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Costa Rica

Costa Rica - US Consular Information Sheet
June 05, 2008
COUNTRY DESCRIPTION:
Costa Rica is a middle-income, developing country with a strong democratic tradition.
Tourist facilities are extensive and generally adequate.
The capi
al is San Jose.
English is a second language for many Costa Ricans.
Read the Department of State Background Notes on Costa Rica for additional information.

ENTRY/EXIT REQUIREMENTS:
For entry into Costa Rica, U.S. citizens must present valid passports that will not expire for at least thirty days after arrival, and a roundtrip/outbound ticket.
Some U.S. airlines may not permit passengers to board flights to Costa Rica without such a ticket.
Passports should be in good condition; Costa Rican immigration will deny entry if the passport is damaged in any way.
Costa Rican authorities generally permit U.S. citizens to stay up to ninety days; to stay beyond the period granted, travelers must submit an application for an extension to the Office of Temporary Permits in the Costa Rican Department of Immigration.
Tourist visas are usually not extended except under special circumstances, and extension requests are evaluated on a case-by-case basis.
There is a departure tax for short-term visitors.
Tourists who stay over ninety days may experience a delay at the airport when departing.
Persons who overstayed previously may be denied entry to Costa Rica.
Persons traveling to Costa Rica from some countries in South America and Sub-Saharan Africa must provide evidence of a valid yellow fever vaccination prior to entry.
The South American countries include Bolivia, Brazil, Colombia, Ecuador and Venezuela.
See “SPECIAL CIRCUMSTANCES” for information on requirements to carry documentation within Costa Rica and on travel by dual national minors.


The most authoritative and up-to-date information on Costa Rican entry and exit requirements may be obtained from the Consular Section of the Embassy of Costa Rica at 2114 “S” Street NW, Washington, DC 20008, telephone (202) 234-2945/46 , fax (202) 265-4795 , e-mail consulate@costarica-embassy.org, web site http://www.costarica-embassy.org, or from the Costa Rican consulates in Atlanta, Chicago, Houston, Los Angeles, Miami, New Orleans, New York, San Juan (Puerto Rico), San Francisco, and Tampa.
The Costa Rican immigration agency web site is http://www.migracion.go.cr.
It is advisable to contact the Embassy of Costa Rica in Washington or one of Costa Rica's consulates in the United States for specific information regarding customs requirements before shipping any items.
Visit the Embassy of Costa Rica web site at http://www.costarica-embassy.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:
There have been no recent acts of terrorism in Costa Rica.
Visitors to Costa Rica may experience the effects of civil disturbances such as work stoppages and strikes.
Although infrequent, these acts can create inconveniences for visitors.
On both the Caribbean and Pacific coasts, currents are swift and dangerous, and there are few lifeguards or signs warning of dangerous beaches.
Every year eight to twelve American citizens drown in Costa Rica due to riptides or sudden drop-offs while in shallow water.
Extreme caution is advised.

Adventure tourism is popular in Costa Rica, and many companies offer white-water rafting, bungee jumping, jungle canopy tours, deep sea diving, and other outdoor attractions.
Americans are urged to use caution in selecting adventure tourism companies.
The government of Costa Rica regulates and monitors the safety of adventure tourism companies; enforcement of safety laws is overseen by the Ministry of Health.
Registered tourism companies with operating permits must meet safety standards and have insurance coverage.
The safety regulations enforced in Costa Rica are not the same as safety regulations enforced in the United States.

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

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. and Canada, or for callers outside the U.S. and Canada, a regular toll-line at 1-202-501-4444.
These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).

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

CRIME:
Over one and a half million foreign tourists, the majority American, visit Costa Rica annually.
All are potential targets for criminals, primarily thieves looking for cash, jewelry, credit cards, electronic items and passports.
U.S. citizens are encouraged to exercise the same level of caution they would in major cities or tourist areas throughout the world.
Local law enforcement agencies have limited capabilities and do not act according to U.S. standards.
Travelers should minimize driving at night, especially outside urban areas.

Americans should avoid areas with high concentrations of bars and nightclubs, especially at night, and steer clear of deserted properties or undeveloped land.
For safety reasons, the Embassy does not place its official visitors in hotels in the San Jose city center, but instead puts them at the larger hotels in the outlying suburbs.
Americans should walk or exercise with a companion, bearing in mind that crowded tourist attractions and resort areas popular with foreign tourists are common venues for criminal activities.
Travelers should ignore any verbal harassment, and avoid carrying passports, large amounts of cash, jewelry or expensive photographic equipment.
Tourists are encouraged to carry photocopies of the passport data page and Costa Rican entry stamp on their persons, and leave the original passport in a hotel safe or other secure place.
Costa Rican immigration authorities conduct routine immigration checks at locations, such as bars in downtown San Jose and beach communities, frequented by illegal immigrants.
American citizens detained during one of these checks who have only a copy of the passport will be required to provide the original passport with appropriate stamps.



