Date: Tue 6 De 2011
Source: Jamaica Observer [edited]
<http://www.jamaicaobserver.com/news/Islandwide-alert-for-measles-importers#ixzz1frw7kmDM>

Island-wide alert for measles importers
---------------------------------------
In keeping with increased reports of outbreaks and the ongoing spread of measles in several countries in Europe (UK, France, Spain) and the Americas (Canada, USA), the Ministry of Health has heightened its alert for imported cases of measles.

"In light of the expected increased travel to and from these areas during the holiday season, the Ministry is urging parents and guardians to ensure that their children, one year and over, are adequately immunised against measles, mumps and rubella with the MMR vaccine," said Dr Eva Lewis Fuller, chief medical officer. "If children are not immunised or parents are not sure of their vaccination status, they should be taken to their doctor or the nearest health centre immediately to get the vaccine." Measles is a highly contagious disease, which is characterised by fever, cough and a fine, red skin rash which starts on the face and spreads to the body. The disease is spread through coughing and sneezing.

"At this time, Jamaica has not confirmed any case of measles but the Ministry remains vigilant as the country prepares to be certified as having eliminated measles," the ministry said. Persons can contact the toll free number 1-888-663-5683 daily between the hours of 9:00am to 5:00pm for more information.

Jamaica

Flag of Jamaica
Still current at: 08 December 2011
Updated: 08 December 2011

This advice has been reviewed and reissued with amendments to the Travel Summary and the Safety and Security - Political Situation section (parliamentary elections). The overall level of the advice has not changed; there are no travel restrictions in place in Jamaica.


(see travel advice legal disclaimer)


  • On 29 December 2011 Parliamentary elections will take place in Jamaica. You should avoid all political rallies and meetings. See Safety and Security - Political Situation.

  • The hurricane season in Jamaica normally runs from June to November. You should monitor weather updates. See natural disasters.

  • 141 British nationals required consular assistance in Jamaica in the period April 2010 – March 2011. See General - Consular Assistance Statistics. There are high levels of crime and violence, particularly in Kingston. See the Safety and Security - Crime.

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

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

Safety and Security - Crime

Jamaica (particularly the capital city, Kingston) suffers from a high crime rate – including violent crime. Gang violence and shootings are usually concentrated in inner city neighbourhoods, including West Kingston, Grant's Pen, August Town, Harbour View, Spanish Town and certain parts of Montego Bay. Public order incidents and demonstrations, sometimes violent, can occur in Kingston, Spanish Town and Montego Bay.

The motive for most attacks on tourists is robbery. Although the Jamaican government has a system of mobile police patrols, there is a risk in walking alone in isolated areas or on deserted beaches even in daylight hours. Vigilance is particularly advised when drawing money from ATMs.

Most hotels and resorts are well guarded. However, robberies can occur. Hotel guests are advised to follow hotel security procedures such as using room or hotel safes, locking windows and doors and reporting suspicious activity to the hotel. Longer-term visitors and residents should ensure proper door locks and window grilles are fitted and consider employing a guard and/or fitting a house alarm. Gated/guarded compounds represent the safest accommodation in the Kingston area.

Criminals have targeted visiting British nationals and those returning to resettle permanently in Jamaica. There have been some violent incidents, including cases of armed robbery, murder and rape. Before returning to resettle, seek advice from the Jamaican High Commission in London and/or the local Jamaican Information Service.

You should still maintain vigilance even when staying with family or friends.

You should follow these guidelines:

Be particularly alert for thieves but do not offer resistance in the event of an attempted robbery.

Don’t walk or use buses at night. Only hire taxis authorised by the Jamaica Tourist Board usually operated by the Jamaica Union of Travellers Association (JUTA) or taxis ordered from hotels for your sole use (i.e. unshared).

Do not give lifts to strangers and keep car doors and windows locked.

Avoid large crowds and public demonstrations. Criminals use the confusion of such events to engage in acts such as robbery.

Do not carry large amounts of cash or wear eye-catching jewellery. Use hotel safety deposit boxes to store valuables, money and passports.

Try to vary which restaurants you use. Frequenting the same place too often might make you a target for thieves.

Unless you are fully acquainted with the route and are driving in daylight hours, you should not self-drive a car to or from Kingston International Airport. Instead, take an official 'JUTA' taxi, or taxi recommended by your hotel or airport’s official taxi dispatcher for your journey to or from the airport. There have been outbreaks of violence in the Mountain View area on one route from the airport to the city. You should therefore avoid this route and use the alternative Humming Bird route via South Camp Road.

For more general information see victims of crime abroad.

