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Greenland

Located to the northeast of Canada, Greenland lies mostly within the Arctic Circle, extending to within less than 500 miles (800 km) of the North Pole. It is bordered on the north by the Lincoln Sea and the Arctic Ocean, and on the east and south by the G
eenland Sea, the Denmark Strait, and the Atlantic Ocean.

Its climate is bleak and Arctic, although rapid changes like bright sunshine and powerful blizzards are common. Average January and July temperatures in the south are 21°F (-6°C) and 45°F (7°C). In the north, average January and July temperatures are -31°F (-35°C) and 39°F (4°C). Average monthly precipitation decreases from 9 inches (24 cm) in the south to about half an inch (1.5 cm) in the north. Although summer rainfall is concentrated in the southwest, snow can fall in any month. Summers can be rather pleasant on the southwest coast, but the inland ice is uniformly cold, with a July average of 10°F (-12°C) and a February mean of -53°F (-47°C).

Health Precautions
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General Cautions
Recent medical and dental exams should ensure that the traveler is in good health. Carry appropriate health and accident insurance documents and copies of any important medical records. Bring an adequate supply of all prescription and other medications as well as any necessary personal hygiene items, including a spare pair of eyeglasses or contact lenses if necessary.

Denmark, Greenland and the Faeroe Islands US Consular Information Sheet
August 15, 2006
COUNTRY DESCRIPTION: Denmark is a highly developed stable democracy with a modern economy. Greenland is a self-governing dependency of Denmark. The Faroe Islands are a self-governing overseas administrative division of Denmark. Read the Department of State Background Notes on Denmark for additional information.

ENTRY REQUIREMENTS: Passport and visa regulations are similar for Denmark, Greenland, and the Faroes. A valid passport is required. U.S. citizen tourist and business travelers do not need visas for visits of up to 90 days. That period begins when entering any of the following countries which are parties to the Schengen agreement: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, The Netherlands, Norway, Portugal, Spain, and Sweden. See our Foreign Entry Requirements brochure for more information on Denmark and other countries. Contact the Royal Danish Embassy at 3200 Whitehaven Street, N.W. Washington, DC 20008, telephone (202) 234-4300 or visit its website at for the most current visa information.

Note: Although European Union regulations require that non-EU visitors obtain a stamp in their passports upon initial entry to a Schengen country, many borders are not staffed with officers carrying out this function. If an American citizen wishes to ensure that his or her entry is properly documented, it may be necessary to request a stamp at an official point of entry. Under local law, travelers without a stamp in their passports may be questioned and asked to document the length of their stay in Schengen countries at the time of departure or at any other point during their visit, and could face possible fines or other repercussions if unable to do so.

Find more information about Entry and Exit Requirements pertaining to dual nationality and the prevention of international child abduction .
SAFETY AND SECURITY: Denmark remains largely free of terrorist incidents, however the country shares, with the rest of Western Europe, an increased threat of Islamic terrorism. Like other countries in the Schengen area, Denmark's open borders with its Western European neighbors allow the possibility of terrorist groups entering and exiting the country with anonymity. Americans are reminded to remain vigilant with regard to their personal security and to exercise caution.

Public demonstrations occasionally occur in Copenhagen and other Danish cities and are generally peaceful events. Prior police approval is required for public demonstrations, and police oversight is routinely provided to ensure adequate security for participants and passers-by. Nonetheless, as with any large crowd comprised of diverse groups, situations may develop which could pose a threat to public safety. U.S. citizens are advised to avoid areas where public demonstrations are taking place.
For the latest security information, Americans traveling abroad should regularly monitor the Department of State's web site , where the current Worldwide Caution Public Announcement , Travel Warnings, and Public Announcements can be found.

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas. For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State's pamphlet A Safe Trip Abroad .
CRIME: Denmark, Greenland, and the Faroes all have very low violent crime rates, however, non-violent crimes of opportunity have slightly increased over the last few years, especially in Copenhagen and other major Danish cities, where tourists can become targets for pickpockets and sophisticated thieves. Criminals frequent airports, train stations, and cruise ship quays to take advantage of weary, luggage-burdened travelers. Thieves also operate at popular tourist attractions, shopping streets, and restaurants. In hotel lobbies and breakfast areas, thieves take advantage of even a brief lapse in attention to snatch jackets, purses, and backpacks. Women's purses placed either on the backs of chairs or on the floor are typical targets for thieves. Car and home break-ins are also on the rise.

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

Denmark has a program to provide financial compensation to victims who suffer serious criminal injuries. According to existing regulations, the victim must report the incident to the police within 24 hours. Danish police routinely inform victims of serious crime of their rights to seek compensation. The relevant forms can be obtained from the police or the Danish Victims' Compensation Board: Civilstyrelsen, Erstatningsnaevnet, Gyldenløvesgade 11, 1600 Copenhagen V, TEL: (45) 33-92- 3334; FAX: (45) 39-20-45-05; www.erstatningsnaevnet.dk ; Email: erstatningsnaevnet@erstatningsnaevnet.dk . Claim processing time is a minimum of 4 weeks. There is no maximum award limit.

See our information for Victims of Crime .
MEDICAL FACILITIES AND HEALTH INFORMATION: Excellent medical facilities are widely available in Denmark. In Greenland and the Faroe Islands, medical facilities are limited and evacuation is required for serious illness or injury. Although emergency medical treatment is free of charge, the patient is charged for follow-up care.

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 (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC's website at . 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 .

MEDICAL INSURANCE: The Department 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 Denmark is provided for general reference only, and may not be totally accurate in a particular location or circumstance.

A valid U.S. driver's license may be used while visiting Denmark, but the driver must be at least 18 years old. Driving in Denmark is on the right side of the road. Road signs use standard international symbols. Many urban streets have traffic lanes reserved for public transport only. Unless otherwise noted on traffic signs, the speed limit is 50 km/h in urban areas, 80 km/h on open roads, and 130 km/h on expressways.

Use of seat belts is mandatory for drivers and all passengers. Children under three years of age must be secured with approved safety equipment appropriate to the child's age, size, and weight. Children from three to six years of age may use approved child or booster seats instead of seat belts.

Driving under the influence of alcohol or drugs is considered a very serious offense. The rules are stringently enforced, and violations can result in stiff fines and possible jail sentences.

Copenhagen, the capital and largest city in Denmark, has an extensive and efficient public transportation system. Trains and buses connect Copenhagen with other major cities in Denmark and to Norway, Sweden, and Germany. Bicycles are also a common mode of transportation in Denmark. Passengers exiting public or tourist buses, as well as tourists driving rental cars, should watch for bicycles on their designated paths, which are usually located between the pedestrian sidewalks and the traffic lanes.

Danish expressways, highways, and secondary roads are of high quality and connect all areas of the country. It is possible to drive from the northern tip of Denmark to the German border in the south in just four hours. Greenland has no established road system, and domestic travel is performed by foot, boat, or by air. The majority of the Faroe Islands are connected by bridges or serviced by boat. Although the largest islands have roads, most domestic travel is done on foot, horseback, boat, or by air.

The emergency telephone number for police/fire/ambulance in Denmark and the Faroe Islands is 112. In Greenland contact the local police.

Please refer to our Road Safety page for more information. Visit the website of the country's national tourist office and national authority responsible for road safety at . See also additional information on driving in Denmark at .

AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the government of Denmark's Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Denmark's air carrier operations. This rating applies to Greenland and the Faroe Islands as well. For more information, travelers may visit the FAA's Internet website at www.faa.gov/safety/programs_initiatives/oversight/iasa .

SPECIAL CIRCUMSTANCES: The official unit of currency in Denmark is the Danish krone. ATM machines are widely available throughout Denmark. Please see our information on customs regulations .

For information concerning the importation of pets into Denmark, please visit the following website:
.

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 protection 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 Denmark's laws, even unknowingly, may be expelled, arrested, or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Denmark are severe and convicted offenders can expect long jail sentences and heavy fines. Engaging in sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States. Please see our information on Criminal Penalties .

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

REGISTRATION/EMBASSY LOCATION: Americans living or traveling in Denmark are encouraged to register with the nearest U.S. Embassy or Consulate through the State Department's travel registration website , and to obtain updated information on travel and security within Denmark. 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 Dag Hammarskjolds Alle 24; 2100 Copenhagen, telephone: (45) 33-41-71-00; Embassy fax: (45) 35-43-02-23; Consular Section fax: (45) 35-38-96-16; After-hours emergency telephone: (45) 35-55-92-70. Information is also available via the U.S. Embassy's website at http://www.usembassy.dk. The United States has no consular presence in Greenland or the Faroe Islands.
* * *
This replaces the Consular Information Sheet dated February 10, 2006, to update the section on Entry Requirements and Traffic Safety and Road Conditions.

Travel News Headlines WORLD NEWS

Date: Thu, 17 Oct 2019 05:32:08 +0200 (METDST)
By Tom LITTLE

Kulusuk, Denmark, Oct 17, 2019 (AFP) - Kayaking past blue-white icebergs drifting along near a pristine harbour, wandering around colourful houses or trekking in the snow-capped wilderness: July and August are high season for tourists in eastern Greenland.   Many of the 85,000 tourists who visit each year head to the west coast, but eastern Greenland, with its glaciers, wilderness and wildlife starring whales and polar bears, is also drawing visitors.

Sarah Bovet, a 29-year-old Swiss artist, said it's hard to know what to expect.   "Thinking you're going to be surprised, you are even more so in reality," she said standing outside a hostel in the tiny village of Kulusuk.   Bovet was on an artistic residency in Greenland when she visited Kulusuk and its 250 souls.   Although she had imagined a small village before arriving, its stunning views and bright colours still came as a surprise.   With just one supermarket, an airport built in the 1950s by the US military to serve a Cold War radar base, and a harbour surrounded by brightly painted wooden houses, most of the villagers appreciate the extra revenue from tourism.

Justus Atuaq, a young hunter in Kulusuk, takes tourists out on sled tours in March and April -- the spring high season -- earning money that helps him feed and care for the dogs he uses for racing and hunting.   "Now I can take dogsleds for hunting, and sometimes tourists coming from other countries also want to dogsled," he said outside his wooden house.   Tourists also take boat trips during the summer high season from July to August.   Arrivals to the island grew 10 percent year-on-year from 2014 to 2017, and three percent in 2018, according to the tourist board, Visit Greenland.   Many adventure seekers and nature lovers arrive by plane, but cruise ships also bring admirers, hugging the picture perfect coastline.

- Growing strategic importance -
But they are not alone in taking an interest in the world's largest island.   The Danish territory's rich natural resources and growing strategic importance as the Arctic ice sheet melts have attracted the attention of US President Donald Trump.   The Arctic region has untapped reserves of oil, gas and minerals, as well as abundant stocks of fish and shrimp.   In August, Trump offered to buy Greenland, then called off a visit to Copenhagen over its refusal to sell.

Denmark colonised Greenland in the 1700s, granting it autonomy in 1979.    Today, many Greenlandic political parties advocate full independence.   The territory still receives an annual subsidy from Copenhagen, which was 4.3 billion Danish kroner (576 million euros) in 2017, and tourism could help it to become economically self-reliant.   Like many parts of Greenland, Kulusuk has no tarmac roads and visitors must travel by plane or boat.   The growth in tourism could put a strain on the village's infrastructure, and the sector faces unique challenges given Greenland's location, weather and the cost of travelling there.

Day tours of Kulusuk with flights from the Icelandic capital Reykjavik are 97,000 Icelandic kronur ($780, 700 euros).   Jakob Ipsen, a 48-year-old who grew up between Denmark and Greenland's west coast, runs Kulusuk's sole hotel.   The 32-room hotel stands beside a fjord, and from its dining room, guests can watch icebergs drift by during the summer.    But the region's isolation can be problematic, Ipsen admits.    "We have to get all our supplies in with the first ship for the whole summer season, and for the winter season when everything is frozen over, we have to get all our supplies in with the last ship for the whole winter," he said.