Travelers should purchase an adequate level of locally valid theft insurance when renting vehicles, park in secured lots whenever possible, and never leave valuables in the vehicle.
The U.S. Embassy receives several reports daily of valuables, identity documents, and other items stolen from locked vehicles, primarily rental cars.
Thefts from parked cars occur in downtown San Jose, at beaches, in the airport and bus station parking lots, and at national parks and other tourist attractions.
Travelers should use licensed taxis, which are red with medallions (yellow triangles containing numbers) painted on the side.
Licensed taxis at the airport are painted orange.
All licensed taxis should have working door handles, locks, seatbelts and meters (called "marias"); passengers are required to use seatbelts.
When traveling by bus, avoid putting bags or other personal belongings in the storage bins.
At all times have your belongings in your line of sight or in your possession.

Thieves usually work in groups of two to four.
A common scam has one person drop change in a crowded area, such as on a bus, and when the victim tries to assist, a wallet or other item is taken.
The most prevalent
scam involves the surreptitious puncturing of tires of rental cars, often near restaurants, tourist attractions, airports, or close to the car rental agencies themselves.
When the travelers pull over, "good Samaritans" quickly appear to change the tire - and just as quickly remove valuables from the car, sometimes brandishing weapons.
Drivers with flat tires are advised to drive, if at all possible, to the nearest service station or other public area, and change the tire themselves, watching valuables at all times.
In late 2006, the government of Costa Rica established a Tourist Police force, and units were established in popular tourist areas throughout the country.
The Tourist Police can assist with the reporting of a crime, which can be difficult for victims due to language barriers and the requirement that only investigative police can accept crime reports.

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 care in San Jose is adequate, but is limited in areas outside of San Jose.
Most prescription and over-the-counter medications are available throughout Costa Rica.
Doctors and hospitals often expect immediate cash payment for health services, and U.S. medical insurance is not always valid outside the United States.
A list of local doctors and medical facilities can be found at the website of the U.S. Embassy in San Jose, at http://sanjose.usembassy.gov.
An ambulance may be summoned by calling 911.
Most ambulances provide transportation but little or no medical assistance.
The best-equipped ambulances are called “unidad avanzada.”
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 Costa Rica is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

Costa Rica has one of the highest vehicle accident rates in the world.
The fatality rate for pedestrians and those riding bicycles and motorcycles is disproportionately high.
Traffic laws and speed limits are often ignored, turns across one or two lanes of traffic are common, turn signals are rarely used, passing on dangerous stretches of highway is common, and pedestrians are not given the right of way.
Roads are often in poor condition, and large potholes with the potential to cause significant damage to vehicles are common.
Pedestrians, cyclists, and farm animals may use the main roads.
Traffic signs, even on major highways, are inadequate and few roads are lined.
Shoulders are narrow or consist of drainage ditches.
All of the above, in addition to poor visibility due to heavy fog or rain, makes driving at night especially treacherous.
Landslides are common in the rainy season.
All types of motor vehicles are appropriate for the main highways and principal roads in the major cities.
However, some roads to beaches and other rural locations are not paved, and many destinations are accessible only with high clearance, rugged suspension four-wheel drive vehicles.
Travelers are advised to call ahead to their hotels to ask about the current status of access roads.
Costa Rica has a 911 system for reporting emergencies.
In the event of a traffic accident, vehicles must/must be left where they are.
Both the Transito (Traffic Police) and the Insurance Investigator must make accident reports before the vehicles are moved.

Please refer to our Road Safety page for more information.
Visit the website of Costa Rica’s national tourist office and national authority responsible for road safety at http://www.mopt.go.cr and www.visitecostarica.com.

AVIATION SAFETY OVERSIGHT:
The U.S. Federal Aviation Administration (FAA) has assessed the Government of Costa Rica’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Costa Rica’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs_initiatives/oversight/iasa.

SPECIAL CIRCUMSTANCES:
Land Ownership and Shoreline Property: U.S. citizens are urged to use caution when making real estate purchases, and consult reputable legal counsel and investigate thoroughly all aspects before entering into a contract.
Coastal land within fifty meters of the high tide line is open to the public and therefore closed to development, and construction on the next one hundred fifty meters inland is possible only with the approval of the local municipality.

Squatters: Organized squatter groups have invaded properties in various parts of the country.
These squatter groups, often supported by politically active persons and non-governmental organizations, take advantage of legal provisions that allow people without land to gain title to unused agricultural property.
Local courts may show considerable sympathy for the squatters.
Victims of squatters have reported threats, harassment, and violence.
Documentation Requirements: Visitors are required to carry appropriate documentation at all times.
However, due to the high incidence of passport theft, tourists are permitted and encouraged to carry photocopies of the datapage and entry stamp from the passport, leaving the passport in a hotel safe or other secure place.
However, as noted under CRIME, Costa Rican immigration authorities conduct routine checks for illegal immigrants, especially in bars located in downtown San Jose and in beach communities.
An American citizen detained during one of these checks and carrying only the copy of the passport will be required to produce the original passport.
Tourists should consider carrying their passports when traveling overnight or a considerable distance from their hotel.
Tourists who carry passports are urged to place them securely in an inside pocket.

