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Tajikistan

Tajikistan - US Consular Information Sheet
December 9, 2008
COUNTRY DESCRIPTION: Tajikistan remains the poorest of the former Soviet republics in Central Asia.
It is a nominally constitutional, democratic, and secular republic, dominated b
President Emomali Rahmon who has been in power since 1992.
Tourist facilities are undeveloped and many goods and services usually available in other countries are unavailable.
Read the Department of State Background Notes on Tajikistan for additional information.

ENTRY/EXIT REQUIREMENTS:
A valid passport and visa are required to enter and exit Tajikistan, as well as for registration at hotels.
The visa should be valid for the entire period of stay in country, through departure, and travelers should ideally request visas which allow for changing travel dates.
Failure to produce a valid visa will require the traveler to leave the country immediately.
Travelers planning to arrive in Tajikistan from countries that have Tajik embassies or consulates must obtain Tajik visas abroad prior to their travel.
Tajikistan is represented by embassies and consulates in the following countries:
United States of America, United Kingdom, Austria, Germany, Belgium, Turkey, China, Afghanistan (Kabul, Mazori Sharif), Iran, Pakistan, India, Russian Federation, Belarus, Kazakhstan, Kyrgyzstan, Uzbekistan, Turkmenistan, Egypt, and United Arab Emirates (Dubai).
Travelers arriving in Tajikistan from countries in which there are no Tajik embassies or consulates must have Tajik visa support, in the form of a letter from the Tajik Ministry of Foreign Affairs (MFA) confirming that a visa may be issued, in order to receive a Tajik visa at the Dushanbe International Airport upon arrival.
Travelers need to have two passport-size photos and a passport valid for at least six months longer than the duration of the planned stay in Tajikistan.
Visas issued at the Dushanbe airport are normally valid for only 45 days.
This “upon arrival” visa service does not apply to any other Tajik airports or land borders.

Travelers staying in Tajikistan three days or longer must, within three days of arrival in Tajikistan, obtain registration stamps at the MFA or the Department of Visas and Registration of the Ministry of Internal Affairs (OVIR), depending on whether the purpose of the visit to Tajikistan is for official or personal travel.
Immigration authorities may deny the departure of travelers who failed to register their visas until after they have paid a fine and obtained the registration stamps at the MFA or OVIR.

In order to receive visa support, an organization inviting a traveler to Tajikistan must submit a request to the MFA at least two weeks in advance of the planned travel date to Tajikistan.
Persons planning to arrive in Tajikistan at the invitation of a private Tajik resident (e.g., a friend or relative in Tajikistan) need to obtain a notification letter from OVIR.
According to OVIR, it may take up to 45 days to obtain the notification letter.
The MFA will issue Tajik visa support on the basis of the OVIR notification letter.
The inviting party will send a copy of visa support to the traveler.
The original MFA visa support will be sent to the Consular bureau at Dushanbe airport.
According to the Ministry of Foreign Affairs, persons traveling at the invitation of Tajik organizations or travel agencies, who are applying for visas at Tajik embassies or consulates abroad, will be able to obtain single-entry Tajik visas valid for 45 days upon direct submission of their visa request to the Tajik embassy or consulate (without a visa support letter).
With the issuance of visa support, travelers applying for visas at Tajik embassies or consulates abroad will be able to obtain multiple-entry visas valid for a maximum of three months.
Travelers who would like their visas extended need to apply for extension in advance through the MFA (official travelers) or OVIR (tourist or commercial travelers).
Entry into the Gorno-Badakhshan region, both from inside and outside of Tajikistan, requires special authorization in advance in addition to a valid Tajik visa.
Travelers can obtain this authorization at Tajik embassies and consulates abroad, or by applying to the MFA or OVIR once in Tajikistan.
Tajik authorities advise that sponsoring organizations in Tajikistan submit requests for travel authorization for the Gorno-Badakhshan Autonomous Region at least two weeks in advance of the planned travel.
The Tajik MFA or OVIR will list the names of the settlements and cities in Gorno-Badakhshan which the traveler plans on visiting in the travel authorization stamp.
The Gorno-Badakhshan travel authorization is not written on a Tajik visa sticker; it is a separate note put in a passport.

The government of Tajikistan requires visitors who remain in country for more than 90 days to present a medical certificate showing that they are HIV-free, or to submit to an HIV test in Tajikistan.
HIV is a growing health threat in Tajikistan.

Visit the Embassy of Tajikistan web site at http://www.tjus.org for the most current visa information.

Note: Departure options from Tajikistan may be limited in an emergency.
U.S. citizens, their family members, and their dependents can maximize departure options by obtaining extended visas for travel to countries with reliable connections to Tajikistan, including Kazakhstan, Kyrgyzstan, Uzbekistan and Russia.
Other destinations, notably Turkey, offer several flights a week and do not require American citizens to obtain visas in advance.
Please note, however, that in emergency situations, flights may be suspended.

Information about dual nationality or the prevention of international child abduction can be found on our website.
For further information about customs regulations, please read our Customs Information Sheet.

SAFETY AND SECURITY:
Supporters of terrorist groups such as the Islamic Movement of Uzbekistan (IMU), the Islamic Jihad Union (IJU), al-Qaida, and the Eastern Turkistan Islamic Movement remain active in Central Asia, as do anti-Western, anti-Semitic extremist organizations such as Hizb’ut-Tahrir.
These groups have expressed anti-U.S. sentiments and may attempt to target U.S. Government or private interests in the region, including in Tajikistan.
Terrorist attacks involving the use of suicide bombers have previously taken place in neighboring Uzbekistan.
Taliban resurgence and successful operations in Afghanistan, including attacks in the north, could also affect the security situation in southern Tajikistan.

Minor explosions have occasionally occurred in Dushanbe in the last two years.
These explosions usually happen at night.
In June 2007, an individual threw a grenade at the Supreme Court building.
Witnesses and unofficial reports indicate that three guards were killed, although no official reports confirmed this.
In November 2007, a small explosive killed an individual outside the Kokhi Vahhdat conference center in the center of Dushanbe.
In both cases, no individual or organization claimed responsibility and authorities continue to investigate.
Also in November 2007, a small improvised explosive device destroyed the official car belonging to the Commander of the President’s National Guard.
Incursions along the Afghan border have resulted in shootings and kidnappings; however, most are believed to be related to narcotics trafficking.
None of these incidents have indicated the targeting of Americans or Westerners.

Criminal groups and terrorists do not distinguish between official and civilian targets.
Because of increased security at official U.S. facilities, terrorists are seeking softer civilian targets such as residential areas, clubs and restaurants, places of worship, hotels, outdoor recreation events, and other venues.
The limited number of facilities catering to Westerners presents a heightened risk.
American travelers should also avoid demonstrations and large crowds.
Demonstrations and mobs are rare in Tajikistan following the 1992-1997 civil war, and police reaction to such behavior is unpredictable.

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 United States and Canada 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:
The current crime rating for Dushanbe is high.
The primary concern is the inability of Tajikistan’s law enforcement entities to provide adequate and immediate assistance.
Lack of manpower, low salaries, and inadequate training all contribute to a lack of professionalism.
Tajikistan’s struggling economy and high unemployment have resulted in incidents of street crime, including pick pocketings, muggings and armed robberies.
Alcohol-related incidents such as bar fights and drunk driving are common.
Criminals are not deterred by the risk of confrontation and tend to operate in groups of two or more to decrease their chances of arrest.
When crimes do occur, they can be violent in nature.
Additionally, the lack of a free media, and the infrequent public outreach between the government and the public through the media, does not provide the average citizen current and accurate information to make informed decisions about safety.

Government statistics are typically inaccurate because many crimes are not reported to law enforcement organizations.
Often police refuse to open minor or routine cases that seem too difficult to resolve.
In 2007, the Ministry of Interior reported a number of arrests related to organized crime, although overall reported crimes saw a slight decrease.
The Ministry also reported a slight increase in firearm and drug-related offenses compared to previous years.