- 'They go back as different people' -
Greenland must tackle its infrastructure challenges if it wants to develop tourism, Visit Greenland says.   Government-funded work is under way to extend runways at the capital Nuuk and Ilulissat, both on the west coast, and a new airport is planned in the south.   The tourist body said it would weigh the environmental impact of boosting infrastructure, both on the environment and on local communities.    Ipsen worries about the effects of uncontrolled tourism to the region.   "We want to try to maintain it as it is, so it's not exploding," he said.

Already, said Johanna Bjork Sveinbjornsdottir, who runs tours in Kulusuk for an Iceland-based company, the rise in visitor numbers is making itself felt.   "In the campsites here out in nature where you used to be alone, there's two, three groups at a time," she said.   Like Ipsen, she is also concerned about the effect that rising visitor numbers could have on the wilderness around the village.    "If you want nature to survive that, you have to build up the infrastructure," she said, pointing to the lack of officially designated campsites around Kulusuk, with no rubbish bins or toilets for travellers outdoors and no one supervising the sites.   Despite the concerns, Sveinbjornsdottir hopes visitors will keep coming.   "They go back as different people," she said. "Everything is beyond what you ever imagined."
Date: Fri, 16 Nov 2018 14:19:01 +0100

Copenhagen, Nov 16, 2018 (AFP) - Greenland's parliament has adopted a plan to upgrade or build airports to serve the massive North Atlantic island, keen to attract more tourists to its pristine Arctic wilderness.   Two airports -- in the capital Nuuk and in the tourism centre Ilulissat -- will be substantially upgraded, making it possible to fly directly to Greenland from Europe and North America.

A new national airport will be built in Qaqortoq in the south.   Greenland is an autonomous Danish territory. The plans have been controversial because of Copenhagen's direct financial involvement.   The project is estimated to cost at least 3.6 billion kroner (482 millions euros, $546 million).   Almost 20 percent of the financing will be provided by Denmark, which contributes 3.6 billion kroner to the island's annual budget.   Parliament adopted the proposal late Thursday with 18 out of 29 votes.

In September, the project plunged Greenland into a three-week political crisis, with an independent supporting party quitting the government coalition in protest against Denmark's involvement.   The social democratic Siumut party, which has dominated Greenland politics for four decades, was ultimately able to cling to power with a new, narrower majority.   "We are creating lots of opportunities for Greenland's future. We are not selling out," Prime Minister Kim Kielsen insisted in parliament's debate, local television KNR reported.   The three airports will serve the main population centres of the island, which is home to 55,000 people spread out across an area more than four times the size of France.

Smaller communities have meanwhile complained they will remain isolated.   In addition, "other risks have also been raised, like the reaffirmed presence of the US military, which not everyone sees as a positive thing, and the environmental risks brought on by better international connections," Mikaa Mered, a professor of Arctic geopolitics at the ILERI School of International Relations in Paris, told AFP.

Since 2009, Greenland has been largely independent when it comes to its economic policy but foreign and defense issues remain under Copenhagen's control.   "The big winner in this affair is Copenhagen. Both on the political, economic and geopolitical levels, Copenhagen is strengthening its positions across the board, vis-a-vis China and the triangular alliance with Washington," Mered said, referring to Beijig's eagerness to invest in the Arctic which has raised concern in the US.   Construction of the airports is scheduled to be completed by 2023.
Date: Fri, 13 Jul 2018 14:25:42 +0200

Stockholm, July 13, 2018 (AFP) - A massive iceberg drifting near the coast of Greenland has triggered fears of flooding if it breaks up, leading the authorities to  evacuate a high-risk zone.    The authorities have urged residents of the Innarsuit island settlement with houses on a promontory to move away from the shore over fears that the iceberg, which was spotted on Thursday, could swamp the area.   "We fear the iceberg could calve and send a flood towards the village," Lina Davidsen, a security chief at the Greenland police, told Danish news agency Ritzau on Friday.

The settlement in northwestern Greenland has 169 inhabitants, but only those living closest to the iceberg have been evacuated, Ritzau reported.    "The iceberg is still near the village and the police are now discussing what do to next," Kunuk Frediksen, a police chief in the Danish autonomous territory, told AFP.   The incident comes weeks after scientists at New York University shot and released a video of a massive iceberg breaking free from a glacier in eastern Greenland in June.    Last year, four people died and 11 were injured after an earthquake sparked a tsunami off another island settlement called Nuugaatsiaq, sending several houses crashing into the sea.
Date: Mon, 14 Aug 2017 17:54:23 +0200

Stockholm, Aug 14, 2017 (AFP) - Police in Greenland warned people to stay away from western areas of the island as wildfires scorched swathes of scrubland.     In a statement, the police said it "still discourages all traffic -- including hiking and hunting -- in two areas around Nassuttooq and Amitsorsuaq."     "The fires are not expected to end within the next few days," the statement added.    Some of the blazes have been burning since July 31.

Denmark's meteorological service BMI said the island registered its hottest-ever temperature of 24.8 degrees (77 Fahrenheit) on August 10.   Last year was Greenland's hottest on record.    The Danish territory has lost about 4,000 gigatons of ice since 1995, British researchers said in June, making ice melt on the huge island the biggest single contributor to rising sea levels.
Date: Sun, 18 Jun 2017 16:10:26 +0200

Stockholm, June 18, 2017 (AFP) - Four people were listed as missing Sunday after an earthquake sparked a tsunami off Greenland and forced some residents to be evacuated.   "Four people are missing," local broadcaster KNR quoted local police chief Bjorn Tegner Bay as telling a news conference in the autonomous Danish territory.   There were no confirmed fatalities, but Bay said 11 houses had been swept away after a magnitude 4 overnight quake off Uummannaq, a small island well above the Arctic Circle.    "The huge waves risk breaking over Upernavik and its environs. The residents of Nuugaatsiaq are going to be evacuated," police said on Facebook, referring to nearby hamlets.

Some residents posted images to social media showing huge waves breaking over buildings in the town.   "A good explanation is that the quake created a fault at the origin of a tsunami," meteorologist Trine Dahl Jensen told Danish news agency Ritzau, warning of potential aftershocks.   "It's not normal, such a large quake in Greenland," she said.   KNR quoted Ole Dorph, mayor of Qaasuisup, a municipality in the area affected, as lamenting "a serious and tragic natural catastrophe which has affected the whole region."   Danish Prime Minister Lars Lokke Rasmussen tweeted news of what he termed a "terrible natural catastrophe at Nuugaatsiaq."   The world's largest island situated between the North Atlantic and Arctic oceans, Greenland, population 55,000, has an ice sheet particularly vulnerable to climate change.
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Zambia

Zambia US Consular Information Sheet
June 02, 2008
COUNTRY DESCRIPTION:
Zambia is a developing country in southern Africa. Tourist facilities outside of the capital, Lusaka, Livingstone (Victoria Falls), and well-known game parks are not f
lly developed. Read the Department of State Background Notes on Zambia for additional information.
ENTRY/EXIT REQUIREMENTS: A passport and visa are required. A visa may be obtained in advance at a Zambian Embassy or Consulate or at the port of entry. Zambia raised the visa fee for American passport holders to $135 as of January 26, 2008. American citizens should bring exact change, whenever practical. Visas are valid for 3 years, and for multiple entries. At the time of entry, the immigration officer will stamp your passport with the permitted length of stay. This is normally 30 days and can ordinarily be extended twice (for a total time of 90 days) by visiting the immigration home office in Lusaka. All Americans, except resident diplomats, must pay an airport departure tax which is collected in U.S. dollars. Airlines include this tax in the cost of the ticket. However, passengers will need to verify that this tax has been paid at the airport. The passenger will receive a “no-fee” receipt reflecting this payment.

Travelers transiting through South Africa should ensure that they have at least two blank (unstamped) visa pages in their passports. South African immigration authorities routinely turn away visitors who do not have enough blank visa pages in their passports. Zambian Immigration officials insist visitors carry the original or a certified copy of their passport and their immigration permit at all times. Certified copies must be obtained from the immigration office that issued the permit. American citizens should closely follow immigration guidelines, including visa requirements for travel to Zambia.
NOTE: Some tour operators were previously able to obtain visas at reduced rates using a special tourism waiver. Zambia announced that they were ending this waiver program as of January 26, 2008 and that all American tourists would be required to pay the new $135 fee. Travelers with outstanding reservations with tour operators should be prepared to pay the difference upon arrival in Zambia.
Additional information on entry requirements may be obtained from the Embassy of the Republic of Zambia, 2419 Massachusetts Avenue NW, Washington, DC 20008, telephone (202) 265-9717 or 19 or online at http://www.zambiaembassy.org. 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:
U.S. citizens are advised to exercise caution when traveling in northern Luapula Province and in areas of the Northern Province adjacent to the Democratic Republic of Congo (DRC). Although a cease-fire is currently in effect, the DRC is not yet stable and uncontrolled militias operate in the eastern DRC. In the past, armed gunmen have occasionally attacked vehicles near the DRC-Zambian border. Land mines and unexploded ordnance along the western, southern, and eastern borders make off-road travel to those areas potentially hazardous. For these reasons, the U.S. Embassy discourages travelers from driving off-road or on remote little-used tracks near the borders with DRC and Angola. American citizens who must drive in these areas are encouraged to drive in convoy and to carry satellite telephones.

U.S. citizens should avoid political rallies and street demonstrations and maintain security awareness at all times. For the latest security information, Americans traveling abroad should regularly monitor the Department 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 pamphletA Safe Trip Abroad.

CRIME: Travel in many sections of Lusaka, Livingstone and most other major cities as well as in the major game parks, is generally safe during daylight hours. Travelers using public transportation or visiting high pedestrian traffic areas are advised to be vigilant against robbery and pick-pocketing.

Vehicle thefts, burglaries, and armed robbery occur throughout the country. Carjacking remains an ongoing problem, especially in Lusaka and other major cities. Carjackers generally employ a strategy of blocking the back of one’s car when the car is waiting to pass through a security gate into a residence or other facility. It is recommended to drive with doors locked and windows closed at all times and remain vigilant when entering or exiting one’s residence.
Foreign tourists have frequently been the target of small-scale financial scams involving bogus “fees” to be paid to various Zambian officials and groups. The embassy cautions travelers to make sure that they receive an official, Government of Zambia receipt for any fines and duties paid. Often, travelers will be told that the official does not have a receipt book or that this type of fine is not receipted. Polite, but firm insistence on a Zambian Government receipt will often result in these fines disappearing.
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: Government hospitals and clinics are often understaffed and lack supplies. Private medical clinics in major cities can provide reasonable care in many cases, but major medical emergencies usually require medical evacuation to South Africa, Europe, or the United States. Basic medical care outside of major cities is extremely limited. Doctors and hospitals often expect immediate cash payment for health services. Travelers should carry their prescription drugs and medications in original labeled containers, as well as the written prescription from their physician. (See “Criminal Penalties” section.)
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 Zambia is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Traffic circulates on the left side of the road, and there are many British-style roundabouts rather than intersections with traffic lights. There is no left turn on red. Seat belts are mandatory, as are helmets for motorcyclists. A child's seat is not mandatory by law, but is essential for safeguarding children. The speed limit is 50 km/30 mph in Lusaka and 100 km/60 mph outside of city limits. However, speed limits are rarely respected, and most cars drive 80 km/50 mph in the city and 120 km/75 mph outside town. Most vehicles operate at even faster speeds on the road from Lusaka to Livingstone. Drivers under the influence of alcohol who are involved in accidents are tested at Lusaka's University Teaching Hospital (UTH) and then taken to court.