Exit Procedures for Costa Rican Citizens: Costa Rican children may only depart the country upon presentation of an exit permit issued by immigration authorities.
This policy, designed to prevent international child abduction, applies to dual national U.S./Costa Rican citizens.
Parents of minors who obtained Costa Rican citizenship through a parent or through birth in Costa Rica are advised to consult with appropriate Costa Rican authorities prior to travel to Costa Rica, especially if one (or both) parent(s) is not accompanying the child.



Disaster Preparedness: Costa Rica is located in an earthquake and volcanic zone.
Serious flooding occurs annually on the Caribbean side near the port city of Limon, but flooding occurs in other parts of Costa Rica as well, depending on the time of year and rainfall.
General information about natural disaster preparedness is available via the Internet from the U.S. Federal Emergency Management Agency (FEMA) at http://www.fema.gov/.

CRIMINAL PENALTIES:
While in a foreign country, a U.S. citizen is subject to that country's laws and regulations, which sometimes differ significantly from those in the United States and may not afford the protections available to the individual under U.S. law.
Penalties for breaking the law can be more severe than in the United States for similar offenses.
Persons violating Costa Rica’s laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Costa Rica 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 Costa Rica are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department’s travel registration web site so that they can obtain updated information on travel and security within Costa Rica.
Americans without Internet access may register directly with the nearest U.S. Embassy or Consulate.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency.
The U.S. Embassy is located in Pavas, San Jose, and may be reached at (506) 2519-2000; the extension for the Consular Section is 2453.
The Embassy is open Monday through Friday, and is closed on Costa Rican and U.S. holidays.
Those seeking information are strongly encouraged to utilize the embassy web site http://sanjose.usembassy.gov/, and can email consularsanjose@state.gov with any questions/concerns.
For emergencies arising outside normal business hours, U.S. citizens may call (506) 2220-3127 and ask for the duty officer.
*

*

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This replaces the Country Specific Information for Costa Rica dated August 15, 2007, to update sections on Registration/Embassy Location and Special Circumstances.

Travel News Headlines WORLD NEWS

Date: Sun 23 Feb 2020
Source: Q Costa Rica News [edited]
<https://qcostarica.com/costa-rica-is-the-first-country-in-america-where-very-resistant-antibiotic-bacteria-for-meningitis-is-isolated/>

A 50-year-old man and a senior became the 1st 2 people in Costa Rica -- and in the Americas -- found to be infected with the bacteria most resistant to antibiotics used in the treatment of meningitis and meningococcal septicaemia that cause serious brain damage and even death. The Centro Nacional de Referencia en Bacteriolog­a (CNRB) -- National Center of Reference in Bacteriology, of the Instituto Costarricense de Investigacian y Enseaanza en Nutricin y Salud (Inciensa) -- Costa Rican Institute for Research and Education in Nutrition and Health (Incense), issued an alert, in early February [2020], after documenting the circulation of _Neisseria meningitidis_ (_N. meningitidis_) serogroup Y, resistant to penicillin and not sensitive to cefotaxime [and ceftriaxone?], two 3rd generation antibiotics, reports La Nation.
====================
[Invasive meningococcal disease (meningococcaemia and meningitis) is a life-threatening infection caused by _Neisseria meningitidis_ that evolves rapidly, often even when appropriate treatment has been started promptly. Because antimicrobial treatment for invasive meningococcal disease with a 3rd-generation cephalosporin (cefotaxime and ceftriaxone) is the widely accepted standard recommendation (<https://academic.oup.com/cid/article/39/9/1267/402080>), resistance of _N. meningitidis_ to cefotaxime and ceftriaxone is very worrisome.

The news report above says that 2 patients in Costa Rica were infected with _N. meningitidis_ serogroup Y resistant to penicillin and 2 3rd generation cephalosporins, one of which was cefotaxime. The other 3rd generation cephalosporin is not specified, but is perhaps ceftriaxone, the other 3rd generation cephalosporin usually used to treat this disease. We are also not told in the news report above if the 2 patients were epidemiologically linked, nor are we told the extent (that is, MICs [minimum inhibitory concentration] of penicillin or cefotaxime), the mechanisms of resistance, or resistance to any of the other antimicrobial drugs used to prevent or treat this disease.

More information would be appreciated from knowledgeable sources. Reduced susceptibility of _N. meningitidis_ to penicillin has been reported in the past in many countries, including the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>), usually due to decreased affinity of target penicillin-binding proteins for penicillin and less commonly to beta-lactamase production (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC89938/>, <https://pubmed.ncbi.nlm.nih.gov/3134848-relative-penicillin-g-resistance-in-neisseria-meningitidis-and-reduced-affinity-of-penicillin-binding-protein-3/>, and <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC162989/pdf/392577.pdf>).

Meningococcal isolates with reduced susceptibility to penicillin G usually were reported susceptible to 3rd-generation cephalosporins (cefotaxime and ceftriaxone). For example, despite the decrease in susceptibility to penicillin G in 33% of 2888 isolates of _N. meningitidis_, all isolates were susceptible to ceftriaxone in Brazil from 2009 to 2016 (<https://pubmed.ncbi.nlm.nih.gov/29717974-surveillance-of-antimicrobial-resistance-in-neisseria-meningitidis-strains-isolated-from-invasive-cases-in-brazil-from-2009-to-2016/>). Similar data have been reported for the US (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169190/>).

