Date: Thu 23 May 2013
Source: Jamaica Observer [edited]
<http://www.jamaicaobserver.com/latestnews/Death-of-Belize-babies-linked-to-bacteria-outbreak>

The deaths of [7 out of] 12 babies at the Karl Heusner Memorial Hospital (KHMH) have been linked to the outbreak of _Enterobacter cloacae_, an organism that is said to be responsible for major outbreaks in neonatal intensive care units (NICU) all over the world.

In a release on Wednesday [22 May 2013], Director of Medical Services at the hospital, Dr Adrian Coye noted that the organism is not a superbug. "The problem lies in the fact that it is very fastidious, difficult to clear, and there is transmission by direct contact and also by indirect contact. So it can be on the skin of any of us right now in this room, on your clothing material, on stethoscopes, on IV drip stands, the surfaces in the clinical area, etc," he said. "The profile of the resistance pattern within the organism we have found is sensitive to antibiotics that we do have in the hospital and made available through the Ministry of Health."

Due to the nature of the outbreak, he said help will be coming from the Washington-based Pan American Health Organisation (PAHO). "In that light, this is part of why we see that even PAHO Washington is sending us assistance to see and help us analyze the outbreak that we have, because it is matching a global trend," he said.

Although 12 babies died, only 7 tested positive for the organism. "And so the other deaths happened as a result of pre-maturity-related issues and are not related to this infection."

According to Boye [Coye?], the hospital is implementing an aggressive approach to determine whether there is actually an environmental source. "So we've actually brought in a specialist for the purpose of studying all aspects of our ventilation and all other areas within the unit that we can."

In the aftermath of the deaths, the hospital's NICU has been closed, and an independent contractor has ordered an assessment of the air quality in the unit. This will be followed by the removal and disinfection of all equipment and terminal cleaning of the entire unit.

The Ministry of Health said it is making all of its resources available to the KHMH to investigate and deal promptly with "this alarming situation" at the country's only referral hospital.
=====================
[_Enterobacter cloacae_ is a Gram-negative, facultative anaerobic bacillius in the Enterobacteriaceae family. It frequently causes a wide variety of opportunistic infections in hospitalized patients, especially in ICUs. These infections have included bacteremia; intravenous catheter, urinary tract, lower respiratory tract, skin, and soft tissue infections; surgical wound and intra-abdominal infections; septic arthritis; and osteomyelitis. Outbreaks have been traced to contaminated hands of personnel; hospital equipment, such as endoscopes, stethoscopes and dialysis equipment; blood products; parenternal nutrition solutions; and albumin. _E. cloacae_ has become a nosocomial pathogen in neonatal units (1-4).

Management of infections caused by _E. cloacae_ is complicated by the organism's resistance to multiple antibiotics. _E. cloacae_ produce AmpC beta-lactamases, which are chromosome-encoded cephalosporinases that mediate resistance to cephalothin, cefazolin, cefoxitin, most penicillins, and beta-lactamase inhibitor-beta-lactam combinations (5). AmpC enzymes may be initially inducible but can be expressed constitutively at high levels following mutation, called derepression (5). Overexpression confers resistance to broad-spectrum cephalosporins including cefotaxime, ceftazidime, and ceftriaxone, which can emerge during therapy with these drugs (6). These organisms frequently exhibit additional resistance to other classes of antibiotics.

Carbapenems are the most reliable beta-lactam drugs for the treatment of severe _E. cloacae_ infections, but carbapenem resistance can arise by mutations that reduce influx (outer membrane porin loss) or enhance efflux (efflux pump activation).