Driving on Zambian roads can be hazardous. Most roads do not have shoulders or sidewalks; pedestrians and livestock use the roadways both day and night. While the main roads in Lusaka as well as the principal highways linking Lusaka with the major provincial capital are generally maintained, many secondary roads are in poor repair. During the rainy season (end of October to mid-March), travelers who do not have a four-wheel drive vehicle will encounter problems driving on rural roads. Even in daylight, passing another vehicle can be particularly dangerous given the general condition of roads. Driving at night can be hazardous and is discouraged. When breakdowns occur, local drivers place a few branches behind the car to indicate trouble, but this is hardly visible at night. As a result, many drivers use their high beams at night to detect stopped vehicles and pedestrians.
Since 2000, Americans have been involved in a number of series car accidents. There are no emergency services for injured or stranded drivers. Car accident victims are vulnerable to theft by those who pretend to be “helpful.” It is advisable to have a cell phone when undertaking a trip outside of town, although many parts of the country do not yet have cell phone service.

City traffic is comprised mostly of cars and minibuses; motorcycles are rare. Minibuses serve as the primary means of inter-city travel in Zambia. They are often overcrowded and seldom punctual. Drivers often use pass using road shoulders or opposing traffic lanes. Often they will stop with little or no warning, in order to pick up or drop off passengers. Some luxury buses do ply the routes between Lusaka and Livingstone and the Copperbelt. Please refer to our Road Safety page for more information. Visit the web site of the country’s national tourist office and national authority responsible for road safety at http://www.zambiatourism.com/.
AVIATION SAFETY OVERSIGHT:As there is no direct commercial air service to the United States by carriers registered in Zambia, the U.S. Federal Aviation Administration (FAA) has not assessed Zambia’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:
Perpetrators of business fraud often target foreigners, including Americans. While such fraud schemes in the past have been largely associated with Nigeria, they are now prevalent throughout Africa, including Zambia. For additional information, please consult The Department of State's publication "International Financial Scams." In addition, Americans are advised to exercise caution when approached with unsolicited offers to purchase gemstones or precious metals for export as the Embassy has received multiple recent complaints from Americans who have been victimized as a result of their involvement in these deals.
U.S. citizens are encouraged to carry a copy of their U.S. passports with them at all times, so that, if questioned by local officials, proof of identity and U.S. citizenship is readily available. Zambian police do not provide the U.S. Embassy with timely notification of the arrest of American citizens. If you are detained, you should insist on your right to contact a U.S. consular officer.
MasterCard and Visa cards are accepted in major supermarkets, restaurants, stores, and hotels in Lusaka and Livingstone (Victoria Falls). Credit card fraud is increasing in Zambia and there have been several cases involving fraudulent charges, including some at major hotels catering primarily to foreign visitors. Many businesses use carbonized paper documents to process payment. These documents are not secure and can pose a threat to cardholders. The Embassy urges caution when using debit or credit cards at any point of purchase, especially if the transaction is not processed electronically. Normally, American travelers can withdraw money (in local currency) from ATMs in major cities in Zambia using their ATM cards or credit cards from the United States. However, from time to time, the banks lose their connections with the credit card exchanges, thus making withdrawals impossible. Zambian banks and bureaux de change will not accept dollar-denominated notes issued before 1990.
Travel to military areas and photographing military facilities, airports, bridges, and other facilities deemed to be of security relevance, are prohibited. Often these sites are not clearly marked and the first notification that a tourist would receive is a police officer demanding their film and/or camera. Authorities may also challenge photography of areas other than tourist attractions. Service providers in Zambia, including the tourism sector, are not subject to the same standards of safety oversight that exist in the United States; visitors should evaluate risks carefully.

Travelers are cautioned to observe local or park regulations and heed all instruction given by tour guides. Even in the most serene settings, wild animals can pose a threat to life and safety.

Large numbers of travelers visit tourist destinations, including South Luangwa National Park and Livingstone (Victoria Falls), without incident. However, American citizens are advised to avoid rafting and other whitewater boating activities on the Zambezi River below Victoria Falls during the high-water season, February through June. During periods of high water, the Batoka Gorge section of the river becomes unpredictable and several tourists have been involved in fatal accidents.
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 Zambian laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Zambia 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.

It is against both Zambian and U.S. law to buy, possess or transport animals or animal products, such as tortoise shell, rhino horn, elephant ivory, tusks of any animal or any items made out of these materials. In Zambia, penalties range from large fines to mandatory 5-year prison sentences. The Zambian Wildlife Authority has screeners at international ports of entry/exit and WILL prosecute offenders to the fullest extent of the law.

While many of these items are sold in open markets particularly aimed at foreign tourists, it remains the responsibility of the customer to ensure that he/she is not purchasing a prohibited item.

Further instructions on the importation of items to the U.S. may be found on the U.S. Customs and Border Protection web site at
http://www.customs.gov/xp/cgov/travel/vacation/kbyg/prohibited_restricted.xml.

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 Zambia 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 Zambia. 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 the corner of Independence and United Nations Avenues. The mailing address is P.O. Box 31617, Lusaka, Zambia. Telephone exchanges have recently changed within Zambia. When calling from the United States, please contact the American Embassy during regular work hours, Monday through Thursday from 7:30 a.m. to 5:00 p.m., and on Friday from 7:30 a.m. to 12:30 p.m. by dialing 011-260-21-125-0955. For after-hours emergencies involving American citizens, please dial 011-260-21-125-0955 extension 1. The fax number is 260-21-125-2225. The web site is http://zambia.usembassy.gov.
* * *
This replaces the Country Specific Information for Zambia dated February 14, 2008, to update sections on Entry/Exit Requirements and Crime.

Travel News Headlines WORLD NEWS

Date: Tue, 29 Oct 2019 20:07:03 +0100 (MET)

Lusaka, Oct 29, 2019 (AFP) - More than two million Zambians are facing "severe" food insecurity after drought and flooding reduced harvests, the Red Cross said Tuesday.   Southern Africa is grappling with one of the worst droughts in decades after months of erratic rainfall and record-high temperatures.   Zambia Red Cross warned the drought had left an estimated 2.3 million people facing "severe food insecurity", up from 1.7 million a month ago.   "The successive mixture of drought and flooding has been catastrophic for many communities," said Zambia Red Cross head Kaitano Chungu in a statement.

While rainfall hit a record low in southern and western Zambia, flash floods and  waterlogging occurred in the north and east of the country.   The Red Cross said that combination resulted in "poor harvests", with families in the worst-affected areas surviving on wild fruit and roots -- posing a serious risk to their health.   "In most of the affected areas there isn't enough drinking water, which means that people and animals-both livestock and wildlife-are having to use the same water points," said Chungu.    "This is unacceptable as it exposes people to diseases and creates a heightened risk of animal attacks," he added.

Zambia's regional neighbours have also felt the impact.   More than five million rural Zimbabweans -- nearly a third of the population -- could face food shortages before the next harvest in 2020, according to the United Nations.   And wildlife has been affected as well.   At least 55 elephants died in Zimbabwe and 100 in Botswana over the past two months due to lack of food and water.
Date: 21 Oct 2019
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/polio-cases-reported-in-zambia-chad-and-togo-73820/>

Circulating vaccine-derived polio virus (cVDPV) type cases have been confirmed in 10 African countries through [16 Oct 2019] this year [2019]. Now, the World Health Organization (WHO) is reporting 3 additional countries from the continent that more recently reported circulating vaccine-derived polio virus type 2 (cVDPV2) cases: Zambia, Chad and Togo.

Zambia
The Ministry of Health of Zambia reported last week on a confirmed case of circulating vaccine-derived polio virus type 2 (cVDPV2) in a 2-year-old child in Chienge district, Luapula province on the border with Democratic Republic of the Congo. This is the 1st case of cVDPV2 reported from Zambia in 2019. [Date of onset of paralysis reported to be 16 Jul 2019 according to another media report <https://www.lusakatimes.com/2019/10/21/polio-case-has-been-recorded-in-zambias-luapula-province/>.

In addition to the initial case-patient, 34 stool samples were collected from healthy contacts, and 2 samples tested positive for VDPV2, which were genetically linked to the case-patient. No established links have so far been found with the ongoing outbreak of cVDPV2 in Democratic Republic of the Congo, where 37 cases have been reported in 2019. The last recorded case of indigenous polio in Zambia was in 1995, while between 2001 and 2002, 5 cases of wild polio virus were identified among Angolan refugees in the Western province of the country.

Chad
Last week, WHO was informed about cVDPV2 in Chad. A cVDPV2 was isolated from a 13-month-old case of acute flaccid paralysis (AFP), with onset of paralysis on [9 Sep 2019] in Chari Baguirmi province, bordering Cameroon. The isolated virus has 32 nucleotide changes from Sabin 2, and is genetically linked to a cVDPV2 detected in Borno, Nigeria and is part of the Jigawa emergence. The last indigenous wild poliovirus cases were reported in 2000 in Chad.

Togo
In addition, last week WHO was informed about cVDPV2 in Togo. A cVDPV2 was isolated from a 30-month-old case of AFP with onset of paralysis on [13 Sep 2019] in Plateaux province, bordering Benin and Ghana. The isolated virus has 32 nucleotide changes from Sabin 2 and is genetically linked to a cVDPV2 detected in Irewole state, Nigeria and is part of the Jigawa emergence as well. The last indigenous wild poliovirus case was reported in 1999 in Togo.
======================
[Three more countries are joining the list of cVDPV outbreak countries, all with cVDPV2 isolates. Two of the 3 countries (Togo and Chad) have viruses related to the Jigawa, Nigeria cVDPV2 outbreak. The case in Zambia is suspected to be associated with the ongoing cVDPV2 transmission in the Democratic Republic of the Congo (DR Congo), but genetic testing is presumably still pending or has been negative. See my comments below after the following section, as they are relevant to what is ongoing globally with respect to cVDPVs.

Below are the HealthMap/ProMED map links to countries where cVDPV cases/outbreaks have occurred in the past 12 months, a total of 20 countries.

Angola: <http://healthmap.org/promed/p/165>
Benin: <http://healthmap.org/promed/p/59>
Cameroon: <http://healthmap.org/promed/p/65>
Central African Republic: <http://healthmap.org/promed/p/66>
Chad: <http://healthmap.org/promed/p/57>
China: <http://healthmap.org/promed/p/155>
Democratic Republic of the Congo: <http://healthmap.org/promed/p/194>
Ethiopia: <http://healthmap.org/promed/p/95>
Ghana: <http://healthmap.org/promed/p/53>
Indonesia: <http://healthmap.org/promed/p/184>
Kenya: <http://healthmap.org/promed/p/174>
Mozambique: <http://healthmap.org/promed/p/177>
Myanmar: <http://healthmap.org/promed/p/148>
Niger: <http://healthmap.org/promed/p/58>
Nigeria: <http://healthmap.org/promed/p/62>
Papua New Guinea: <http://healthmap.org/promed/p/188>
Philippines: <http://healthmap.org/promed/p/158>
Somalia: <http://healthmap.org/promed/p/125>
Togo: <http://healthmap.org/promed/p/64>
Zambia: <http://healthmap.org/promed/p/170> - ProMED Mod.MPP]
Date: Fri, 23 Aug 2019 15:08:04 +0200 (METDST)
By Obert SIMWANZA

Lusaka, Aug 23, 2019 (AFP) - Children living in a central Zambian mining town are still exposed to high levels of toxic lead 25 years after the mine closed, Human Rights Watch said Friday, as lawyers announced plans to take legal action.   Decades of lead mining have left Kabwe, around 150 kilometres (95 miles) north of Lusaka, severely polluted, with serious health implications for residents.   The mine, which operated from the early 1900s until its closure in 1994, was at one time the world's largest lead mine. It was run by the Zambian government from the early 1970s when the mining industry was nationalised.     In a report published Friday, HRW said the town in the Copperbelt area still has extreme levels of contamination and children continue to be exposed to high levels of toxic lead in soil and dust around their homes, schools and play areas.

HRW's children's rights fellow and report author Joanna Naples-Mitchell described the situation in Kabwe as "a public health emergency" and said the government was "not responding with the sense of urgency that is warranted".    "The Zambian government is aware that Kabwe has been severely contaminated... since the 1990s and efforts to clean up have been inadequate," she told AFP.   A class action suit is being prepared to demand compensation for poisoning from Anglo American South Africa, a former investor in the mine, London-based law firm Leigh Day announced Friday. The law firm deals in human rights issues.   The case will be brought in courts in South Africa, where the mining firm is based, said the lawyers, who are acting on behalf of some 200 children who have been treated for lead poisoning.   Anglo American on Friday said in a statement it did not believe it was "in any way responsible for the current situation" in Kabwe.    "We were concerned to learn of the situation at Kabwe as reported by the press," it said, adding "the nationalisation more than 40 years ago effectively placed these issues under the control of the Zambian Government".