However, one previous study reported 8 clinical isolates _N. meningitidis_ in Delhi, India in 2006 that were resistant to ceftriaxone and cefotaxime, with most also resistant to penicillin, ciprofloxacin, and chloramphenicol (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698303/>). All of the isolates were identified as serogroup A _N. meningitidis_, but no further details concerning these isolates were given in this report (<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1865813/>).

Resistance to other antimicrobial agents that may be used for therapy of meningococcal infections or for prophylaxis of case contacts has been reported in several countries. This includes resistance to chloramphenicol, fluoroquinolones, and rifampin. Horizontal exchange of genes that encode resistance for penicillin, rifampin, and the fluoroquinolones from other _Neisseria_ species that share a common ecological niche with _N. meningitidis_ in the nasopharynx has been proposed as one possible mechanism of acquisition of meningococcal antibiotic resistance (<http://jac.oxfordjournals.org/cgi/content/full/49/3/545>). - ProMED Mod.ML]

[HealthMap/ProMED-mail map of Costa Rica: <http://healthmap.org/promed/p/17>]
Date: Tue 21 Jan 2020
Source: Ahora Noticias, Costa Rica [in Spanish, machine trans., edited]
<https://www.ahoranoticiascr.com/2020/01/21/autoridades-cerraron-pizzeria-debido-a-casos-de-hepatitis-a-en-san-ramon/>

As many as 22 people suffered from hepatitis A infection in San Ramon de Alajuela, and consequently the Health authorities closed a pizzeria in the area. A source close to this media confirmed the existence of the cases which were detected since 13 Jan 2020.

The cases were thought to be related to food consumption in that establishment 4 of patients were employees of the pizzeria. In statements to the media La Nación, Azalea Espinoza of the Directorate of Surveillance of the Ministry of Health, said they intervened in the business, issued a closing health order, and proceeded to cleaning and disinfecting it. [Byline: Carlos Miranda]
========================
[Although the eating establishment was identified as a pizzeria, pizza itself is not likely to be the vehicle of transmission as it is cooked before serving unless ingredients are added after the cooking process. It is unclear if the pizzeria employees were the source of, or just part of, the outbreak.

With an incubation period averaging 28 but up to 45 days, more cases may occur. The cases are not broken down in regard to age. In children, most cases of HAV infection are subclinical so it is likely that the cases reported were in adults. In the developing world, HAV is not reported much in adults as most children have been infected, and therefore immune to subsequent infection, by the age of 10. That outbreaks are occurring in the area suggests improvement in potable water so fewer children are infected and therefore still susceptible to HAV as adults. - ProMED Mod.LL]

[HealthMap/ProMED map available at: Costa Rica:
<http://healthmap.org/promed/p/17>]
Date: Wed, 8 Jan 2020 02:28:38 +0100 (MET)

San José, Jan 8, 2020 (AFP) - Costa Rica on Tuesday vehemently objected to the US government's decision to raise the alert level for tourists visiting the Central American country due to the risk of crime.   "We express energetic protest on the part of the Costa Rican government for the decision to change the recommendation level for American tourists," said foreign minister Manuel Ventura.

Ventura's statement came shortly after the US government issued a new travel advisory for visitors to Costa Rica.   According to the alert, "petty crime is the predominant threat for tourists in Costa Rica."   But the advisory warns that "armed robbery, homicide and sexual assault" could also occur.   Costa Rica also rose from Level 1, the lowest level, to Level 2 on he US State Department's travel alert scale. The highest is Level 4, which recommends no visiting.

The Central American country, known for its natural resources and beaches, attracts 1.2 million US tourists each year, according to official figures. In 2019, a total of more than 3 million foreign tourists visited.   "The change is surprising, because it puts Costa Rica -- which ended 2019 with a rate of 11 homicides per 100,000 inhabitants -- on par with countries on the continent that are among the most violent in the world," the Costa Rican foreign ministry said in a statement.

Data from the Ministry of Public Service indicates that there were 688 cases of theft of mobile phones, passports and money from tourists in 2019 -- only 0.02 percent of visitors to Costa Rica.   Tourism in Costa Rica has been shaken in recent years by several murders of female tourists, as well as sexual violence, including a Venezuelan-American woman who was killed near her hotel outside of the capital San Jose.
Date: Thu 8 Jan 2020
Source: Outbreak News Today [edited]

The Costa Rica Ministry of Health reported [Tue 7 Jan 2019] (computer translated) on the 2nd ever _Naegleria fowleri_, or "brain-eating amoeba" infection in their history.

The case is a 15-year-old who is presenting with a clinical picture of primary amebic meningoencephalitis (PAM) remains in a serious state at the Liberia Hospital. The investigation into the case shows the young man acquired the amoeba by inhaling water in the thermal springs of Guayabo de Bagaces.

The 1st case of primary amebic meningoencephalitis in the history of Costa Rica was recorded in 2014 in an American child who later died.