Crimes of opportunity can occur against anyone, and the Embassy reminds visitors to be careful and cautious in their own personal security, whether within the city limits of Dushanbe or in the more remote areas of the country.
Americans should be aware that danger increases after dark, and they are advised to use caution when traveling alone or on foot after dark.
The U.S. Embassy encourages visitors to travel in pairs and to notify colleagues of their whereabouts when not working, especially during evening hours.
Travelers are also encouraged to carry a copy of their passport (separate from their wallets) to speed up issuance of a new passport in case of theft.

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

INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting 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.

The local equivalent to the “911” emergency line in Tajikistan is: 01 - Fire, 02 - Police, 03 - Ambulance
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
The quality of Tajikistan’s medical infrastructure is significantly below Western standards, with severe shortages of basic medical supplies, including disposable needles, anesthetics, and antibiotics.
Many trained medical personnel left the country during and following the civil war.
Elderly travelers and those with pre-existing health problems may be at particular risk due to inadequate medical facilities.

Significant disease outbreaks are possible due to population shifts and a decline in some immunization coverage among the general population.
There have been outbreaks of typhoid in the Dushanbe area and in the south, and the risk of contracting malaria, cholera, and water-borne illnesses is high.
Throughout Central Asia, rates of infection of various forms of hepatitis and tuberculosis (including drug-resistant strains) are on the rise.
Tuberculosis is an increasingly serious health concern in Tajikistan.
For further information, please consult the CDC’s Travel Notice on tuberculosis at http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx.
It is advised to drink only bottled or thoroughly boiled water while in Tajikistan.

The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Tajikistan.
However, the government of Tajikistan does require visitors who remain in country for more than 90 days to present a medical certificate showing that they are HIV-free, or to submit to an HIV test in Tajikistan.
HIV is a growing health threat in Tajikistan.

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

Travel to, from, and within Tajikistan is difficult and unreliable.
Neighboring countries may unilaterally close borders and some borders are poorly delineated.
Armed police or military checkpoints can make road travel outside of Dushanbe more difficult.
Crossing the Tajik-Uzbek border, in particular, has been known to present difficulties for drivers operating vehicles with non-Tajik government-issued plates.
Road travel should be undertaken only in daylight hours and on routes known to the traveler or a reliable escort.
Those traveling to Gorno-Badakhshan by car should do so only during daylight hours.
The roads traverse mountainous terrain along the Afghan border that is difficult to navigate, even in daylight hours.
Public transportation vehicles in the city are often overcrowded and not always safe.
If you are driving, be vigilant because pedestrians often tend to cross the street at inappropriate places or walk along the highway without paying attention to vehicular traffic.
Bus services between major cities have been severely disrupted by border closures and should not be relied upon.
The State Traffic Inspectorate (GAI, or in Tajiki, BDA), which has checkpoints in many cities and at regular intervals along all highways outside the city, frequently stops vehicles for inspection of the vehicle and the driver’s documents.

During the winter months, the potential dangers when traveling outside of Dushanbe in the mountainous areas of the country are heightened.
Every year, accidents and casualties occur on Tajikistan’s mountain roads and passes, often when drivers ignore warnings not to travel over a closed mountain pass.
Avalanches are a common occurrence in Tajikistan’s mountains during the winter months.
The tunnel bypassing the Anzob Pass is still not complete and travel via this construction project is not advised in any season.
Please exercise caution and limit winter travel to Tajikistan’s mountain regions.

In certain parts of the country, including in the Vakhsh and Rasht valleys and along the Afghan-Tajik border, land mines and cluster munitions form an additional hazard.
If an area has land mine warning signs, or is marked off with red and white plastic tape, heed the warning and do not venture off the road.
In all cases, do not pick up or handle anything that looks like unexploded munitions.

Emergency phone numbers in Tajikistan:
police – 02, ambulance – 03, state traffic control (GAI) duty officer – 235-45-45.
Please refer to our Road Safety page for more information.

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

SPECIAL CIRCUMSTANCES: Tajikistan has a cash-only economy.
International banking services are limited, but ATM machines have been installed in several locations.
Cash is dispensed in both U.S. and local currency.
Few establishments in the country accept credit cards and none accepts traveler's checks.
Tajikistan's national currency is the Somoni, which is convertible.

Tajik customs authorities may subject all items that are imported into or exported from Tajikistan to a high level of scrutiny.
The Government of Tajikistan may enforce strict customs regulations against those who import and export goods.
The export of antiques and cultural valuables requires special permission.
There are also currency restrictions.
Travelers must fill out a Customs Declaration Form upon arrival in Tajikistan, have it stamped by Tajik customs officials at the port of entry and retain the form until departure to demonstrate that the travelers are not leaving Tajikistan with more money than they brought into the country.
Please contact the Embassy of the Republic of Tajikistan in the United States, 1005 New Hampshire Avenue NW, Washington, DC, 20037; telephone (202) 223-6090, fax:
(202) 223-6091, e-mail: tajikistan@verizon.net, web site: http://www.tjus.org for specific information about customs requirements.

The Republic of Tajikistan does not recognize dual citizenship with most countries, including the United States (one exception is with Russia, where dual citizenship is regulated by a special interstate agreement).
Dual nationals who attempt to leave Tajikistan on U.S. passports without valid Tajik visas in them are likely to have problems with immigration authorities upon departing Tajikistan.

Travelers to Tajikistan are subject to frequent document inspections by local police.
U.S. citizens are strongly encouraged to carry copies of their U.S. passports, Tajik visas, and visa registration at all times (including while traveling within Tajikistan) so that, if questioned by local officials, proof of identity,
U.S. citizenship, and valid visa status in Tajikistan are readily available.
Always check your visa and registration validity dates so that these documents can be renewed if necessary before they expire.
Taking photographs of anything that could be perceived as being of military or security interest, including many government buildings, may result in problems with the authorities.
In accordance with the Vienna Convention on Consular Relations and certain bilateral agreements, local authorities must grant a U.S. consular officer access to any U.S. citizen who is arrested.
U.S. citizens who are arrested or detained should ask to contact the U.S. Embassy immediately.

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

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 Tajik laws, even unknowingly, may be expelled, arrested or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Tajikistan 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 Tajikistan 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 Tajikistan.
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 109A Ismoili Somoni Avenue, Dushanbe, Tajikistan, Main Phone: 992-37-229-2000, Consular Direct Line: 992-37-229-23-00, consular e-mail dushanbeconsular@state.gov, embassy fax:
992-37-229-20-50, Duty Officer: 992-90-770-10-32, web site: http://dushanbe.usembassy.gov
* * *
This replaces the Country Specific Information for Tajikistan dated February 14, 2008, to update the sections on Entry/Exit Requirements, Crime, Aviation Safety Oversight and Registration/Embassy Location.

Travel News Headlines WORLD NEWS

Date: Mon, 6 Aug 2018 06:19:37 +0200
By Akbar Borisov, with Christopher Rickleton in Almaty

Dushanbe, Tajikistan, Aug 6, 2018 (AFP) - En route to mountainous Tajikistan's "roof of the world" lies a hastily-erected memorial to four bike tourists killed in an attack claimed by the Islamic State group late last month.     Roses and tulips lie scattered at the tribute -- featuring a plaque inscribed in English -- in the foreground of a scrubby mountain landscape.    "We express sincere condolences on behalf of all Tajik people and Tajikistan to the families and relatives of the died tourists in our country tragically and cruelly," the plaque reads.

It was here, approximately 100 kilometres south of Tajikistan's capital Dushanbe, that American tourists Lauren Geoghegan and Jay Austin, Dutch citizen Rene Wokke and Swiss citizen Markus Hummel were fatally wounded in an attack initially reported as a hit-and-run road accident.    The attack comes as a deep blow to Tajikistan, which has been trying to promote the authoritarian country as a tourism hotspot, simplifying visa bureaucracy and even declaring 2018 "the year of tourism."

Police said the gang that attacked the group of seven tourists, injuring two others, had also stabbed their victims, while a video released via IS' official media channel indicated the attackers were inspired by the Islamist group.   "It was a tragedy," 32-year-old account manager and biking enthusiast Pau Ros told AFP ahead of a seven-day cycle over Tajikistan's legendary Pamir Highway with girlfriend Mariona Miranda.   "This happens around the world now. But we are not going to change our lives because that is what these bad people would want," said Ros, who is a native of Barcelona.