- 'Severely contaminated' -
The HRW report said that although lead and zinc mining have stopped in the town, various medical studies conducted over the past seven years show children there still had elevated levels of lead in their blood.   Between 2003 and 2011, the World Bank funded a government project to decontaminate Kabwe's affected townships, and to test and treat children. But some 76,000 people, or a third of the town's population, still live in contaminated areas.   One recent study published last year and cited by HRW estimated that more than 95 percent of children in the townships surrounding the lead mine have elevated blood lead levels and that about half of them require medical intervention.   "This is the worst environmental disaster I have seen in 30 years of practice," said lawyer Richard Meeran of Leigh Day.    Johannesburg-based collaborating lawyer Zanele Mbuyisa said they will argue that "the environmental damage created has potentially contaminated almost three generations of men, women and children".

- Insufficient resources -
Three years ago, the government launched another five-year World Bank-funded project to get rid of the lead and carry out new rounds of testing and treatment.   The project targets around 10,000 people including children, pregnant women and mothers.   "We think this a very important opportunity for the Zambian government to find a lasting solution to this problem," said Naples-Mitchell.   She urged Zambia to find new and effective methods to clean up the lead, adding that their 2018 study indicated that pollution levels were "as high they had been in the 1970s".    In a letter last month, the government indicated to HRW that it does not have enough resources to address the full scale of the contamination.   The government did not immediately comment on the report.   Children are more vulnerable to lead poisoning since they absorb four to five times as much as an adult and this can retard their growth and IQ, while in worst cases it can result in brain damage or even death.
Date: Sat 6 Jul 2019
From: Johannes Jochum <j.jochum@uke.de> [edited]

A 19-year-old German woman was diagnosed with East African trypanosomiasis (due to _Trypanosoma brucei rhodesiense_) during a stay in Zambia.

The patient had been working since August 2018 in a school project close to Kabwe. From 29 May to 4 Jun [2019] she visited South Luangwa National Park. On 31 May [2019], she received a mildly painful insect bite on her calf during an afternoon game-viewing drive from Kafunta River Lodge.

She recalled seeing numerous tsetse flies during this drive but was told there had not been any cases of trypanosomiasis for years in this area. The bite initially healed well and she returned to Kabwe.

On the evening of 11 Jun [2019], she developed high fever, rigors, and severe headache. The site of the insect bite on her calf was swollen and showed livid discoloration. Several point-of-care tests for malaria were negative.

Antibiotic treatment at a local hospital led to no improvement of her symptoms. On 16 Jun [2019] she was admitted to Lusaka Coptic Hospital where African trypanosomiasis was diagnosed by blood microscopy. Central nervous system involvement was ruled out by spinal tap, and treatment with suramin was started on 17 Jun [2019]. The patient returned in stable condition to Germany on 2 Jul [2019] where she sought further treatment and follow-up at our institution.

South Luangwa National Park is known to be endemic for East African trypanosomiasis with several cases in recent years; the most recent report in ProMED-mail is in March 2019:  <http://www.promedmail.org/post/http://promedmail.org/post/20190320.6377064>.

Game animals and livestock are the main reservoir of this zoonotic disease in south-eastern Africa. Tourists acquire the disease occasionally during game safaris in Zambia, Malawi, Zimbabwe, Uganda, and Tanzania. West African trypanosomiasis (_Trypanosoma brucei gambiense_) accounts for substantially more cases in total, affecting local populations mostly in remote rural areas of the Democratic Republic of Congo, Angola, and Central African Republic  (<https://www.who.int/trypanosomiasis_african/country/en/>).
---------------------------------------------
Communicated by:
Dr. Johannes Jochum
Department of Tropical Medicine
Bernhard Nocht Institute for Tropical Medicine
Department of Medicine
University Medical Center Hamburg-Eppendorf
Hamburg, Germany
==========================
[This is the website of the national park:

Trypanosomiasis is endemic in the national parks in southern Africa, where there are tsetse flies and a reservoir of the trypanosomes in the wildlife. It is important to consider trypanosomiasis in febrile travellers to these national parks with negative tests for malaria. - ProMED Mod.EP]

[HealthMap/ProMED-mail map:
Date: Tue 14 May 2019
Source: Lusaka Times [edited]

Government has revealed that about 17 people are admitted to Mpulungu urban clinic for suspected cholera. Mpulungu District Commissioner Dennis Sikazwe has confirmed the development to ZANIS [Zambia News and Information Services] in Mpulungu today [14 May 2019].

Mr. Sikazwe said the Ministry of Health has since recommended that schools be closed for the period of one week to ensure that the situation is contained. He added that all operations of ferrying people from Mpulungu to Nsumbu in Nsama district by boats has been suspended for the period of one week. Mr. Sikazwe has also revealed that the ministry has put up measures to sensitize people on the need to maintain high levels of hygiene during this period.

The District Commissioner has also urged people to work with the medical staff at the health facility in order to control a further spread of the disease. He has also urged people to report all suspected cholera cases to the nearest health centres.

In Mbala, 5 people have been admitted at Tulemane clinic for suspected cholera. Sources from Tulemane clinic, who sought anonymity, confirmed the development to ZANIS in Mbala yesterday [13 May 2019]. Mbala District Commissioner Kedrick Sikombe, who could not confirm the matter, has promised to give a detailed report once he gets details from the Ministry of Health in the area.
==================
[The mortality from cholera and most diarrheal illnesses is related to non-replacement of fluid and electrolytes from the diarrheal illness.

As stated by Lutwick and colleagues (Lutwick LI, Preis J, Choi P. Cholera. In Chronic illness and disability: the paediatric gastrointestinal tract. Greydanus DE, Atay O, Merrick J, editors. New York: Nova Bioscience; 2018:113-127), oral rehydration therapy can be life-saving in outbreaks of cholera and other forms of diarrhoea: "As reviewed by Richard Guerrant et al. (1), it was in 1831 that cholera treatment could be accomplished by intravenous replacement, and, although this therapy could produce dramatic improvements, not until 1960 was it 1st recognized that there was no true destruction of the intestinal mucosa, and gastrointestinal rehydration therapy could be effective, and the therapy could dramatically reduce the intravenous needs for rehydration. Indeed, that this rehydration could be just as effective given orally as through an orogastric tube (for example, refs 2 and 3) made it possible for oral rehydration therapy (ORT) to be used in rural remote areas and truly impact the morbidity and mortality of cholera. Indeed, Guerrant et al. (1) highlight the use of oral glucose-salt packets in war-torn Bangladeshi refugees, which reduced the mortality rate from 30% to 3.6% (4) and quotes sources referring to ORT as "potentially the most important medical advance" of the 20th century. A variety of formulations of ORT exist, generally glucose or rice powder-based, which contain a variety of micronutrients, especially zinc (5).

"The assessment of the degree of volume loss in those with diarrhoea to approximate volume and fluid losses can be found in ref 6 below. Those with severe hypovolemia should be initially rehydrated intravenously with a fluid bolus of normal saline or Ringer's lactate solution of 20-30 mL/kg followed by 100 mL/kg in the 1st 4 hours and 100 mL/kg over the next 18 hours with regular reassessment. Those with lesser degrees of hypovolemia can be rehydrated orally with a glucose or rice-derived formula with up to 4 L [4.2 qt] in the 1st 4 hours, and those with no hypovolemia can be given ORT after each liquid stool with frequent reevaluation."

References
1. Guerrant RL, Carneiro-Filho BA, Dillingham RA: Cholera, diarrhoea, and oral rehydration therapy: triumph and indictment. Clin Infect Dis 2003;37(3):398-405; available at <http://cid.oxfordjournals.org/content/37/3/398.long>.
2. Gregorio GV, Gonzales ML, Dans LF, Martinez EG: Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database Syst Rev 2009;(2):CD006519; available at <http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006519.pub3/full>.
3. Gore SM, Fontaine O, Pierce NF: Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials. BMJ 1992;304(6822):287-291; available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1881081/>.
4. Mahalanabis D, Choudhuri AB, Bagchi NG, et al: Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med 1973;132(4):197-205; available at <http://www.searo.who.int/publications/journals/seajph/media/2012/seajph_v1n1/whoseajphv1i1p105.pdf>.
5. Atia AN, Buchman AL: Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol 2009;104(10):2596-2604; abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/19550407>.
6. WHO. The treatment of diarrhea, a manual for physicians and other senior health workers. 4th ed. 2005; available at <http://whqlibdoc.who.int/publications/2005/9241593180.pdf>. - ProMED Mod.LL]

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

Anguilla

Anguilla US Consular Information Sheet
March 03, 2009
COUNTRY DESCRIPTION: Anguilla is a British overseas territory in the Caribbean, part of the British West Indies. It is a small but rapidly developing island with particularly well-developed
ourist facilities.

ENTRY/EXIT REQUIREMENTS:
The Intelligence Reform and Terrorism Prevention Act of 2004 requires all travelers to and from the Caribbean, Bermuda, Panama, Mexico and Canada to have a valid passport to enter or re-enter the United States. U.S. citizens must have a valid U.S. passport if traveling by air, including to and from Mexico.
If traveling by sea, U.S. citizens can use a passport or passport card. We strongly encourage all American citizen travelers to apply for a U.S. passport or passport card well in advance of anticipated travel.
American citizens can visit travel.state.gov or call 1-877-4USA-PPT (1-877-487-2778) for information on how to apply for their passports.

In addition to a valid passport, U.S. citizens need onward or return tickets, and sufficient funds for their stay.
A departure tax is charged at the airport or ferry dock when leaving. For further information, travelers may contact the British Embassy, 19 Observatory Circle NW, Washington, DC
20008; telephone (202) 588-7800; or the nearest consulate of the United Kingdom in Atlanta, Boston, Chicago, Dallas, Los Angeles, New York, Denver, Houston, Miami, Orlando, Seattle, or San Francisco. Visit the British Embassy web site 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:
For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ web site, where the current Travel Warnings and Travel Alerts, as well as the Worldwide Caution, can be found.

Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll free in the U.S. 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:
While Anguilla's crime rate is relatively low, both petty and violent crimes
do occur. Travelers should take common-sense precautions to ensure their personal security, such as avoiding carrying large amounts of cash or displaying expensive jewelry. Travelers should not leave valuables unattended in hotel rooms or on the beach. They should use hotel safety deposit facilities to safeguard valuables and travel documents. Similarly, they should keep their lodgings locked at all times, whether they are present or away, and should not leave valuables in their vehicles, even when locked.

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 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.

The local emergency line in Anguilla is 911.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
There is only one hospital, Princess Alexandra Hospital (telephone: 264-497-2551), and a handful of clinics on Anguilla, so medical facilities are limited.
Serious problems requiring extensive care or major surgery may require evacuation to the United States, often at considerable expense.

There are no formal, documented HIV/AIDS entry restrictions for visitors to and foreign residents of Anguilla, but there have been anecdotal reports of exclusion.
Please verify this information with the British Embassy before you travel.

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

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

Unlike the U.S., traffic in Anguilla moves on the left. The few roads on the island are generally poorly paved and narrow. While traffic generally moves at a slow pace, with the increasing number of young drivers in Anguilla, there are occasional severe accidents caused by excessive speed. Although emergency services, including tow truck service, are limited and inconsistent, local residents are often willing to provide roadside assistance. For police, fire, or ambulance service dial 911.

Please refer to our Road Safety page for more information.
Visit the Government of Anguilla web site for further road safety information.

AVIATION SAFETY OVERSIGHT:
Civil aviation operations in Anguilla fall under the jurisdiction of British authorities. The U.S. Federal Aviation Administration (FAA) has assessed the Government of the United Kingdom’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for oversight of Anguilla’s air carrier operations.
For more information, travelers may visit the FAA web site.