1. Verweij PE, Van Belkum A, Melchers WJ, et al. Interrepeat fingerprinting of third-generation cephalosporin-resistant _Enterobacter cloacae_ isolated during an outbreak in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 1995;16(1):25-9. Abstract available at: <http://www.ncbi.nlm.nih.gov/pubmed/7897170>.
2. van den Berg RWA, Claahsen HL, Niessen M, et al. _Enterobacter cloacae_ outbreak in the NICU related to disinfected thermometers. J Hosp Infect 2000;45(1):29-34. Abstract available at: <http://www.ncbi.nlm.nih.gov/pubmed/?term=van+den+Berg+RWA%2C+Claahsen+HL%2C+Niessen+M>.
3. Georgia Kartali G, Eva Tzelepi E, Spyros Pournaras S, et al. Outbreak of Infections Caused by _Enterobacter cloacae_ Producing the Integron-Associated Beta-Lactamase IBC-1 in a Neonatal Intensive Care Unit of a Greek Hospital. Antimicrob Agents Chemother 2002;46(5):1577-1580. Available at: <http://aac.asm.org/content/46/5/1577.full>.
4. Liu SC, Leu HS, Yen MY, Lee PI, Chou MC. Study of an outbreak of Enterobacter cloacae sepsis in a neonatal intensive care unit: the application of epidemiologic chromosome profiling by pulsed-field gel electrophoresis. Am J Infect Control. 2002;30(7):381-5. Abstract available at: <http://www.ncbi.nlm.nih.gov/pubmed/12410213>.
5. Jacoby GA. AmpC beta-lactamases. Clin Microbiol Rev. 2009;22(1):161-82. Abstract available at: <http://www.ncbi.nlm.nih.gov/pubmed/19136439>.
6. Chow JW, Fine MJ, Shlaes DM, et al. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med. 1991 Oct 15;115(8):585-90. Abstract available at: <http://www.ncbi.nlm.nih.gov/pubmed/19136439>.

Belize is a country located on the northeastern coast of Central America (<http://en.wikipedia.org/wiki/Belize>). Belize City, with a population of 67 964 residents, is the largest city and capital of Belize (<http://en.wikipedia.org/wiki/Belize_City>). Karl Heusner Memorial Hospital is the main public hospital in Belize City, where it is both the national referral hospital, and the district hospital for Belize District (<http://en.wikipedia.org/wiki/Karl_Heusner_Memorial_Hospital>).

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/1AYt>. - ProMed Mod.ML]
Date: Tue 26 Mar 2013
Source: Beimopan [edited]
<http://www.guardian.bz/index.php?option=com_content&amp;view=article&amp;id=6058:ministry-of-health-cautions-public-on-rising-cases-of-hepatitis-a&amp;catid=40:politics&amp;Itemid=90>

The Ministry of Health is investigating a cluster of 14 suspected cases of hepatitis A that have occurred over the last 3 weeks in Trio Village, Stann Creek District. One such case has been confirmed by laboratory testing.

Hepatitis A is a food and waterborne disease with symptoms that may include yellowing of the eyes and skin, dark urine, light-colored stool along with mild fever, vomiting, diarrhea and loss of appetite among others. This self-limiting disease can also be contracted from close contact with infected individuals.

The Ministry advises the public to take necessary precautions (as listed below) to prevent contamination and spread of the virus:
- Wash hands properly using soap and clean water especially before preparing or serving food, after using the toilet and after changing diapers.
- Wash all vegetables, fruits and other raw food with clean water before eating it.
- Do not consume contaminated water or ice. Boil and treat all drinking water with chlorine.
- Disinfect contaminated dishes, toilets and common surfaces.

Since the start of the year [2013], a few cases have been identified, mainly in the rural communities of the Corozal, Cayo and Toledo Districts. We are aggressively conducting house-to-house health education and environmental cleanup campaigns to treat the cases in all the affected areas.
==================
[Belize is located on the northeastern coast of Central America. It is the only country in the area where English is the official language, although Kriol and Spanish are more commonly spoken. Belize is bordered to the north by Mexico, to the south and west by Guatemala and to the east by the Caribbean Sea. Its mainland is about 290 km (180 miles) long and 110 km wide. It supports a population of 312,698 inhabitants (2010 census). A map of Belize can be accessed at: <http://www.lonelyplanet.com/maps/central-america/belize/>.