- IS-linked? -
Authorities have played down video evidence that appears to show five men -- four of whom they say were killed resisting arrest -- swearing an oath of allegiance to IS leader Abu Bakr al-Baghdadi.   On Friday Tajikistan's state prosecutor said the clip had been released "with the aim of deflecting suspicions from another terrorist organisation -- the Islamic Renaissance Party", a former opposition party banned by the government in 2015. 

The IRPT has refuted links to the attack, as has Iran, a country that Tajikistan has poor ties with and says provided training to a 33-year-old man called Hussein Abdusamadov, who was detained for allegedly leading the attack on the cyclists.   In a brief interview with AFP, the mother of Abdusamadov, who was shown sporting a black eye in his police photo, could not say if he had traveled to Iran but said he spoke Arabic and had worked in Russia, a migration destination for hundreds of thousands of Tajiks.   "We do not know when he came back to (Tajikistan). The police just came to our door and told us he had committed a crime," Gulchekhra Shodmonova told AFP.

Analysts have pointed to a number of reasons to doubt the official narrative linking IRPT and Iran to the attack -- chiefly a downturn in Tajikistan's relations with Iran, an intensified crackdown on the opposition since 2015 and the IS video evidence.     Mahmudjon Faizrahmon, a spokesman-in-exile for the party that has always described itself as peaceful opposition force said on Thursday that police brought his 62-year-old mother for questioning after he denied links between the party and the attack on Twitter.     In addition to Abdusamadov, Tajikistan's prosecutor says 10 people have been detained under suspicion of financing the crime and failing to supply information to police before the attack took place.

- 'Simply Cycling' -
At the US embassy in Dushanbe, Tajikistan, a simple bicycle donated by a local student provides a fitting flourish to a display honouring 29-year-old Geoghegan and Austin, whose blog Simplycycling.org was popular among other bike-the-world cyclists.   The pair whose photo stood on a table at the heart of the display described themselves as enthusiasts who fell in love with cycling in adulthood but were not above "hitching a ride when a stretch of road is dangerous or just awful."   It is uncertain how the attack from which only one tourist, a Frenchman, emerged unscathed, will affect one of the few sources of economic optimism in the poorest country to gain independence from the Soviet Union.    Tajikistan announced plans to create a "tourist police" earlier this week, but provided few details.    One representative of a Bed and Breakfast in Dushanbe told AFP that a Polish tourist who had planned on cycling the highway had flown home. 
Date: Mon, 30 Jul 2018 10:24:00 +0200

Dushanbe, Tajikistan, July 30, 2018 (AFP) - Four foreign tourists were killed in Tajikistan on Sunday by armed attackers in what was originally reported as a hit-and-run road accident, the interior minister said Monday.   "(The suspects) had knives and firearms," minister Ramazon Hamro Rahimzoda said of the attack that left tourists from the United States, Switzerland and the Netherlands dead and two others injured.
Date: Sun, 29 Jul 2018 20:22:04 +0200

Dushanbe, Tajikistan, July 29, 2018 (AFP) - Four tourists were killed and another three injured on a bike tour in southern Tajikistan on Sunday when a car hit them before fleeing the scene, authorities said.   The seven cyclists included two Americans, two Dutch nationals and three other foreigners, the interior ministry told AFP without specifying the nationalities of those who died.   However, the US embassy in Tajikistan said two of the fatalities were US citizens.

The hit-and-run accident took place in the district of Danghara, 150 kilometres (90 miles) south of the capital Dushanbe.    "Three foreigners were killed at the scene and another died in hospital," the interior ministry said, adding that three other tourists had also received medical treatment.

Authorities in the Central Asian nation announced later Sunday one arrest and the deaths of two other suspects during a special operation launched to find those responsible for the deadly hit-and-run incident.   "One person has been arrested, two others resisted arrest and have been killed," the interior ministry said, without giving further details about the suspects.   Tajikistan is the poorest of the ex-Soviet republics and has been ruled by the iron hand of President Emomali Rakhmon since 1992.
Date: Tue 7 Nov 2017
Source: UN OCHA, ReliefWeb, Int Fed of Red Cross and Red Crescent Societies (IFRC) report [edited]

Measles outbreak DREF [Disaster Relief Emergency Fund] Operation MDRTJ025 Final Report
----------------------------------------------------------------------
A. Situation analysis
Description of the disaster
The measles epidemic in Tajikistan started in April 2017 in Rudaki district, and gradually spread to the capital city of Dushanbe and the surrounding districts, as well as Khatlon oblast. In mid-April 2017, 263 registered cases of measles were reported, out of which 157 were laboratory confirmed. By 1 May 2017, the number of notified and investigated cases rose from 263 to 345, with 246 patients (71 per cent) hospitalised. There were 2 child deaths registered over the course of the epidemic -- one in Khatlon oblast and one in the Districts of Republican Subordination).

The group most affected by the epidemic were children between 1 and 9 years of age. This also corresponded to the cohort born after the last national measles and rubella (MR) immunisation campaign conducted in 2009. Normally, the immunisation centre of the Ministry of Health and Social Protection (MoHSP) carries out immunisation on an annual basis for approx. 97 per cent of this cohort. The remaining 3 per cent -- including migrants, Roma and displaced people -- however, tends to remain non-immunised.

In response to the outbreak, the MoHSP decided to conduct a nationwide MR vaccination campaign targeting children aged 1-9 years, 15-26 May 2017, with the support of the Measles and Rubella Outbreak Response Initiative (MRI) Fund. The government of Tajikistan issued a decree on National Additional Immunisation Days in the country on 28 Apr 2017. The MoHSP issued an internal order on immunisation accordingly.
=====================
[The complete IFRC report is available at

Maps of Tajikistan can be seen at
Date: Mon, 30 Jan 2017 09:06:48 +0100

Dushanbe, Tajikistan, Jan 30, 2017 (AFP) - Authorities in Tajikistan said Monday that at least seven people were killed in a series of avalanches that hit the mountainous Central Asian country over the weekend.   Avalanches killed at least five people on a highway linking the capital Dushanbe with Khujand, Tajikistan's second largest city, the emergency services committee said.

Two more died in avalanches in the remote Pamir region in the country's east, the committee said.   Authorities said a rescue operation was ongoing and the casualty toll could continue to rise.    A spokesperson for the committee told AFP around 800 people had been evacuated Sunday following the avalanches.   Mountainous and poverty-struck Tajikistan is prone to natural disasters including avalanches, landslides and earthquakes.   In February 2015, a single avalanche claimed six lives in the east of the country.
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Paraguay

Paraguay - US Consular Information Sheet
September 15, 2008
COUNTRY DESCRIPTION:
Paraguay is a constitutional democracy with a developing economy.
Tourist facilities are adequate in the capital city of Asuncion, but they vary greatly
n quality and prices.
Travelers outside Asuncion should consider seeking travel agency assistance, as satisfactory or adequate tourist facilities are very limited in other major cities and almost nonexistent in remote areas.
Read the Department of State Background Notes on Paraguay for additional information.
ENTRY/EXIT REQUIREMENTS:
A passport and visa are required.
U.S. citizens traveling to Paraguay must submit completed visa applications in person or by secure messenger to the Paraguayan Embassy or one of the consulates and pay a fee.
Paraguay issues visas for one-entry or multiple entries up to the validity of the U.S. passport.
Applicants under 18 years of age traveling alone must appear with both of their parents or a legal guardian.
In case of a guardian, an original and one copy of proof of legal guardianship are required.
A document of authorization from parents/guardian will be accepted only if it is notarized and certified by the county clerk.
Travelers entering or departing Paraguay with regular U.S. passports will be fingerprinted.
Some airlines include the Paraguayan airport departure tax in the price of the airline ticket.
It is recommended that you check with the airline in order to determine whether or not the departure tax has been included.
If the tax is not included in the airline ticket then payment would be required upon departure in either U.S. or local currency (no credit cards or checks accepted). Visit the Embassy of Paraguay web site at http://www.embaparusa.gov.py 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:
As stated in the Department of State's latest Worldwide Caution, U.S. citizens overseas may be targeted by extremist groups and should maintain a high level of vigilance.
The U.S. Embassy is not aware of any specific terrorist threat to Americans in Paraguay.
Individuals and organizations providing financial support to extremist groups operate in Ciudad del Este and along the tri-border area between Paraguay, Brazil and Argentina.
Small armed groups have also been reported to be operating in the San Pedro and Concepcion Departments.
Drug trafficking remains a serious concern in the Department of Amambay.
Because of concerns about the lack of security in border areas, the U.S. Embassy in Asuncion requires U.S. Government personnel and their family members to provide advance notice and a travel itinerary when traveling to Ciudad del Este or Pedro Juan Caballero.
As a general precaution, the Embassy also counsels its employees traveling outside the capital to provide an itinerary including dates, contact names, and telephone numbers where the employee may be reached.