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 Anguilla laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Anguilla 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 Anguilla 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 Anguilla. 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 with consular responsibility over Anguilla is located in Bridgetown, Barbados in the Wildey Business Park in suburban Wildey, southeast of downtown Bridgetown.
The main number for the Consular Section is (246) 431-0225; after hours, the Embassy duty officer can be reached by calling (246) 436-4950.
Visit the U.S. Embassy Bridgetown online for more information.
Hours of operation are 8:30 a.m. – 4:30 p.m. Monday through Friday, except Barbadian and U.S. holidays.
* * *
This replaces the Country Specific Information for Anguilla dated April 2, 2008, to update sections on Country Description, Entry/Exit Requirements, Information for Victims of Crime, and Medical Facilities and Health Information.

Travel News Headlines WORLD NEWS

Date: Sat, 9 Sep 2017 19:31:32 +0200

Paris, Sept 9, 2017 (AFP) - France's meteorological agency on Saturday issued its highest warning for the Caribbean islands of St Martin and St Barts as Hurricane Jose bore down, three days after they were hit by Hurricane Irma.   The alert warned of a "dangerous event of exceptional intensity," with winds that could reach 120 kilometres (75 miles) per hour, and strong rains and high waves.

St Barts is a French overseas territory, as is the French part of St Martin, which is divided between France and the Netherlands.   Twelve people were killed on the two islands by Hurricane Irma, thousands of buildings were flattened and the authorities are struggling to control looting.   The French state-owned reinsurer CCR on Saturday estimated the damage at 1.2 billion euros ($1.4 billion).   Irma is now heading for Florida, where a total of 6.3 million people have been ordered to evacuate, according to state authorities.
Date: Tue 29 Apr 2014
Source: National Institute for Public Health and the Environment [edited]

1 Oct 2013-29 Apr 2014 (week 18) St Maarten - Since the last report (week 15 [17?]) 52 new cases have been confirmed among St Maarten residents. Up to 29 Apr 2014, now a total of 343 confirmed cases have been reported. One of these confirmed cases was hospitalized.

The median age of the confirmed patients was 44 years, range 4-92 years. Of those cases for which gender was available, 201 were female and 130 were male.

- On 6 Dec 2013, the 1st indigenous chikungunya [virus infection] case of St Maarten was reported. Retrospectively, the 1st patient with suspected complaints was reported in mid-October 2013 in St Martin.
------------------------------------
Communicated by:
Roland Hubner
Superior Health Council
Brussels
Belgium
=====================
[The report also has graphs showing case numbers over time.

Maps of St Martin/St Maarten can be accessed at
Date: 5-11 May 2014
Source: Institut de Veille Sanitaire (French Institute for Public Health Surveillance, InVS) [edited]

Cases since the beginning of the outbreak in December 2013:
- St Martin: (susp) 3240 cases; deaths 3; stable.
- St Barthelemy: (susp) 500 cases; stable.
- Martinique: (susp) 24 180; deaths 3; increasing.
- Guadeloupe: (susp) 13 600 cases; deaths 1; increasing.
- French Guiana: (susp) not available; (probable or confirmed) 122 cases with 83 locally acquired; increasing, with a new cluster in Kourou and 2 near Cayenne.
======================
[The 16 May 2014 report from Guyaweb (<http://www.guyaweb.com/actualites/news/sciences-et-environnement/le-chik-revient-kourou-setend-cayenne-desormais-saint-laurent/>) states that there are 2 new cases in Saint-Laurent-du-Maroni, overlooking the Suriname River, of which one is certainly autochthonous, and a new focal point occurred in Kourou with 4 cases.

Maps of the area can be seen at
and <http://healthmap.org/promed/p/35574>. - ProMed Mod.TY]
Date: 7-13 Apr 2014
Source: INVS Point Sanitaire No. 14 [in French, trans. ProMed Mod.TY, edited]

Cases since the beginning of the outbreak in December, 2013:
- St. Martin: (susp.) 2980 cases, (probable and conf.) 793 cases; Deaths 3; Decreasing.
- Saint Barthelemy: (susp.) 460 cases, (probable or confirmed) 135 cases; Decreasing.
- Martinique: (susp.) 16 000, (probable or confirmed) 1473 cases; Deaths 2; Increasing.
- Guadeloupe: (susp.) 4710 cases, (probable or confirmed) 1261 cases; Deaths 1; In epidemic status.
- French Guiana: (susp.) 7 cases with 4 locally acquired, (probable or confirmed) 39 cases with 26 locally acquired) 30 cases; (imported) 16 cases; Moderate to increasing; Half of probable and confirmed cases are located in Kourou; however indigenous cases have also been recorded from the Cayenne Matoury, Remire and Macouria communities.
=================
[Maps showing case distributions on each island can be accessed at the above URL. - ProMed Mod.TY]
Date: Thu 27 Mar 2014
Source: The Daily Herald [edited]

As St. Maarten continues to take measures to combat the spread of the chikungunya virus, the number of cases continues to climb.

Health Minister Cornelius de Weever announced on Wednesday [26 Mar 2014], that the total number of confirmed chikungunya cases thus far stood at 224.

De Weever also announced that government will be signing a Memorandum of Understanding (MOU) with French St. Martin as a means of collectively responding to the mosquito threat that puts the population at risk. He said both sides have been working closely together to address the dengue and chikungunya threats.

The MOU will cover, amongst other things, a regular exchange of epidemiological information on vector-borne diseases and collectively publishing and representing data collected under the agreement.

The need for collective information campaigns and enhancement of the mosquito vector-control programme will also be included in the MOU. The MOU also describes the need for planning execution and evaluation of collective responses to the chikungunya threat.
=========================
[The increase in the number of chikungunya virus infections over the past week in St. Maarten is of concern, rising from 123 cases to 224 cases. This number is confirmed in another report that also indicates that there are an additional 325 suspected cases (<http://www.rivm.nl/dsresource?type=pdf&disposition=inline&objectid=rivmp:239786>).  - ProMed Mod.TY]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/35574>.]
More ...

Netherlands

The Netherlands - US Consular Information Sheet
January 04, 2007
COUNTRY DESCRIPTION:
The Netherlands is a highly developed, stable democracy.
Tourist facilities are available throughout the Kingdom.
Read the Department of State
ackground notes on The Netherlands for additional information.

ENTRY/EXIT REQUIREMENTS:
A passport is required.
Visas are not required for U.S. citizens for tourist visits of up to 90 days.
That period begins when you enter any of the Schengen group of countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden.
To be admitted into the Netherlands, travelers must have a passport with a validity that exceeds their intended stay, a return airline ticket, and enough money to finance the planned stay.
For further information on entry requirements, contact the Embassy of the Netherlands at 4200 Linnean Ave. N.W., Washington, D.C. 20008, telephone (202) 244-5300, or one of the Dutch consulates in Chicago, Houston, Los Angeles, New York or Miami.
Additional information is available on the Netherlands' National Bureau for Tourism's Internet web site at http://www.goholland.com.
See our Foreign Entry Requirements brochure for more information on the Netherlands and other countries.
Visit the Embassy of the Netherlands web site at http://www.netherlands-embassy.org/homepage.asp for the most current visa information.
Information on work, residency and immigration requirements in the Netherlands can be found on the web site of the Dutch immigration authorities at www.ind.nl.

Note: Although European Union regulations require that non-EU visitors obtain a stamp in their passport upon initial entry to a Schengen country; many borders are not staffed with officers carrying out this function.
If an American citizen wishes to ensure that his or her entry is properly documented, it may be necessary to request a stamp at an official point of entry.
Under local law, travelers without a stamp in their passport may be questioned and asked to document the length of their stay in Schengen countries at the time of departure or at any other point during their visit, and could face possible fines or other repercussions if unable to do so.

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:
In 2004, the Dutch government implemented heightened security measures in response to concerns of international Islamic extremist terrorist activity on Dutch soil.
The November 2004 murder of Dutch filmmaker Theo van Gogh by an Islamic extremist in Amsterdam further increased concerns over Islamic extremist activity in the Netherlands.
One individual was arrested and later sentenced to life in prison for van Gogh's murder and related Islamic extremist activities.
Since the murder, the Dutch government has remained on heightened alert.

U.S. citizens in the Netherlands are encouraged to monitor media reports, and are reminded to maintain a high level of vigilance and to take appropriate steps to increase their security awareness.
As with other countries in the Schengen area, the Netherlands' open borders with its European neighbors allow the possibility of terrorist groups entering/exiting the country with anonymity.
Demonstrations are commonplace in the Netherlands and may range in number from a few people to several thousand.
Prior police approval is required for public demonstrations, and police oversight is routinely provided.
Nonetheless, situations may develop which could pose a threat to public safety.
U.S. citizens are advised to avoid areas in which public demonstrations are taking place.

For the latest security information, Americans traveling abroad should regularly monitor the Department's Internet web site where the current Travel Warnings and Public Announcements, including the Worldwide Caution Public Announcement, can be found.

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

The Department of State urges American citizens to take responsibility for their own personal security while traveling overseas.
For general information about appropriate measures travelers can take to protect themselves in an overseas environment, see the Department of State's pamphlet A Safe Trip Abroad.
CRIME:
While the rate of violent crime in the Netherlands is low, tourists are often targets of thieves.
Visitors frequently fall prey to pickpockets, bag snatchers and other petty burglars.
Theft from automobiles and hotel rooms are also on the rise.
Never leave baggage or other valuables unattended.

While thieves may operate anywhere, the U.S. Consulate General in Amsterdam receives frequent reports of thefts from specific areas.
Within Amsterdam, thieves are very active in and around train and tram stations, the city center and public transport.
More specifically, trains to and from Schiphol Airport are considered to be high risk, and theft of laptop computers has increased.
Thieves often work in pairs; one distracts the victim, often by asking for directions, while the accomplice moves in on the victim's momentarily unguarded handbag, backpack, laptop or briefcase.
The timing of these thefts usually coincides with train stops, enabling the thieves to escape.
In addition, many Americans have reported that their purses and briefcases have been stolen while eating in downtown restaurants, including hotel breakfast rooms.
A good rule of thumb is to never leave your personal items unattended when going to the restroom, buffet table, etc.

Confidence artists have victimized a number of Americans.
Typically, a U.S. citizen is notified via email of a winning lottery ticket, an inheritance, or other offer, which requires his/her assistance and cooperation to conclude.
The American is asked to forward advance payments for alleged"official expenses," "taxes," etc. and, often, to come to Amsterdam to conclude the operation.
Several Americans have lost tens of thousands of dollars in such scams.
Funds transferred in response to such offers cannot be recovered.
Information on fraud schemes can be found on the U.S. Embassy's web page.
For additional information, please contact the nearest office of the U.S. Secret Service or visit that agency's web site at www.secretservice.gov.
Additional information is also provided in the Department of State's pamphlet, Advance Fee Business Scams.
Travelers may also contact the Fraud Unit, Amsterdam Police, Police Headquarters, PB 2287, 1000 CG Amsterdam, Netherlands, tel. (31) (20) 559-2380, fax (31) (20) 559-5755.

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.
In the Netherlands, the U.S. Consulate General in Amsterdam provides all passport and American citizen services.
A lost or stolen passport can usually be replaced within a few hours during normal working hours for those with immediate travel plans.
If you are the victim of a crime while in the Netherlands, in addition to reporting to local police, please contact the U.S. Consulate General for assistance.
It is a good idea to make a photocopy of the "biographic page" of your passport, to bring extra passport photos, and to keep these separate from your actual passport just in case it is lost or stolen.
Consulate staff can, for example, help you 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.
Contact information is provided at the bottom of this document.

The Criminal Injuries Compensation Fund (CICF) of the Netherlands provides financial compensation, under specific circumstances, for victims of crime and for those who have suffered injuries and consequent loss caused by such incidents.
The fund also provides for dependents or immediate family members of homicide victims.
For more information, contact the Dutch Ministry of Justice at (31) (70) 414-2000.