Hepatitis A is a viral liver disease that can cause mild to severe illness. Hepatitis A virus is transmitted through ingestion of contaminated food and water, or through direct contact with an infectious person. Hepatitis A is associated with a lack of safe water and poor sanitation. Improved sanitation and the hepatitis A vaccine are the most effective ways to combat the disease. Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is associated with high mortality.

The disease can wreak significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school or daily life. In developing countries, countries with transitional economies, and regions where sanitary conditions are variable, children often escape infection in early childhood. These improved economic and sanitary conditions may initially lead to a higher susceptibility in older age groups and higher disease rates, as infections occur in adolescents and adults, and consequently, large outbreaks can occur.

Several hepatitis A vaccines are available internationally. All are similar in terms of how well they protect people from the virus and their side-effects. No vaccine is licensed for children younger than one year of age. Nearly 100 percent of people develop protective levels of antibodies to the virus within one month after a single dose of the vaccine. Even after exposure to the virus, a single dose of the vaccine within 2 weeks of contact with the virus has protective effects. Still, manufacturers recommend 2 vaccine doses to ensure a longer-term protection of about 5-8 years after vaccination. Millions of people have been immunized worldwide with no serious adverse events. The vaccine can be given as part of regular childhood immunization programmes and can also be given with other vaccines for travellers.

For more information, see:
<http://www.who.int/mediacentre/factsheets/fs328/en/index.html>. - ProMed Mod.CP]

[A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/1AYt>.]

Belize

Flag of Belize
Still current at: 06 November 2012
Updated: 06 November 2012
No restrictions in this travel adviceAvoid all but essential travel to part(s) of countryAvoid all but essential travel to whole countryAvoid all travel to part(s) of countryAvoid all travel to whole country

This advice has been reviewed and reissued with amendments to the Travel Summary and the General - Consular Assistance Statistics section (British visitor statistics). The overall level of the advice has not changed; there are no travel restrictions in place in this travel advice for Belize.


(see travel advice legal disclaimer)


  • The hurricane/tropical cyclone season in Belize normally runs from June to November. See Natural Disasters - Hurricanes.

  • 8,199 British tourists visited Belize in 2011 (Source: Belize Tourist Board).Most visits are trouble free. See General - Consular Assistance Statistics.

  • You should take usual precautions against muggings, be on your guard and exercise caution, as there have been occasional violent incidents against tourists. You should also avoid certain areas of Belize City, including George Street and Kraal Road, where gang violence including gun crime is on the increase, especially at night.

  • There is a low threat from terrorism. But you should be aware of the global risk of indiscriminate terrorist attacks, which could be in public areas, including those frequented by expatriates and foreign nationals.

  • You should take out comprehensive travel and medical insurance before travelling. See General - Insurance. SeeGeneral - Insurance.

Safety and Security - Terrorism
There is a low threat from terrorism. But you should be aware of the global risk of indiscriminate terrorist attacks, which could be in public areas, including those frequented by expatriates and foreign travellers. For more general information see our terrorism abroad page.

Safety and Security - Crime
There have been incidents of violent crime and physical assaults, including armed robbery and rape, targeted at tourists. Armed criminal gangs from Guatemala have been known to operate in the past around densely forested areas of Belize and close to a number of tourist sites. These incidents are now uncommon and the Belize Defence Force patrols these areas.

For more general information see our Rape and Sexual Assault Abroad page.

Mugging is a risk to travellers. Although the majority of reported incidents are in Belize City, crime occurs in all districts including tourist spots such as San Pedro, Caye Caulker and Placencia. Muggings can occur at any time. Avoid dark alleys, keep valuables out of sight, and do not wear jewellery. Where possible you should travel in groups. You should use a qualified guide for trips off the beaten track. In some areas of Belize City there has recently been an increased risk of gang related violence. We advise visitors to avoid the areas around George Street and Kraal Road and to exercise caution when walking in the city.

