embassy of Nigeria web site at http://www.nigeriaembassyusa.org/ 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:
The Department of State continues to caution U.S. citizens about the possible dangers of travel to some parts of Nigeria. [Please also see the Crime Section below.] In light of the risk of kidnapping, crime, militant activity, or armed attacks, the U.S. Mission restricts the travel of U.S. government personnel to the following states to official travel only: Delta, Bayelsa, Rivers and Akwa Ibom in the Niger Delta, and Edo and Imo in the south. Only essential travel by non-official Americans is recommended to these areas. In addition, the military's Joint Task Force patrols the creeks in the Niger Delta because of ongoing militant and piracy incidents, especially against oil-related facilities or infrastructure, so individuals may be questioned, detained or arrested when traveling in these sensitive areas without evidence of permission from the Nigerian government or for carrying electronic equipment such as cameras, recorders, etc. Periodically, travel by U.S. mission personnel is restricted in certain parts of Nigeria based on changing security conditions, often due to crime, general strikes, or student/political demonstrations or disturbances. See the Department of State’s Travel Warning for Nigeria for more information.

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 current Travel Warnings, Travel Alerts, and 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: Violent crime committed by individual criminals and gangs, as well as by some persons wearing police and military uniforms, is a problem, especially in Lagos, Abuja and other large cities, although it can occur anywhere. Some visitors and resident Americans have experienced armed muggings, assaults, burglary, carjacking, kidnappings and extortion, often involving violence. Home invasions are on the rise in Lagos, with armed robbers accessing even guarded compounds by following, or tailgating, residents or visitors arriving by car into the compound, subduing guards and gaining entry into homes or apartments. Armed robbers in Lagos also access waterfront compounds by boat. U.S. citizens, as well as Nigerians and other expatriates, have been victims of armed robbery on roads to airports during both daylight and evening hours. Law enforcement authorities usually respond to crimes slowly or not at all, and provide little or no investigative support to victims. U.S. citizens and other expatriates have experienced harassment and shakedowns at checkpoints and during encounters with Nigerian officials.

Nigerian-operated fraud scams, known as 419s, are noted for their cleverness and ingenuity. These scams target foreigners worldwide, posing risks of both financial loss and personal danger to their victims. Scams are often initiated through internet postings or from internet cafes, by unsolicited emails, faxes, and letters, or can involve credit card use. As anywhere else, no one should provide personal or financial information to unknown parties or via Nigerian telephone lines. The expansion of bilateral law enforcement cooperation, which has resulted in numerous raids on commercial fraud premises, has reduced the overall level of overt fraud activity, but new types of sophisticated scams are introduced daily.

American citizens are very frequently the victims of Nigerian confidence artists offering companionship through internet dating websites. These confidence artists almost always pose as American citizens visiting or living in Nigeria who unexpectedly experience a medical, legal, financial or other type of “emergency” that requires the immediate financial assistance of the American citizen in the United States. In these cases, we strongly urge the American citizen in the United States to be very cautious about sending money to any unknown person purportedly acting on their behalf, or traveling to Nigeria to meet someone with whom their sole communications have been via the internet. Other common scams involve a promise of an inheritance windfall, work contracts in Nigeria, or an overpayment for goods purchased on-line. For additional information on these types of scams, see the Department of State's publication, International Financial Scams.

Commercial scams or stings that targets foreigners, including many U.S. citizens, continue to be a problem. One needs to be alert to scams that may involve U.S. citizens in illegal activity, resulting in arrest, extortion or bodily harm. These scams generally involve phony offers of either outright money transfers or lucrative sales or contracts with promises of large commissions or up-front payments, or improperly invoke the authority of one or more ministries or offices of the Nigerian government and may cite, by name, the involvement of a Nigerian government official. In some scams, government stationery and seals are also improperly used to advance the scam. The ability of U.S. consular officers to extricate U.S. citizens from unlawful business deals or scams and their subsequent consequences is extremely limited. U.S. citizens have been arrested by police officials and held for varying periods on charges of involvement in illegal business activity or scams. Nigerian police or other law enforcement officials do not always inform the U.S. Embassy or Consulate immediately of the arrest or detention of a U.S. citizen. The U.S. Department of Commerce has advisories to the U.S. business community on a variety of issues that should be seriously reviewed with respect to doing business in Nigeria. To check on a business’s legitimacy while in the United States, contact the Nigeria Desk Officer at the International Trade Administration, Room 3317, Dept. of Commerce, Washington, D.C. 20230, telephone 1-800-USA-TRADE or (202) 482-5149, fax (202) 482-5198. If you are abroad, contact the nearest U.S. Embassy or Consulate.

The Department of State encourages all travelers abroad to register their travel. The most convenient way to do so would be through the online travel registration page. Travelers may also register in person at the U.S. Embassy in Abuja or the U.S. Consulate General in Lagos. See the section on Registration / Embassy Location below.

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, for example, can provide you with a list for appropriate medical care, or contact family members or friends and explain how funds could be transferred to you to cover unexpected costs. 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 the Department of State’s information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: While Nigeria has many well-trained doctors, medical facilities in Nigeria are in poor condition, with inadequately trained nursing staff. Diagnostic and treatment equipment is most often poorly maintained, and many medicines are unavailable. Caution should be taken as counterfeit pharmaceuticals are a common problem and may be difficult to distinguish from genuine medications. This is particularly true of generics purchased at local pharmacies or street markets. Hospitals often expect immediate cash payment for health services.

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

MEDICAL INSURANCE: The Department of State strongly urges Americans to consult with their medical insurance company prior to traveling abroad to confirm whether their health insurance policy applies overseas and whether it will cover emergency expenses such as a medical evacuation from a foreign country to the United States or another location. Please see the our brochure 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 Nigeria is provided for general reference only and may not be totally accurate in a particular location or circumstance.

Roads in many areas are generally in poor condition, causing damage to vehicles and contributing to hazardous traffic conditions. There are few working traffic lights or stop signs. The rainy season from May to October is especially dangerous because of flooded roads and water-concealed potholes.

Excessive speed, unpredictable driving habits, and the lack of basic maintenance and safety equipment on many vehicles are additional hazards. Motorists seldom yield the right-of-way and give little consideration to pedestrians and cyclists. Gridlock is common in urban areas. Chronic fuel shortages have led to long lines at service stations, which disrupt or block traffic for extended periods.

Public transportation vehicles are unsafe due to poor maintenance, high speeds and overcrowding. Motorbikes, known in Nigeria as "okadas," are a common form of public transportation in many cities and pose particular danger to motorists, their own passengers and pedestrians. Motorbike drivers frequently weave in and out of traffic at high speeds and observe no traffic rules. Motorbikes are banned within Abuja's city limits. Passengers in local taxis have been driven to secluded locations where they were attacked and robbed. Several of the victims required hospitalization. The U.S. Mission advises that public transportation throughout Nigeria be avoided.

It is recommended that short-term visitors not drive in Nigeria. A Nigerian driver's license can take months to obtain, and to date an international driving permit is not recognized. Major hotels offer reliable car-hire services complete with drivers. Reliable car-hire services can also be obtained at the customer service centers at the airports in Lagos, Abuja, and Kano. Inter-city travelers must also consider that roadside assistance is extremely scarce, and as noted above medical facilities and emergency care are poor, meaning that being involved in a traffic incident might result in a lack of available medical facilities to treat either minor or life-threatening injuries.

All drivers and passengers are reminded to wear seat belts, lock doors, and raise windows. It is important to secure appropriate automobile insurance. It is also important to be aware that drivers and passengers of vehicles involved in accidents resulting in injury or death have experienced extra-judicial actions, i.e., mob attacks, official consequences such as fines and incarceration or involvement with the victim's family. Night driving should be done with extreme caution, but it is recommended to avoid driving between 6:00 p.m. and 6:00 a.m. as bandits and police roadblocks are more numerous at night. Streets are very poorly lit, and many vehicles are missing one or both headlights, tail lights, and reflectors.

The Government of Nigeria charges the Federal Road Safety Commission with providing maps and public information on specific road conditions. The Federal Road Safety Commission may be contacted by mail at: Ojodu-Isherri Road, PMB 21510, Ikeja, Lagos; telephone [243] (1) 802-850-5961 or [234] (1) 805-684-6911.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service to the United States by carriers registered in Nigeria, the U.S. Federal Aviation Administration (FAA) has not assessed Nigeria’sCivil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

The Port Harcourt International Airport, which was closed in mid-2006 for rehabilitation, resumed operations in December 2007 for domestic daylight flights. Installations and improvements needed for international flights and night operations are expected to be completed in 2008.

For additional information on aviation safety concerns, see the Department of State’s Travel Warning for Nigeria.
SPECIAL CIRCUMSTANCES:
Permission is required to take photographs or videotape any government buildings, airports, bridges, and in areas where the military is operating throughout the country. These sites include, but are not limited to, Federal buildings in the Three Arms Zone (Presidential palace area, National Assembly, Supreme Court/Judiciary) of the capital of Abuja, other government buildings around the country and foreign Embassies and Consulates. Many restricted sites are not clearly marked, and application of these restrictions is subject to interpretation by the Nigerian security services and can result in detention. Permission may be obtained from Nigeria's State Security Services, but even permission may not prevent the imposition of penalties or detention. Penalties for unauthorized photography or videography may include confiscation of the still or video camera, exposure of the film or deletion of film footage, a demand for payment of a fine or bribe, and/or detention, arrest, or physical assault. For these reasons, visitors to Nigeria should avoid taking still photos or videotaping in and around areas that are potentially restricted sites, including any government sites.

The Nigerian currency, the naira, is non-convertible. U.S. dollars are widely accepted. Nigeria is a cash economy, and it is usually necessary to carry sufficient currency to cover the expenses of a planned visit, which makes travelers an attractive target for criminals. Credit cards are rarely accepted beyond a few upscale hotels. Due to credit card fraud in Nigeria and by cohorts in the United States, credit card use should be considered carefully. While Citibank cashes some traveler’s checks, most other banks do not. American Express does not have offices in Nigeria; however, Thomas Cook does. Inter-bank transfers are often difficult to accomplish, though money transfer services such as Western Union are available. For further information, visitors may contact the U.S. Embassy or Consulate.

Please see the Department of State’s information on Customs Information.

CRIMINAL PENALTIES: While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law. Penalties for breaking the law can be more severe than in the United States for similar offenses. Persons violating Nigerian laws, even unknowingly, may be expelled, detained, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Nigeria 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 the Department of State’s information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in Nigeria 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 Nigeria and other general information.Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.

The U.S. Embassy is located at 1075 Diplomatic Drive, Central Area, Abuja. American citizens can call [234] (9) 461-4176 during office hours (Monday through Thursday, 7:30 a.m. to 4:30 p.m.; Friday, 7:30 a.m. to 1:30 p.m.). For after-hours emergencies, call [234] (9) 461-4000. The email address for the Consular Section in Abuja is ConsularAbuja@state.gov.