In the event of an emergency in Jamaica, call 119 for police and 110 for an ambulance.

Safety and Security - Terrorism

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

Safety and Security - Political Situation

On 29 December 2011 Parliamentary elections will take place across Jamaica. Political rallies and meetings, which have the potential to turn violent, may occur in the period leading up to or following the elections. You should check local media for the latest information, remain vigilant and avoid any political rallies or meetings.

Jamaica country profile

Safety and Security - Local travel

Safety and Security - Local Travel - Road Travel

You can drive in Jamaica on a UK driving licence for up to six months. If you are unfamiliar with Kingston, you should not drive a vehicle in the city. If you get lost, you may risk putting yourself and your passengers in personal danger. Some hire cars and minbuses, including those hired through international companies, do not have seatbelts fitted in the rear seats. You are advised to check with the hire car company in advance of arrival.

Tourists are advised to use Jamaica Tourist Board (JTB) approved taxis or minibuses for excursions, airport transfers and sightseeing. Do not hail taxis in the street. Most hotels and resorts have assigned JTB drivers who carry photo ID and display a prominent blue JTB sticker on the front windscreen.

Road traffic accidents and fatalities are common in Jamaica. Much of the road network is badly maintained with poor signage, while roads in rural areas are narrow, winding and poorly lit at night, if at all. Speeding and drink-driving are commonplace. Drive defensively, and apply caution on the roads whether in a vehicle or as a pedestrian. Drivers and front seat passengers must wear seat belts at all times. Motorcycle riders must wear helmets. When driving, it is recommended that you keep the windows up and doors locked.

Tropical storms and/or roadworks can render some roads temporarily impassable. Check your route in advance.

For more general information see driving abroad.

Contrary to popular myth, it is illegal to smoke marijuana ('ganja') in Jamaica. There are severe penalties for all drug offences, including those involving ganja. Every year many British nationals are arrested for attempting to traffic ganja and other drugs. Possession of even small quantities of illegal drugs can lead to imprisonment. All sentences are served in Jamaica. Prison conditions are harsh. Pack all of your luggage yourself and do not carry anything through customs for anyone else.

Jamaica has laws which make certain homosexual acts illegal. The attitude of many Jamaicans to gay, lesbian, bisexual, transgender and intersex people is hostile.

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

Entry Requirements - Visas


British nationals do not require visas to enter Jamaica. However, overstaying without the proper authority can result in detention and/or a fine.

Entry Requirements - Passport validity


You must hold a valid passport to enter Jamaica. Your passport must be valid for a minimum period of six months from the date of entry into Jamaica.

Entry Requirements - Travelling with children


For information on entry requirements, check with the Jamaican High Commission in London.

Personal imports of meat and dairy products from the UK are banned. Customs officials can search all baggage and will impound and destroy banned foodstuffs.

Medical treatment can be expensive. The standard of private medical facilities can vary throughout the island.

Dengue fever is common across the Caribbean and can occur throughout the year. Dengue is a mosquito-borne infection that can cause a feverish illness associated with headache, muscle aches and pains, and rash. Some cases of dengue are severe. Dengue can be prevented by avoiding being bitten by the disease-carrying mosquitoes that feed predominately during daylight hours. For more information on prevention, see the National Travel Health Network and Centre website: http://www.nathnac.org/pro/factsheets/dengue.htm.

In the 2010 Report on the global AIDS epidemic the UNAIDS/WHO Working Group estimated that around31,000 adults aged 15 or over in Jamaica were living with HIV; the prevalence percentage was estimated at around 1.7% 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 general information on how to do this see HIV and AIDS.

You should seek medical advice before travelling to Jamaica and ensure that all appropriate vaccinations are up-to-date. For further information on vaccination requirements, health outbreaks and general disease protection and prevention you should visit the websites of the National Travel Heath Network and Centre (NaTHNaC) and NHS Scotland's Fit For Travel or call NHS Direct on 0845 46 47.

For more general health information see travel health.

The hurricane season in the Caribbean normally runs from June to November. You should monitor local and international weather updates from the World Meteorological Organisation and the US National Hurricane Centre. See tropical cyclones for more detailed information about what to do if you are caught up in a hurricane.

General- Insurance

You should take out comprehensive travel and medical insurance before travelling. Check for any exclusions and that your policy covers you for all the activities you want to undertake. For more general information see travel insurance.

If things do go wrong when you are oversees then this is how we can help.