_Naegleria fowleri_ is a microscopic amoeba which is a single-celled living organism. It can cause a rare and devastating infection of the brain called primary amebic meningoencephalitis (PAM). The amoeba is commonly found in warm freshwater such as lakes, rivers, ponds and canals.

Infections can happen when contaminated water enters the body through the nose. Once the amoeba enters the nose, it travels to the brain where it causes PAM (which destroys brain tissue) and is usually fatal. Infections usually occur when it is hot for prolonged periods of time, which results in higher water temperatures and lower water levels.  _Naegleria fowleri_ infections are rare. Most infections occur from exposure to contaminated recreational water. Cases due to the use of neti pots and the practice of ablution have been documented.

[Byline: Robert Herriman]
=======================
[Amoebic meningoencephalitis is rare but is found worldwide and the reservoir is fresh water sources like lakes and rivers. It has been discussed if it is found in household water supplies, but so far cases have not been linked to tap water although it is possible in theory. - ProMED Mod.EP]

[HealthMap/ProMED map available at:
Date: Fri 25 Oct 2019
From: Donald J. Brightsmith <dbrightsmith@cvm.tamu.edu> [edited]

There have been 37 cases of autochthonous transmission of malaria in 2019 as reported by the Costa Rican Ministry of Health (<https://www.ministeriodesalud.go.cr/index.php/vigilancia-de-la-salud/analisis-de-situacion-de-salud>). The ministry also reports 39 cases of malaria in country that were likely contracted in foreign countries, mostly in Nicaragua.

The autochthonous cases came mostly from the northern part of the country in the district of Crucitas, but cases were also reported from other areas of the country.
---------------------------------------------------
Donald J. Brightsmith
University College of Veterinary Medicine & Biomedical Sciences
Texas A&M University
College Station, TX
=============================
[ProMed thanks Dr. Donald J. Brightsmith for communicating this to us.

This is a comment from the WHO website, "Costa Rica: 'Ripe' for malaria elimination?"

"Costa Rica is one of 21 countries identified by WHO as having the potential to eliminate malaria by 2020. Its success in bringing down cases of indigenous malaria -- that is, transmission of the malaria parasite within a country's own borders -- has been commendable, so much so that it has received an award from the Pan American Health Organization in recognition of the strides made. Notably, no one has died from malaria since 2009.

"However, after recording 3 consecutive years of zero indigenous cases between 2013 and 2015, local transmission of the disease has slowly been creeping upwards: 4 cases in 2016 and 12 in 2017. Of equal concern is imported malaria: To date, 21 such cases have been detected in 2018, up from 5 for all of 2017.

"In June 2018, the Costa Rican Ministry of Health issued a public health alert following the reporting of 10 imported malaria cases in just one week in the country's northern region bordering malaria-endemic Nicaragua. The Ministry is working to quickly identify and treat imported cases to prevent onward transmission to local communities in high-risk zones of the country. The areas of concern are mainly agricultural sites, like banana plantations.

"One such area is the canton of Matina, home to some of Costa Rica's largest plantations that grow the yellow fruit. Situated next to a major port on the Caribbean Sea, the canton's agricultural produce is shipped to markets worldwide, making Matina an important economic hub.

"Although Matina is far from the area of the recent alert, and no cases of malaria have been reported this year, all 4 indigenous cases reported in 2016 originated from the canton, as well as 2 of the 12 indigenous cases in 2017. Health authorities are not taking any chances and are working with the canton's fincas bananeras (banana plantations) to step up malaria surveillance activities, particularly among plantation workers and nearby communities." - ProMED Mod.EP]

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

World Travel News Headlines

Date: Tue, 26 May 2020 09:15:57 +0200 (METDST)

Riyadh, May 26, 2020 (AFP) - Saudi Arabia will end its nationwide coronavirus curfew from June 21, except in the holy city of Mecca, the interior ministry said Tuesday, after more than two months of stringent curbs.   Prayers will also be allowed to resume in all mosques outside Mecca from May 31, the ministry said in a series of measures announced on the official Saudi Press Agency.   The kingdom, which has reported the highest number of virus cases in the Gulf, imposed a full nationwide curfew during Eid al-Fitr, the Muslim holiday that marks the end of the fasting month of Ramadan.

The ministry said it will begin easing restrictions in a phased manner this week, with the curfew relaxed between 6 am and 3 pm between Thursday and Saturday.   From Sunday until June 20, the curfew will be further eased until 8 pm, the ministry added.   The kingdom will lift the lockdown entirely from June 21.   "Starting from Thursday, the kingdom will enter a new phase (in dealing with the pandemic) and will gradually return to normal based on the rules of social distancing," Health Minister Tawfiq Al-Rabiah said on Monday.   Saudi Arabia has reported around 75,000 coronavirus infections and some 400 deaths from COVID-19.