The U.S. Consulate General is located at 2 Walter Carrington Crescent, Victoria Island, Lagos. American citizens can call [234] (1) 261-1215 during office hours (7:30 a.m. to 4:00 p.m.). For after-hours emergencies, call [234] (1) 261-1414, 261-0050, 261-0078, 261-0139, or 261-6477. The e-mail address for the Consular Section in Lagos is Lagoscons2@state.gov.

The Embassy and Consulate website is http://nigeria.usembassy.gov/.
* * *
This replaces the Consular Information Sheet dated April 16, 2007, to update sections on Country Description, Safety and Security, Crime, Traffic Safety and Road Conditions, Aviation Safety Oversight, Special Circumstances and Registration / Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon, 6 Jan 2020 21:10:44 +0100 (MET)

Kano, Nigeria, Jan 6, 2020 (AFP) - A bomb ripped through a crowded market on a bridge along Nigeria's border with Cameroon on Monday, killing nine people and injuring several others, security sources said.    The bomb exploded around 1520 GMT on the Nigerian side of the El Beid bridge, which separates the town of Gamboru in Nigeria from Fotokol in Cameroon.    "Preliminary findings revealed that nine people were killed... and all are Nigerians," an army officer said, speaking on condition of anonymity.

Twenty-six people were injured, including 21 Nigerians and five Cameroonians, the officer said.   Many on the bridge jumped into the river, witnesses said.    The leader of a local civilian militia told AFP that the victims included young children selling groceries on the bridge.   The Boko Haram jihadist group operates on both sides of the border and has frequently carried out deadly suicide attacks.   Gamboru, a trading hub, has been rocked by violence since August 2014 when Boko Haram jihadists seized the town along with nearby Ngala.

Nigerian troops retook both towns in September 2015 with the help of Chadian forces after months of fierce battles.   But jihadist fighters continue to launch sporadic attacks, ambushing troops and vehicles, farmers and attacking refugee camps.   Boko Haram and its rival Islamic State West Africa Province (ISWAP), which split from it in 2016, are known to operate in areas around Gamboru and Ngala.   Boko Haram's decade-long conflict has killed 36,000 people and displaced around two million from their homes in northeast Nigeria.   The violence had spread to neighbouring Niger, Chad and Cameroon, prompting a regional military coalition to fight the militants.
Date: Sun 29 Dec 2019
Source: The Guardian [edited]

The World Health Organisation (WHO) has confirmed 13 cases of yellow fever, which has resulted in 3 deaths in 4 local government areas of Plateau State.

WHO State Coordinator, Wonk Vingey Bassey, confirmed the incident while presenting a report on a survey conducted on affected councils during an emergency stakeholders' meeting in Jos. The meeting followed the outbreak of the disease in Jos North, Bassa, Riyom and Wase local government areas of the state.

Bassey, who gave the breakdown according to councils, said the deaths were recorded in Wase local government [area]. The coordinator, represented by the consultant Elizabeth Ahinchi, advocated early inspection and reporting of cases of the outbreak, in addition to intensified routine campaigns in communities.

State Commissioner for Health, Dr. Ninkwom Ndam, said the state government is working in collaboration with federal authority and other partners to strengthen healthcare services to citizens. Also, Executive Secretary, Plateau State Healthcare Board, Dr. Livinus Niamkwap, noted that the recent outbreak in the 4 councils calls for proactive measures to avert escalation to other areas.

Participants at the meeting discussed extensively on the way forward, laying emphasis on the need for the provision of mosquito nets, surveillance, awareness campaigns in media stations and worship centres, as well as financial support, among others.  [Byline: Isa Abdulsalami Ahovi]
====================
[A 17 Dec 2019 report indicated that from 1 Jan through 10 Dec 2019, a total of 4189 suspected yellow fever (YF) cases were reported from 604 of 774 local government area (LGAs) across all the 36 states and the federal capital territory in Nigeria (see Yellow fever - Africa (27): Nigeria, WHO http://promedmail.org/post/20191217.6845662). Although that report indicated that there have been YF cases in all 36 states, previous reports do not specifically mention Plateau State. Although the need for the provision of mosquito nets, surveillance, and awareness campaigns in media stations and worship centres is real, it is curious that no mention is made of a vaccination campaign or of the proportion of the populations in the affected areas that have been vaccinated previously. Vaccination is the best YF preventive measure. - ProMED Mod.TY]

[HealthMap/ProMED-mail map:
Date: Sat 28 Dec 2019
Source: Punch [edited]
<https://punchng.com/lassa-fever-claims-one-in-ebonyi/>

Lassa fever has reportedly killed one man in Igbeagu community in the Izzi Local Government Area of Ebonyi State. He died on Friday [27 Dec 2019].

O and his sibling, UO, had been admitted to St Vincent Hospital in the area. The 2 of them were suspected to have been infected by the disease.

A source, who spoke on condition of anonymity, said, "We are in a big trouble again. This killer disease has come again. The last time we experienced it, it wasn't funny. It killed over 4 persons. Now it is here again. It is important that stakeholders know about its presence and the implication. They should intervene and save us from it."

Meanwhile, the Ebonyi State Government has directed the evacuation of the victim's sibling and other patients to the South-East Virology Centre, Abakaliki, for further treatment.

Ebonyi State Governor David Umahi, who spoke through his Special Assistant on Media, Mr Francis Nwaze, had equally directed the closure of the hospital with immediate effect.

The governor's aide said, "The governor directed that all the family members and close relatives of the above be quarantined at the South East Virology Centre, Abakaliki for comprehensive medical examination. Also, Governor Umahi has directed that the Ministry of Health under the watch of the Commissioner for Health in conjunction with the members of Staff of Federal Teaching Hospital, Abakaliki to immediately address all issues relating to the Lassa fever outbreak including comprehensive examination of all suspects and clean-up of St. Vincent Hospital. Place precautionary announcements in all media houses in the state on preventive measures of Lassa fever."  [Byline: Edward Nnachi]
======================
[Lassa fever [LF] cases have not been unusual in Ebonyi state this year (2019) beginning with a Lassa fever outbreak in Ebonyi state in February 2019, when the Ebonyi state government successfully treated and discharged 14 Lassa fever patients brought to the centre. To date this year (2019), 7% of all Lassa fever cases have been in the state.

There is no mention of the circumstances under which the individuals contracted Lassa fever virus infections. Transmission of LF virus occurs when individuals are in contact with rodent reservoir host excreta or are within healthcare facilities. It would be interesting to know whether the prevalence of Lassa fever virus has been increasing in populations of rodent hosts in areas where human cases are occurring.

Images of the rodent reservoirs of Lassa fever virus:
_Mastomys natalensis_:
_Mastomys erythroleucus_ and _Hylomyscus pamfi_:

There is no specific mention in the plans above of public education for avoidance of contact with these rodents and their excreta. - ProMED Mod.TY]

[Maps of Nigeria:

HealthMap/ProMED map available at:
Ebonyi State, Nigeria: <http://healthmap.org/promed/p/1306>]
Date: Tue 17 Dec 20
Source: WHO Emergencies preparedness, response, Disease Outbreak News (DONs) [edited]

Nigeria is responding to successive yellow fever outbreaks, with nearly a 3-fold increase in number of confirmed cases in 2019 compared to 2018, suggesting intensification of yellow fever virus transmission. Additionally, there have been cases reported in parts of the country that have confirmed cases for the 1st time since the outbreak started in September 2017. From [1 Jan through 10 Dec 2019], a total of 4189 suspected yellow fever cases were reported from 604 of 774 Local Government Area (LGAs) across all the 36 states and the Federal Capital Territory in Nigeria.

Of the total 3547 samples taken, 207 tested positive for yellow fever by Immunoglobulin M (IgM) in Nigerian network laboratories. In addition, 197 samples from 19 states were confirmed positive using reverse transcriptase polymerase chain reaction (RT-PCR). The case fatality rate for all cases (including suspected, probable and confirmed) is 5.1%, and 12.2% for confirmed cases.

Of the total (197 cases) confirmed cases, 68% (134 cases) were reported from 4 states, including Bauchi, Katsina, Edo and Ebonyi. Cases in Edo state have declined after a reactive vaccination campaign in late 2018. From [1 Jan through 10 Dec 2019], a total of 115 confirmed cases and 23 deaths were reported from Bauchi (62 cases), Katsina (38 cases) and Benue (15 cases). These cases tested positive by RT-PCR at national laboratories and/or RT-PCR and serologic tests at a regional reference laboratory, Institute Pasteur Dakar (IPD). Further epidemiological investigations are underway.

Public health response
----------------------
The outbreak response activities are being coordinated by a multi-agency yellow fever Incident Management System (IMS). On [5 Nov 2019], an Emergency Operations Centre (EOC) was activated for the 3rd time, in response to the upsurge of confirmed yellow fever cases reported in a wide-geographic distribution including Bauchi, Benue and Katsina. A national rapid response team has been deployed to Bauchi and other affected states to support the outbreak response activities including surveillance, case management support and risk communications.

In addition to the existing laboratories in the country, new and operational laboratories have been added to the national laboratory network in Abuja, Edo and Enugu states.

A targeted response has been implemented in Alkaleri Local Government area (LGA) in Bauchi state. However, reports of ongoing transmission indicate that more vaccination and a wider geographical scope are needed. Katsina state has recently completed a state-wide preventive mass vaccination campaign; however, challenges linked to vaccine accountability and access to security-compromised areas may result in pockets of populations with immunity gaps. Risk of spread through population movements exist in neighbouring Kano and Kaduna states where population immunity is low.

Nigeria is considered a high-risk country by the Eliminate Yellow Fever Epidemics (EYE) strategy. By 2024, it is anticipated that all the states in Nigeria will have undergone campaign activities to protect at-risk populations against yellow fever. This plan may be further updated or accelerated based on risk, vaccine and implementation feasibility. The country is in the process of completing a planned phase-3 vaccination campaign in 2019 and evaluating the recently concluded mass vaccination campaign.

WHO risk assessment
-------------------
The yellow fever outbreak transmissions reported in Bauchi, Benue and Katsina states since August 2019, with spread to multiple other states, represents an intensification of yellow fever transmission and an elevated risk for yellow fever outbreak to spread and amplify. This is particularly a high risk if yellow fever is introduced into densely populated urban areas where preventive mass vaccination campaigns have not been conducted so far. Areas at risk include those without prior reported cases since 2017 and areas with a large number of under-immunized populations including urban areas such as Kano and Lagos. The preventive mass vaccination campaigns for yellow fever and the ongoing effort to strengthen routine immunization are important activities to reduce the risk of disease spread and amplification.

WHO continues to monitor the epidemiological situation and review the risk assessment based on the latest available information. Based on available information, WHO currently assesses the overall risk as high at the national level, moderate at the regional level, and low at the global level.

Nigeria is facing several concurrent public health emergencies, including circulating vaccine-derived polio virus (cVDPV), measles, monkeypox, Lassa fever, cholera outbreaks, and a humanitarian crisis in the north-east of the country.