Since January 2007, there have been numerous kidnapping incidents mainly in the Alto Parana department.
Targets have been members of the Paraguayan business community or their family members.
It is believed that the individuals responsible for the kidnappings are financially motivated and have pre-selected their targets based on the victims’ wealth.

U.S. citizens should avoid large gatherings or any other event where crowds have congregated to demonstrate or protest.
Such activities have resulted in intermittent road closures including major routes traveled by tourists and residents.
While generally nonviolent, demonstrations and/or roadblocks have turned violent in the past.
Areas where such closures and barricades exist should be avoided.
U.S. citizens who encounter demonstrations and/or roadblocks should not attempt to continue the planned travel or to confront those at the roadblock.
Instead, they should avoid areas where individuals are demonstrating and in case of roadblock, wait for the road to reopen or return to the origin of their trip.
Uniformed police often conduct roving checks of vehicles and passengers.

For the latest security information, Americans traveling abroad should regularly monitor the Department of State, Bureau of Consular Affairs’ website 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 United States and Canada, 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:
Crime has increased in recent years with criminals often targeting those thought to be wealthy.
Although most crime is nonviolent, there has been an increase in the use of weapons and there have been incidents where extreme violence has been used.
U.S. citizens have on occasion been the victims of assaults, kidnappings, robberies, and rapes.
Local authorities frequently lack the training and resources to solve these cases.
Under these circumstances, U.S. citizens traveling to or residing in Paraguay should be aware of their surroundings and security at all times.
They should take common sense precautions including refraining from displaying expensive-looking cameras and jewelry, large amounts of money, or other valuable items.
Resistance to armed assailants has often aggravated the situation and therefore is not advised.

Armed robbery, carjackings, car theft, and home invasions are a problem in both urban and rural areas.
Street crime, including pick pocketing and mugging, is prevalent in cities.
The number of pick pocketing incidents and armed assaults is also increasing on public buses and in the downtown area of Asunción.
As many incidents on public buses involve individuals snatching valuables, passengers should not wear expensive-looking jewelry or display other flashy items.
There have been incidents of pilferage from checked baggage at both airports and bus terminals.
Travelers have found it prudent to hide valuables on their person or in carry-on luggage.
Unauthorized ticket vendors also reportedly operate at the Asuncion bus terminal, badgering travelers into buying tickets for substandard or non-existent services.

In many countries around the world, counterfeit and pirated goods are widely available.
Transactions involving such products may be illegal under local law.
In addition, bringing them back to the United States may result in forfeitures and/or fines.
More information on this serious problem is available at http://www.cybercrime.gov/18usc2320.htm
INFORMATION FOR VICTIMS OF CRIME:
The loss or theft abroad of a U.S. passport should be reported immediately to the local police and the nearest U.S. Embassy or Consulate.
If you are the victim of a crime while overseas, in addition to reporting 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 are 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.

Below are the local equivalent phone numbers to the “911” emergency line in Paraguay.
In Asuncion, the following phone numbers exist for roadside/ambulance assistance:
Emergency Services, including police and ambulances:
911.
Fire Department, including rescue of accident victims: 131, 132.
See our information on Victims of Crime.

MEDICAL FACILITIES AND HEALTH INFORMATION:
Adequate medical facilities, prescription and over-the-counter medicine, supplies, and services are available only in Asuncion.
Elsewhere, these are limited and may not exist.

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.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to Paraguay or foreign residents of the country.

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

U.S. citizens have been injured and killed in traffic accidents.
Only minimal standards must be met to obtain a Paraguayan driver's license, and driver education prior to licensing is not common.
Drivers throughout Paraguay routinely ignore traffic regulations.
No vehicle insurance is required, and many Paraguayans drive without any insurance coverage.
Persons who drive in Paraguay should be prepared to drive defensively and with their own insurance in both urban and rural areas.

Public transportation is readily available for urban and inter-city travel.
Buses vary in maintenance conditions and may not meet U.S. safety standards.
Armed robberies and pick pocketing occur on buses in cities and rural areas, sometimes with the apparent collusion of the bus driver.
Taxis are available and may be called using telephone numbers listed in the newspapers.
No passenger train service exists.
Bicycle travel may not be safe due to traffic and other road hazards.
Most urban streets consist of cobblestones over dirt.
Some roads in Asuncion and other large cities are paved.
However, these roads frequently develop potholes that often remain unrepaired.
Nearly all rural roads are unpaved, and during rainy periods and the rainy season (November-March/April), they may be impassable.
Road signs indicating hazards, such as sharp curves or major intersections, are lacking in many areas.

Driving or traveling at night is not advisable outside Asuncion because pedestrians, animals, or vehicles without proper lights are often on the roads.
In addition, assaults and other crimes against motorists traveling at night have occurred.
Extra precautions should be exercised along infrequently traveled portions of the rural roads.

Intercity highway maintenance is not equal to U.S. standards.
The privately maintained toll road between Caaguazu and Ciudad del Este and the routes between Asuncion and Encarnacion and Asuncion and Pedro Juan Caballero are in good condition.
Most other intercity routes are in good to fair condition, with brief stretches in poor condition.
The Trans-Chaco route is in fair condition except for the portion between Mariscal Estigarribia and the Bolivian border, which is unpaved and at times impassable.

The Touring and Automobile Club provides some roadside assistance to its members.
The Club may be contacted in Asuncion by visiting its offices at 25 de Mayo near Brazil, First Floor, or telephoning 210-550, 210-551, 210-552, 210-553, Monday through Friday from 8:00 a.m. to 5:00 p.m., or Saturday from 8:00 a.m. to noon, except for Paraguayan holidays.
The Touring Club also has offices in Ciudad del Este (tel. 061-512-340), Coronel Oviedo (tel. 0521-203-350), Encarnación (tel. 071-202-203), San Ignacio Misiones (tel. 082-232-080), Caaguazu Campo 9 ( tel. 0528-222-211), Santani (tel. 043-20-314), Pozo Colorado (cell phone. 0981-939-611, Villa Florida (tel. 083-240-205) and Ybyyau (tel. 039-210-206).
Towing services are scarce outside urban areas.
Twenty-four-hour tow truck services from Asuncion may be contacted by telephoning (021) 224-366, (021) 208-400, (cellular service provider) Tigo by dialing *822 or 0971-951-930.
For an extra fee, these companies may provide service outside Asuncion, but they typically demand immediate payment and may not accept credit cards.

Please refer to our Road Safety page for more information.
Visit the website of Paraguay’s national tourist office and national authority responsible for road safety at http://www.senatur.gov.py and http://www.mopc.gov.py/
AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Paraguay’s Civil Aviation Authority as not being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Paraguay’s air carrier operations.
For more information, travelers may visit the FAA’s web site at http://www.faa.gov/safety/programs%5Finitiatives/oversight/iasa/
SPECIAL CIRCUMSTANCES: Paraguay’s customs authority may enforce strict regulations concerning temporary importation into or export from Paraguay of items such as firearms, medications, toys resembling weapons, or protected species.
It is advisable to contact the Paraguayan Embassy in Washington, D.C., or one of Paraguay's consulates in the United States for specific information regarding customs requirements.