In March, Saudi Arabia suspended the year-round "umrah" pilgrimage over fears of the disease spreading in Islam's holiest cities.   That suspension will remain in place, the interior ministry said.   Authorities are yet to announce whether they will proceed with this year's hajj -- scheduled for late July -- but they have urged Muslims to temporarily defer preparations for the annual pilgrimage.   Last year, some 2.5 million faithful travelled to Saudi Arabia from around the world to participate in the hajj, which Muslims are obliged to perform at least once during their lifetime.
Date: Tue, 26 May 2020 05:52:24 +0200 (METDST)

Santiago, May 26, 2020 (AFP) - Chile registered a new high for coronavirus cases on Monday, with nearly 5,000 infections in 24 hours, including two ministers in President Sebastian Pinera's government.   Health authorities announced 4,895 new infections in the South American country and 43 deaths.

Public Works Minister Alfredo Moreno and Energy Minister Juan Carlos Jobet said they were among those with the disease.   "I have been informed that the COVID-19 test I had a few days ago was positive," Moreno said on Twitter, adding that he had no symptoms so far.   The 63-year-old minister had placed himself in quarantine after one of his staff tested positive.  Jobet also tested positive after starting to quarantine preventatively on Saturday, "when he experienced mild symptoms, which could be associated with the disease," a statement from the Energy Ministry said.

The 44-year-old minister "has had no direct contact with President Sebastian Pinera or other cabinet members in recent days," the statement said, without specifying how he became infected.   Three other ministers, who had self-quarantined after being in contact with infected people, all tested negative and resumed work.

Chile suffered a surge in infections last week, prompting the government to order the lockdown of Santiago.   The capital is the main focus of the pandemic in Chile, with 90 percent of the country's 74,000 cases.   Last week, the Senate was closed after three senators tested positive for the coronavirus. Sessions were held by video conference.
Date: Tue, 26 May 2020 01:15:01 +0200 (METDST)

Quito, May 25, 2020 (AFP) - Demonstrators defied coronavirus restrictions to march in cities across Ecuador on Monday in protest against President Lenin Moreno's drastic economic measures to tackle the crisis.   Moreno last week announced public spending cuts including the closure of state companies and embassies around the world, but trade unions Monday said workers were paying a disproportionate price compared to Ecuador's elite.   "This protest is because the government is firing workers to avoid making the rich pay," Mecias Tatamuez, head of the county's largest union, the Unitary Front of Workers (FUT), told reporters at a march in Quito.

Around 2,000 people marched in the capital, waving flags and banners and shouting anti-government slogans.   The protesters wore masks and respected distancing measures recommended against the spread of the coronavirus that has caused at least 3,200 deaths in the country, making it South America's worst hit nation per capita. Authorities say more than 2,000 further deaths are likely linked to the virus.

Demonstrations took place in several other cities, including Guayaquil, the epicentre of Ecuador's health crisis, where union leaders said hundreds marched through the city.   Moreno ordered the closure of Ecuadoran embassies, a reduction in diplomatic staff and scrapped seven state companies as part of measures designed to save some $4 billion.    He also announced the liquidation of the TAME airline, which has lost more than $400 million over the last five years.

The government says the pandemic has so far cost the economy at least $8 billion.   Public sector working hours have been cut by 25 percent, with an accompanying 16 percent pay cut.   Moreno said on Sunday that 150,000 people had lost their jobs because of the coronavirus.   Ecuador was struggling economically before the pandemic hit, due to high debt and its dependence on oil.   The IMF predicts that the economy will shrink by 6.3 percent this year, the sharpest drop of any country in South America.
Date: Mon, 25 May 2020 22:20:46 +0200 (METDST)

Dublin, May 25, 2020 (AFP) - Ireland recorded no new deaths from the coronavirus on Monday for the first time since March 21.   Prime Minister Leo Varadkar called it a "significant milestone", adding on Twitter: "This is a day of hope. We will prevail."

The announcement came one week after Ireland, which has suffered 1,606 deaths from 24,698 infections, began to ease lockdown measures that had been in place for nearly two months.   Ireland entered lockdown in late March, recording a peak of 77 deaths on a single day on April 20.   "In the last 24 hours we didn't have any deaths notified to us," chief medical officer Tony Holohan said at a daily press briefing.   He warned that the zero figure could be a result of a lag in reporting of deaths over the weekend, but he added: "It's part of the continued trend that we've seen in (the) reduction in the total number of deaths."

Ireland has announced a five-step plan to reopen the nation by August and took the first steps last Monday -- allowing outdoor employees to return to work, some shops to reopen and the resumption of  activities such as golf and tennis.   While the news of no fresh deaths was greeted as progress, officials remain concerned there will be a "second wave" as the lockdown is loosened.   "The number of new cases and reported deaths over the past week indicates that we have suppressed COVID-19 as a country," Holohan added in a statement.   "It will take another week to see any effect on disease incidence that might arise from the easing of measures."
Date: Mon, 25 May 2020 21:59:40 +0200 (METDST)

Luxembourg, May 25, 2020 (AFP) - Luxembourg will ease its coronavirus restrictions on Wednesday, reopening cafes and restaurants and allowing civil and religious ceremonies under strict conditions, the government announced.   The tiny country has so far registered only 3,993 COVID-19 cases, of which 110 have been fatal. Four people are in intensive care and shops were closed on March 18 to slow the spread of the new coronavirus.