WHO advice
----------
Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes and has the potential to spread rapidly, with serious public health impacts. There is no specific treatment, although the disease is preventable using a single dose of yellow fever vaccine, which provides lifetime immunity. Supportive care is required to treat dehydration, respiratory failure and fever; antibiotics are recommended to treat associated bacterial infections.

The early detection and investigation of yellow fever cases through strong surveillance is key to controlling the risk of yellow fever outbreaks. Prevention of mosquito bites (e.g. repellents, wearing long clothes) is an additional measure that limits the risk of yellow fever transmission. In urban centres, targeted vector control measures are also helpful to interrupt transmission.

WHO recommends vaccination against yellow fever for all international travelers more than 9 months of age going to Nigeria, as there is evidence of persistent or periodic yellow fever virus transmission. Nigeria also requires a yellow fever vaccination certificate for travelers older than one year of age arriving from countries with risk of yellow fever transmission.

Yellow fever vaccines approved by WHO are safe, highly effective and provide life-long protection against infection. In the context of international travel, the amendment to Annex 7 of the International Health Regulations (IHR 2005) changes the period of validity of the related international certificate of vaccination against yellow fever, and the protection provided by vaccination against yellow fever infection from ten (10) years to the life of the person (traveler) vaccinated. Accordingly, as of [11 July 2016], for both existing or new certificates, revaccination or a booster dose of yellow fever vaccine cannot be required of international travelers as a condition of entry into a State Party, regardless of the date their international certificate of vaccination was initially issued.

On [1 July 2019], WHO updated the areas at-risk of yellow fever transmission and the corresponding recommendations for vaccination of international travelers. The list of countries at-risk, and revised recommendations for vaccination against yellow fever are available on the WHO website: International travel and health (ITH).

WHO encourages its Member States to take all actions necessary to keep travelers well informed of risks and of preventive measures, including vaccination. Travelers should also be made aware of yellow fever signs and symptoms and instructed to seek rapid medical advice should they develop signs of illness. Travellers returning to Nigeria who may be infected with possible high levels of the virus in the blood may pose a risk for the establishment of local cycles of yellow fever transmission in areas where the competent vector is present.

WHO does not recommend any restrictions on travel or trade to Nigeria on the basis of the information available on this outbreak.
====================
[The above report provides a comprehensive summary of the yellow fever (YF) situation in Nigeria for this year (2019). Increased surveillance, targeted responses by the national response team, the addition of diagnostic laboratories in several localities and vaccination campaigns are all positive responses to the YF situation. Fortunately, no mention is made of cases in the densely populated cities nor of a shortage of YF vaccine, so campaigns could be able to proceed without delay. As noted in earlier posts, because of the geographic wide-spread distribution of yellow fever (YF) in Nigeria, achieving vaccination coverage of the population to the 80-90% coverage necessary to prevent cases is a serious challenge.

Nigerians traveling to countries abroad where YF virus is transmitted present  a risk of introducing the virus to other areas of Nigeria with abundant vectors that could initiate a new outbreak. Also of serious concern is the possibility of an unvaccinated person becoming infected in Nigeria, at the popular game park for example, going to an area historically free of YF but with abundant vector populations, such as southeast Asia, and initiating an outbreak where few local individuals have been vaccinated. - ProMed Mod.TY]

[Maps of Nigeria:
Date: Wed 4 Dec 2019
Source: UK Government, Public Health England [edited]

Public Health England (PHE) confirms an individual has been diagnosed with monkeypox [MPX] in England.

Monkeypox is a rare viral infection that does not spread easily between people, and the risk to the general public in England is very low. It is usually a self-limiting illness, and most people recover within a few weeks. However, severe illness can occur in some individuals.  The patient is believed to have contracted the infection while visiting Nigeria.

The patient was staying in southwest England prior to transfer to the specialist high-consequence infectious disease centre at Guy's and St Thomas' NHS Foundation Trust, London, where [the patient is] receiving appropriate care.

As a precautionary measure, PHE experts are working closely with NHS colleagues to implement rapid infection-control procedures, including contacting people who might have been in close contact with the individual to provide information and health advice. This includes contacting passengers who travelled in close proximity to the patient on the same flight to the UK. If passengers are not contacted, then there is no action they should take.

Dr Meera Chand, consultant microbiologist at Public Health England, said: "Monkeypox does not spread easily between people, and the overall risk to the general public is very low. We are following up with those who have had close contact with the patient to offer advice and to monitor them as necessary."

PHE and the NHS have well-established and robust infection-control procedures for dealing with cases of imported infectious disease, and these will be strictly followed to minimise the risk of transmission.

This is not the 1st time that the virus has been detected in the UK. PHE reported the 1st UK cases of monkeypox in September 2018.

Background
Monkeypox is a rare disease caused by monkeypox virus and has been reported mainly in central and west African countries. In most cases, monkeypox is a mild condition that will resolve on its own and has no long-term effects on a person's health. Most people recover within a few weeks [see comment below].

Initial symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills, and exhaustion. A rash can develop, often beginning on the face, then spreading to other parts of the body. The rash changes and goes through different stages before finally forming a scab, which later falls off.
====================
[Sporadic cases of monkeypox (MPX) continue to occur in Nigeria this year (2019), so it is not surprising if the individual became infected there and travelled to England during the incubation period. The USA CDC states that the incubation period (time from infection to symptoms) for monkeypox is usually 7-14 days but can range from 5-21 days, allowing adequate time for travel prior to the appearance of symptoms (see <https://www.cdc.gov/poxvirus/monkeypox/symptoms.html>).

There is no mention in the above report if the individual acquired the MPX infection from wildlife hosts or from contact with infected people. There is no mention above of the current condition of the patient. The health authorities in England are prudent to track individuals who had been in contact with the patient. Consideration of vaccination of contact individuals with the new MPX/smallpox vaccine, especially those providing care of this patient, in this type of situation may be a useful approach to prevent person-to-person transmission.

Prevention of MPX virus infections in the endemic countries in West and Central Africa will not be possible without knowing the source of infection and locality where they occurred. The question remains about the source of recent infections. Monkeys are not the reservoirs of the virus, despite the name that the virus has received. Studies of prevalence of MPX virus in populations of rodent hosts are not mentioned in this or in previous reports. The main reservoirs of MPX virus are suspected to be rodents, including rope squirrels (_Funisciurus_ spp., an arboreal rodent) and terrestrial rodents in the genera _Cricetomys_ and _Graphiurus_. Halting the bushmeat trade and consumption of wild animals to halt MPX virus exposure will be culturally and economically difficult, so continued occurrence of cases can be expected.

The MPX virus clade involved in these and previous cases is not mentioned. As noted in previous ProMED-mail posts, the monkeypox virus clade in the Congo Basin causes more severe disease in humans -- with a case fatality rate of 11-17% -- than the clade in Ghana, which causes few fatalities. The reported case fatality rate in Nigeria is low.

Similar reports of this case can be found at <https://www.theguardian.com/science/2019/dec/04/person-diagnosed-with-monkeypox-in-england-after-visiting-nigeria>, provided by ProMED Mod.MHJ, and in <https://www.bbc.com/news/uk-england-50659118>, which also shows typical MPX lesions, communicated by Mary Marshall (<mjm2020@googlemail.com>). - ProMED Mod.TY]

[HealthMap/ProMED-mail maps:
More ...

Bosnia and Herzegovina

Bosnia & Herzegovina US Consular Information Sheet
December 01, 2008
COUNTRY DESCRIPTION:
Since the December 1995 signing of the Dayton Peace Accords, there has been significant progress in restoring peace and stability in Bosnia and Herze
ovina.
Significant progress has been made in reconstructing the physical infrastructure that was devastated by the war. Nonetheless, political tensions among the ethnic groups persist. Hotels and travel amenities are available in the capital, Sarajevo, and other major towns, but they are relatively expensive. In the more remote areas of the country, public facilities vary in quality.
For more details, read the Department of State Background Notes on Bosnia and Herzegovina.

ENTRY/EXIT REQUIREMENTS:
A passport is required for travel to Bosnia and Herzegovina. American citizens do not require a visa for tourist stays up to three months.
Travelers who are not staying at a hotel (i.e. a private residence) must register with the local police within 24 hours of arrival. U.S. citizens planning to remain in Bosnia and Herzegovina for more than three months must obtain a visa prior to travel, or apply for a temporary residence permit from the local police station having jurisdiction over their place of residence. Applications for temporary residence permits should be submitted 15 days prior to the expiration of the initial three month tourist visa. A police certificate indicating that the applicant has no criminal record is required for this permit and should be obtained from the applicant’s state of residence in the U.S.
For additional information please contact the Embassy of Bosnia and Herzegovina, at 2109 E. Street, NW, Washington, DC 20037, telephone 202-337-6473.
Visit the Embassy of Bosnia and Herzegovina web site at http://www.bhembassy.org for the most current visa information.

Beginning in May 2008, the immigration authorities of Bosnia and Herzegovina began to strictly enforce a provision of a Bosnian law that requires any unaccompanied minor (under 18) to have written permission from both parents in order to enter and leave the country.
If traveling with one parent only, the minor is required to have written permission for the trip from the non-traveling parent. 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:
Landmines remain a problem in Bosnia and Herzegovina. As of 2008, there are still an estimated 13,000 minefields and an estimated 222,000 active land mines.
The area of suspected landmine contamination is estimated at over 2000 square kilometers more than 4% of the country’s territory.
These devices have killed more than 400 people since 1996.
While most urban areas have been largely cleared, special care should be taken when near the former lines of conflict, including the suburbs of Sarajevo.
The de-mining community recommends staying on hard surfaced areas and out of abandoned buildings.
Families traveling with children in Bosnia and Herzegovina should be especially aware of the danger posed by mines and unexploded ordnances.
For more information about landmines please visit http://www.bhmac.org/en/stream.daenet?kat=19
Localized political difficulties continue and random violence may occur with little or no warning.

Bosnian criminals use firearms and explosives to settle personal, business, and political disputes.
In October 2008, an explosive device detonated in a public shopping mall in Vitez, killing a store security guard.
The foreign community is rarely the target of such violence, but there is always the danger of being in the wrong place at the wrong time.
While most Bosnian citizens appreciate the assistance of the international community, occasional anti-foreign sentiment is sometimes encountered.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).
The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State’s A Safe Trip Abroad.
CRIME:
The overall crime rate throughout the country remains relatively low­the most common being confrontational crimes and residential break-ins.
Pick-pocketing and vehicle break-ins are also a problem. Most pickpockets operate in pairs and employ distraction methods to execute their craft.
There are also documented cases of pick-pocketing and other scams to get money from foreign passengers aboard public transportation.
Travelers should take normal precautions to protect their property from theft and exercise common sense personal security measures, traveling in groups, and staying in well-lighted areas after dark.
Confrontations with local citizens resulting from traffic incidents or public disagreements should be avoided.