A lack of resources and training impedes the ability of the police to investigate crimes effectively and to apprehend serious offenders. As a result, many crimes remain unresolved. Nevertheless, victims of crime should immediately report to the police all incidents of assault, robbery, theft or other crimes.


When a crime is reported, the police will take a statement and investigate the matter. Victims should be aware that this may take several weeks. You can pay a fee at any point during the process to receive a copy of the report when it is completed. Regardless of where you gave your statement, payment for a copy of the report can only be made at the main police stations: Belize City, Belmopan, Benque Viejo, Corozal, Dangriga, Orange Walk, Punta Gorda, San Ignacio and San Pedro.

For more general information see our victims of crime abroad page.

Safety and Security - Local travel
There have been a number of adventure sports-related incidents which have resulted in injuries to foreign tourists, including fatalities. Some of these incidents have involved water sports such as snorkelling and diving. Severe weather conditions and local tour operators applying inadequate safety precautions have been cited as causes. You should consult local weather forecasts before undertaking any sporting activities and only use registered and licensed operators.

You should exercise particular care when travelling in the Belize/Guatemala border area because of the ongoing dispute between the two countries. You are advised to use only the officially recognised border crossings.

There have been armed attacks on tourists travelling to tourist destinations in Guatemala, including Tikal in the Peten region. See Guatemala Travel Advice for further information.

You can find more information on local travel on the Belize Tourism Board's website.

Safety and Security - Local Travel - Road travel
You can use your UK Driving Licence or an International Driving Permit to drive in Belize for visits under three months. For longer stays, an International Driving Permit is required.

Road traffic accidents are a common occurrence and local driving standards are poor. You should take great care when driving. You should exercise caution during rainy conditions as the main roads can become slippery. In southern parts of the country, particularly in Stann Creek and Toledo, temporary bridges and causeways in low-lying areas may flood during severe weather conditions.

For more general information see our driving abroad page.

Safety and Security - Political situation

Belize Country Profile

Political demonstrations can occur in Belize City and Belmopan, often at short notice. Most are peaceful, although some have resulted in civil disorder.

You should follow local media and avoid large gatherings of people or demonstrations.

You should not become involved with drugs of any kind: possession is considered a serious crime in Belize and can lead to a fine and/or imprisonment.

Overt homosexuality is generally considered to be socially unacceptable and some homosexual acts are illegal. There are no openly gay bars or clubs, though there are some unofficial gay hangout spots in Belize City, Caye Caulker and San Pedro.

You are not required to carry identification whilst in Belize, but it can be useful to carry a picture ID.


For more general information for different types of travellers see our your trip page.

Entry Requirements - Visas
British nationals can visit Belize for up to 30 days without a visa. Ensure that your passport is stamped on entry as lack of proof of entry can result in either a fine and/or imprisonment. Visitors can obtain an extension to their visas for 30 days at any immigration office countrywide. The fee is BZD$60 for each extension.

Entry Requirements - Passport validity
You must hold a valid passport to enter Belize. Your passport must be valid for a minimum period of six months from the date of entry into Belize.

Entry Requirements - UK Emergency Travel Document (ETD)
UK ETDs are accepted for entry, airside transit and exit from Belize.


Entry Requirements - Travelling with children
Single parents or other adults travelling alone with children are required to provide documentary evidence of parental responsibility before being allowed to enter the country and, in some cases, before permitting the children to leave the country.

Entry Requirements - Departure tax
The departure tax is US$35 which can be paid only in US dollars or with a credit/ debit card. It is included in some air tickets, though by no means all. There is a bank inside the airport where travellers can convert Belize dollars to US dollars to a maximum of BZD$1000. Larger amounts require a day’s notice. Passengers will need to provide the teller with their passport and boarding pass.

Contact your GP around eight weeks before your trip to check whether you need any vaccinations or other preventive measures. Country specific information and advice is published by the National Travel Health Network and Centre, and useful information about healthcare abroad, including a country-by-country guide of reciprocal health care agreements with the UK, is available from NHS Choices.