See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION: Good medical facilities are widely available.
Emergency medical response can be accessed by calling 1-1-2.
Reputable pharmacies are widely available and can assist with emergency prescription needs.
Some common medications are not available in the Netherlands without a prescription, and some prescription drugs cannot be mailed into the country.
Travelers are therefore urged to carry an adequate supply of prescription drugs in their original container while traveling.
Some U.S. over-the-counter medications are not available in the Netherlands and travelers should carry an adequate supply of these as well.
Those traveling with any preexisting medical problems should bring a letter from the attending physician, describing the medical condition and any prescription medications, including the generic name of prescribed drugs.

Vaccinations are not required for travel to the Netherlands.
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.
Medical evacuations cost thousands of dollars and are not always covered by travel insurance.
Foreign doctors and hospitals usually require payment at the time service is rendered, and this too may not be covered by a traveler's policy.
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 the Netherlands is provided for general reference only, and it may not be totally accurate in a particular location or circumstance:

Travel in, around, and between cities is possible via a highly advanced national train, light rail, tram, and bus network, by use of an extensive system of bike paths, and by automobile and motorcycle on the modern highway system.
Rail is often a convenient alternative to driving, particularly in the areas around Amsterdam, The Hague, and Rotterdam, where road congestion is frequent.
Rail network information is available at http://www.ns.nl.

Intercity travel by road is relatively safe in comparison with some other European countries.
Nonetheless, more than 1,000 people die and another 10,000 are injured in traffic accidents in the Netherlands each year.
More than two thirds of the fatal accidents occur outside urban areas.

A valid driver's license issued by a Department of Motor Vehicles in the U.S. is valid for use in the Netherlands for up to 180 days.
Seat belt and child seat use is compulsory.
Driving is on the right side of the road.
The maximum speed limit on highways is 120 km/h, with a highway speed limit of 100 km/h posted in most urban areas.
Secondary roads and some urban area highways have a speed limit of 80 km/h.
The speed limit in towns and cities is 50 km/h, with 30 km/h posted in residential areas.
The Dutch government has reduced speed limits on certain roads near cities in an effort to reduce air pollution.
During traffic jams, authorities also reduce speed limits; drivers should be sure to check for revised limits posted on electronic billboards above the highways.
Please note that drivers must yield the right-of-way to drivers and bikers coming from the right at intersections or traffic circles, unless otherwise posted.
The maximum allowable blood alcohol level in the Netherlands is 0.5 per mille.
The use of cellular telephones while driving is illegal without the use of a "hands-free" device.

Lanes at the center of many urban two-way streets are reserved for buses, trams and taxis.
In cities, pedestrians should be mindful of trams, which often cross or share bicycle and pedestrian paths.
Motorists must be especially mindful of the priority rights of bicyclists.
Pedestrians should not walk along bicycle paths, which are often on the sidewalk and usually designated by red pavement.
Travelers should also be watchful for one-way roads.

Taxi service in the Netherlands is safe but expensive.
Trams and buses are both convenient and economical, but often frequented by pickpockets.

Please refer to our Road Safety page for more information.
Visit the website of the Netherlands Bureau for Tourism at http://www.goholland.com.
Information also is available from the Netherlands Ministry of Transportation, Public Works and Water Management (Ministerie van Verkeer en Waterstraat) at http://www.minvenw.nl.

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

SPECIAL CIRCUMSTANCES:
Dutch customs authorities stringently enforce regulations concerning importation into the Netherlands of items such as firearms and other controlled materials.
Contact the Embassy of the Netherlands in Washington, D.C., or one of the Dutch consulates in Chicago, Houston, Los Angeles or New York for specific information regarding customs requirements.
Please see our Customs Information sheet.

Everyone age 14 and above is required to carry identification at all times while in the Netherlands.
Accepted forms of identification for U.S. citizens are either a Dutch residence card, issued by the Ministry of Foreign Affairs, or a U.S. passport.

U.S. citizens who obtain Dutch nationality may be required by the Dutch authorities to relinquish their U.S. citizenship.
For further information visit http://www.ind.nl/EN/verblijfwijzer/ and/or http://netherlands.usembassy.gov/dual_nationality.html.

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 Dutch laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use or trafficking in illegal drugs in the Netherlands are strict and convicted offenders can expect jail sentences and heavy fines.
Engaging in illicit sexual conduct with children or using or disseminating child pornography in a foreign country is a crime, prosecutable in the United States.
Please see our information on Criminal Penalties.

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

REGISTRATION / EMBASSY LOCATION:
Americans living or traveling in the Netherlands are encouraged to register with the U.S. Consulate General through the State Department's travel registration website, and to obtain updated information on travel and security within the Netherlands.
Americans without Internet access may register directly with the U.S. Consulate General in Amsterdam.
By registering, American citizens make it easier for the Embassy or Consulate to contact them in case of emergency and to provide periodic information on issues of interest to American citizens.

The U.S. Embassy is located in The Hague, at Lange Voorhout 102; tel. (31) (70) 310-2209.
However, all requests for consular assistance should be directed to the Consulate General in Amsterdam at Museumplein 19, tel. (31) (20) 575-5309.
The after-hours emergency telephone number is (31) (70) 310-2209.
The U.S. Embassy and Consulate General web site at http://netherlands.usembassy.gov/ answers many questions of interest to Americans visiting or residing in the Netherlands.
*
*
*
This replaces the Consular Information Sheet dated June 28, 2006, to update the sections on Safety and Security and Aviation Safety Oversight.

Travel News Headlines WORLD NEWS

Date: Fri 4 Oct 2019
Source: Dutch News [edited]

A total of 3 people have died and one woman has had a miscarriage after eating cold meat contaminated with _Listeria_, the public health institute RIVM [Netherlands National Institute for Public Health and the Environment] said on Friday [4 Oct 2019]. All are thought to have become ill after eating meat products from the Offerman company over the past 2 years, the agency said.

In total, at least 20 people have become ill after eating Offerman cold cuts. The company issued a health warning on Friday [4 Oct 2019], and Jumbo, which stocks 135 different products from Offerman, ordered an immediate recall. Aldi too has recalled its Offerman products, which were also widely sold to company canteens.

The source of the infection was traced by the RIVM and product safety board NVWA [Netherlands Food and Consumer Product Safety] after an analysis of the different types of _Listeria_ infection this week. "It has only been recently possible to use this technique and without it, we would not have been able to identify the source," the RIVM said. [Probably they are referring to whole genome sequencing. - ProMED Mod.ML]

The factory where the bacteria originate[d] is located in Aalsmeer and has been closed pending a thorough clean-up, the AD reported on Friday afternoon [4 Oct 2019]. According to broadcaster NOS, the NVWA had ordered Offerman to take extra hygiene measures because there were suspicions that something was going wrong. "But this would appear not to have done the job," an NVWA spokesman told the broadcaster.

_Listeria_ is found in meat that has not been properly cooked and in raw foods [that] have been kept [refrigerated?] for a long time, the RIVM said. Most people suffer mild flu-like symptoms, but the bacteria can cause serious symptoms in the elderly, new-borns and people with weak immune systems. It is particularly dangerous to pregnant women and can cause miscarriages. Every year about 80 cases of [listeriosis] are reported to the RIVM.
========================
[Genotyping, e.g., by whole genome sequencing, clinical isolates of _Listeria monocytogenes_ can identify clusters of cases that have a common source, and genotyping the isolates from the food and environmental surfaces at food processing facilities can confirm the source, if genotypes match, as likely happened in the outbreak described above.

Refrigerated cold cut meats that are not cooked before eating (i.e., ready-to-eat) are well-recognized sources for listeriosis. Even if initial contamination adds only a few _Listeria_ organisms to the food, the contamination can be significant for refrigerated foods because _L. monocytogenes_ can subsequently multiply at refrigerator temperatures to a sufficient number to cause disease. People at increased risk for disseminated listeriosis include pregnant women (and their new-borns), adults aged 65 years or older, and people with weakened immune systems. - ProMED Mod.ML]

[HealthMap/ProMED-mail map:
Date: Sat 28 Sep 2019
Source: Food Safety News [abridged, edited]

About 30 people are part of a _Salmonella_ outbreak in the Netherlands linked to eggs from Spain. The Dutch Food and Consumer Product Safety Authority (NVWA) in August 2019 advised people not to eat eggs stamped with the code 3-ES-4624944A because of _Salmonella_ contamination. The agency added it was important to wash hands after touching them, as the _Salmonella_ can be found on the outside of the eggs. The eggs were supplied to neighborhood supermarkets, market stalls and catering establishments that may have further processed them into various dishes. They are not thought to have been sold at large supermarket chains in the country.

Salmonellosis is not a notifiable infection in the Netherlands. There were an estimated 27 440 patients with acute gastroenteritis due to salmonellosis in 2017.

A total of 30 patients have been reported with an identical _Salmonella_ Enteritidis type based on whole genome sequencing, some of which fell ill last year, in 2018. At least 5 patients are known to have eaten eggs from the batch the NVWA issued a warning about, according to the Dutch National Institute for Public Health and the Environment (RIVM).

Harald Wychgel, a RIVM spokesman, said because these studies ask people what they have eaten in recent weeks, it is not expected consumption of eggs can be confirmed for all patients. "The outbreak has been going on since 2018 with a number of patients that is insufficient to initiate source detection. RIVM linked a small cluster of patients to a batch of eggs that were withdrawn from the market at the end of August [2019]," he told Food Safety News.

"Although there has been a recall, it may still be the case that patients will be found because they may still have products at home. The eggs in question have been traced by the NVWA and are withdrawn from the market."

Information from the Rapid Alert System for Food and Feed (RASFF) shows the eggs were also distributed to Belgium.  [Byline: Joe Whitworth]
==========================
[Salmonellosis is often thought to be associated with cracked eggs or eggs dirty with faecal matter, a problem controlled by cleaning procedures implemented in the egg industry. It is clearly the case, however, that most of the salmonellosis outbreaks linked to eggs were associated with uncracked, disinfected grade A eggs, or foods containing such eggs. The undamaged eggs become contaminated during ovulation, and thus were contaminated with the bacteria before the eggshell was formed. To avoid this, uncooked eggs should only be used as an ingredient if pasteurized. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Date: Mon 23 Sep 2019
Source: NL Times [edited]

A Hyalomma tick, commonly referred to as a giant tick, was found in Wageningen. This is the 3rd specimen of this type of tick, which can carry dangerous diseases like Crimean Congo virus and spotted fever, to be found in the Netherlands this year [2019]. The other sightings were in Drenthe and in the Achterhoek in July 2019.

This latest giant tick was found on a pony in Wageningen, according to Omroep Gelderland. It was previously thought that the Netherlands is too cold for the giant tick to grow into adulthood, but due to climate change, the conditions in the Netherlands are increasingly favourable for the animal. It is believed that this type of tick enters the Netherlands through migratory birds.

The Hyalomma tick is known as the giant tick because it is much larger than a normal tick. It can be recognized by the line pattern on its legs. Unlike other ticks that passively wait for a host to pass by, this type of tick actively hunts its host, according to the European center for disease control. They've been known to follow a host for 10 minutes or more, covering a distance of up to 100 meters.

This type of tick is a known carrier of the Crimean-Congo virus, which causes Crimean-Congo haemorrhagic fever. This is a serious disease that has a fatality rate of up to 50 percent, according to the American Centers for Disease Control. The tick found in Drenthe earlier this year [2019] was tested for this virus and was not a carrier, public health institute RIVM said at the time.