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 Victims of Crime, including possible sources of U.S. assistance..
The local equivalent to the “911” emergency line in Bosnia and Herzegovina is: Police­122; Ambulance--124 and Fire­123.
MEDICAL FACILITIES AND HEALTH INFORMATION:
The lack of adequate medical facilities, especially outside Sarajevo, may cause problems for visitors.
Because many medicines are not obtainable, travelers should bring their own supply of prescription drugs and preventive medicines.
Private practitioners and dentists are becoming more common; however, quality of care varies and rarely meets U.S. or western European standards.
All major surgery is performed in public hospitals.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Bosnia and Herzegovina

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 Bosnia and Herzegovina is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Road travel is possible throughout most of the country.
However, some roads are still damaged from the war, and poorly maintained.
Roads are sometimes blocked due to landslides, de-mining activity, and traffic accidents.
Bosnia and Herzegovina is among the rare countries in Europe that has fewer than ten kilometers of four-lane highway.
The existing, two-lane roads between major cities are quite narrow at places, lack guardrails, and are full of curves.
Travel by road can be risky due to poorly maintained roads, and morning and evening fog in the mountains.
Driving in winter is hazardous due to fog, snow, and ice.
Local driving habits are poor, and many vehicles are in bad condition.
Many accidents occur when drivers exceed safe speeds along winding mountain roads.
Accidents involving drunk driving are an increasing problem.
Driving after dark is especially dangerous, and street lighting is not common outside the major towns.
Road construction may be poorly marked, and automobiles share the road with heavy vehicles and agricultural equipment.
Travelers are encouraged to convoy with other vehicles, if possible, and to plan their trip to ensure they travel only during daylight hours.

Although the number of service stations outside major cities has increased in recent years, many do not offer mechanical or other services.
The emergency number for vehicle assistance and towing service is 1282; Speed limit traffic signs are not always obvious or clear.
The speed limit on the majority of roads is 60 km/h, and on straight stretches of road it is generally 80 km/h.
The use of seat belts is mandatory.
Talking on a cell phone while driving is prohibited.
The tolerated percentage of alcohol in the blood is .03%.

In order to drive legally in Bosnia and Herzegovina, you must have an international driving permit in addition to your U.S. license.

Please refer to our Road Safety page for more information.
Visit the web site of the Bosnia and Herzegovina’s national tourist office and national authority responsible for road safety at http://www.bihamk.ba
AVIATION SAFETY OVERSIGHT:
As there is no direct commercial air service to the United States by carriers registered in Bosnia and Herzegovina, the U.S. Federal Aviation Administration (FAA) has not assessed Bosnia and Herzegovina’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards.
For more information, travelers may visit the FAA’s web site at http://faa.gov/safety/programs_initiatives/oversight/iasa .
During the winter months, flights into and out of Sarajevo are frequently delayed or canceled due to heavy fog.
Travelers should be prepared for last-minute schedule changes, lengthy delays, alternate routings, or time-consuming overland transportation.

SPECIAL CIRCUMSTANCES:
Bosnia and Herzegovina is still predominantly a cash economy.
Although the use of credit cards has become more widespread in recent years, travelers still should not expect to use them to cover all expenses. Automated Teller Machines (ATMs) are available in sufficient numbers at international banks in Sarajevo and other major cities and towns.
Traveler's checks can be cashed in banks in major cities, but often with delays of a few weeks or strict monthly limits.
Cash transfers from abroad may also involve delays.
The convertible mark, the national currency, is pegged to the euro under a currency-board regime, which guarantees its stability.
All official payments must be made in convertible marks, though many private stores and service providers also accept euros.
Any bank in Bosnia and Herzegovina should be able to exchange U.S. dollars into convertible marks with the usual bank commission (between 1% and 2%).

Photographing military installations, including airports, equipment, bridges, government checkpoints, troops and the U.S. Embassy, is forbidden.
If in doubt, please ask permission before taking photographs. 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 Bosnia and Herzegovina laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Bosnia and Herzegovina 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 Bosnia and Herzegovina are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site and to obtain updated information on travel and security within Bosnia and Herzegovina.
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 Alipasina 43, telephone (387) (33) 445-700, fax: (387) (33) 221-837; http://sarajevo.usembassy.gov/.
On weekends, holidays, and after hours, an Embassy duty officer can be reached at telephone (387) (33) 445-700.
If after dialing you receive a recorded message, press “0”, and then ask for the duty officer.
* * *
This replaces the Consular Information Sheet dated March 11, 2008, to update sections on Country Description, Entry and Exit Requirements, Safety and Security; and Crime.

Travel News Headlines WORLD NEWS

Date: Tue, 14 May 2019 17:36:11 +0200

Sarajevo, May 14, 2019 (AFP) - Torrential downpour has flooded hundreds of homes and swamped roads in northern Bosnia, officials said Tuesday, as rescuers searched for a six-year-old boy swept away by a swollen stream.   The child went missing in the northern Zepce region, national television BHRT reported on Tuesday. 

The heavy rain, which started Sunday, has sparked fears of a repeat of the 2014 floods that devastated the Balkan region, killing 77 people.   Weather services have predicted the rain will taper off.   Several Bosnian towns in the hardest-hit north have declared a state of emergency and begun protective evacuations.

More than 200 people have been evacuated in villages around north-eastern Doboj, where two rivers have overflowed.   "About 100 houses were flooded, as well as the offices of five companies and 50 hectares of land," said civil defence official Senad Begic.    Floods have also hit around 200 households in northwest Prijedor and 100 east in the town of Celinac.    "The danger has not passed and I invite inhabitants to follow the instructions of the authorities, without panic," urged Radovan Viskovic, Prime Minister of Republika Srpska, Bosnian's Serb-run region.

Dozens of homes were also flooded in neighbouring Croatia, where eight tourists, including two children, were rescued by firemen at a campsite on the banks of the Korana river, national TV reported.   After rising rapidly overnight, water levels in major rivers are falling slightly or stagnating, according to weather services.   In the spring of 2014, the Balkans region was hit by its worst floods in more than a century, which affected 1.6 million people and caused an estimated two billion euros in damage, mostly to houses and farmland.
Date: Thu, 24 Dec 2015 20:40:42 +0100

Sarajevo, Dec 24, 2015 (AFP) - Air pollution forced Bosnian authorities to shut schools in the capital Sarajevo on Thursday, while smog levels also spiked in other parts of the Balkan country due to a lack of rainfall, local officials said.   The air quality index, whose "normal" levels range from 0 to 50, reached 94 in Sarajevo on Thursday, official data showed.   Registered levels had been even higher in recent days, with the index soaring above the dangerous 300 mark and the city literally shrouded in a smog.

Regional authorities in Sarajevo decided to close primary and secondary schools Thursday, they said in a statement, while the city council demanded an early start to the winter holiday, so that children would be spared from being exposed to the smog.   Winter holidays traditionally start later in Bosnia than in western Europe, just ahead of the New Year.

Health authorities urged citizens meanwhile, particularly those with health problems, pregnant women and children, to refrain from going out at all.   Red Cross and non-governmental activists distributed protective masks to people across the city, which is surrounded by mountains that lock in the air especially during dry spells.   Pollution levels were also exacerbated by fumes from heating tens of thousands of homes.

Weather forecasts indicate that smog levels are not expected to improve before January.   Several other Bosnian towns were also hit by smog, especially those with large industrial areas such as Lukavac and Tuzla, where the air pollution index reached 293 and 193 respectively on Thursday.
Date: Tue, 24 Nov 2015 11:23:17 +0100

Sarajevo, Nov 24, 2015 (AFP) - Bosnian prosecutors were investigating an explosion at a police station Tuesday which authorities said could be an act of "terrorism", days after two members of the country's military were shot dead.   Unknown perpetrators threw an explosive device on the roof of the station in the central town of Zavidovici in the early hours, causing minor damage but no injuries, police spokeswoman Aldina Ahmic said.   "There are indications that this case has elements of the criminal act of terrorism," said Ahmic.

The national prosecutor's office has taken over the case and formed a special team tasked with investigating.   The incident comes less than a week after two military men were killed on November 18 by a man who attacked them with automatic weapons near a barracks in Sarajevo before blowing himself up.   Authorities have said that the perpetrator had links to Islamist circles and that the attack was almost certainly a "terrorist act".

Muslims make up about 40 percent of Bosnia's 3.8 million people while the rest of the Balkan country is mostly Serb Orthodox or Catholic.   The vast majority of Bosnian Muslims are moderates but a tiny minority openly support radical Wahhabism.   After the deadly Islamic State attacks in Paris earlier this month, Bosnia's Islamic spiritual leader Husein Kavazovic urged Europe's Muslims to keep the peace, saying the killings were a "sin towards God".
Date: Mon 27 Apr 2015
Source: WBNS-TV, Associated Press (AP) report [edited]

Authorities in Bosnia's capital have declared a foodborne outbreak after nearly 200 preschool children became sick at public day care centers in Sarajevo. Local health minister Emira Tanovic-Mikulec declared the outbreak on Mon 27 Apr 2015. Lab tests show that the food the children ate last week [week of 20 Apr 2015] was infected with salmonella enteridis [see comment below]. Out of the 193 children with fever, diarrhea, and abdominal cramping, 51 had to be hospitalized but none are in a life-threatening condition, hospital officials say.

About 2900 kids eat food prepared in a central kitchen that supplies the 29 centers in Sarajevo. The symptoms started last Wed 22 Apr 2015, when macaroni with cheese and eggs was on the menu.
================
[Both cheese (especially if unpasteurized) and eggs (if undercooked or recontaminated from poor kitchen hygiene) are common reservoirs for salmonellosis. The serotype is not specially stated as, in the original post, the statement is "was infected with salmonella enteridis" which could mean salmonella enteritis (as the name of the condition) or _Salmonella_ Enteritidis (as the name of the organism). - ProMED Mod.LL]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu 2 Apr 2015
Source: Outbreak News Today [edited]
-------------------------------------------------------------------------
The US Centers for Disease Control and Prevention (CDC) issued 3 travel notices Wednesday due to on-going measles outbreaks in Angola, Bosnia-Herzegovina and Ethiopia. In Angola, the US federal health agency says the country is experiencing an on-going measles outbreak. The number of confirmed measles cases increased from 6558 in 2013 to 12 036 in 2014; and cases continue to occur in 2015.

In Europe, as of February 2015, the Federal Institute of Public Health in the Federation of Bosnia and Herzegovina has reported more than 3800 cases since January 2014. Most of the cases have been in 3 Central Bosnia Canton municipalities: Bugojno, Fojnica, and Travnik.

Finally, on the Horn of Africa, Ethiopia is experiencing an on-going measles outbreak. The number of confirmed measles cases increased from 6100 in 2013 to more than 14,000 confirmed cases in 2014; cases continue to occur in 2015.

The CDC recommends that travellers to all 3 destinations protect themselves by making sure they are vaccinated against measles, particularly infants 6-11 months of age (1 dose of measles vaccine) and children 12 months of age or older (2 doses of measles vaccine). Clinicians should keep measles in mind when treating patients with fever and rash, especially if the patient has recently travelled internationally.  [Byline: Robert Herriman]
More ...