General - Arrival and departure taxes


Arrival and departure taxes are usually levied at the point of sale for scheduled flights and should be included in the cost of your ticket. These taxes are not always included in the ticket price for charter flights. Arrival tax is 10 US Dollars for air passengers and 2 US Dollars for cruise passengers. Departure tax is 1,000 Jamaican Dollars.

General - Consular Registration

If you are living, working or staying in Jamaica for three months or more you should register with our LOCATE service to tell us when and where you are travelling abroad or where you live abroad so our consular and crisis staff can provide better assistance to you in an emergency.

General - Consular Assistance Statistics

141 British nationals required consular assistance in Jamaica in the period April 201 - March 2011 for the following types of incident: 24 deaths; nine hospitalisations; and 86 arrests, for a variety of offences.
Date: 24 Feb 2011
Source: Stabroek news [edited]
<http://www.stabroeknews.com/2011/news/breaking/02/24/ackee-kills-23-in-jamaica-in-less-than-3-months/>
-----------------------------------------------
With 23 confirmed deaths and 194 suspected cases of ackee poisoning in less than 3 months, government chemists are now conducting intensive testing on the fruit to determine the reason for the unusually high number of fatalities linked to it.  Speaking at a press conference at the Health Ministry's head office in downtown Kingston Tuesday, Director of Health Promotion and Protection Dr Eva Lewis-Fuller said that while the cases were initially being reported in St Mary and St Ann, the ministry has since received reports from other parishes as well.  "At this time, all parishes are involved in the outbreak, mainly parishes of the north-east region and some parishes of the west," she said.   "We have been investigating this, because there has been some unusual characteristics of this outbreak. It is not following the pattern that we are used to in the old days when we have ackee poison, when it affected mainly child[ren] over 5 and it was evenly distributed between men and women," Lewis-Fuller added.

Dr Lewis-Fuller said that men accounted for 60 per cent of those cases reported to the ministry -- the majority of them being between the ages of 25-44. The last [or the latest?] confirmed death was that of a 52-year-old man from St Mary on 10 Feb 2011 at the Port Maria Hospital. Tuesday [22 Feb 2011], the ministry said that it is no closer to finding out the reason for the increase in ackee poisoning, but has been cautioning persons -- through advertisements -- about the proper preparation of the fruit as well as warning against forcefully opening the ackee pods.  "We do have some theories and hypotheses," said Dr Lewis-Fuller. "We had very cold weather during December and there are theories surrounding the delayed opening of the ackee and, therefore, persons might have been stimulated to do their own thing with opening the ackee."

Ackee contains hypoglycin, which is known for lowering the blood sugar to lethal levels. Symptoms of ackee poisoning include uncontrollable vomiting, diarrhoea, abdominal cramps, and drowsiness. The ministry has assured that there has been no suspected case of ackee poisoning in countries where the fruit has been exported. They believe this is due to the fact that ackee prepared for export is tested for hypoglycin. In the meanwhile, Chief Medical Officer at the Ministry Dr Sheila Campbell-Forrester said ackee poisoning has now been upgraded to the status of a reportable condition, although there has been a tapering off of reported cases in the past few weeks.  "Ackee poisoning was really not a reportable disease and so we may have been having cases of ackee poisoning in the past, which were not been reported or recorded or may have been missed [or] thought to be gastroenteritis," she said.
====================
[For more information on ackee fruit poisoning, readers are encouraged to read the moderator's comments on ProMED-mail post 20110115.0176. - ProMed Mod.TG]
Date: 14 Jan 2011
Source: Jamaica Observer [edited]
<http://www.jamaicaobserver.com/news/Warning-over-eating-unopened-ackees>

Warning over eating unopened ackees
-----------------------------------
The Ministry of Health is warning members of the public against eating unfit and unopened ackees. The Ministry's surveillance unit has detected 35 cases of ackee poisoning from 1 Dec 2010 to 12 Jan 2011.  Minister Rudyard Spencer has ordered the Outbreak Response Team to improve both public education and the capacity of the surveillance system at the Ministry's head office. Spencer said that special attention should be paid to ensure that householders use only fit and well opened ackees.

Ackees should also be properly cleaned by removing the seed and the pink or reddish membrane, then washed before cooking to prevent possible poisoning especially because of the high levels of toxins that may be contained in the unripe fruit. Ackees should be cooked by themselves while other foods, including salted fish, should be cooked separately.  "It cannot be said too often that ackee should be allowed to open naturally and fully on the tree before it is picked and eaten or sold. They should not be opened by force, or by using a knife or any other implement. The water that is used to boil the ackee should be discarded immediately and should not be ingested or reused for cooking other foods such as ground provisions and rice," said Spencer.