Paraguay does not recognize dual Paraguayan nationality for American citizens.
Under Article 150 of the Paraguayan Constitution, naturalized Paraguayans lose their nationality by virtue of a court ruling based on unjustified absence from the Republic for more than three years, or by voluntary adoption of another nationality.
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 Paraguay’s laws, even unknowingly, may be expelled, arrested, or imprisoned.
Penalties for possession, use, or trafficking in illegal drugs in Paraguay 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 residing or traveling in Paraguay 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 Paraguay.
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 1776 Mariscal Lopez Avenue, Asuncion; telephone (011-595-21) 213-715, fax (011-595-21) 213-728; Internet: http://paraguay.usembassy.gov, email: paraguayconsular@state.gov.
The Consular Section is open for U.S. citizen services, including registration, Monday through Thursday from 1:00 p.m. to 4:30 p.m. and Fridays from 7:30 a.m. to 10:30 a.m., except for U.S. and Paraguayan holidays; telephone (011-595-21) 213-715, fax (011-595-21) 228-603.

Travel News Headlines WORLD NEWS

Date: Tue, 28 May 2019 03:40:13 +0200
By Hugo OLAZAR

Nanawa, Paraguay, May 28, 2019 (AFP) - Like 70,000 people living close to the broken banks of the Paraguay River, where the water level has risen seven meters (23 feet) in some places, Graciela Acosta has had to pack up her belongings and evacuate.   Piled up on a canoe are the 39-year-old housewife's bed, wardrobe, bedside table and her dog Pirulin.

Acosta is getting ready to cross the border into Argentina with her daughter to seek refuge in a reception center in the neighboring town of Clorinda.   "I've had enough! It's the third time that I've had to move everything because of the floods," said Acosta.   "I pray to God that it ends. Every time. it costs a lot of money."   However, there's no chance of Acosta leaving her home in Nanawa, a town of just 6,000 people that borders Argentina to the west and faces the capital Asuncion to the east across the Paraguay River, for good.   "As soon as the water level drops, I'll go home," she said.

- 'Greater impact' -
In Nanawa, only around 500 people were able to avoid evacuation, due to living in homes with upper floors above the flood levels.   They're used to this as the Paraguay River, one of the largest in the Americas, breaks its banks and causes havoc in the poorest Nanawa neighborhoods built on the flood plain.   The river's brown waters rise almost to the height of street signs: in some areas, there is up to one or two meters of water covering roads.

Paraguayans have seen worse, though, back in 1983, according to the assistant director of the country's meteorology and hydrology service, Nelson Perez.   "It's not the Paraguay River's worst flood, but the impact is greater because more people live close to the river," said Perez.   "These are the worst floods I've seen," said Ruben Acosta, 55, who peddles his moving services by canoe.   It's a far cry from January and February, when the river's level was so low that navigating it became difficult.   "It rained a lot in March, three times more than usual, and it also rained a lot in April and May," said Perez, who pointed to deforestation as an added problem.

- 'It's like being in Venice' -
Wading through water up to his chest, Rigoberto Nunez leaves a cemetery carrying a chandelier, a vase, some crucifixes and family portraits, all plucked from the family vault.   "I prefer to take them away to be safe," says the 47-year-old traveling salesman.    The town is without electricity or police and inhabitants are afraid of looters.   Nunez is heading to a reception center provided by Argentine authorities in a Clorinda slum where he's already stashed his furniture.   Enrique Cardozo's workshop has already been ravaged by the floods.   "I've lost my sofa, the cupboard, I had nowhere to put them," said the 51-year-old father of four.

The family has moved into the first floor of their house, which is just 15 meters from the river.   "It rained non-stop for a week. One day, the water rose one meter. It was impressive, we couldn't save everything," said Cardozo.   "There's nowhere you can put your feet on the ground. It's like being in Venice, we move about by Gondola!"

On the other side of the river, Asuncion has not been spared as several areas have also had to be evacuated.   In the Sajonia residential zone, inhabitants and shopkeepers have seen their sidewalks lined with sandbags, to keep back the floodwaters.   According to Perez, though, the problems -- and waters -- will soon subside.   The water level rose only slightly on Monday, and will continue to do so for a few more days before it drains away during the first half of June, he said.
Date: Mon, 27 May 2019 12:07:58 +0200

Asuncion, May 27, 2019 (AFP) - Heavy flooding in Paraguay has displaced 70,000 families and is threatening to further inundate the capital Asuncion in the coming weeks, the country's weather bureau said.   Water levels on the Paraguay River are rising at a rate of 4-5 centimetres (1.5-2 inches) every day and is only 46 cm (18 in) below a "disaster" level, according to official data from the Department of Meteorology and Hydrology (DMH).

Crossing that threshold would "have a very strong impact" because of the number of Asuncion residents who have moved into the city's floodplain, said DMH deputy director Nelson Perez on Sunday.   The city's water service infrastructure was clogged with garbage which was exacerbating the floods, Perez added. 

Unusually heavy downpours over May, including two days which together exceeded Asuncion's average monthly rainfall, have exacerbated the flooding, said DMH meteorologist Eduardo Mingo.    Some 40,000 people in Asuncion have already been affected by the floods, official data reported.   A further 10,000 people have been displaced in the southern town of Pilar on the Argentinian border.   The government has mobilized armed forces to help displaced residents relocate to shelters, but hundreds of families have opted to stay behind in their inundated homes.
Date: Thu, 4 Apr 2019 03:06:45 +0200

Asuncion, April 4, 2019 (AFP) - More than 20,000 families across Paraguay have been affected by severe flooding from two weeks of heavy rain that caused the country's main river to burst its banks, a senior official said Wednesday as an emergency was declared in the capital.   National Emergency Minister Joaquin Roa made the announcement as forecasters said the precipitation would continue for the rest of the week.   The Paraguay River, which runs some 1,000 kilometres north to south and splits the country in two, is expected to continue overflowing.

A 90-day emergency was declared in Asuncion on Wednesday due to the flooding. Hardest-hit are some 5,000 families living in the Banado Sur working-class neighbourhood on the city outskirts.   The people affected by flooding "need sheet metal roofing, wood, and all types of help," a municipal official told AFP.   The Paraguay River flows past Asuncion and eventually merges into the Parana River in Argentina.   "We did not expect it to swell so quickly," said Pablo Ramirez, a resident of Banado Sur, a neighbourhood in the capital, dismayed after returning to his home after he left it one month ago due to flooding.

Ramirez, who relies on crutches to get around following a car accident, said that he will not leave home this time. The flooding "will go by quickly," he said optimistically.   Pedro Velasco, the leading neighbourhood Catholic priest, said that one week ago they warned emergency officials that the river was about to overflow and asked for trucks to deliver aid and help evacuate people.   "They didn't move until Monday, but by then it was already too late and they couldn't come in" because of the flooding, Velasco said.   Roa said that his office will deliver 400,000 of food in the next days in coordination with the Paraguayan military.
Date: Thu 28 Feb 2019
Source: Hoy [in Spanish trans. Mod.TY, edited]

Patients who present with febrile symptoms and who reside in the area where the 1st positive case was reported positive request tests for hantavirus [infection]. Until now there are 5 cases, 3 were positive in initial laboratory tests and 2 are suspect cases that will be tested outside [the country] because the Central Laboratory does not do confirmatory tests.

The febrile cases of residents in Capiata [Central department], the area where the 1st cases of hantavirus occurred, are adding up and now Health Surveillance has reported 2 more suspected cases, all children between 2 and 7 years old living in the same city; community intervention continues in search of possible cases.

The 1st cases confirmed in a private laboratory remain hospitalized in intensive care and the others who have improved are now receiving ambulatory treatment, stated Dr Sandra Irala of Health Surveillance.

"The clinical picture of hantavirus [infection] is that of a patient with a temperature above 38 deg C [100.4 deg F] and respiratory difficulty is another characteristic in the endemic area such as that of Chaco. In the non-endemic area [hantavirus infection] is suspected if the patient presents with fever and other possible causes are eliminated," the doctor indicated in a press conference.

The rodents that transmit the hantavirus do not inhabit urban areas and the way in which the disease [virus] is acquired is through contact with excreta and other secretions such as saliva and urine of these [infected] rodents.

Irala pointed out that the cases that are initially positive should have a cross-section of studies for final confirmation, so the samples were sent to Argentina, where there is a reference laboratory for the detection of this type of virus.

The person acquires the virus by inhaling air contaminated with the virus that is transported through dust particles, which is why it is recommended before cleaning, especially of storage buildings, to open doors and windows to ventilate the environment and moisten the soil to before proceeding with the sweeping.