Chad

Chad - US Consular Information Sheet
March 29, 2007
COUNTRY DESCRIPTION: Chad is a developing country in north central Africa with one of the lowest per capita incomes in the world. Chad faces challenges in the areas of political stability and
conomic development. Years of war, drought, and lack of economic growth have severely damaged the country's institutions and its infrastructure. Facilities for tourism are limited. The capital is N'Djamena. French and Arabic are the primary languages. Read the Department of State Background Notes on Chad for additional information.
ENTRY/EXIT REQUIREMENTS: A valid passport and visa are required. Visitors must check in with the National Police and obtain a registration stamp within 72 hours of arrival. Further entry information may be obtained from the Embassy of the Republic of Chad, 2002 R St. N.W., Washington D.C. 20009, telephone (202) 462-4009. Overseas, inquiries should be made at the nearest Chadian embassy or consulate. Some travelers originating in countries with no Chadian embassy or consulate can arrange for airport entry visas. This process is generally limited to business or official travelers, and arrangements must be made by the traveler’s local contact in Chad several days in advance of arrival. The U.S. Embassy is not in a position to assist private U.S. citizens with their visa application for travel to Chad.

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

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: See the Department of State’s Travel Warning for Chad.

For the latest security information, Americans traveling abroad should regularly monitor the Department’s website where the current Travel Warnings and Travel Alerts, including the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S., 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: Americans and Europeans are perceived to be wealthy and certain precautions should be taken. Travelers are advised not to leave cash or valuables unsecured in their hotel room and not to wear expensive jewelry or show large amounts of cash. Travelers are also advised to dress modestly, not to walk outside after dark, and to lock their car doors. Petty crimes such as purse snatching, pick-pocketing and theft from vehicles do occur, particularly in areas frequented by expatriates. Violent crime is somewhat rare, but does occur. Burglary and vehicle thefts increase during times of political instability. Expatriate residences have been targeted for armed robbery, and some foreigners have been assaulted in the process. Travelers to northern Cameroon should contact the U.S. Embassy’s Regional Security Officer in N'Djamena prior to crossing the Chad/Cameroon border because of a high incidence of road attacks there.

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: Medical facilities in Chad are extremely limited. Medicines are in short supply or unavailable, including many over-the-counter preparations sold in the United States. Travelers should carry any needed, properly labeled, medicines with them. In the event of major injury or illness, visitors generally will require medical evacuation.

There are two medical clinics in the capital of N’Djamena, International SOS and the Centre Medico-social de l’Ambassade de France. Advance membership is required to access these two clinics.

Malaria is a serious and sometimes fatal disease.
Plasmodium falciparum malaria, the type that predominates in Chad, is resistant to the antimalarial drug chloroquine.
Because travelers to Chad are at high risk for contracting malaria, the Centers for Disease Control and Prevention (CDC) advises that travelers should take one of the following antimalarial drugs: mefloquine (Lariam - TM), doxycycline, or atovaquone/proguanil (Malarone -TM).
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 tell the physician their travel history and what antimalarials they have been taking.
For additional information on malaria, including protective measures, visit the CDC Travelers’ Health web site at http://www.cdc.gov/travel/malinfo.htm.

Other widespread diseases in Chad include diarrhea and upper respiratory infections. AIDS is becoming an increasingly serious problem as infection rates have risen to alarming levels (up to 25 percent in high-risk groups). Meningitis outbreaks usually occur annually and several other diseases (cholera, diphtheria, chicken pox, typhoid) periodically appear.

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

Roads are in poor condition and dangerous. In the capital city of N'Djamena, only the main roads are paved; the rest of the roads are either hard-packed dirt or looser dirt and sand. During the summer rainy season (mid-June to mid-September) many roads become impassable or are restricted by rain barriers, while during the drier season, clouds of dust rising from the roads reduce visibility.

Visitors should take great care while driving. Both paved and unpaved roads are poorly maintained, and often have large ruts and potholes. All drivers should adjust their speed accordingly. At night, streets are not lit; it is imperative to watch for pedestrians, bicyclists, motorcyclists, and livestock, as they may not become visible until they are in very close proximity.

Driving in Chad tends to be erratic both in cities and in rural areas. In cities, particularly N'Djamena, motorists share the roads with bicycles, motor scooters, pedestrians, and non-motorized wheelchairs. Lanes are not marked, and it is not uncommon for a normally two-lane thoroughfare to become a four-lane road during rush hours (generally 7:00 a.m.-9:00 a.m. and 3:00 p.m.-6:00 p.m. Monday-Thursday; 7:00 a.m.-9:00 a.m. and 11:00 a.m.-12:30 p.m. on Friday). Drivers are urged to be particularly observant at these times because motorists often attempt to overtake slower traffic by moving into oncoming lanes, usually at high speeds.There are only a few traffic lights in N'Djamena, and these are often out of service. Drivers yield to traffic on their right, particularly when entering the many traffic circles.

In rural areas, drivers should watch for livestock crossing the roads, and for large hawks that rest on the roads. These birds can be fearless, and cause damage by smashing into drivers' windshields; drivers may avoid this by slowing down when approaching the hawks, and allowing them sufficient time to fly away. Finally, drivers should be alert to older transport trucks traveling between cities, which do not always have functioning headlights.

No emergency services exist, so drivers should exercise extreme caution. Travelers should always wear seat belts. When traveling by car, be sure to carry a spare tire. Roadside service is limited to good Samaritans and children who will help push cars to the side or out of holes. When traveling outside the capital, it is imperative to carry sufficient quantities of drinking water. Drivers should ensure that their gas tanks are at least half-full at all times, as gas stations are not widely available. Gas may be purchased in an emergency in bottles from roadside stands, but it is generally of poor quality.

Travelers on roads in all areas of the country are subject to attack by armed bandits.
Please refer to our Road Safety page for more information.

AVIATION SAFETY OVERSIGHT: As there is no direct commercial air service between the United States and Chad, the U.S. Federal Aviation Administration (FAA) has not assessed Chad’s Civil Aviation Authority for compliance with International Civil Aviation Organization (ICAO) aviation safety standards. For more information, travelers may visit the FAA’s internet website at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES: All photography requires a government permit. Taking photos of military sites, official buildings, and airports is strictly prohibited, even with a permit. Such sites are not always clearly marked. Film and cameras may be confiscated, often by undercover police.

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 Chadian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Chad 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 onCriminal Penalties.

CHILDREN'S ISSUES: Embassy N’Djamena does not issue immigrant visas. Therefore, American citizens who adopt children in Chad are required to travel to the U.S. Embassy in Yaounde, Cameroon, or another Embassy for visa processing before return to the United States.

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 Chad are encouraged to register with the U.S. Embassy in Chad through the State Department’s travel registration website , Americans withoutInternet access may register directly with the nearest U.S. Embassy or Consulate. By registering, American citizens make it easier for the Embassy to contact them in case of emergency. The U.S. Embassy in Chad is located in N'Djamena on Avenue Felix Eboue; mailing address is B.P. 413; telephone (235) 51-62-11, 51-70-09, 51-77-59, 51-90-52, 51-92-18 and 51-92-33, fax (235) 51-56-54.
* * *
This replaces the Country Specific Information dated July 10, 2006 with no updates.

Travel News Headlines WORLD NEWS

Date: Wed, 14 Aug 2019 15:14:41 +0200 (METDST)

N'Djamena, Aug 14, 2019 (AFP) - A female suicide bomber killed six people after blowing herself up in western Chad early Wednesday, a senior army officer said, in an attack attributed to Nigeria's Boko Haram jihadists.   "Six people died, including a soldier," in the attack in Kaiga-Kindjiria district, said the source, speaking on condition of anonymity.    A number of people were also injured, the officer said, without giving figures.   A provincial security official said a woman wearing an explosives-laden belt "blew herself up near the home of a traditional chief".   Four guards as well as a soldier were among the dead, and five people were wounded, the official said.   The death toll of six was confirmed by Chadian army spokesman Colonel Azem Bermandoa, and by a local NGO.   There was no immediate claim of responsibility.

Kaiga-Kindjiria lies in Lac province, which abuts the vast Lake Chad -- a region shared by Chad, Cameroon, Niger and Nigeria.   Boko Haram launched an insurgency in northeastern Nigeria a decade ago that has since spilled over into neighbouring countries.   It has carried out at least 10 cross-border attacks in Chad since 2018, mainly targeting army positions.   In March, 23 troops were killed when their forward position on the northeastern side of the lake came under attack.   In June, 11 soldiers were killed and six were wounded in clashes at Tchoukoutalia, according to the authorities, who said 26 jihadists were killed.   Boko Haram's campaign has left some 27,000 people dead and displaced around two million in Nigeria alone, according to some estimates.   In 2015, the four Lake Chad countries, together with Benin, set up a combined force to fight Boko Haram with the help of local groups of armed citizens.
Date: Sun, 26 May 2019 12:12:06 +0200

N'Djamena, May 26, 2019 (AFP) - Four Chadian soldiers and a television reporter were killed when their vehicle hit a mine on a road in eastern Chad, security sources said Sunday.   The victims were headed towards an army position that had been attacked by elements of the Boko Haram Islamist group overnight Friday, the sources said.   "This delegation of the Chadian army was headed to Ngounboua (on Lake Chad), where elements of Boko Haram had attacked an army position overnight, illing at least one on our side," a security source told AFP. 

The source said 23 Boko Haram fighters were killed, confirming a toll given by Chadian army spokesman Azem Bermandoa on national television.   Dimouya Soiapebe, the head of Lake Chad Province, said soldiers and a journalist for the national broadcaster had gone to the scene to "raise the morale of the troops" when the bomb went off.   "Terrorists often lay explosive devices on the roads leading to positions they have attacked," Soiapebe said.

In March, 23 soldiers were killed in the Lake Chad region in the deadliest attack yet on the Chadian army by Boko Haram, which launched an insurgency in Nigeria a decade ago.   The revolt has claimed more than 27,000 lives and uprooted some 1.8 million people.
Date: Thu, 11 Apr 2019 05:29:58 +0200
By Amaury HAUCHARD

Adré, Chad, April 11, 2019 (AFP) - Dinar Tchere is fighting time and the sun, and he fears he may be losing.   This morning, the health worker is expected in a remote village of eastern Chad, where he will administer the measles, mumps and rubella vaccine to poor children.   But he's behind schedule -- and there is limited time before his enemy, the blistering Sahelian heat, will destroy his precious drugs.  Tchere takes his gear and the ice-packed cooler that shields the vaccines, puts them in an NGO pickup and heads out from his clinic in Hilouta, in Ouaddai province, on the dusty untarmacked road.