Medical facilities in Belize are limited. Serious medical cases are normally evacuated to the United States (at the patient’s expense). Make sure you have adequate travel health insurance and accessible funds to cover the cost of any medical treatment abroad and repatriation.

In the 2010 Report on the Global AIDS Epidemic the UNAIDS/WHO Working Group estimated that around 4,400 adults aged 15 or over in Belize were living with HIV; the prevalence percentage was estimated at around 2.3% of the adult population compared to the prevalence percentage in adults in the UK of around 0.2%. You should exercise normal precautions to avoid exposure to HIV/AIDS. For more information see our HIV and AIDS page.

If you need emergency medical assistance during your trip, dial 911 and ask for an ambulance. You should contact your insurance/medical assistance company promptly if you are referred to a medical facility for treatment.

Our travel health pages offer further advice on how to stay healthy when overseas.

Natural Disasters - Hurricanes
The hurricane/tropical cyclone season in Belize normally runs from June to November. You should monitor local and international weather updates from the World Meteorological Organisation and the National Hurricane Centre. For information and advice on what to do if you are caught up in a hurricane or tropical storm see our tropical cyclones page.

Natural Disasters - Earthquakes

Belize does not suffer from earthquakes, but tremors from earthquakes in neighbouring countries can occasionally be felt in Belize.

  • In the event of an earthquake, you should drop to the ground and take cover under sturdy furniture, in a doorway or next to an inside wall, away from windows or objects which may fall. Cover your head with a pillow or your arms and wait for the earthquake to stop before moving to a safe area outside.
  • Further advice may be found on the Red Cross website.

General - Insurance
You should take out comprehensive travel and medical insurance before travelling. Check for any exclusions, and that you policy covers you for all activities you may wish to undertake. For more general information see our travel insurance [page.


If things do go wrong when you are overseas see our When Things Go Wrong page.


General - Registration
Whether you live or are travelling overseas, we advise you to register with our LOCATE service so our consular and crisis staff can provide better assistance to you in an emergency.


General - Passports
The British High Commission in Belmopan does not issue passports. Applications for new passports are accepted but are processed at the British Embassy in Washington. This may take up to six weeks. The courier cost is borne by the applicant. Before travelling you should ensure that your passport is valid for at least six months and has a plentiful supply of unused pages.


General - Money
ATMs are readily available in the larger towns and generally accept UK cards. Credit cards are not widely accepted, but this is starting to change. US dollars are accepted as currency (US$1 = BZ$2).

General - Consular Assistance Statistics
8,199 British tourists visited Belize in 2011 (Source: Belize Tourist Board). 24 British nationals required consular assistance in Belize in the period 01 April 2011 - 31 March 2012, including for four deaths, two hospitalisations and four arrests.

Date: Mon, 8 Oct 2012 07:19:58 +0200 (METDST)
by Isabel Sanchez

BELIZE CITY, Oct 8, 2012 (AFP) - Belize, a tropical tourist paradise, is developing a dark side and turning into a transit point for the trafficking of drugs bound for the United States. This tiny Central American state, while not a producer of narcotics, has a lot of coastline and not a lot of authorities -- and is strategically situated between Mexico and Guatemala -- making it susceptible to smugglers, experts and officials say. "We are facing a trafficking problem," David Henderson, the country's police chief, acknowledged to AFP. "It's a challenge," he said, adding that Belize was working with its neighbors to keep drug cartels from putting down roots in this country, formerly colonial British Honduras. Despite the situation, the police force totals just a thousand -- making it tough to adequately patrol the country's entire territory. "It's very difficult to keep an eye on everything," conceded police spokesman Raphael Martinez. The 300 kilometers (186 miles) of coastline and the 150 kilometers shared border with Mexico, along the Hondo River, are particularly vulnerable to the trafficking of drugs, weapons, illegal immigrants and contraband.