The possibility of acquiring a hantavirus [infection] is if you have a history of having visited the Chaco area or if you were in a country that registers outbreaks of hantavirus, such as southern Argentina.

The disease has a 30% mortality rate and in Paraguay every year about 20 cases are registered, all in the Chaco region.

Alerting symptoms
-----------------
The symptoms of hantavirus [infection] are similar to other infectious diseases and include fever, headache, and gastrointestinal problems and, according to the development and the seriousness of the case, the patient may present with respiratory manifestations.

Before the appearance of any of these or other symptoms [the Ministry of Health] urges the public to go to the nearest health service to make the appropriate diagnosis and appropriate treatment. Under no circumstances should self-medication be used as this could aggravate the picture and obstruct the actual diagnosis of the disease.
=====================
[The active surveillance efforts in the neighborhood of the initial case has detected more patients now with a total 3 confirmed and 2 suspected. The tests used in the private laboratory to determine that 3 cases as confirmed are not indicated, nor if samples of these 3 cases were sent to the reference laboratory in Argentina for confirmation.

Most of the previous cases of hantavirus infection in Paraguay have been diagnosed in Boqueron department in the north western part of the country. This is the 1st report of hantavirus infections in the Central department of Paraguay. The possible hantavirus involved in this suspected case is not stated. A 2011 report indicated that Leguna Negra hantavirus was responsible for hantavirus pulmonary syndrome (HPS) cases in Presidente Hayes department. In addition to Laguna Negra virus (rodent host _Calomys laucha_), other hantaviruses that can cause HPS and are found in Paraguay (and their rodent hosts) include Juquitiba (_Akodon cursor_), Ape Aime-Itapua (_Akodon montensis_), Araucaria (_A. montensis_, _Oligoryzomys nigripes_), Jabora and Jabora-like (_A. montensis_), Alto Paraguay (_Holochilus chararius_), and Lechiguanas (_Oligoryzomys nigripes_). - ProMED Mod.TY]

[Maps of Paraguay:
Date: Tue 12 Jun 2018
Source: WHO, Malaria [edited]

- What were the key elements to Paraguay's malaria elimination success that helped the country reach zero indigenous cases of the disease?
Paraguay is the 1st country in the Americas since Cuba in 1973 to be certified malaria-free, representing a significant public health achievement not only for Paraguay but for the Americas as a whole. Achieving elimination in Paraguay required substantial levels of political commitment and leadership, as well as sustained investments in its national malaria programme over a period spanning more than 50 years. Notable aspects of its approach include:

Rapid and targeted response
---------------------------
With free universal health services in Paraguay and a strong malaria surveillance system, malaria cases were detected early, investigated promptly, and classified correctly.

Dedicated elimination strategy
------------------------------
After reporting its last case of malaria in 2011, Paraguay launched a 5-year plan to consolidate the gains, prevent re-establishment of transmission, and prepare for elimination certification. Activities centred on strengthening epidemiological surveillance, robust case management, and a public information campaign on the diagnosis, treatment, and prevention of malaria to promote behaviour change among populations in at-risk areas.

Integration
-----------
During 2015 and 2016, as part of a broader health reform, malaria surveillance, diagnosis, and treatment activities were integrated within Paraguay's general health services, with the aim of expanding health coverage to at-risk populations and preventing re-establishment.

Strengthening surveillance skills
---------------------------------
A 3-year initiative to hone the skills of front-line health workers in the country's 18 health regions was launched in 2016 to keep the malaria surveillance system sustainable over the long term. Supported by The Global Fund to Fight AIDS, Tuberculosis and Malaria, the project addresses disease prevention, identification of suspected cases, accurate diagnosis and prompt treatment to respond to the on-going threat of malaria importation from endemic countries in the region and Africa.

- How has Paraguay managed to stay malaria-free since 2012? What are the systems in place that made this possible and how long will the country keep those systems operational?
As part of the WHO elimination certification process, countries must demonstrate that they have the capacity to prevent the re-establishment of malaria transmission. The availability of free universal health services in Paraguay and a strong malaria surveillance system ensure imported cases of malaria are detected and responded to in a timely manner to prevent local transmission.

The inclusion of the national malaria programme within the National Malaria Eradication Service (SENEPA, in the Spanish acronym), the institution within the ministry of health responsible for the control of vector-borne diseases, helps guarantee the programme's future existence.

Further, congressional legislation provides predictable and long-term financing for the national malaria programme: by law, 1.5 percent of annual income from Paraguay's social security programme is allocated to SENEPA. Together, these elements ensure that efforts to prevent the re-establishment of malaria transmission can be sustained in the decades to come.

- What are the benefits of malaria elimination for Paraguay?
Eliminating malaria in Paraguay means that no one will fall ill or die from local transmission of the disease, bringing about tangible health benefits at the individual and community levels, as well as broader socio-economic outcomes.

- What role did national leadership, political will, civil society and international partners play in Paraguay's success?
Eliminating malaria is a collective effort, requiring the sustained engagement of many partners at the national, regional and global levels. However, achieving elimination is a country-driven process. For elimination efforts to succeed, government stewardship is essential, together with the engagement and participation of affected communities.

- Does Paraguay coordinate cross-border surveillance activities to prevent importation of malaria cases and do they provide antimalarial treatment to visitors and migrants?
Paraguay provides free treatment to all citizens, visitors, and migrants, regardless of their nationality or residency status. The national malaria programme has identified 3 populations at greatest risk: the military, Brazilian students attending universities in Paraguay, and Paraguayans travelling to Africa. Targeted interventions include strengthening passive detection systems, promotion of health education, and providing prophylaxis to travellers heading to and returning from malaria-endemic regions in Africa.

To step up cross-border collaboration, the Pan American Health Organization (PAHO) funded a project focused on strengthening entomological surveillance and control of vector-borne diseases in the 'triple border' area of Argentina, Brazil, and Paraguay. A key outcome of the project, which ran from 2010 to 2012, was the development of an _Anopheles_ mosquito range map, a tool that shows the geographic distribution of malaria-carrying mosquitoes.

- What are the lessons learned from Paraguay's experience that can be applied in other countries looking to eliminate malaria?
Paraguay provides universal free health services to all, one of the critical elements that helps drive a country towards malaria elimination. Sustained political commitment and robust financial support are further keys to success. Continued surveillance of suspected cases, targeted community engagement and education, as well as strengthening skills of front-line health workers, are recommended strategies that WHO encourages countries to adopt as part of their national malaria elimination programmes.
 
- Is Paraguay replicating its elimination strategy with other infectious and mosquito-borne diseases?
Paraguay has an integrated approach to entomological surveillance activities, taking into account several vector-borne diseases including dengue, leishmaniasis, and Zika virus. Integration of malaria surveillance into the general health system had been a challenging task in Paraguay, but the lessons and experiences learned from other vector-borne diseases have contributed to the smooth integration and transition of the malaria programme. At the same time, the approach used to eliminate malaria is now being applied to eliminate Chagas disease and schistosomiasis.
======================
[ProMED congratulates Paraguay for this important public health achievement. It is important to demonstrate that malaria eradication is possible, and the achievement could be an inspiration for the countries in southeast Asia experiencing a decline in artemisinin susceptibility. - ProMED Mod.EP]

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

World Travel News Headlines

Date: Mon, 1 Jun 2020 10:23:53 +0200 (METDST)

Yerevan, June 1, 2020 (AFP) - Armenian Prime Minister Nikol Pashinyan and his family have tested positive for the coronavirus, he said Monday, as the rate of new infections soared in the Caucasus nation.   "My coronavirus test was positive yesterday," Pashinyan said in a self-recorded video message on Facebook, adding that his family were also infected.   He said he had no "viable symptoms" of the virus and would be working from home.   The prime minister and his wife Anna Hakobyan, who is a journalist, have four children.   The ex-Soviet republic of some three million has so far reported 9,492 cases of the coronavirus and 139 deaths.

Coronavirus patients have overwhelmed Armenia's hospitals and last week health officials said that intensive care treatment could be soon restricted to patients with the best chance of survival.   Pashinyan's announcement came nearly one month after Armenia on May 4 lifted a state of emergency imposed in March to slow the spread of the coronavirus.