Twenty minutes later he is in Agang, a village of 400 people, and there, another private dread has turned to reality. No-one is there to be vaccinated.   "It's just what I feared -- most of the mums have gone off to the market to do their shopping," groans Tchere, a stocky, shaven-headed man in his fifties.    There is nothing to do but hope that the mothers and their children will return. He stretches out a mat on the soil, under a mango tree.   His luck starts to turn. One by one, mothers with their children make their way to the spot, and soon there is no room on his mat for youngsters waiting for their jab.

- Cold chain -
Always worried by the heat -- the thermometer now reads 40 degrees Celsius (104 degrees Fahrenheit) -- Tchere dips his finger into the cooler to check that the ice has not melted, and starts the vaccination.   "Our biggest headache is ensuring that the vaccines are always kept cold," says Tchere, who heads one of 21 health centres in the region.   "Since the troubles of 2007, we no longer have a solar panel or fridge."   The "troubles" refer to years-long violence by armed groups on the tense border between Sudan and Chad.   Hilouta, which lies less than two kilometres (one mile) from the border, became a combat zone.   With no power, how does Tchere keep his vaccines cool?   "I stock them in Sudan, in a clinic on the other side of the border. They've got a fridge," he explains.

But there's a problem: because of security concerns, Sudan refuses to let people cross the border by motorbike -- Tchere's only form of transport when he cannot use the pickup.   So on the eve of every immunisation session, Tchere walks into Sudan, carrying his cooler, fills it up with vaccines, and walks back into Chad.   His clinic administers to about 60 villages. He says e does four vaccination sessions per month -- two in the clinic, and two in the villages.   Most often, he does the outside trips on his motorbike, always taking care never to take the same route back home, in order to avoid holdups.

The state no longer pays the running costs of his health centre -- a French NGO, Premiere Urgence Internationale (PUI), has stepped in, using financial help provided by the European Union.   In Arkoum, about 50 kilometres (30 miles) from Hilouta, Felix Djembonoudji, a nurse who runs the health centre, says that the stockpile of vaccines -- held in the district's main town of Adre, several hours away by road -- has run out.   "The people (in Adre) sometimes don't receive any -- we've been without MMR (vaccine) for five days," he says.

- Measles threat -
Measles is often dismissed by so-called anti-vaxxers who oppose immunisation as a disease of the past or non-threatening.   Experts say that it is neither -- measles is on the comeback trail.    And out of every 20 children who catch measles, as many as one will suffer from pneumonia, according to the US Centers of Disease Control (CDC). Blindness, encephalitis and severe diarrhoea are also serious complications.   Only one child in five in Chad is fully vaccinated against measles, according to a 2017 survey.   "Measles can also cause malnutrition in non-vaccinated children, which in itself is a cause of premature death," said PUI's mission chief in Chad, Fabienne Mially.

According to UN figures, more than one child in 10 in Chad will die before their fifth birthday.   In Agang, the measles vaccination session comes to an end, and Tchere is packing up his gear when a horse appears on the horizon, its hooves kicking up dust, bearing a man and his six-month-old baby.   The infant needs his second MMR vaccine. "It's important!" pleads the father. The child will get his jab.   Tchere returns to his clinic in Hilouta. There is no water or electricity. Two local people are awaiting him in the gloom, desperate for a medical consultation.    "The working day is long," he sighs, as he welcomes them in.
Date: Tue, 9 Apr 2019 04:47:15 +0200
By Amaury HAUCHARD

Hadjer Hadid, Chad, April 9, 2019 (AFP) - "I've already earmarked a customer for this drum -- I need to get a move on!"   Ali Ahmat,12, flicks his whip to persuade a hard-driven horse to press on with his cart, laden with 200 litres (44 imperial gallons) of freshly-fetched water.   The young entrepreneur is one of the informal but indispensable links in a chain to supply people in Ouaddai, eastern Chad, with water, the stuff of life.

Scorching temperatures, an open sky, a shortage of deep wells and lack of water purification system make this a thirsty part of the world indeed.   "After the rainy season, water becomes scarce," says Mahamat Adoum Doutoum, chief of the Guerri region, where only two deep wells exist for 86,000 inhabitants. "So people go to look for water in the wadi."   Wadis -- "riverbeds" in Arabic -- are watercourses that run strong and fast during the rains and are often dangerous to cross, but largely dry up for the rest of the year. When there is no more rain, people dig wells in the wadis and install pumps to extract groundwater.

Ali and dozens of other water carriers flock to the pumps to collect supplies they plan to sell to people who have no access to the source, often in dusty settlements.   Each refill of his 200-litre drum costs Ali 100 CFA francs (0.15 euros / $0.17), but he can sell the water for five times as much in town. "We do between seven or eight return trips each day, roughly," he says.     Towards the end of a hot Sunday, the blazing sun has set and Ali's cart is heading towards Hadjer Hadid.

The town harbours a refugee camp for people who fled conflict and mass killings in the Darfur region of western Sudan, the far side of the border.   Pascal, a Sudanese refugee and father of five in his 50s, is also used to the return trips between the town, the bed of the wadi and the muddy wells.    He first came to Chad about 15 years ago and says that he "suffered" to be able to buy his own donkey.   The beast of burden was an investment that has paid off, however, enabling Pascal to deliver water to the townsfolk over the past two years and bring a small sum home to his family.

- Add bleach -
But he remains concerned about the quality of the water.   "To drink the water, you also have to add bleach," Pascal says.   While water has become as rare as it is valuable, the kind to be found around wadis is unsafe. Traditional wells dug into the earth at the wadis provide water that is often the same colour as the soil.   "The water can be contaminated at various points, either at the source, which may be unprotected, or during transport, using receptacles which are inappropriate, dirty or uncovered, and during storage and distribution," says Fabienne Mially, mission chief in Chad for the French aid group Premiere Urgence Internationale (PUI).

The NGO supports 11 health centres in the Ouaddai region, where awareness sessions on the importance of proper drinking water are regularly organised.   In Borota, a village several hours' drive from Hadjer Hadid, the head of the local health centre has no illusions. Of the six standpipes in the village, none is working any more.   "They were installed by NGOs," says the official, Koditog Bokassa, who says that wadi water is the only available source of water locally.   He hands out sachets of bleach to dilute in untreated water.   But Bokassa lacks the means to satisfy everybody and PUI has become the sole supplier of bleach in central parts.    The state used to deliver some, but has not done so for more than a year, he says. It is quite common to see young people at the wadis drink directly from their cans.

- 'Barely enough' -
The town has holding basins and water towers designed to retain water during the rainy season.   "But the holding basins are insufficient and the two water towers broke down several years ago," says local resident Hassan.   One trader has bought two barrels of 200 litres apiece, which he leaves in the courtyard of his house. "It's barely enough for the children, but it's better than nothing."   The water deliverer Pascal does not have the money to buy a drum of such munificence. For the seven members of his household, there are seven 20-litre cans on the stoop.    "I haul water every day, but I have the same problem as everyone else," he said.
Date: Sun, 7 Apr 2019 06:19:43 +0200
By Amaury HAUCHARD

Abeche, Chad, April 7, 2019 (AFP) - The chief medical officer at Adre hospital takes a routine phone call: a patient has been admitted with gunshot wounds and needs emergency surgery.   A dusty town in eastern Chad, once part of the proud Ouaddai empire, Adre is caught up in a mounting conflict between local farmers and nomadic camel herders from the north of the sprawling country.   Last year, the hospital treated more than 100 patients with bullet wounds.

In a territory where almost everyone seems to have a gun -- a legacy of rebellions launched from eastern Chad and of the brutal conflict in Sudan's Darfur -- squabbles over grazing land and trampled crops swiftly lead to violence.   Such disputes are tragically familiar in many parts of Africa.    But in arid eastern Chad, near the border with Sudan, the bloodshed is particularly acute, rooted in a bitter drought and population pressure sharpening rivalry over access to land.   The vicious circle of attack and retribution is running full tilt.

- Seasonal -
Admissions in Adre rise sharply during "times of tension", a source at the local hospital said.   Those times mirror the seasons. At the end of the rainy season, in December and January, herders drive their beasts northwards into the Sahel. When water sources start running low, they return south, from about the end of June.   Local chief Abderahim Dahab, who supervises 136 villages in his traditional leadership role, said the modern-day bloodshed contrasted with long-established cohabitation.   "Movement of livestock has always happened peacefully, for decades," he said.   Migratory herders benefit from pasture on which to feed their animals, and farmers benefit from the animals, whose droppings fertilise the soil. And farmers and herders mutually benefit from trading with each other for food.

Historian Mahamat Saleh Yacoub said two factors explained the breakdown between the two communities.   The first is a drought that has gripped the Sahel since the 1970s and seems to be worsening. Everyone who spoke to AFP agreed that the key issue is a lack of water.   "The herders are now coming earlier in the year and going back later. The established ways have broken down," said another district chief.   Saleh Yacoub, who is head of the ENS college of higher education in Abeche, near Adre, said the second cause was a population increase -- "as much among people as among livestock".   Herds are getting larger, straining the fragile ecological resources of the Ouaddai.

- Ethnic friction -
The rivalry has "become intertwined with ethnic problems", added Yacoub.   "The herds all belong to the same people: colonels, generals, people in politics," explained a village elder sitting on his mat with a glass of tea.   "We have had meetings, we write letters to the deputy prefect (district administrator), the prefect himself, but get nothing back," he protested. "The population has no power against them."

Many cattlemen are members of the Zaghawa ethnic group, who come from the northeast of the giant country.    The Zaghawa include President Idriss Deby Itno, who came to power in 1990.    Members of their ethnicity have entered every rank of the Chadian state, although Ouaddai's governor, Ramadan Erdebou, dismisses any suggestion that tribalism is to blame for the region's problems.   "This ethnic question is a false debate. There are Chadian women and Chadian men and one single unity, Chad," said Erdebou, who was formerly the chief of the regime's powerful intelligence services.

- Disarmament -
Erdebou's predecessor was sacked after an explosion of communal violence last October claimed eight lives.   One of his first moves in office was to announce a massive disarmament campaign among the population.   He also warned that a mission would be coming from the capital N'Djamena to chase away "those farmers who have cultivated crops along the corridors (set aside) for livestock movement."

These designated corridors were established by law in 1959, to give nomads and their herds passage of up to one kilometre (more than half a mile) wide for their seasonal migrations.   "But Zaghawa herders feel they can do what they like and don't respect them," said a farmer, who maintains he lost his entire peanut crop in 2016 when hundreds of dromedaries trampled his field.   "How do you expect Ouaddians to agree to be disarmed when you see that the herdsmen have more and more weapons?" asked a local official.

In 2015, the National Assembly in the distant western capital passed a Pastoral Code that led to an outcry from people who found it heavily biased in favour of the cattle breeders. Deby overturned the law.   "It's hard to want national unity when those in power only favour their own," said the local official, who asked not to be named, saying he feared reprisals.   But, Saleh Yacoub observed, when quarrels turn violent, "the Zaghawa become the target for all the grievances, regardless of whether they are legitimate or not."   In a visit to Abeche in February, Deby named no names but acknowledged there was a "serious problem."   He vowed to "take matters in hand".   "The hour for vendettas is past," he declared.
More ...