If not properly ripened, ackee contains high levels of a toxin called hypoglycin which can potentially lead to death if consumed. Symptoms of ackee poisoning include vomiting, stomach cramps/abdominal pain, dizziness, diarrhoea and sweating. If persons are experiencing these symptoms they should seek medical attention immediately and should have a sweet drink while on their way to the health centre or hospital.

All incidents of ackee poisoning have been from ackees cooked at home. There has been no incident involving tinned ackees. For more information members of the public may contact the Ministry of Health or their nearest health centre.
==================
[Improperly prepared ackee fruit (_Blighia sapida_), almost a staple in Jamaica, is responsible for an illness known as "Jamaican vomiting sickness" or "Jamaican vomiting sickness syndrome" and either term is known as JVS. The name is indicative of what a victim experiences, severe vomiting and profound hypoglycemia.

The ackee fruit is one that becomes edible when it is ripe and bursts open revealing its seeds. The yellowish aril, the fleshy part surrounding the black seeds is the edible portion. At the time of ripeness or harvest the fruit is a brilliant red or red-orange color. In order to consume the fruit, there must be no red in the meat of the fruit to be consumed. The red peel contains high levels of hypoglycin A and hypoglycin B.

Fatalities have resulted from improper preparation and consumption of this fruit. Fatalities are believed to occur more often in those who forcibly open the fruit before it is fully ripe, have included some of the outer covering of the fruit, are malnourished, or used the water from the cooked fruit for some other consumption purposes.

Two toxic water-soluble substances can be extracted from the fruit. The 1st toxin, hypoglycin A, is L-(alpha)-amino-(beta) -[methylene cyclopropyl]propionic acid. Hypoglycin B is a (gamma) -L-glutamyl derivative of hypoglycin A and is less toxic than hypoglycin A. hypoglycin A, but not hypoglycin B, can be found in the aril of the fruit. The unripe fruit has a much higher concentration of hypoglycin A (approximately 20 times) than that of the ripe aril. Both components are found in the seeds. Therefore, the seeds and the membrane at the base of the seed mantle are always poisonous.

Hypoglycin A, which is now simply called hypoglycin, is metabolized by means of transamination and oxidative decarboxylation to methylene cyclopropyl acetic acid (MCPA). MCPA forms nonmetabolizable carnitine and coenzyme A (CoA) esters, thereby depressing tissue levels of these cofactors and making them less available for other biochemical reactions. Hypoglycemia results because both CoA and carnitine are necessary cofactors for long-chain fatty acid oxidation and because oxidation is a requisite for active gluconeogenesis.

MCPA also inhibits the dehydrogenation of several acyl-CoA dehydrogenases, including butyryl CoA, glutaryl CoA, and isovaleryl CoA. As a result of the inhibition of butyryl CoA dehydrogenase, the oxidation of long-chain fatty acids stops at the level of hexanoyl CoA and butyryl CoA. This effect leads to the decreased production of nicotinamide adenine dinucleotide (NADH) and acetyl CoA.

Because NADH and acetyl CoA are required as a cofactor of 3-phosphoglyceraldehyde phosphate dehydrogenase and as an activator of pyruvate carboxylase, respectively, their diminished concentration contributes to the inhibition of gluconeogenesis. The inhibition of glutaryl CoA dehydrogenase results in the accumulation of glutaryl CoA, which could inhibit transmitochondrial malate transport, a rate-limiting step in the early phase of gluconeogenesis, and consequently suppress gluconeogenesis. Altered levels of circulating insulin do not cause hypoglycemia associated with hypoglycin action.

Jamaican vomiting sickness is characterized by a sudden onset of vomiting that is preceded by generalized epigastric discomfort starting 2-6 hours after the ingestion of a meal containing ackee. Once the sickness begins, symptom progression is rapid. Patients experience pronounced sweating, tachypnea, tachycardia, headache, and generalized weakness. After a period of prostration, which may last as long as 18 hours, a 2nd bout of vomiting may occur. Unless treatment is given, this episode is usually followed by convulsions, coma, and death.

Tonic-clonic convulsions occur in 25 per cent of the patients. Seizures occur in 85 per cent of all fatal cases. Fatty degeneration of the liver similar to Reye syndrome also occurs. The average time to death is 12.5 hours. Symptoms of the disease do not include fever or diarrhea.  Treatment may need to be aggressive depending upon the degree of dehydration, hypoglycemia, delirium, and seizures present.