The prime minister acknowledged his government had failed to enforce anti-virus measures and there had been widespread quarantine violations.   Pashinyan was elected prime minister in the wake of mass popular protests he led two years ago against veteran leader Serzh Sarkisian and his Republican Party.   He has since led a relentless crusade against graft and initiated sweeping judicial reforms.
Date: Mon, 1 Jun 2020 09:17:15 +0200 (METDST)

San Salvador, June 1, 2020 (AFP) - Tropical Storm Amanda triggered flash floods, landslides and power outages as it barrelled through El Salvador and Guatemala Sunday, killing 14 people, authorities said, warning of further heavy rain to come.   El Salvador President Nayib Bukele declared a 15-day state of emergency to cope with the effects of the storm, which he estimated to have caused $200 million in damage, but which weakened later in the day as it moved into Guatemala.

Amanda, the first named storm of the season in the Pacific, unleashed torrents of floodwater that tossed vehicles around like toys and damaged about 200 homes, the head of the Civil Protection Service William Hernandez said.   The fatalities were all recorded in El Salvador, Interior Minister Mario Duran said, warning that the death toll could rise.   One person is still missing, senior government official Carolina Recinos added.   "We are experiencing an unprecedented situation: one top-level emergency on top of another serious one," San Salvador mayor Ernesto Muyshondt said, referring to the coronavirus pandemic.

He added that half of those killed died in the capital, and that 4,200 people had sought refuge in government-run shelters after losing their homes or being forced to leave because they were in high-risk areas.   In some flooded areas, soldiers worked alongside emergency personnel to rescue people.   "We lost everything, we've been left with nowhere to live," said Isidro Gomez, a resident of hard-hit southeastern San Salvador, after a nearby river overflowed and destroyed his home.

Another victim, Mariano Ramos, said that at dawn residents of his San Salvador neighborhood were slammed by an avalanche of mud and water. An elderly man died in the area, officials said.   El Salvador's environment ministry warned residents of the "high probability" of multiple landslides that could damage buildings and injure or kill people.

Nearly 90 percent of El Salvador's 6.6 million people are considered vulnerable to flooding and landslides due to its geography.   In neighboring Guatemala, officials said roads had been blocked by at least five landslides and some flooding was reported, but no evacuations were underway.   Even though Amanda weakened to tropical depression status, Guatemalan officials warned that heavy rain would continue, with swollen rivers and possible "landslides affecting highways ... and flooding in coastal areas."
Date: Mon, 1 Jun 2020 06:55:18 +0200 (METDST)

Lima, June 1, 2020 (AFP) - Peru on Sunday reported 8,800 new COVID-19 infections, setting a new daily record for a country that already has the second highest number of novel coronavirus cases in Latin America after Brazil.   The death toll is now at 4,506, the third highest in the region -- itself the new hotspot of the deadly disease -- after Brazil and Mexico, with President Martin Vizcarra warning the country is only halfway through the crisis.

Infections have jumped in Peru despite a months-long mandatory lockdown and a nigh time curfew and the government ordering international borders to be closed.   The spike is concentrated around the capital Lima, where one third of the population lives, and put tremendous strain on Peru's economy and healthcare system.   Four out of every ten Peruvians lost their source of income when the lockdown began, according to one study, and last week Peru secured a two-year, $11 billion credit line from the International Monetary Fund.

- 'Tremendous challenge' in Chile -
Neighbouring Chile on Sunday reported 57 more fatalities in the past 24 hours, a new record that brings the country's COVID-19 death toll to 1,054.   "We are facing the largest pandemic of the past 100 years," said Deputy Health Minister Paula Daza, as she announced the latest figures.    "It is a tremendous challenge; we are living very difficult times in our country."

In Santiago, where the 80 percent of the virus cases were reported, 96 percent of the emergency room beds were taken, officials said.   Officials reported a sharp increase in cases over the past two weeks.   In early May the government of President Sebastian Pinera said that the number of virus cases had hit a plateau, and lockdown restrictions would be loosened.
Date: Mon, 1 Jun 2020 03:38:38 +0200 (METDST)
By Anna SMOLCHENKO

Moscow, June 1, 2020 (AFP) - Shopping malls and parks are set to reopen in Moscow on Monday as the Russian capital eases coronavirus restrictions despite having the world's third-largest caseload.   The relaxation of the confinement orders in Moscow, the epicentre of Russia's outbreak with a population of more than 12 million, comes after President Vladimir Putin announced the epidemic had passed its peak in the country.

Under lockdown since March 30, residents of Europe's most populous city were until now only allowed to leave their homes for brief trips to shop, walk dogs or travel to essential jobs with a permit.   While Muscovites welcomed the opportunity to return to parks and malls after weeks of being cooped up at home, many ridiculed the Moscow mayor's "experiment" aimed at regulating people's walks and exercise.

As a two-week test measure, Sergei Sobyanin said residents of Moscow will be allowed to take walks according to a staggered schedule based on their home address.   "Regular walks are allowed between 9am and 9pm but no more than three times a week -- twice on weekdays and once on a weekend," said Sobyanin on his blog, adding that a detailed schedule would be released separately.   People can jog or exercise between 5am and 9am but must wear masks, according to the new rules.   Sobyanin said he feared that without limits on walking, people would throng the streets in scenes reminiscent of May Day outpourings in Soviet times.

- 'Sheer lunacy' -
The new regulations unleashed a flood of mockery on social media, with political commentator Alexander Golts calling them "sheer lunacy".   Critics quipped that life in Moscow was beginning to imitate dystopian fiction such as the novels of Aldous Huxley and Yevgeny Zamyatin.

Popular comedian Maxim Galkin, who has nearly eight million followers on Instagram, released a sketch in which Putin and Sobyanin discuss a "breathing schedule" for Moscow residents.   The five-minute parody has been viewed nearly six million times over the past few days.   When the restrictions are relaxed, dry-cleaners, laundry services and repair workshops will be allowed to reopen, while restaurants, cafes and cinemas will remain closed for now.

Moscow authorities also said that no mass gatherings would be allowed during the city-wide quarantine that will remain in place until at least June 14.   On Thursday authorities sentenced prominent reporter and activist Ilya Azar to 15 days in jail for staging a lone protest in central Moscow.   Dozens of his supporters have also been briefly detained over the past few days.   Rights organisations including Amnesty International and the Council of Europe have warned Moscow against using the coronavirus lockdown as a pretext to muzzle activists.

Many critics have also questioned the move to lift the restrictions as Russia reported more than 9,000 new infections on Sunday.   With more than 405,000 confirmed infections and over 4,600 deaths, the country has the world's third-largest caseload after the United States and Brazil.   Analysts say Putin is keen to open up the Russian economy and has recently ordered a World War II victory parade postponed by the contagion to be held on June 24.   The 67-year-old leader is also widely expected to announce a new date for a vote on constitutional reforms that could pave the way for him to potentially stay in power until 2036.
Date: Sun, 31 May 2020 11:16:20 +0200 (METDST)

Mogadishu, May 31, 2020 (AFP) - At least 10 people died and 12 were wounded when an explosive device ripped through a minibus outside the Somali capital Mogadishu on Sunday, the government said.   The deadly explosion occurred near Lafole village along the Afgoye-Mogadishu where the passenger bus was travelling early in the day.   "At least 10 civilians were killed in an explosion at Lafole area this morning, those who died were all civilians," the information ministry said in a statement, adding that the victims were on their way to a funeral.

Witnesses said the minibus was completely destroyed, and described an horrific scene with everyone on board either dead or wounded and many bodies ripped apart or burned beyond recognition.   "This was a horrible incident this morning, the explosive device went off as the bus was passing by the area and destroyed it completely," said Daud Doyow, a witness.   "Bodies of civilians were strewn in pieces and most of the people died," he added.   "There were more than 20 people on board and 10 of them were confirmed dead while the rest are seriously wounded and taken to hospital, this is a horrible scene here," said another witness, Abdirisak Adan.   No group immediately claimed responsibility for the bombing, but Somalia's al Qaeda-aligned Shabaab group carries out regular attacks in and around the capital, often killing civilians.
Date: Wed, 27 May 2020 17:58:12 +0200 (METDST)

Nairobi, May 27, 2020 (AFP) - Kenya said Wednesday it had documented a record 123 cases of coronavirus in the past 24 hours, a "staggering" figure although one also explained in part by wider testing.   "Today, I come to you with sombre news," Health Minister Mutahi Kagwe said.   "Our figures today are staggering. Out of the 3,077 samples tested, we have 123 positive cases. For the first time we have hit a triple digit.    "This is the highest number of positive cases we have ever recorded in a single day since we recorded the first case on March 13."