British Indian Ocean Territory

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

More ...

World Travel News Headlines

Date: Fri, 17 Jan 2020 17:48:09 +0100 (MET)

Barcelona, Jan 17, 2020 (AFP) - Spain's Balearic Islands passed a bill Friday aimed at clamping down on alcohol-fuelled holidays in the Mediterranean archipelago which bans happy hours when drinks are offered a discount and open bars.   "This is the first law adopted in Europe which restricts the sale and promotion of alcohol in certain touristic areas," the regional government of the Balearic Islands which have long been a magnet for young German and British tourists, who often drink heavily and enjoy rowdy late-night clubbing.

The restrictions will apply to three areas with a reputation for excess: San Antoni on the island of Ibiza and El Arenal and Magaluf -- which has been nicknamed "Shagaluf" because of its reputation for drunken casual sex -- on Mallorca, the largest of the Balearic's four islands.   The law, which was drawn up in consultation with the tourism industry also bans pub crawls and two-for-one drink offers, prohibits the sale of alcohol in shops between 9:30 pm and 8 am and forbids advertising party boats in the designated areas.   Establishments that break the new rules risk fines of up to 600,000 euros ($669,000) and the threat of being closed down for three years.

The new law also takes aim at the so-called "balconing" craze, the term given to holidaymakers who decide to jump into a swimming pool from a hotel or apartment balcony, a stunt which claims several lives every year.   It bans "balconing" across the entire archipelago and requires hotels to evict anyone who does it. Those caught jumping from balconies face fines of up to 60,000 euros ($67,000).   Up until now only some resorts on the Balearics imposed fines for "balconing".

The regional government of the Balearics said the law, which stiffens measures already introduced in 2015, will "fight excesses in certain tourist zones" and "force a real change in the tourism model of those destinations".   Magaluf made global headlines in 2014 after a video showing a young woman performing oral sex on several men on the dance floor of a nightclub went viral.   Local shops sell souvenir T-shirts with the catchphrase "On it 'till we vomit".

The four islands which make up the Balearics -- Palma de Mallorca, Ibiza, Menorca and Formentera, received nearly fourteen million tourists in 2018, drawn by their crystal clear waters, and in many cases by all-inconclusive package holidays.   The archipelago is Spain's second most visited region. Spain is the world's second most visited country after France.
Date: Fri, 17 Jan 2020 12:55:16 +0100 (MET)

Rennes, France, Jan 17, 2020 (AFP) - Several oyster farmers along France's Atlantic and Mediterranean coasts have been forced to halt sales since December after their sites were contaminated by the highly contagious norovirus, which they blame on overflowing sewage treatment plants.   Authorities ordered the suspensions at 23 of the country's 375 designated fields, and recalls of affected oysters as well as mussels and clams, after tests revealed the virus, which can cause severe vomiting and diarrhoea.

The move came just before the year-end holidays, when oysters are a traditional delicacy on millions of French tables.   "The oysters are not sick. They're carrying the virus because it's in the water they are constantly filtering," Philippe Le Gal, president of France's national shellfish council (CNC), told AFP this week.   "They were in the wrong place at the wrong time," he said, adding the ban had prompted many people to stop eating oysters altogether.   Local officials say oyster farmers are paying the price of insufficient spending on wastewater treatment, with facilities strained to the limit even as development of coastal areas has surged in recent years.

Heavy rains before Christmas prompted treatment basins to overflow, they say, spilling tainted water into rivers.   "This was predictable -- they've kept issuing building permits even though treatment sites are already at full capacity," said Joel Labbe, a senator for the Morbihan region in Brittany.   Oyster farmers are demanding compensation, and a delegation met with agriculture ministry officials in Paris last week warning that more than 400 businesses had been impacted by the sales ban.

This week, angry growers dumped trash bins full of oysters and mussels in front of the offices of the regional ARS health authority in Montpellier over the decision to halt sales from a nearby basin on the Mediterranean coast.   "We're the victims, and we shouldn't have to suffer any financial damages," Le Gal said.
Date: Fri, 17 Jan 2020 04:44:41 +0100 (MET)

Suva, Fiji, Jan 17, 2020 (AFP) - Fiji opened evacuation centres and warned of "destructive force winds" Friday as a cyclone bore down on the Pacific island nation for the second time in three weeks.   Two people were missing after attempting to swim across a swollen river late Thursday when heavy rain fell ahead of the advancing Cyclone Tino, police said.   On the outer islands, locals prepared to go to emergency shelters while many tourists fled beach resorts and made their way to the capital Suva before regional flights and inter-island ferry services were suspended.

The Fiji Meteorological Service said Tino was strengthening as it headed for Fiji's second-largest island, Vanua Levu, warning of wind gusts of up to 130 kilometres per hour (80 mph), heavy rain, coastal flooding and flash flooding in low lying areas.    "I'm preparing to go to an evacuation centre soon with my family and wait for the cyclone to pass," Nischal Prasad, who lost his home in northern Vanua Legu when Cyclone Sarai struck just after Christmas, told AFP.   "Sarai destroyed my house and almost left my family homeless. My daughters had to hide under their bed from the strong winds. It was a scary experience," he said.

Russian tourist Inna Kostromina, 35, said she sought safety in Suva after being told her island resort was in the path of the cyclone.   "We didn't want to get stuck in there and with the authorities warning of coastal flooding, anything can happen. So we decided to move to Suva for now. I think we will be much safer here."    Police said a man and his daughter, believed to be aged nine or 10, were attempting to swim across a flooded river when they were caught in the strong currents.    The incident happened on Thursday before the storm developed into a tropical cyclone, but a police spokesman linked the tragedy to "heavy rain brought about by the current weather system (which) raised the river level".   Although the Pacific islands are popular tourist destinations in summer it is also the cyclone season, and Fiji is being targeted for the second time in three weeks.

In late December, Tropical Cyclone Sarai left two people dead and more than 2,500 needing emergency shelter as it damaged houses, crops and trees and cut electricity supplies.    On its present track, Tino would hit Tongatapu, the main island of neighbouring Tonga, on the weekend.    Two years ago, Tongatapu was hit by Cyclone Gina, with two people killed and nearly 200 houses destroyed.
Date: Thu, 16 Jan 2020 16:38:39 +0100 (MET)
By Hiroshi HIYAMA

Tokyo, Jan 16, 2020 (AFP) - Japan has confirmed a case of a mystery virus that first emerged in China and is from the same family as the deadly SARS pathogen, authorities said Thursday.   It appears to be only the second time the novel coronavirus has been detected outside China, after the World Health Organization (WHO) confirmed a case in Thailand.   Japan's health ministry said a man who had visited the central Chinese city of Wuhan, the apparent epicentre of the outbreak, was hospitalised on January 10, four days after his return to Japan. He reported a persistent fever.

Tests on the patient, who was released from hospital on Wednesday, confirmed he was infected with the new virus.   "This is the first domestic discovery of a pneumonia case related to the new coronavirus," the ministry said in a statement.   "We will continue active epidemiological research while also coordinating efforts with the World Health Organization and related agencies to conduct a risk assessment."   The outbreak has killed one person so far, with 41 patients reported in Wuhan.

The outbreak has caused alarm because the new virus is from the same family as the pathogen that causes SARS (Severe Acute Respiratory Syndrome), which killed 349 people in mainland China and 299 in Hong Kong in 2002 and 2003.   Authorities in Wuhan said a seafood market was the centre of the outbreak. It was closed on January 1.   Japanese authorities said the man had not visited the market and that it was possible he had been in contact with a person infected with the virus while in Wuhan.

- Outbreak in Japan 'unlikely' -
Health ministry official Eiji Hinoshita told reporters that the risk of the disease spreading from the patient was considered low, with careful checks done on those who had been in close contact with him.   "At this point, we feel it is unlikely this will lead to a dramatic outbreak," he said, adding that the patient was no longer suffering a fever and was recuperating at home.

Officials declined to give further information on the man, including his nationality, citing privacy concerns.   Local media said the patient was a Chinese national in his 30s living in Kanagawa, just southwest of Tokyo.   Public broadcaster NHK said he had already recovered and was resting at home, as quarantine officials at Tokyo's Narita airport boosted health checks on all travellers.

The health ministry urged people who develop a cough or fever after visiting Wuhan to wear a surgical mask and "swiftly visit a medical institution".   Hinoshita said Japan would need to be on guard ahead of the Lunar New Year, a popular travel period in China.   "It is expected that Japan will see many visitors from China," he said.   It is not yet clear whether the mystery virus can be transmitted between humans, but on Wednesday authorities said it was possible it had spread inside a family.

The woman diagnosed in Thailand, who is in a stable condition, also said she had not visited the Wuhan seafood market.   And WHO doctor Maria Van Kerkhove on Tuesday said she "wouldn't be surprised if there was some limited human-to-human transmission, especially among families who have close contact with one another".   Hong Kong authorities on Tuesday said several dozen people had been hospitalised with fever or respiratory symptoms after travelling to Wuhan, but no cases of the new virus have so far been confirmed.
Date: 20 Jan 2020
Source: News Joins [In Korean, machine trans. edited]
----------------------------
An unexplained pneumonia in China caused the Korean quarantine authorities to strengthen the quarantine, and a fever-sensing camera is installed to monitor the body temperature of Chinese tourists who entered Korea at Incheon Port 1 International Passenger Terminal. 

Pneumonia confirmed by the new coronavirus, which is prevalent in Wuhan, China, was confirmed for the first time on [20 Jan 2020]. According to health officials, a Chinese woman, A, who arrived at Incheon International Airport on a plane from Wuhan last weekend, was confirmed with pneumonia. The patient showed signs of pneumonia, including high fever and cough. The health authorities entered the airport at the same time, confirmed the symptoms of high fever, suspected pneumonia, and went into quarantine and testing. The Centers for Disease Control immediately quarantined A and entered treatment with a nationally designated quarantine bed. The Centers for Disease Control will hold an emergency press conference at 1:30 pm on [20 Jan 2020] and release the reporter A.
 
Meanwhile, Beijing's Daxing District Health and Welfare Committee said 2 fever patients who had been to Wuhan were confirmed as a new pneumonia patient on [19 Jan 2020]. They are currently being treated at a designated hospital and said they are stable. Daxing District is where Beijing New Airport opened last year [2019]. The Guangdong Provincial Health and Welfare Committee said on [19 Jan 2020] that a 66-year-old man who had visited a relative's home in Wuhan showed fever and lethargy and was diagnosed with Wuhan pneumonia. Confirmation patients have also emerged in Shenzhen, a neighbouring Hong Kong province in southern China, raising concerns that the new pneumonia has already spread throughout China.
 