A photo of the fruit and more history about the plant may be found at
<http://wwwchem.uwimona.edu.jm:1104/lectures/ackee.html>

Portions of this comment were extracted from
<http://emedicine.medscape.com/article/1008792-overview> - ProMed Mod.TG]

[The interactive HealthMap/ProMED map for Jamaica is available at
<http://healthmap.org/r/00Vh> - ProMed CopyEd.EJP]
Date: Sun 9 Jan 2011
Source: The Gleaner [edited]
<http://jamaica-gleaner.com/gleaner/20110109/lead/lead5.html>

An autopsy into the death of Argentinean tourist, who died after eating a meal of fish and potatoes 2 weeks ago, points to an ingestion of saltpetre, according to reports reaching The Sunday Gleaner.  Sodium nitrate (saltpetre) is often used for curing meats. It is believed that the tourist, whose command of the English language was limited, purchased the product, mistaking it for table salt. He reportedly used it excessively in the meal that he prepared, and this was evidenced by the half-empty bottle of saltpetre that was found at the villa he occupied in St Mary. The tourist was vacationing here with [a couple] who came to Jamaica to renew their wedding vows, having married in Japan a year ago. [She] is a Jamaican university teacher residing in Japan.  "Saltpetre (nitrate) prevents the haemoglobin in the blood from carrying oxygen at high levels. So you get headache, blue colour to skin and dizziness, trouble breathing, heart failure, and ultimately, death," a biochemist, who is not part of the medical team investigating the case, told this newspaper. He said if too much was inhaled, it could scorch the nasal passages and the lungs. Unconfirmed reports are that the tourist's throat was badly burnt from the effects of whatever he ate.

"The only type of fish that would trigger that type of result would likely be barracuda or fugu (puffer fish) because of the level of toxicity that could come from those types of fish," said the expert, dismissing assumptions that the fish could have caused the death. Countries such as the United States and the United Kingdom have regulated the use of saltpetre, he said.  US Federal regulations permit a maximum addition of 2.75 oz of sodium, or potassium nitrate, per 100 pounds of chopped meat, and 0.25 oz sodium, or potassium nitrite, per 100 pounds of chopped meat. Since these small quantities are difficult to weigh out on most available scales, it is strongly recommended that a commercial pre-mixed cure be used when nitrate or nitrite is called for in any recipe.  Dr Marion Ducasse, director of emergency, disaster management and special services in the Ministry of Health said she could not say how soon the autopsy would be released as investigations were still going on.  [byline: Janet Silvera]
===============
[Sodium nitrate has on a number of occasions been mistaken for table salt. Clinical signs of ingestion may include gastroenteritis, abdominal pains, dizziness, bloody diarrhea, convulsions, and collapse. Purging and diuresis are expected. If the victim receives small, repeated doses there may be headache and mental impairment. Generally in the case of mistaking sodium nitrate for sodium chloride, the dose may be larger for large meals typical of celebrations. Rare cases of nitrates being converted to the more toxic nitrites have been reported.  Sodium nitrate has been used in curing meat for centuries. Bacterial action converts the nitrate to nitrite, which kills the organism responsible for botulism poisoning. Generally sodium nitrite has replaced sodium nitrate, except in slow-cured hams.

Nitrite is added to certain foods to prevent the growth of the spore-forming bacterium _Clostridium botulinum_, whose toxin causes botulism, leading to paralysis and, potentially, death. The word botulinum comes from the Latin word botulus, meaning sausage, which was responsible for many deaths centuries ago before curing with nitrite was used. In addition to serving as an antimicrobial, nitrite is used to produce the characteristic flavor, texture, and pink color of cured meats.

At significant blood levels, the nitrite's oxidation of the iron in hemoglobin from the ferrous to the ferric state yields methemoglobin, which does not carry oxygen and imparts a brown hue to the blood. Symptoms of methemoglobinemia include headaches, fatigue, tachycardia (fast heart rate), weakness, and dizziness. As oxygenation of tissues decreases to the point of becoming truly inadequate, dyspnea (shortness of breath), acidosis, arrhythmias (irregular heart rhythms), coma, convulsions, and even death may occur.

This article mentions a limitation imposed by some countries on nitrites/nitrates in meat preservation. The combination of nitrites or nitrates with meat can form nitrosamines, which has been shown to cause cancers, especially gastric cancers and esophageal cancers. Because of the nitrate concentration in processed meats, there has also been a link to colon cancer. So while these nitrous compounds can be beneficial for preserving meat, it must be done correctly, using small amounts of the preservative. - ProMed Mod.TG]

[The HealthMap/ProMED-mail interactive map of Jamaica can be seen at
<http://healthmap.org/r/0lXJ>. - ProMed Sr.Tech.Ed.MJ]
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