In mid-September, authorities from Mexico and Belize met to explore the possibility of boosting checks along their common border in an effort to crack down on trafficking. "Belize is a transit point for cocaine shipments," Commander Anastacio Garcia, who heads the military in the Mexican state of Quintana Roo that borders onto Belize, recently told reporters. The commander of the Mexican army's naval zone number 5, Conrado Aparicio, confirmed drug trafficking over land and by sea had increased in Quintana Roo. He also highlighted trafficking along the border between Belize and Guatemala, done in such a way, he noted, that only small quantities of narcotics are smuggled at a time. "The cartels have local contacts, they pay in drugs and weapons," said a local agent who requested anonymity. "Some supply fuel to planes or speedboats and serve as guides so the drugs can be moved on to Mexico."

On a US black list since 2011
In 2011, Belize made its debut on a US list of "major drug transit or major illicit drug producing countries." According to the US State Department, cartels expedite narcotics to the United States via Mexico using tiny Belize as a stopover point for drugs coming from Colombia, Peru and Ecuador. The amount of cocaine passing through Belize has been estimated at 10 tonnes per year.

In its 2012 International Narcotics Control Strategy Report, the State Department said Belize's remote jungles "provided a hospitable environment for growing cannabis" last year and that drug trafficking and related crimes increasingly threatened the state's stability. "Without action and redress, Belize's security environment will continue to deteriorate," the report said, urging the country, among other things, to beef up its border security. By placing a greater emphasis on institution and capacity building, Belize will be "more capable of successfully confronting illegal drug trafficking," it added. In April, a plane carrying cocaine crashed in the jungle close to Corozal, not far from the Mexican border. Local media reports said those on board were able to escape with their load before police arrived, illustrating the weakness of law enforcement. With a poverty rate near 40 percent, this undeveloped country has in recent years become more and more prone to violence.

According to the United Nations, Belize was considered among the most dangerous in the Americas, with a homicide rate of 41.7 per 100,000 people in this nation of just 330,000. In Belize City, the economic capital, criminal gangs are becoming increasingly powerful. The sluggish global economy has taken a toll on Belize, where 25 percent of the economy is linked to tourism.  The country is also behind on an overdue debt interest payment and narrowly avoided full-blown default in late September after paying a portion of what it owes. It was subsequently granted a two-month reprieve by its creditors.
Date: Sat, 20 Aug 2011 23:55:06 +0200 (METDST)

TEGUCIGALPA, Aug 20, 2011 (AFP) - Tropical Storm Harvey made landfall on Belize on Saturday, but forecasters said it was expected to fizzle out after dumping heavy rains over Central America.  The eye of the storm made landfall near Dangriga and weakened as it moved farther inland. It was moving westward at a speed of 21 kilometers (13 miles) per hour, with maximum sustained winds near 80 kilometers per hour, the Miami-based US National Hurricane Center said in its 2100 GMT advisory. Located about 70 kilometers from Belize City, the storm was forecast to continue moving inland over Belize before hovering over northern Guatemala later Saturday. Harvey was expected to produce total rain accumulations of eight to 15 centimeters (three to six inches) across Belize, Guatemala, Honduras and Mexico's Yucatan Peninsula, with up to 25 centimeters in isolated areas. "These rains could produce life-threatening flash floods and mudslides, especially over higher terrain," the NHC said.

In Belize and Guatemala, authorities warned people about the risks of heavy rains and a tropical wave along the Caribbean coast, but there were no reports of damage or casualties. "The phenomenon did not cause loss of life or infrastructure damage," said a top emergency services official, Juan Jose Reyes. Stormy weather killed hundreds of people last year in Central America, a region highly vulnerable to weather disaster due to its rugged terrain and poor infrastructure. Over 50,000 people have died over the past four decades from natural disasters that have also caused billions of dollars in damages in the region, which the United Nations considers among the world's most vulnerable to climate change. In Guatemala alone, heavy rains left 174 people dead and over $1 billion in damages last year, while landslides in Costa Rica killed 24 people and caused $330 million in damage.
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