A total of 1,471 cases of COVID-19 have been recorded in Kenya since the start of the epidemic. Of these, 55 have been fatal.   The tally of infections has doubled since mid-May but the country has also tripled its number of daily tests, from less than 1,000 to nearly 3,000, which has helped unearth more cases.

Kagwe sounded a warning about the vulnerability of crowded slums in the capital Nairobi, which leads the list of new cases followed by the port city of Mombasa.   "There is a raging number of infections in these areas," he said, adding: "No-one should have a false sense of security about their immunity to COVID-19."   Among its anti-coronavirus measures, Kenya has a national 7pm-5am curfew, which is currently in force until June 6, and has a ban on entering or exiting the cities of Nairobi, Mombasa, Kilifi, Kwale and Mandera.
Date: Wed, 27 May 2020 16:38:21 +0200 (METDST)

Nicosia, May 27, 2020 (AFP) - Cyprus hopes to attract tourists after its coronavirus lockdown by paying the medical costs of anyone who tests positive for COVID-19 while holidaying on the island, officials said Wednesday.   The plan was outlined in a letter to tour operators and airlines detailing the measures Cyprus is taking to ensure the safety of its tourism sector.   The letter was made public Wednesday and signed by the ministers of foreign affairs, transport, and tourism.

The Mediterranean island is marketing itself as a safe holiday destination during the global pandemic.   The Republic of Cyprus has reported 939 novel coronavirus cases and only 17 deaths.   The government said it is "committed to taking care of all travellers who test positive during their stay, as well as their families and close contacts".   It pledged to cover accommodation, dining and medical care if a tourist falls ill with the virus.   The "traveller will only need to bear the cost of their airport transfer and repatriation flight," it said.

- 'Quarantine hotels' -
A 100-bed hospital will be available exclusively for tourists who test positive, with more beds available "at very short notice if required".   An additional 112 beds in intensive care units with 200 respirators will be reserved for critically ill patients.   Designated "quarantine hotels" will have 500 rooms available for family members and close contacts of patients.

Other hotels on the island will be allowed to remain open if a guest tests positive, but their room will "undergo a deep clean".   Authorities have forecast a 70 percent decline in tourist arrivals in 2020.    Tourism earned Cyprus EUR2.68 billion ($2.94 bn) in 2019 -- about 15 percent of gross domestic product -- down one percent from the previous year, which was bolstered by a record 3.97 million arrivals.   Cyprus plans to reopen its airports on June 9 to arrivals from 13 countries considered low risk.   These include Israel, Greece, Germany, Austria and Malta but the island's two biggest markets Britain and Russia are not on the approved list.

hose arriving between June 9-19 will need to provide a health certificate proving they do not have the virus.   That requirement will be dropped from June 20, when another six countries will be added to the approved list, including Switzerland and Poland.   Cyprus says it will update the list of approved countries on a weekly basis based on scientific advice.

Officials will administer temperature checks and free random testing of arrivals.   Having tested over 10 percent of its population, Cyprus says it has one of the lowest coronavirus infection rates in Europe.   "Very few countries worldwide, especially in the Mediterranean, can boast about such statistics," the letter said.
Date: Wed, 27 May 2020 14:45:11 +0200 (METDST)

Stockholm, May 27, 2020 (AFP) - Airline SAS said Wednesday it would resume flights on several domestic and international routes in June, over two months after the operator grounded most of its fleet over the new coronavirus' impact on travel.   "This primarily includes domestic flights within and between the Scandinavian countries, but flights to New York, Chicago and Amsterdam from Copenhagen are also set to resume," SAS said in a statement.

The Scandinavian airline announced in mid-March it was halting most of its traffic and furloughing around 90 percent of its staff.   In late April the airline, whose two largest shareholders are the Swedish and Danish states, announced it was laying off about 5,000 people, representing 40 percent of the company's workforce.

In early May the company secured a state-guaranteed credit line of 3.3 billion Swedish kronor ($344 million or 313 million euros) to help it navigate the impact of the new coronavirus.   Even with the resumption of some flights, the airline continues to operate at a reduced capacity, but the added routes means an effective doubling of the aircraft in use from 15 to 30, according to SAS.   Finnair, of Nordic neighbour Finland, announced early last week it would start resuming its long-haul flight to Asia in July.
Date: Wed, 27 May 2020 14:25:21 +0200 (METDST)

Yerevan, May 27, 2020 (AFP) - Virus cases have overwhelmed Armenia's hospitals, officials said Wednesday, raising the prospect that intensive care treatment could be restricted to patients with the best chance of survival.   The tiny Caucasus nation of some three million has so far reported 7,774 coronavirus cases and 98 deaths.   At a cabinet meeting on Wednesday, Prime Minister Nikol Pashinyan said "the situation with the coronavirus pandemic is very severe in Armenia."

Health ministry spokeswoman Alina Nikoghosyan told AFP: "if the current situation persists, in the coming days, intensive care will only be available for the patients with the best survival chances."   Health Minister Arsen Torosyan said Sunday that out of the country's 186 intensive care beds for coronavirus patients, only 32 remained empty and would soon be filled.

The prime minister called for stricter enforcement of measures aimed at containing the outbreak such as the wearing of face masks in public spaces.   This comes after the country lifted a state of emergency on May 4 which it had declared in March because of the pandemic.   Pashinyan said his government had failed to enforce anti-virus measures and there had been widespread quarantine violations.   "Our mistake was that we put too much trust in our citizens' sense of responsibility," he said.

Deputy Prime Minister Tigran Avinyan said he did not rule out that the government could have to impose a fresh nationwide lockdown.   Analysts have criticised the government's handling of the crisis, saying a decision to close borders was taken too late and officials sent the public "confusing messages."   "Officials were calling for the wearing of face masks, but they themselves didn't wear them until recently," said analyst Tatul Hakobyan.
Date: Wed, 27 May 2020 09:53:01 +0200 (METDST)

New Delhi, May 27, 2020 (AFP) - India is wilting under a heatwave, with the temperature in places reaching 50 degrees Celsius (122 degrees Fahrenheit) and the capital enduring its hottest May day in nearly two decades.   The hot spell is projected to scorch northern India for several more days, the Meteorological Department said late Tuesday, "with severe heat wave conditions in isolated pockets".   As global temperatures rise, heatwaves are a regular menace in the country -- particularly in May and June. Last year dozens of people died.

Met officials said Churu in the northern state of Rajasthan was the hottest place on record on Tuesday, at 50 Celsius, while parts of Punjab, Haryana and Uttar Pradesh sweltered in the high 40s.   Parts of the capital, New Delhi, recorded the hottest May day in 18 years with the mercury hitting 47.6 Celsius.   No deaths have been reported so far this year, but last year the government said the heat had killed 3,500 people since 2015. There have been fewer
fatalities in recent years.

The country of 1.3 billion people suffers from severe water shortages with tens of millions lacking running water -- to say nothing of air conditioning.   Parts of Delhi and elsewhere regularly see scuffles when tankers arrive to deliver water. Last year Chennai made international headlines when the southern city ran out of water entirely.   The heatwave adds to problems the country already has dealing with the spread of coronavirus.   India now has the 10th highest number of coronavirus cases globally, climbing above 150,000 on Wednesday with almost 4,500 deaths.

Last week cyclone Amphan killed more than 100 people as it ravaged in eastern India and Bangladesh, flattening villages, destroying farms and leaving millions without power.   Huge swarms of desert locusts, meanwhile, have destroyed nearly 50,000 hectares (125,000 acres) of crops across western and central India, and may enter Delhi in coming days.   The north-eastern states of Assam and Meghalaya are also currently experiencing floods, with more heavy rainfall forecast in the coming days.