The Chinese government has said that "there is no basis for human-to-human propagation," but domestic experts pointed out that "the nature of coronavirus is less likely to prevent human-to-human propagation."   [Byline: Esther Toile]
========================
[This is now the 4th international identification of the 2019-nCoV (novel coronavirus) associated illness reported outside of China.  To date, all 4 cases have reported being in Wuhan China in the 14 days preceding onset of illness.  Illness in each involved a history of fever and dry cough.  Cases were reported by Thailand (2 cases) and Japan, and now South Korea.  An update following a Ministry of Health Korea press conference mentioned that there were 5 individuals accompanying this woman, none of whom were currently showing symptoms. (<http://news1.kr/articles/?3821049>).

As mentioned in an earlier post (see Novel coronavirus (10): China (HU, GD, BJ) http://promedmail.org/post/20200119.6898567), there have also been cases confirmed in China outside of Wuhan City, with cases reported in Beijing, Guangdong and possibly Shanghai. It is becoming more difficult to conclude that there has been limited person-to-person transmission as the case numbers are climbing both inside of Wuhan City, elsewhere in China, and in individuals travelling from Wuhan China to other countries (Japan, Thailand and South Korea).

A map of South Korea can be found at:
Date: 15 Jan 2020
Source: Fox News [edited]

CDC is facing criticism over its response to a polio-like illness. The Centers for Disease Control and Prevention has confirmed 10 additional cases of acute flaccid myelitis.  An Ohio teen is determined to walk again despite doctors' warnings that she may not after she contracted a rare polio-like illness that's left her paralyzed from the waist down.  IK, a catcher on her middle school's softball team, said it started with what felt like a cramp in her leg on Christmas. "I just thought, 'Oh gosh, it's just growing pains or a Charley horse,'" NK, the 13-year-old's mother, told News 5 Cleveland.  But the next day, IK couldn't stand on her own, and her worried parents rushed her to Akron Children's Hospital, where she was diagnosed with acute flaccid myelitis (AFM). It's a rare but serious condition that affects the nervous system, specifically the grey matter of the spinal cord, which weakens the body's muscles and reflexes.

Health officials have noticed an increase of cases in children occurring every 2 years since 2014, according to the Centers for Disease Control and Prevention (CDC). And while it often is referred to as a "polio-like" illness, tests so far have tested negative for poliovirus.  Symptoms typically begin with sudden onset of arm or leg weakness and loss of muscle tone and reflexes, but can also include facial droop or weakness, difficulty moving eyes, drooping eyelids, difficulty swallowing,  slurred speech, and pain in the arms and legs.  Severe symptoms may include respiratory failure, or serious neurological complications, according to the CDC. Parents are encouraged to seek medical care right away if a child is suspected of developing any symptoms

Since her diagnosis, IK has been working in physical therapy and has received steroid treatments as well as multiple plasma exchange, according to the news outlet. Her mother said it's been like "a bad dream" for the family as they watch her struggle to gain strength.  "It's a lot, but I just try to go with the flow, just to push through," IK, who has received support from her teammates, classmates and members of the community, told News 5 Cleveland.  [Byline: Alexandria Hein]
======================
[Acute flaccid myelitis (AFM) is a rare but serious condition. It affects the nervous system, specifically the area of the spinal cord called gray matter, which causes the muscles and reflexes in the body to become weak.

In 2019, there were 33 total confirmed cases in 16 US states
[<https://www.cdc.gov/acute-flaccid-myelitis/cases-in-us.html>].

The case definition for AFM is based on clinical and lab criteria

Clinical Criteria: An illness with onset of acute flaccid limb weakness.
Laboratory Criteria:
Confirmatory Laboratory Evidence: a magnetic resonance image (MRI) showing spinal cord lesion largely restricted to grey matter and spanning one or more vertebral segments. Supportive Laboratory Evidence: cerebrospinal fluid (CSF) with pleocytosis (white blood cell count over 5 cells/mm3) Case Classification:
- Confirmed: Clinically compatible case AND Confirmatory laboratory evidence: MRI showing spinal cord lesion largely restricted to grey matter and spanning one or more spinal segments.
- Probable: Clinically compatible case AND Supportive laboratory evidence: CSF showing pleocytosis (white blood cell count over 5 cells/mm3)

With the high number of cases reported in 2018 and 2019, CDC enhanced AFM surveillance through collection of data at the national level by encouraging healthcare providers to recognize and report to their health departments all patients whom they suspect may have AFM; health departments are being asked to send this information to CDC to help us understand AFM activity nationwide. - ProMED Mod.UBA]

[HealthMap/ProMED map available at:
Date: Sat 18 Jan 2020
From: Guido Calleri <guidocalleri@aslcittaditorino.it> [edited]

90 persons presented to the Infectious Diseases Hospital Amedeo di Savoia, Torino, North-West Italy between 24 Dec 2019 and 10 Jan 2020 after consuming raw sausages from a wild boar hunted in the area of Susa Valley, 50 km [31.1 mi] away from Torino, in late November 2019.

All of them either were symptomatic (fever, muscle and/or abdominal pain, nausea) or had peripheral blood eosinophilia over 500/cmm, or both. IgG serology for trichinella was performed by immunoblot (Trichinella E/S IgG kit, EFFEGIEMME, Milan, Italy) and resulted positive in 48/90 (53.3%), allowing a diagnosis of confirmed trichinella infection.

Otherwise, a diagnosis of suspected trichinella infection was made with a negative serology, probably due to performing the test too early, before the development of antibodies or possibly a false negative result. In a few cases (under 10 cases) an alternative diagnosis was considered.

All patients were treated with oral albendazole 400 mg twice daily for 10 days and prednisone 50 mg/day.

Most likely, all patients were infected after eating meat from a single animal, given the low prevalence of the infection in this area: no human case has ever been detected in Torino province, and only one wild boar has been found positive for trichinella at microscopy in Susa valley in the last 10 years.
---------------------------------------
Guido Calleri, Filippo Lipani, Giovanna Paltrinieri, Silvia Faraoni,
Valeria Ghisetti
ASL Citta di Torino, Infectious Diseases Unit and Microbiology Lab,
and ASL TO3,
Department of Prevention
Torino, Piedmonte, Italy
======================
[ProMED thanks Guido Calleri, Filippo Lipani, Giovanna Paltrinieri, Silvia Faraoni, and Valeria Ghisetti for sending us this information. The report underlines that _Trichinella_ are found in wild boars in Europe and should be assessed by a certified laboratory for _Trichinella_ before used for human consumption. Sausages made of smoked meat are especially dangerous, because the temperatures seldom reach what is needed to kill the trichinella larvae. - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Date: Fri 17 Jan 2020
Source: Outbreak News Today [edited]

Media sources in Bangladesh are reporting a Nipah virus infection in the city of Khulna. The reported case is a 20-year-old female who has been hospitalized since last Saturday [11 Jan 2020] at the Khulna Medical College Hospital (KMCH).

"A medical board has confirmed her infection by Nipah virus. As her infection is a risk to other patients, she is being treated separately at the hospital's Medicine unit 1," said SM Kamal Hossain, chief of KMCH Medicine Department.

According to the World Health Organization (WHO), in the Bangladesh and India outbreaks, consumption of fruits or fruit products (e.g. raw date palm juice) contaminated with urine or saliva from infected fruit bats was the most likely source of infection. Fruit bats of the family Pteropodidae -- particularly species belonging to the _Pteropus_ genus -- are the natural hosts for Nipah virus. There is no apparent disease in fruit bats.

In more recent outbreaks of the disease, person-to-person transmission has been seen in Bangladesh and India.

The disease in humans can range from asymptomatic infection to fatal encephalitis. Encephalitis and seizures occur in severe cases, progressing to coma within 24 to 48 hours.

The case fatality rate is estimated at 40% to 75%; however, this rate can vary by outbreak depending on local capabilities for surveillance investigations, according to the WHO.

Those who survive acute encephalitis make a full recovery, but around 20% are left with residual neurological consequences, such as persistent convulsions and personality changes.

There is no treatment or vaccine available for either people or animals.
======================
[Nipah virus infections occur sporadically in Bangladesh in a geographic area termed the Nipah belt and during certain seasons of the year when the reservoir fruit bat is abundant. As noted in the previous comment (ProMED-mail archive no. http://promedmail.org/post/20150204.3143251), giant fruit bats or flying foxes (_Pteropus_ of several species) are reservoirs of Nipah virus, and they contaminate date palm sap or fruit. This is the season for cases of Nipah virus infection to occur. The transmission season is usually January to April.

As noted earlier, it is unfortunate that the public awareness efforts have not prevented these cases from occurring. Perhaps because cases are sporadic and geographically scattered there is little public perception of risk of infection and serious disease. Until effective public education to prevent infection by avoiding eating contaminated fruit or date palm sap is implemented, sporadic cases will continue to occur.

Interestingly, a simple skirt constructed out of locally available materials can prevent access of the bats to the palm sap collecting pots, but apparently they are not commonly used. Boiling the palm sap would inactivate the virus, but local consumers indicated that it alters the flavour of the sap.

An image of a _Pteropus_ fruit bat can be found at

[HealthMap/ProMED map available at:
Khulna, Khulna, Bangladesh: <http://healthmap.org/promed/p/14886>]
Date: Wed 15 Jan 2020
Source: Hindustan Times [edited]

Government High School, Tajpur village, has been put under surveillance after 16 students of the school were found to be infected with mumps, a viral infection that swells up the saliva-producing glands of a person.

A rapid response team had been dispatched to the school last week, after the students, all aged between 11 and 14, were found infected. The school currently has 106 students [enrolled], and all are under observation. The team had also surveyed the entire village and collected samples, to be sent to the Integrated Diseases Surveillance Program (IDSP) lab for testing.

Lack of measles, mumps, and rubella [MMR] vaccination is what leaves a person prone to the infection. Mumps virus spreads from person to person through infected saliva. If an individual is not immune, they can contract the viral by breathing in saliva droplets from an infected person.

Dr. Divjot Singh, epidemiologist, district health department, said the situation is now under control. "We have asked the school's principal to relieve all students infected with mumps. The school will remain under surveillance for 15 more days. Medical officers are also carrying out awareness drive at the school and the village against mumps," said Dr. Divjot Singh.

Last year [2019], a mumps outbreak was reported from 2 areas of the district, including Andlu village in Raikot and Red Cross Bhavan, Sarabha Nagar, Ludhiana.  [Byline: Harvinder Kaur]
Date: Wed 15 Jan 2020
Source: Devon Live [abridged, edited]

An outbreak of 19 new cases of mumps has been reported across Devon in the last week. The contagious viral disease particularly affects under 25s. The new mumps figures have been released in the official Government weekly Statutory Notifications of Infectious Diseases report, with the highest number in Exeter.

It follows a warning that mumps is on the rise, particularly in university towns. Traditionally known as the "kissing disease" because it spreads fast between groups of young people, mumps is a contagious viral infection recognisable by the painful swellings in the side of the face under the ears (the parotid glands), giving a person a distinctive "hamster face" appearance.

In severe cases, it can develop into viral meningitis if it moves in the outer layer of the brain. Other complications include swelling of the testicles or ovaries (if the affected person has gone through puberty), which may affect a person's fertility.  [Byline: Colleen Smith]