The Drenthe tick was a carrier of the _Rickettsia aeschlimannii_ bacterium, which causes the rare spotted fever. "Spotted fever is easy to diagnose and treat with antibiotics," Dutch health agency RIVM said in a statement released over the summer.  Several Dutch agencies track sightings of the tick. Those who have seen the Hyalomma tick should report it to the NVWA, the agency said.  [Byline: Janene Pieters]
========================
[With the discovery of this tick in the 3rd locality in the Netherlands, one wonders whether it is as yet undiscovered in other parts of the country. This giant tick that was found earlier this year (2019) in Drenthe was confirmed as a _Hyalomma marginatum_, a species originating in tropical climates and previously confined to southern parts of Europe. Specimens of the tick have been found in several other northern European countries, including Germany, where it is thought to have overwintered, and in Sweden. Most have been found on livestock, primarily horses. Fortunately, Crimean-Congo virus has not been found in any of the ticks in the Netherlands,

An image of _Hyalomma marginatum_ can be accessed at the source URL above. - ProMED Mod.TY]

[HealthMap/ProMED map available at:
Date: Sun, 1 Sep 2019 17:22:26 +0200 (METDST)

The Hague, Sept 1, 2019 (AFP) - Dutch national carrier KLM will scrap 10 European flights Monday due to a two-hour strike by ground staff demanding higher wages, an airline spokeswoman said Sunday.   The move, which will see ground staff down tools between 8.00 am and 10.00 am (0600 GMT to 0800 GMT), comes after the airline and Dutch union federation FNV failed to reach an agreement.   "KLM have preventively decided to annul 10 European flights because of the strike," Manel Vrijenhoek said.   "We are still looking at which flights at this stage," she told AFP.

Air France, Delta and other SkyTeam airlines as well as no-frills carrier Transavia are also set to be affected by the strike, KLM spokeswoman Vrijenhoek confirmed.   The FNV said Saturday it was demanding a four percent increase for some 15,000 members of ground staff, with KLM's latest offer stalling at two percent.   "It's no good. Therefore we are calling a work stoppage," FNV campaign leader Joost van Doesburg said.   "If KLM retains its position after the strike, new labour actions cannot be excluded," he said in a statement.   A strike by public transport workers in May forced dozens of flights to be cancelled at Schiphol, one of Europe's busiest air travel hubs.   More than 41 million passengers passed through Schiphol in the first six months of the year, according to the latest airport figures.
Date: Thu, 25 Jul 2019 13:14:32 +0200

The Hague, July 25, 2019 (AFP) - Thousands of travellers flying to and from Amsterdam's Schiphol airport were met with another day of cancellations on Thursday. Dozens of flights were suspended after a malfunction in the kerosene refuelling system on Wednesday, which was later resolved.  But the disruptions went on to wreak further havoc on Thursday with Dutch airline KLM announcing it had cancelled 61 flights from Schiphol, one of the world's busiest transport hubs.   "We are restarting our operations gradually," a KLM spokeswoman told AFP.    The airport was not able to give an exact figure on the number of flight delays and cancellations.

On Wednesday night, around 300 flights from Amsterdam-Schiphol were cancelled due to a malfunction by the only company at the airport which supplies the fuel system, Aircraft Fuel Supply. Tens of thousands of passengers were affected with many stuck on aircrafts that were grounded.    Some travellers whose planes could not take off on Wednesday were forced to spend the night at the airport, a spokeswoman for Amsterdam-Schiphol said.
More ...

World Travel News Headlines

Date: Fri, 13 Dec 2019 16:41:23 +0100 (MET)
By Mariëtte Le Roux and Joseph Schmid

Paris, Dec 13, 2019 (AFP) - French commuters gritted their teeth for a ninth day of public transport strikes Friday, with unions vowing to keep up their protest against a pension overhaul through the holidays unless the government backs down.   Officials have said they are ready to negotiate, with Education Minister Jean-Michel Blanquer meeting teachers' representatives on Friday to try and stave off another day of class shutdowns.   "It was an intense and frank meeting... but we still need details, and maintain our call to strike on Tuesday," Stephane Crochet of the SE-Unsa union said.

Unions are hoping for a repeat of 1995, when they forced a rightwing government to back down on pension reforms after three weeks of metro and rail strikes just before Christmas.   The prospect of a protracted standoff has businesses fearing big losses during the crucial year-end festivities, and travellers worried that their Christmas plans may be compromised.   "Right now it's a catastrophe here, but we're hoping there will be a solution before Christmas," Frederic Masse, a foie gras producer at the huge Rungis wholesale food market south of Paris, told AFP on Friday.

The capital city was again choked by huge traffic jams as most metro lines remained shut, only a handful of buses and trams were running, and one in four TGV trains were cancelled.   "I'm sick of this, and I won't be able to keep working if it goes on," Zigo Makango, a 57-year-old security agent, told AFP onboard a bus in the Bobigny suburb northeast of Paris.   To get home at night Makango said he has to use taxis, but "my boss doesn't reimburse me for that".

- 'Historic reform' -
President Emmanuel Macron on Friday expressed his "solidarity" with people impacted by the strike, "but I want the government to continue its work" in forging a single pension system, a key campaign promise.   "It's a historic reform for the country," he told journalists at an EU summit in Brussels. 

The overhaul unveiled by Prime Minister Edouard Philippe would do away with 42 separate regimes, some of which offer early retirement and other benefits to public-sector employees such as train drivers, dockers and even Paris Opera employees.   But Philippe angered unions further by proposing a reduced payout for people who retire at the legal age of 62 instead of a new, so-called "pivot age" of 64.

They have called for new mass demonstrations for next Tuesday, the third since the action started on December 5 in the biggest show of strength in years by France's notoriously militant unions.   Philippe insisted on Twitter that "My door is open and my hand outstretched".   But Laurent Brun of the hard-line CGT union, the largest among public-sector workers including those at rail operator SNCF, has already warned "There won't be any Christmas truce" unless the government drops the plan entirely.

- France divided -
A poll released Thursday by the Elabe institute found France evenly divided on Philippe's plan, with 50 percent for and 49 percent against.  But 54 percent rejected the mooted 64-year cutoff for a full pension, and 54 percent supported the protest.

Staff at four of France's eight oil refineries were on strike Friday, affecting output and raising fears of shortages down the line.   And both Paris operas, the Garnier and the Bastille, again cancelled Friday performances and others through the weekend.   Macron's government insists the changes will make for a fairer system and help erase pension system deficits forecast to reach as much as 17 billion euros ($19 billion) by 2025.   The average French person retires at just over 60, years earlier than most in Europe or other rich OECD countries.
Date: Fri, 13 Dec 2019 14:05:22 +0100 (MET)

Milan, Dec 13, 2019 (AFP) - More than 300 flights were cancelled Friday in Italy due to a planned one-day strike by workers from Alitalia and Air Italy.   Alitalia said in a statement that 315 flights were cancelled on Friday, with another 40 cancelled Thursday night and Saturday morning. It was not immediately clear how many flights were cancelled at Air Italy.   The 24-hours strike, which involves pilots, flight attendants and ground personnel, was called by three unions to draw attention to what they called "the ongoing crisis at Alitalia and Air Italy."

The strike was felt most in Sardinia, with about 30 flights cancelled.    Money-losing Alitalia has been under special administration since 2017 when employees rejected a restructuring plan that would have laid off 1,700 workers out of an approximately 11,000.   The government has so far looked for buyers without success.    Unions plan to meet on Tuesday with Economy Minister Stefano Patuanelli.    A potential consortium of buyers for the ailing carrier fell apart last month after Atlantia, which operates Rome's airports, pulled out.
Date: Fri, 13 Dec 2019 05:24:44 +0100 (MET)
By Neil SANDS

Wellington, Dec 13, 2019 (AFP) - Adventure tourism is a key part of New Zealand's international appeal but the White Island volcano eruption is a tragic reminder that such activities carry genuine risk that must be better explained to travellers, experts say.   The South Pacific nation offers a wealth of adrenaline-fuelled pursuits, from heli-skiiing on snow-capped mountains to ballooning and blackwater rafting through caves.

Some, such as bungee-jumping, jet-boating and zorbing -- where you hurl yourself down a hill inside an inflatable ball -- were invented or popularised in a country that prides itself on catering to intrepid visitors.   The tourism industry as a whole is among New Zealand's biggest earners, generating about NZ$16.2 billion ($10.7 billion) and attracting 3.8 million international visitors annually.     "Adventure tourism is a massive sector in New Zealand. We are promoting ourselves as the adventure capital of the world," professor Michael Lueck, a tourism expert at Auckland University of Technology, told AFP.

New Zealand is also renowned for its rugged landscapes, which feature prominently films such as Kiwi director Peter Jackson's "Lord of the Rings".   Day-trips to White Island combined both, taking tourists including cruise ship passengers to a desolately beautiful island off the North Island coast where they could experience the thrill of standing on an active volcano.   Instead, at least 16 people are believed to have died and dozens suffered horrific burns when 47 tourists and guides were caught on the island during Monday's eruption.

The disaster has raised questions about why tourists were allowed on a volcano where experts had recently raised threat levels, as well as broader issues about the regulation of risky activities in the tourism sector.   "There will be bigger questions in relation to this event," Prime Minister Jacinda Ardern told parliament after the eruption.   "These questions must be asked, and they must be answered."

- 'Slapdash' or world's best? -
The disaster on White Island -- also known as Whakaari -- is not the first mass-fatality accident to affect tourists in New Zealand.   In 2015, seven people were killed when a scenic helicopter flight crashed into Fox Glacier. Two years earlier, a hot-air balloon claimed 11 lives and in 2010 nine died when a plane carrying skydivers plunged into a paddock.

Briton Chris Coker's son Brad, 24, died in the skydive plane crash and since then he has campaigned from afar for tighter regulations in New Zealand's adventure tourism sector.   "In my opinion, the New Zealand authorities... are still slapdash about tourist safety," Coker told news website stuff.co.nz after the White Island eruption.   "To run tourists there is insane. I know they signed a waiver and so on, but it's not really taking care of people."

Trade body Tourism Industry Aotearoa disputes such assessments, saying operators are "working within a world's best regulatory framework", but could not eliminate risk completely.   "Operators put safety first, but adventure activity inherently carries some risk and it's critical that 'adventure' remains in adventure tourism," TIA chief executive Chris Roberts told AFP.   "Operators take all practical actions to minimise the risks and the safety culture of individual operators remains the key factor in preventing accidents."

Roberts said the issue was not tourism operators, but the alert system they relied on at volcanic destinations such as White Island, which attracts about 17,000 visitors a year.   The GeoNet monitoring agency raised White Island's threat level in the week before the eruption but also advised current activity "does not pose a direct hazard to visitors".   "The reviews need to look at the science and specifically the guidance provided about volcanic activity, and whether the operating practices followed for the past 30 years need to change," Roberts said.

- 'Understand the risks' -
Travel companies such as White Island Tours brief customers before setting off and require them to sign a waiver declaring they understand the risk, as well as supplying equipment such as hard-hats and gas masks.   However, some relatives of those affected by the eruption have expressed scepticism that their loved ones truly appreciated the potential danger they faced.   Options for legal redress are limited under New Zealand's Accident Compensation Commission scheme, which covers victims' medical bills and provides modest compensation but does not allow civil suits for damages.

Neither Roberts nor Lueck expected the White Island eruption to hit international arrivals in New Zealand, which have continued to climb despite major earthquakes in 2011 and 2016.   The nature of any review arising from White Island remains uncertain, but Lueck said at the very least tourists needed to be better informed about any risks.   "Operators and tourism boards should have tourists understand what these risks are, and not brush over quickly signing a waiver," he said.   "Only then can tourists make an informed decision and decide whether or not they want to take that particular risk."
Date: Thu, 12 Dec 2019 21:25:36 +0100 (MET)

Kinshasa, Dec 12, 2019 (AFP) - Twenty-three cases of Ebola have been recorded in four days in eastern Democratic Republic of Congo, where deadly violence is hampering efforts to end the 16-month-old epidemic, authorities said on Thursday.   Ten cases were recorded on Tuesday alone in Mabalako in North Kivu province, after six on Monday, according to the Multisectoral Committee for Epidemic Response (CMRE).   Three out of the six were practitioners of traditional medicine, it said.