Prime Minister Xavier Bettel told a news conference on Monday that eateries could reopen terraces with a maximum of four people at a single table.   Indoor dining in cafes and restaurants will resume on Friday, he said, with social distancing of 1.5 metres (five feet) between groups.   Marriages and funerals will also be allowed if the attendees wore face masks and kept two metres distance from each other.   Bettel however said cafes and restaurants would have to close at midnight.

Francois Koepp, the general secretary of the Horeca federation grouping hotels, restaurants and cafes, welcomed the announcement, saying the sector had "greatly suffered from the confinement".   He said it provided employment to some 21,000 people in this nation of 620,000 inhabitants.   Cinema theatres and gyms will open at the end of the week but children's parks will remain closed.   The government has pledged to give every citizen over 16 a voucher worth 50 euros ( $54) to spend in hotels to provide a boost to the sector.   The vouchers will also be given to some 200,000 cross border workers from Belgium, France and Germany.
Date: Mon, 25 May 2020 20:36:16 +0200 (METDST)

Prague, May 25, 2020 (AFP) - The Czech Republic and Slovakia will reopen their border this week for those travelling to the other country for up to 48 hours, Czech Prime Minister Andrej Babis said Monday.   "This will be possible without tests or quarantine" starting Wednesday, he added in a message posted on Twitter.   The Czech Republic and Slovakia formed a single country until 1993. Babis himself was born in the Slovak capital of Bratislava.

Both countries have fared well in the current pandemic, with Slovakia posting the lowest death toll per capita in the EU and the Czech Republic keeping its COVID-19 figures down as well.   The Czech government will also open border crossings with Austria and Germany on Tuesday but will still require negative COVID-19 tests from those entering the country.   "We have negotiated similar conditions on the other side of the border with our German and Austrian colleagues," Interior Minister Jan Hamacek said.   The interior ministry said blanket border checks would be replaced by random ones and added it would still not allow tourists into the country.

Czech Health Minister Adam Vojtech said the government was working on other measures to ease the travel restrictions adopted in mid-March.   "We would like to introduce them next week," he added.   Vojtech said EU citizens could now come to the Czech Republic "on business or to visit their family for a maximum of 72 hours if they submit a negative coronavirus test."

The country is also accessible to non-EU citizens who do seasonal jobs there, on condition they have tested negative.   Czech restaurants, bars, hotels, castles, zoos and swimming pools have been open since Monday, when the government lifted many anti-virus measures.   Czechs also no longer have to wear face masks outside their homes, except in shops and on public transport.
Date: Mon, 25 May 2020 17:45:38 +0200 (METDST)
By Shafiqul ALAM

Dhaka, May 25, 2020 (AFP) - Some 15,000 Rohingya refugees are now under coronavirus quarantine in Bangladesh's vast camps, officials said Monday, as the number of confirmed infections rose to 29.   Health experts have long warned that the virus could race through the cramped settlements, housing almost a million Muslims who fled violence in Myanmar, and officials had restricted movement to the area in April.

Despite this, the first cases in the camps were detected in mid-May.   "None of the infections are critical. Most hardly show any symptoms. Still we have brought them in isolation centres and quarantined their families," Toha Bhuiyan, a senior health official in the surrounding Cox's Bazar area told AFP.   He said narrow roads to three districts of the camps -- where the majority of the infections were detected -- have been blocked off by authorities.

The 15,000 Rohingya inside these so-called blocks faced further restrictions on their movement, he said.   It comes as charity workers expressed fears over being infected in the camps as they worked without adequate protection.   Two of the areas under isolation are in Kutupalong camp, home to roughly 600,000 Rohingya.   "We are trying to scale up testing as fast as possible to make sure that we can trace out all the infected people and their contacts," Bhuiyan said.

Seven isolation centres with the capacity to treat more than 700 COVID-19 patients have been prepared, he said.   Officials hope to have just under 2,000 ready by the end of May, he added.   Mahbubur Rahman, the chief health official of Cox's Bazar, said authorities hoped this week they would double the number of tests being performed daily from 188.   He said further entry restrictions have been imposed on the camp, with a 14 day quarantine in place for anyone visiting from Dhaka.   "We are very worried because the Rohingya camps are very densely populated. We suspect community transmission (of the virus) has already begun," Rahman told AFP.

- 'Very little awareness' -
Bangladesh on Monday notched up a record single-day spike in coronavirus cases, with 1,975 new infections, taking the toll to 35,585 cases and 501 deaths.   In early April authorities imposed a complete lockdown on Cox's Bazar district -- home to 3.4 million people including the refugees -- after a number of infections.

But a charity worker with one of the many aid organisations active in the camps said Monday he and many others were "very worried".   "Fear and panic has gripped aid workers because many of us were forced to work without much protection," he told AFP without wishing to be named.   "Social distancing is almost impossible in the camps. There is very little awareness about COVID-19 disease among the refugees, despite efforts by aid agencies."

The lack of information is exacerbated by local authorities having cut off access to the internet in September to combat, they said, drug traffickers and other criminals.   More than 740,000 Rohingya fled a brutal 2017 military crackdown in Myanmar to Cox's Bazar, where around 200,000 refugees were already living.
Date: Mon, 25 May 2020 15:25:38 +0200 (METDST)

Antananarivo, May 25, 2020 (AFP) - Madagascar's government has announced it will dispatch troops and doctors to an eastern town after several bodies were found in the streets and where two people died from the novel coronavirus.   Madagascar's cabinet held a special meeting on Sunday to discuss the situation in Toamasina, the country's second largest city.   The Indian Ocean island nation has registered 527 infections and two deaths, both in Toamasina.

Since Thursday, more than 120 new cases were confirmed, and several bodies were found in the city's streets though the cause of death was not clear.   "Doctors must carry out thorough examinations to see if these deaths are caused by another illness (...) or if they are really due to severe acute respiratory problems which is the critical form of COVID-19," Professor Hanta Marie Danielle Vololontiana, spokesperson for the government's virus taskforce, said in a national broadcast on Sunday.   The government will send 150 soldiers to reinforce Toamasina, maintain order and enforce measures against the coronavirus such as mask wearing and social distancing.

The cabinet also fired Toamasina's prefect without providing any explanation.    A team was also ordered to distribute a drink based on artemisia, a plant recognised as a treatment against malaria, which the Malagasy authorities claim cures COVID-19.    The potential benefits of this herbal tea, called Covid-Organics, have not been validated by any scientific study.    The cabinet has also announced an investigation into the death of a doctor in Toamasina. According to local press, the victim was hospitalised after contracting COVID-19 and was found dead hanged in his room on Sunday morning.
Date: Mon, 25 May 2020 09:20:17 +0200 (METDST)
By Bhuvan Bagga with Indranil Mukherjee in Mumbai

New Delhi, May 25, 2020 (AFP) - Domestic flights resumed in India on Monday even as coronavirus cases surge, while confusion about quarantine rules prompted jitters among passengers and the cancellation of dozens of planes.   India had halted all flights within the country, and departing and leaving for abroad, in late March as it sought to stop the spread of coronavirus with the world's largest lockdown.   But desperate to get Asia's third-largest economy moving again, the government announced last week that around 1,050 daily flights -- a third of the usual capacity -- would resume on Monday.

Aviation Minister Hardeep Singh Puri said strict rules would include mandatory mask-wearing and thermal screenings, although middle seats on the aircraft would not be kept empty.   The announcement reportedly caught airlines and state authorities off-guard, with several local governments announcing that passengers would have to go into quarantine for two weeks on arrival.   Maharashtra, the Indian state with the highest number of coronavirus cases, capped at 50 the number of departures and arrivals in and out of its capital Mumbai.

Airlines scrapped dozens of flights on Monday while hundreds of passengers cancelled their bookings, reports said.   The NDTV news channel said 82 flights to and from New Delhi had been cancelled and nine at Bangalore airport.   Other flights from cities including infection hotspots Mumbai and Chennai were struck off, many at short notice, reports said.   At Mumbai airport social distancing was forgotten as irate passengers harangued staff after their flights were cancelled at the last minute.

- 'Really scary' -
At New Delhi airport, hundreds of people anxious to get home but apprehensive about the risks queued from before dawn -- all wearing masks and standing at least one metre (three feet) apart.   Security personnel behind plastic screens verified check-in documents and that passengers had the government contact tracing app, Aarogya Setu, on their phones.

"While I'm looking forward (to flying home), the idea of flying is really scary," student Gladia Laipubam told AFP as she stood in line.   "Anything can happen. It's very risky. I don't really know when I'll be able to come back to Delhi now. There is no clarity from the university too at this time."   One female airline employee wearing gloves, a mask and a protective face shield said she and many other colleagues felt "very nervous" about starting work again.   "Dealing with so many people at this time is so risky. I must have interacted with at least 200 people since this morning," she told AFP, not wishing to be named.

Cabin crew on the planes had to wear full protective suits with masks, plastic visors and blue rubber gloves, and many were also confused about the rules, the Press Trust of India reported.   "There is no clarity on whether I need to go into home quarantine for 14 days after returning to my base or show up for duty on Monday," one pilot told PTI.   New coronavirus cases in India crossed 6,000 for the third consecutive day on Sunday, surging to a record single-day spike of 6,767 infections.   The country has recorded almost 140,000 cases and over 4,000 deaths.   Singh has said that international flights could resume in June, although dozens of special flights have in recent weeks brought back some of the hundreds of thousands of Indians stuck abroad.
Date: Fri, 22 May 2020 11:02:28 +0200 (METDST)

Suva, Fiji, May 22, 2020 (AFP) - A huge fire at one of Suva's largest markets blanketed the Fijian capital in thick smoke before it was brought under control Friday, firefighters said.   The blaze engulfed the Suva Flea Market, a major tourist attraction near the waterfront, sending plumes of acrid black smoke into the air.   The National Fire Authority said an adjoining shop was also badly damaged but there were no reports of injuries.   "It's been stopped now and no one was injured but that's all we can say at the moment," a spokesman told AFP.   The said the cause of the fire was being investigated.