On Wednesday, three cases were recorded in North Kivu, including one in the Biena neighbourhood -- which has had no new Ebola cases for the last 85 days.   More than 2,200 people have died since the epidemic was declared on August 1, 2018.   As of November 22, the rate of new cases had fallen to 10 per week.   CMRE said "security reasons" -- attacks on Ebola health workers and sites by armed groups and angry youths -- had "paralysed" work in the key zones of Beni, Biakato and Mangina.   The attacks led to a pullout of locally-employed Ebola workers in Biakato by the UN's World Health Organization (WHO) and Doctors Without Borders (MSF).
Date: Thu, 12 Dec 2019 15:59:23 +0100 (MET)

Juba, Dec 12, 2019 (AFP) - Devastating flooding in South Sudan following a fierce drought could tip parts of the country into famine in the next few months, the World Food Programme (WFP) warned on Thursday.   According to the UN refugee agency nearly one million people were affected by floodwaters that submerged entire towns, compounding an already dire humanitarian situation after six years of war.

The WFP said that 5.5 million people are expected to be going hungry in early 2020 -- the time at which the population is generally benefiting from their harvest in October and November of the previous year.   An earlier harvest failed due to drought. This time crops have been washed away.    "The number of people in need is likely to increase because of the catastrophic level of destruction caused by floods since October following a drought that hammered parts of the country earlier in the year," the agency said in a statement.

The floods wiped out 73,000 metric tons of potential harvests as well as tens of thousands of cattle and goats, said the WFP.   "We know the problems that we've been having in South Sudan, but the rains and the floods have led to a national disaster and are much worse than anyone could have anticipated," said WFP Executive Director David Beasley.    "In fact, if we don't get funding in the next few weeks and months, we are literally talking about famine. We need support, we need help and we need it now."   The agency estimated its needs at $270 million (242 million euros) for the first half of 2020.   South Sudan declared a "man-made" famine affecting around 100,000 people in 2017. 

The term "famine" is used according to a scientific system agreed upon by global agencies, when at least 20 percent of the population in a specific area has extremely limited access to basic food; acute malnutrition exceeds 30 percent; and the death rate exceeds two per 10,000 people per day for the entire population.   "Famine in South Sudan was defeated after four months in 2017 by a concerted large-scale humanitarian response," said the WFP.   "Experts now say the country's food security outlook has never been so dire."   Political instability is also high as President Salva Kiir and his rival Riek Machar have again delayed their formation of a power-sharing government, this time by 100 days until February 2020.
Date: Wed, 11 Dec 2019 09:33:13 +0100 (MET)
By Holly ROBERTSON

Sydney, Dec 11, 2019 (AFP) - Up to 20,000 protesters rallied in Sydney on Wednesday demanding urgent climate action from Australia's government, as bushfire smoke choking the city caused health problems to spike.   Sydney has endured weeks bathed in toxic smoke as hundreds of blazes have raged across the countryside, with hospitals recording a 25 percent increase in the number of people visiting emergency departments last week.   On Tuesday smoke alarms rang out across Australia's biggest city, with thick haze triggering smoke alarms and forcing buildings to be evacuated, school children to be kept indoors, and ferries to be cancelled.   The devastating fires have focused attention on climate change, with scientists saying the blazes have come earlier and with more intensity than usual due to global warming and a prolonged drought.   Police estimated the crowd size at 15,000, organisers put the figure at 20,000.

Many of the protestors voiced anger at the government's silence in the face of the crisis.   "The country is on fire" said 26-year-old Samuel Wilkie attending his first climate protest. He described politicians' response as "pathetic".    "Our government is not doing anything about it," said 29-year-old landscape gardener Zara Zoe. "No one is listening, no one is doing anything."   Prime Minister Scott Morrison -- a staunch backer of Australia's vast coal industry -- has said little about the smoke since the crisis began, preferring to focus on fire-hit rural communities.   Organiser Chloe Rafferty said that had created anger at the conservative government's inaction.   "I think the wider public can see that we are not expecting the climate crisis in the future but we are facing the climate crisis now," she told AFP.   "People are experiencing it in their day-to-day lives."   As well as a rise in people visiting hospitals with smoke-related health symptoms, the number of emergency calls for ambulances spiked 30 percent last week.    "For most people, smoke causes mild symptoms like sore eyes, nose and throat," top health department official Richard Broome said.   "However, people with conditions like asthma, emphysema and angina are at greater risk because the smoke can trigger their symptoms."

Smoke from bushfires is one of the biggest contributors to air pollution in Australia, releasing fine particles that can lodge deep within people's lungs and cause "severe" health impacts over time, according to scientist Mick Meyer from government-funded scientific research agency CSIRO.   "The impact of smoke on people remote from the fires may, on occasion, substantially exceed the direct injury to people within the fire zone," he wrote in The Conversation.   "But we currently lack the operational tools to understand the extent of these impacts or to manage them."   Six people have been killed and more than 700 houses destroyed in bushfires this fire season.   Though the human toll has been far lower than the deadliest fire season in 2009 -- when almost 200 people died -- the scale of this year's devastation has been widely described as unprecedented.   Three million hectares (7.4 million acres) of land has been burnt -- the size of some small countries -- and vast swathes of koala habitat scorched.   Official data shows 2019 is on track to be one of the hottest and driest years on record in Australia.
Date: Tue 3 Dec 2019
Source: Trinidad Express [abridged, edited]

The number of local deaths from the influenza virus has risen to 24. At the Health Ministry's update last week, 16 fatalities were reported from the flu, with Health Minister Terrence Deyalsingh appealing to citizens -- especially those considered at-risk -- to get vaccinated.
Date: Sat 30 Nov 2019
Source: The New Indian Express, Express News Service [edited]

According to official data, 14 swine flu [influenza A/H1N1] deaths across the state were recorded this year [2019] till [17 Nov 2019]. The figure is slightly less than the previous year's [2018] toll of 17. The total number of H1N1 swine flu-positive cases [has] also come down this year [2019] compared with 2018 from 402 to 325. Health officials are setting up isolation wards in hospitals as a preventive measure.

As the winter season has set in and the minimum temperatures are coming down, health officials are instructing the public to take precautions in order to stay away from being infected by swine flu. The health department has initiated steps to set up district-[wide] swine flu testing facilities and isolation wards in every district hospital, area hospital, and community health centre.

As per the requirement of treatment procedure, the government has to set up special isolation wards in all government hospitals and provide protection kits to the healthcare staff, especially to those who will attend to the patients suffering from the flu. Across the state, Visakhapatnam registered the highest number of positive swine flu cases and deaths. Out of 325 positive cases, 180 alone were reported from Visakhapatnam, of which 8 died. West Godavari district registered 3 deaths, and Anantapur, East Godavari, and Srikakulam registered one death case each.

All the district health officials have been instructed to intensify awareness camps and screening centres. As part of the action plan, isolation wards with 5-10 beds are to be set up in every teaching, district, and area hospital. A sufficient stock of drugs, masks, and PPE [personal protective equipment] kits are to be made available. Currently, there are 18 labs eligible for conducting confirmation test in the state. "We are creating awareness by distributing pamphlets and putting up screening centres at bus stops and railway stations," DMHO [district medical and health officer] Dr. TSR Murthy said.

Symptoms of swine flu are generally similar to that of seasonal flu. These include cough, fever, sore throat, stuffiness, runny nose, body aches, headache, chills, fatigue, diarrhoea, and vomiting. Later on, breathlessness, chest pain, drowsiness, low blood pressure, sputum mixed with blood, and bluish discoloration of nails also develops.
Date: Thu 28 Nov 2019
Source: GDN Online [edited]

Two expatriates living in Oman died after contracting the seasonal influenza (H1N1) or swine flu in the governorate of Dhofar -- the 1st in July and the 2nd in August [2019]. They were among 78 confirmed cases of swine flu registered at the Sultan Qaboos Hospital over the first 9 months of 2019 in the governorate.

The hospital authorities reported a total of 599 registered suspected cases of H1N1 between January and last September [2019]. Doctors working at Sultan Qaboos Hospital dealt overall with 1779 cases of respiratory infections during the same period.

Patients most vulnerable to the respiratory viruses are those over 18 years, particularly pregnant women; those suffering from chronic illnesses, kidney and heart diseases, liver problems, diabetes, asthma, blood disorders, and HIV/AIDS; and even health workers, according to Muscat Daily.
Date: Wed 11 Dec 2019
Source: UNICEF/WHO Situation report 11 Dec 2019 [edited]

Highlights
- 5 new human cases reported in the past week
- In response to 1st human vaccine-derived poliovirus type 1 (VDPV1) case from the island province of Basilan, in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), outbreak immunization was conducted
in Maluso, Basilan, with bivalent oral polio vaccine (bOPV) against polio type 1, vaccinating 13 547 children under 10 years old (102% of the target).
- Currently 9 human cases confirmed with circulating VDPV type 2 (cVDPV2), 1 case with VDPV1, 1 case with cVDPV1, and 1 case with immunodeficiency-related VDPV type 2 (iVDPV2).
- A case with VDPV1 from Sultan Kudarat is pending genetic analysis; 1 case of cVDPV1 from Malaysia was confirmed as genetically linked to the Basilan case.
- Synchronized polio vaccination campaign conducted on [25 Nov 2019 - 10 Dec 2019] (including 2 days of extension) vaccinated 4 309 566 children under 5, which is 98% of the target total of 4.4 million children under 5. A total of 1 395 365 children under 5 were vaccinated in National Capital Region (NCR), which is 109% of the target, and 2 914 201 (94%) in Mindanao.
- DOH planning to conduct outbreak immunization with bOPV targeting 710,296 children under 10 in the Sulu Archipelago, Zamboanga City, and Lambayong, Sultan Kudarat, on [6-12 Jan 2020].
- Current polio outbreak resulting from persistently low routine immunization coverage, and poor sanitation and hygiene.
- Philippines is affected by both cVDPV1 and cVDPV2. cVDPV is considered a public health emergency of international concern (PHEIC).

cVDPV1
---------
- In response to the 1st human case confirmed with VDPV1 from Maluso, Basilan (BARMM), outbreak immunization was conducted in the area with bOPV for children under 10 years old, vaccinating 13,547 children under 10 years of age (102% of the target).
- A cVDPV1 case in Sabah state, Malaysia, was confirmed to be genetically linked to the Basilan case by the Victorian Infectious Diseases Reference Laboratory (VIDRL) in Australia. Since the 2 viruses are genetically linked, they are both classified as circulating.
- A new VDPV1 case from Sultan Kudarat (Region XII) was confirmed on [6 Dec 2019] and is pending further genetic analysis.
- All 13 cVDPV1 environmental samples found in Manila are genetically linked.

cVDPV2
---------
- All 9 human cases and 17 environmental samples confirmed with cVDPV2 are genetically linked. All human cases were reported from Mindanao (BARMM and Region XII), whereas environmental samples were found in NCR and Davao.
- All samples were tested by the National Polio Laboratory at the Research Institute for Tropical Medicine (RITM), whereas sequencing and genetic analysis is done at the NIID in Japan, and additional genetic characterization is provided by the United States Centers for Disease Control and Prevention (CDC).
=======================
[Given the identification of the cVDPV1 case in Malaysia that is genetically related to the VDPV1 case in Basilan, it is now clear there are at least 2 separate cVDPV outbreaks in the Mindinao region of the Philippines: one of the outbreaks is associated with cVDPV2, and the other with cVDPV1 and one outbreak of cVDPV1 in the Manila Metropolitan area (although only environmental samples have been positive without AFP (acute flaccid paralysis) cases as yet.) What all these areas have in common is pockets of populations with suboptimal vaccination coverages. Clearly, we await further information on the genetic profiling of the newly identified VDPV1 case in Sultan Kudarat, also located in southern Philippines. Note that Basilan Island, Sultan Kudarat, and Sabah state in Malaysia, while all in the same general area, are not contiguous, each being on a different island. In. total, there are 11 cases of AFP in the Philippines that are attributable to infection with a VDPV.

A map showing the provinces in the Philippines can be found at

HealthMap/ProMED-mail map of the Philippines: