EN UN INTERESANTE ESTUDIO EXPERIMENTAL COMUNITARIO (ABAJO) SE ENCONTRÓ COMO GRAN RESULTADO UNA DISMINUCIÓN IMPORTANTE DE LOS CUADROS GRIPALES CUANDO SE VACUNAN SISTEMATICAMENTE LOS NIÑOS, YA QUE SE DISMINUYE LA TRANSMISIÓN NIÑOS ADULTOS MAYORES EN LAS CASAS Y CAE SIGNIFICATIVAMENTE LA INCIDENCIA DE LA ENFERMEDAD EN TODOS LOS GRUPOS DE EDAD.
In a community-based randomized study, immunization of children and adolescents provided 61% protection against influenza in the unimmunized community.
Some data suggest that children are important vectors in the spread of seasonal influenza. In a cluster-randomized double-blind study, investigators examined whether immunizing children (age range, 3–15 years) against influenza protects the whole community. This study was conducted in Hutterite colonies (religious communities of <120 people) in rural Canada during the 2008–2009 influenza season.
Children in 22 colonies received influenza vaccine, and children in 24 colonies received hepatitis A vaccine (control). The children and their contacts in the community were assessed for illness twice weekly and tested by polymerase chain reaction (PCR) if symptoms developed. Six influenza-vaccinated and 13 hepatitis-vaccinated colonies experienced outbreaks. Overall, 119 cases of influenza were confirmed by PCR: 39 of 1271 unvaccinated individuals in the flu-vaccinated communities and 80 of 1055 individuals in the hepatitis A–vaccinated communities (3.1% vs. 7.6%). Immunization of children conferred significant protection against influenza among unvaccinated community members (61%).
Comment: This unique study provides the most clear-cut evidence to date of the importance of children in the spread of influenza. Immunization of children not only protected children but conferred a large protective effect on the entire community. When vaccine shortages occur, vaccination of children, in addition to other high-risk groups, should be a high priority.
— Peggy Sue Weintrub, MD
Published in Journal Watch Pediatrics and Adolescent Medicine March 24, 2010
Loeb M et al. Effect of influenza vaccination of children on infection rates in Hutterite communities: A randomized trial. JAMA 2010 Mar 10; 303:943.
jueves, 25 de marzo de 2010
jueves, 18 de marzo de 2010
March 12, 2010
COUNTRY DESCRIPTION: Venezuela is a medium income country whose economy is dominated by a substantial oil industry. The political climate in Venezuela is highly polarized and volatile. Violent crime is a serious problem, and the capital city of Caracas has been cited as having one of the highest per capita homicide rates in the world. Kidnappings, assaults and robberies occur throughout the country. Scheduled air service and all-weather roads connect major cities and most regions of the country. Venezuela’s tourism infrastructure varies in quality according to location and price. For an in depth country description of Venezuela, please read the Department of State Background Notes on Venezuela.
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REGISTRATION / EMBASSY LOCATION: U.S. citizens living or traveling in Venezuela are encouraged to register with the nearest U.S. embassy or consulate at the Department of State’s travel registration page in order to obtain updated information on local travel and security. U.S. citizens without Internet access may register directly with the nearest U.S. embassy or consulate. Registration is important; it allows the State Department to assist U.S. citizens in an emergency.
Local embassy information is available below and at the Department of State’s list of embassies and consulates.
U.S. Embassy Caracas
Calle Suapure and Calle F
Colinas de Valle Arriba
Emergency after-hours telephone: 58-212-907-8400
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ENTRY / EXIT REQUIREMENTS: A valid passport and a visa or tourist card are required. Tourist cards are issued on flights from the U.S. to Venezuela for persons staying less than ninety days. Visit the Embassy of Venezuela web site for the most current visa information. Venezuelan immigration authorities may require that U.S. passports have at least six months validity remaining from the date of arrival in Venezuela. Some U.S. citizens have been turned back to the United States because their passports were to expire in less than six months. Passports should also be in good condition, as some U.S. citizens have been delayed or detained overnight for having otherwise valid passports in poor condition.
U.S. citizens residing in Venezuela should be careful to obtain legitimate Venezuelan documentation appropriate to their status. There have been numerous cases of U.S. citizens who, having employed intermediaries, received what they believed to be valid Venezuelan resident visas and work permits. They were subsequently arrested and charged with possessing fraudulent Venezuelan documentation. SAIME, the Venezuelan government agency responsible for immigration documents, has informed the Embassy that the only valid resident visas are those for which the bearer has personally signed at SAIME headquarters in Caracas.
Venezuelan law requires Venezuelan citizens to enter and depart Venezuela using Venezuelan passports and Venezuelan immigration authorities are increasingly enforcing this requirement. In order to comply with U.S. and Venezuelan law, persons who hold dual American-Venezuelan nationality must plan to travel between Venezuela and the United States with valid U.S. and Venezuelan passports. Please see our information on dual nationality for entry and exit requirements pertaining to dual nationals.
Venezuela's child protection law mandates that minors (under 18) who are citizens or non-citizen residents of Venezuela and who are traveling alone, with only one parent, or with a third party, must present a copy of their birth certificate and written, notarized authorization from the absent parent(s) or legal guardian, specifically granting permission to travel alone, with one parent, or with a third party. This authorization must reflect the precise date and time of the travel, including flight and/or other pertinent information. Without this authorization, immigration authorities will prevent the child's departure from Venezuela. The Venezuelan Government no longer recognizes blanket or non-specific travel authorizations. When a parent is deceased, a notarized copy of the death certificate is required in lieu of the written authorization. If documents are prepared in the United States, the authorization and the birth certificate must be translated into Spanish, notarized, and authenticated by the Venezuela Embassy or a Venezuelan consulate in the United States. If documents are prepared in Venezuela, only notarization by a Venezuelan notary is required. A permission letter prepared outside Venezuela is valid for 90 days. A permission letter prepared in Venezuela is valid for 60 days.
Travelers entering Venezuela from certain countries are required to have a current yellow fever vaccination certificate. The Venezuelan Ministry of Health recommends the Yellow Fever vaccine for those travelers departing Venezuela, whose final destination is a country that requires that vaccine. This vaccine needs to be given at least 10 days prior to travel. Yellow Fever vaccine is effective for 10 years so travelers should check their shot records to be sure they are updated as needed. In addition, per the Venezuelan Ministry of Health, travelers should carry their International Certificate of Vaccination (or yellow card) with them, as they may be asked to present it upon arrival or departure. Mosquito-borne diseases such as malaria and dengue fever are also common in some areas and travelers should take precautions to prevent infection.
An exit tax and airport fee must be paid when departing Venezuela by airline. In many instances, especially with non-U.S. airlines, the exit tax and airport fee are not included in the airline ticket price and must be paid separately at the airport upon departure. At present, American Airlines does include both fees in the ticket price. Authorities usually require that payment be made in local currency. Both the departure tax and the airport fee are subject to change with little notice. Travelers should check with their airlines for the latest information.
For current information concerning entry, tax, and customs requirements for Venezuela, travelers may contact the Venezuelan Embassy at 1099 30th Street, NW, Washington DC 20007, tel.: (202) 342-2214, or visit the Embassy of Venezuela web site. Travelers may also contact the Venezuelan consulates in Boston,Chicago, Houston, Miami, New Orleans, New York, San Francisco, or San Juan.
The U.S. Department of State is unaware of any HIV/AIDS entry restrictions for visitors to or foreign residents of Venezuela.
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 page.
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SAFETY AND SECURITY: Violent crime in Venezuela is pervasive, both in the capital, Caracas, and in the interior. The country’s overall per capita murder rate is cited as one of the top five in the world. The Venezuelan National Counter Kidnapping Commission was created in 2006, and since then, official statistics have shown alarming increases in reported kidnappings throughout the country. In fact, kidnappings in 2009 have increased anywhere from 40-60 percent from the previous year. Surveys show that the overwhelming majority of kidnappings and other major crimes are not reported to the police. Armed robberies take place throughout the city, including areas generally presumed safe and frequented by tourists. Well-armed criminal gangs operate widely, often setting up fake police checkpoints. Only a very small percentage of crimes result in trials and convictions.
Travel to and from Maiquetía Airport, the international airport serving Caracas, can be dangerous, and corruption at the airport itself is rampant. Both arriving and departing travelers, including foreigners, have been victims of personal property theft and muggings in the airport. The Embassy has received multiple, credible reports that individuals wearing what appear to be official uniforms or other credentials are involved in facilitating or perpetrating these crimes. For this reason, American citizen travelers should be wary of all strangers, even those in official uniform or carrying official identification, and should not pack valuable items or documents in checked luggage. Valuable documents and personal items should be kept in carry-on luggage. The Embassy has also received multiple, credible reports of victims of “express kidnappings” occurring at the airport, in which individuals are taken to make purchases or to withdraw as much money as possible from ATMs, often at gunpoint. In addition, the Embassy has received reports of uniformed airport officials attempting to extort money from travelers, including U.S. citizens, as they go through the normal check-in and boarding process for departing flights. Furthermore, there are known drug trafficking groups working from the airport. Travelers should not accept packages from anyone and should keep their luggage with them at all times.
The road between Maiquetía Airport and Caracas is known to be particularly dangerous. Visitors traveling this route at night have been kidnapped and held captive for ransom in roadside huts that line the highway. Because of the frequency of robberies at gunpoint, travelers are encouraged to arrive and depart only during daylight hours. If not, travelers should use extra care both within and outside the airport. The Embassy strongly advises that all arriving passengers make advance plans for transportation from the airport to their place of lodging. If possible, travelers should arrange to be picked up at the airport by someone who is known to them or at least try to caravan in known groups en route to Caracas. Travelers should be aware of chokepoints inside tunnels and avoid obstacles in the road.
The Embassy has received frequent reports of armed robberies in taxicabs going to and from the airport at Maiquetía. There is no foolproof method of knowing whether a taxi driver at the airport is reliable. The fact that a taxi driver presents a credential or drives an automobile with official taxi license plates marked libre is no longer an indication of reliability. Incidents of taxi drivers in Caracas overcharging, robbing, and injuring passengers are common. Travelers should take care to use radio-dispatched taxis or those from reputable hotels. Travelers should call a 24-hour radio-dispatched taxi service from a public phone lobby or ask hotel, restaurant, or airline representatives to contact a licensed cab company for them.
For more information regarding transportation services, please refer to the U.S. Embassy Caracas web site. The Embassy does not vouch for the professional ability or integrity of any specific provider. The list is not meant to be an endorsement by the Department of State or the Embassy. Likewise, the absence of any individual or company does not imply lack of competence.
While visiting Venezuela, Americans are encouraged to carry as little U.S. currency as possible and to avoid wearing expensive or flashy watches and jewelry. Due to the poor security situation, the Embassy does not recommend changing money at the international airport. Visitors should bring a major credit card, but should be aware of widespread pilfering of credit card data to make unauthorized transactions. Travelers’ checks are not recommended as they are honored in only a few locations. It is possible to exchange U.S. currency at approved exchange offices near major hotel chains in Caracas (personal checks are not accepted) and at commercial banks with some restrictions. Due to currency regulations, hotels cannot provide currency exchange. There are ATMs throughout Venezuela. Malfunctions are common, however, and travelers should be careful to use only those in well-lit public places. ATM data has also been hacked and used to make unauthorized withdrawals from user’s accounts.
Popular tourist attractions, such as the Avila National Park, are increasingly associated with violent crime. Americans planning to participate in outdoor activities in potentially isolated areas are strongly urged to travel in groups of five or more and to provide family or friends with their itineraries prior to departure.
Cross-border violence, kidnapping, drug trafficking, smuggling, and cattle-rustling occur frequently in areas along the 1,000-mile long border between Venezuela and Colombia. Some kidnap victims have been released after ransom payments, while others have been murdered. In many cases, Colombian terrorists are believed to be the perpetrators. Colombia's National Liberation Army (ELN) and the Revolutionary Armed Forces of Colombia (FARC) are active in kidnapping. Common criminals are also increasingly involved in kidnappings, either dealing with victim's families directly or selling the victim to terrorist groups.
In-country travel by U.S. Embassy employees, both official and private, within a 50-mile area along the entire Venezuela/Colombia border, is prohibited. The State Department warns American citizens not to travel within a 50-mile area along the entire Venezuela/Colombia border. U.S. citizens who elect to visit areas along the border region with Colombia despite this warning, apart from the Colombian terrorist threat, could encounter Venezuelan military-controlled areas and may be subject to search and arrest.
The U.S. Embassy must approve in advance the official travel to Venezuela of all U.S. Government personnel. Private travel by U.S. military personnel to Venezuela requires advance approval by the U.S. Embassy. Please consult the Department of Defense Foreign Clearance Guide for further information. Non-military employees of the U.S. Government do not need Embassy approval for private travel.
Political marches and demonstrations are frequent in Caracas and in Venezuela. Travelers should be aware that violence, including exchanges of gunfire and tear gas, has occurred at political demonstrations in the past. Demonstrations tend to occur at or near university campuses, business centers, and gathering places such as public squares and plazas. Marches generally occur on busy thoroughfares, significantly impacting traffic. Most major tourist destinations, including coastal beach resorts and Margarita Island, have not in the past been generally affected by protest actions. The city of Merida, however, a major tourist destination in the Andes, has been the scene of frequent demonstrations, some of them violent, including the use of firearms and tear gas.
Travelers should keep informed of local developments by following the local press, radio and television. Visitors should also consult their local hosts, including U.S. and Venezuelan business contacts, hotels, tour guides, and travel organizers. As circumstances warrant, the Embassy sends out messages to U.S. citizens who have registered on-line. These messages and demonstration notices are also posted on the U.S. Embassy’s web site. U.S. citizens traveling or residing in Venezuela are advised to take common-sense precautions and avoid large gatherings and demonstrations, no matter where they occur.
Harassment of U.S. citizens by pro-government groups, Venezuelan airport authorities, and some segments of the police is uncommon, despite the fact that Venezuela’s most senior leaders, including President Chavez, regularly express anti-American sentiment.
Venezuela is an earthquake-prone country and is occasionally subject to torrential rains, which can cause landslides, such as occurred in late 2008. Travelers who intend to rent or purchase long-term housing in Venezuela should choose structures designed for earthquake resistance. Such individuals may wish to seek professional assistance from an architect or civil/structural engineer, as does the Embassy, when renting or purchasing a house or apartment in Venezuela. Americans already housed in such premises are also encouraged to seek a professional structural assessment of their housing.
For further information on seismic activity, you may wish to visit:
1. The Multidisciplinary Center for Earthquake Engineering Research (MCEER) web site
2. The Global Seismic Hazard Assessment Program web site
3. The Caribbean Disaster Mitigation Project web site
For the latest security information, U.S. citizens traveling abroad should regularly monitor the Department of State's Bureau of Consular Affairs web site, which contains current the Travel Warnings and Travel Alerts as well as the Worldwide Caution.
Up-to-date information on safety and security can also be obtained by calling 1-888-407-4747 toll-free within the U.S. and Canada, or by calling a regular toll line, 1-202-501-4444, from other countries. 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 extensive tips and advice on traveling safely abroad.
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CRIME: Venezuela and its capital, Caracas, are reported to both have among the highest per capita murder rates in the world. Most murders and other violent crimes go unsolved. Armed criminal gangs often operate with impunity throughout the urban areas. The poor neighborhoods that cover the hills around Caracas are extremely dangerous. These areas are seldom patrolled by police and should be avoided. Armed robberies are common in urban and tourist areas throughout Venezuela, even areas presumed safe and visited by tourists. Crimes committed against travelers are usually money-oriented crimes, such as theft and armed robbery. Incidents occur during daylight hours as well as at night. Many criminals are armed with guns or knives and will use force. Jewelry of all sorts, even inexpensive but flashy jewelry, and expensive electronics attract the attention of thieves. Travelers are advised to leave jewelry items, to include expensive-looking wristwatches, at home. Gangs of thieves will often surround their victims and use a chokehold to disable them, even in crowded market areas where there is little or no police presence. Theft from hotel rooms and safe deposit boxes is a problem, and theft of unattended valuables on the beach and from rental cars parked near isolated areas or on city streets is a common occurrence. A guarded garage or locked trunk is not a guarantee against theft. Pickpockets concentrate in and around crowded bus and subway stations in downtown Caracas. Subway escalators are favored sites for "bump and rob" petty thefts by roving bands of young criminals. Many of these criminals are well dressed to allay suspicion and to blend in with crowds using the subways during rush hour. Travelers should not display money or valuables.
"Express kidnappings," in which victims are seized in an attempt to get quick cash in exchange for their release, are a problem. One common practice is for kidnappers to follow potential victims into building garages and kidnap them at gunpoint. Kidnappings of U.S. citizens and other foreign nationals from homes, hotels, unauthorized taxis and the airport terminal do occur, and are more frequently being reported to the Embassy. “Virtual kidnappings,” in which scam surveys are conducted to collect contact information on minors, which is then used to call parents for ransoms without the children being taken, and “inside kidnappings,” in which domestic employees are being paid large sums of money for keys and information in order to enter and kidnap children for ransom, have also been reported to the Embassy. U.S. citizens should be alert to their surroundings and take necessary precautions.
The Department has received reports of robberies during nighttime and early morning hours on the highways around and leading to Caracas. Reports have specifically involved cars being forced off the La Guaira highway leading from Caracas to the Maquetía International Airport, and the "Regional del Centro" highway leading from Caracas to Maracay/Valencia, at which point the victims are robbed. The Department recommends avoiding driving at night and in the early morning where possible.
Police responsiveness and effectiveness in Venezuela vary drastically but generally do not meet U.S. expectations. U.S. travelers have reported robberies and other crimes committed against them by individuals wearing uniforms and purporting to be police officers or National Guard members. Police investigations into kidnappings have revealed that police officers are often involved, and corruption within police forces is a concern. U.S. citizens are encouraged to stay away from police activity, as they may be handling an investigation of a crime.
Incidents of piracy off the coast of Venezuela remain a concern, and foreigners have been targeted. Attacks on foreign tourists in Venezuelan coastal waters and around Margarita Island have increased over the last several years. Recent attacks have been especially violent, including the murder of a U.S. citizen on his boat in November 2008, and the killing of a French yachter in September 2008. Previous violent attacks include the severe beating of a U.S. citizen in 2002, the fatal shooting of an Italian citizen in January 2004, and a machete attack on a U.S. citizen in 2005. U.S. citizen yachters should note that anchoring off shore is not considered safe. Marinas, including those in Puerto la Cruz and Margarita Island (Porlamar), provide only minimal security, and U.S. citizens should exercise a heightened level of caution in Venezuelan waters. Please consult the U.S. Coast Guard web site for additional information on sailing in Venezuela.
In addition to security concerns, yachters should be aware of registration and other required permits in order to anchor in Venezuelan marinas. U.S. citizens docking in Venezuela are strongly encouraged to check with local authorities regarding the proper documentation for their vessels and themselves. Furthermore, rules governing the sale of fuel to foreign sailors in Venezuela vary by state. U.S. citizen yachters should inquire about specific state procedures prior to attempting to purchase fuel in any given location.
Private aircraft companies and operators are strongly encouraged to consult with the Venezuelan Civil Aeronautical National Institute regarding current Venezuelan laws and regulations, such as those pertaining to tail markings, registrations and other required authorizations.
Failure to comply with national or local requirements can result in arrest and criminal charges, as well as property seizures.
The Embassy is aware of several instances where women lured American men to Venezuela after establishing “relationships” with them over the Internet. Some of these men were robbed shortly after they arrived in Venezuela. Others were recruited to act as narcotics couriers or “drug mules.” In three instances, the Americans were arrested at the airport with narcotics in their possession and served extended jail terms in Venezuela.
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.
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INFORMATION FOR VICTIMS OF CRIME: If you are the victim of a crime abroad, you should contact the local police and the nearest U.S. embassy or consulate (see the Department of State’s list of embassies and consulates). This includes the loss or theft of a U.S. passport. The embassy/consulate staff can, for example, help you find appropriate medical care, contact family members or friends and explain how funds may 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.
The local equivalent to the “911” emergency line in Venezuela is: 171. These calls will not be answered by English speakers, but the service is staffed by members of local police forces, who may attempt to find someone who speaks basic English.
Please see our information on victims of crime, including possible victim compensation programs in the United States.
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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 Venezuelan laws, even unknowingly, may be expelled, arrested or imprisoned. Penalties for possession, use, or trafficking in illegal drugs in Venezuela 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.
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SPECIAL CIRCUMSTANCES: Venezuela has had major electoral campaigns each year since 2004 and most recently held a constitutional referendum on February 15, 2009. Elections for the National Assembly are scheduled for September 2010. Venezuelan elections generate extensive campaigning from political parties and civil society groups. Large political rallies or protests could take place in major cities during that time. U.S. citizens should take caution to avoid these large rallies. U.S. citizens can also receive email alerts regarding demonstration notices posted on the U.S. Embassy’s web site.
The government of Venezuela implemented rigid foreign exchange controls in 2003, including a fixed official rate of exchange. Foreign exchange transactions must take place through exchange houses or commercial banks at the official rate. As of October 2005 it is no longer possible to exchange money at hotels. Currency exchange for tourists can be arranged at casas de cambio (exchange houses). There are exchange houses located near most major hotels. It is also possible to exchange money at commercial banks; however, visitors should be aware that the exchange would not be immediate. Exchanges through commercial banks must first be approved by the Commission for Administration of Foreign Currencies (CADIVI). This requires a registration process, which delays the exchange. The exchange control mechanisms also require the exchange houses and commercial banks to obtain authorization from CADIVI to trade Bolívares Fuertes (the local currency) into U.S. dollars. Outside the major cities, a good supply of Venezuelan currency is necessary, as it may be difficult to find exchange houses. The Embassy cannot provide currency exchange services.
Travelers will likely encounter individuals in Venezuela who are willing to exchange Bolívares Fuertes for U.S. dollars at a rate significantly higher than the official rate of exchange. These "black market" currency exchanges are prohibited under the Venezuelan foreign exchange controls, although enforcement, especially for small amounts, is sporadic. Persons charged with violating foreign exchange controls face a fine and possible penalty. Travelers charged in such activity may be detained by the Venezuelan authorities. Additionally, in accordance with an October 2005 law, any person who exchanges more than 10,000 U.S. dollars in the course of a year through unofficial means is subject to a fine of double the amount exchanged. If the amount exceeds 20,000 U.S. dollars the penalty is three to seven years imprisonment. Any person who transports more than 10,000 U.S. dollars into or out of Venezuela by any means must declare this amount to customs officials.
Credit cards are generally accepted at most upscale tourist establishments, but foreign exchange controls have made credit card acceptance less common than in the past. Visa, MasterCard, and American Express have representatives in Venezuela. Due to the prevalence of credit card fraud in Venezuela, travelers should exercise caution in using their credit cards and should check statements regularly to ensure that no unauthorized charges have been made. Most major cities have ATMs with 24-hour service where users may withdraw local currency, but many of these ATMs will not accept U.S.-issued debit cards.
Many U.S. citizens residing in Venezuela have experienced difficulties and delays in renewing their residency visas. U.S. citizens are advised to plan accordingly in advance. Venezuelan authorities can and do ask foreigners for proof of their identification and legal status in the country.
Venezuelan customs authorities may enforce strict regulations concerning temporary importation into or export from Venezuela of items such as plant and animal products, firearms, medications, archaeological or "cultural heritage" items, and pirated copies of copyrighted articles. It is advisable to contact the Embassy of Venezuela in Washington or one of Venezuela's consulates in the United States for specific information regarding customs requirements. Please see our Customs Information.
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MEDICAL FACILITIES AND HEALTH INFORMATION: Medical care at private hospitals and clinics in Caracas and other major cities is generally good. Public hospitals and clinics generally provide a lower level of care and basic supplies at public facilities may be in short supply or unavailable. Cash payment is usually required in advance of the provision of medical services at private facilities, although some facilities will accept credit cards. Patients who cannot provide advance payment may be referred to a public hospital for treatment. Private companies that require the patient to be a subscriber to the service or provide cash payment in advance generally provide the most effective ambulance services. Public ambulance service is unreliable. U.S. citizens should be aware that due to the currency restrictions in effect in Venezuela they might find it difficult to receive wire transfers from abroad, whether through a bank or Western Union. Such wire transfers cannot be used reliably as a source of emergency funds. U.S. citizens traveling to Venezuela may also find it difficult to obtain certain prescription drugs, particularly name brands, and should ensure that they have sufficient quantities of all medications for the duration of their stay.
Information on vaccinations and other health precautions, such as safe food and water precautions and insect bite protection, may be obtained from the Centers for Disease Control and Prevention’s (CDC) hotline for international travelers at 1-877-FYI-TRIP (1-877-394-8747) or via the CDC web site. For information about outbreaks of infectious diseases abroad, consult the infectious diseases section of the World Health Organization (WHO) web site. The WHO web site also contains additional health information for travelers, including detailed country-specific health information.
Adventure Tourism: Venezuela has many natural attractions, to include the world’s tallest waterfall, Angel Falls. Travelers should note, however, that many of these attractions are in remote areas of the country. Medical services may be very limited, and transportation to larger cities may be difficult to arrange or time-consuming in the event of an emergency. Travelers should be aware of the increased risks due to the remoteness of some areas and precarious medical and transportation conditions.
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MEDICAL INSURANCE: The Department of State strongly urges U.S. citizens to consult their medical insurance company prior to traveling abroad to determine whether the policy applies overseas and whether it covers emergency expenses such as a medical evacuation. For more information, please see our medical insurance overseas page.
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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 Venezuela is provided for general reference only, and may not be totally accurate in a particular location or circumstance.
Driving regulations in Venezuela are similar to those in the United States, although many drivers do not obey them. Defensive driving is a necessity. Motorcyclists often weave in and out of lanes and cars, so caution is advised. Child car seats and seatbelts are not required and are seldom available in rental cars and taxis. Outside the major cities, night driving can be dangerous because of unmarked road damage or repairs in progress, unlighted vehicles, and livestock. Even in urban areas, road damage is often marked by a pile of rocks or sticks left by passersby near or in the pothole or crevice, without flares or other devices to highlight the danger. Traffic jams are common within Caracas during most of the day and are frequently exploited by criminals. Armed motorcycle gangs often operate in traffic jams and tend to escape easily. Cases of armed robbery by motorcyclists and theft of other motorcycles have increased and may result in death if the victim does not comply. Stops at National Guard and local police checkpoints are mandatory. Drivers should follow all National Guard instructions and be prepared to show vehicle and insurance papers and passports. Vehicles may be searched. Inexpensive bus service is available to most destinations throughout the country, but the high incidence of criminal activity on public transportation makes bus travel inadvisable. Peak holiday travel occurs during summer and winter school breaks and major civil and religious holidays, including Carnival, Easter, Christmas and New Year's holidays. Lengthy delays due to road congestion are common during these peak periods.
Please refer to our Road Safety page for more information.
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AVIATION SAFETY OVERSIGHT: The U.S. Federal Aviation Administration (FAA) has assessed the Government of Venezuela’s Civil Aviation Authority as being in compliance with International Civil Aviation Organization (ICAO) aviation safety standards for the oversight of Venezuela’s air carrier operations. Further information may be found on the FAA safety assessment page.
Aviation Security Oversight: The U.S. Department of Homeland Security’s Transportation Security Administration (TSA) has been unable to assess the actual security measures at international airports in Venezuela that serve as the last point of departure for nonstop flights to the United States. Air carriers issuing tickets for travel between the United States and Venezuela are directed to notify ticket purchasers in writing of the situation. TSA directed that this advisory be displayed prominently at all U.S. airports and published in the Federal Register, pursuant to Title 49 U.S.C., Section 114.
The Department of Homeland Security is required to assess security at foreign airports with direct service to the United States to determine compliance with standards established by the International Civil Aviation Organization (ICAO). More information about TSA is available on the TSA Web site.
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CHILDREN'S ISSUES: Please see our Office of Children’s Issues web pages on intercountry adoption and international parental child abduction.
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This replaces the Country Specific Information for Venezuela dated July 8, 2009, to update sections on Entry/Exit Requirements, Threats to Safety/Security, Crime, and Special Circumstances.
sábado, 13 de marzo de 2010
BBC Mundo, Enviada especial a Perú
En la capilla del Hospital Regional de Cuzco, a más de 3.300 metros de altura, ya no hay espacio para las plegarias. Los bancos de madera han sido reemplazados por camas y los religiosos, por médicos.
En una de estas camas descansa Cirila, quien ha contraído bartonellosis, una enfermedad transmitida por el mosquito conocido como la manta blanca, que ha comenzado a aparecer a mayor altura. La razón: el aumento de las temperaturas.
Cirila tiene apenas fuerza para hablar. Con lágrimas en los ojos me dice que quiere volver a su casa. Allí la esperan su hija, su parcela y sus animales.
Pero por el momento no está en condiciones de irse. La fiebre y la anemia severa no le permiten siquiera levantarse de la cama.
Los médicos aún no saben si la paciente podrá recuperarse: la mortalidad de los pacientes hospitalizados en las nuevas áreas es de hasta 30%.
"Ésta y otras enfermedades transmitidas por vectores (seres vivos que transmiten una enfermedad) –como el dengue y la malaria- que antes estaban en nichos más o menos propios, han comenzado a aumentar en zonas más elevadas", le dice a BBC Mundo el doctor Manuel Montoya, Jefe del Servicio de Infectología del Hospital Regional de Cuzco.
Fiebre, cansancio, dolor de cuerpo, palidez o verrugas. En pocos días, se puede desarrollar una anemia aguda severa y la muerte del paciente
Es el primer problema de salud pública en Perú
Mortalidad en Perú cien veces mayor que la malaria
Para Montoya la relación entre cambio climático y aumento de las enfermedades transmitidas por mosquitos no ofrece lugar a duda.
"Comenzamos a notar los cambios con mucha más fuerza a partir del '98, con el fenómeno de El Niño. A partir de allí empezamos a ver una suerte de quiebre y un cambio ecológico en las enfermedades transmitidas por vectores", explica.
Añade que a principios del siglo pasado se dio una situación similar. "Cuando hubo una ola de calor en los años '20, hubo una gran proliferación del mosquito Anófeles –que transmite la malaria o paludismo- y se presentaron casos de la enfermedad por falciparum en Quillabamba, en la región de Cuzco. Las crónicas de aquel entonces son espeluznantes. Cuentan que murió cerca de dos tercios de la población".
Sin embargo, no todos los especialistas están de acuerdo con Montoya. Es más, por cada artículo que establece una relación directa entre el cambio climático y la distribución geográfica de las enfermedades transmitidas por vectores, pareciera haber otro que niega rotundamente esta relación causa-efecto.
Montoya dice que los cambios comenzaron a notarse a partir del fenómeno de El Niño en 1998.
Para Paul Reiter, profesor de Entomología Médica del Instituto Pasteur de París, Francia, la teoría de que a más calor, más mosquitos, "es un mito que comenzó a circular en la década de los '90", que carece de base científica.
"Los récords históricos muestran que la malaria se había extendido en el pasado a regiones templadas y había logrado sobrevivir incluso en los años fríos de la Pequeña edad de hielo" (desde el siglo XIV hasta el XIX).
Consultada por BBC Mundo, la experta en Epidemiología Ambiental de la Escuela de Higiene y Medicina Tropical de Londres, Sari Kovats, se mostró renuente a dar credibilidad a la historia, sugiriendo dejar el tema a un lado por la posible falta de evidencia científica que muestre un incremento de las enfermedades tropicales en los Andes a raíz del aumento de temperaturas.
Sin embargo, para quienes trabajan en el terreno, como el doctor Montoya, la evidencia es contundente.
Estoy seguro de que mucho del crecimiento de las enfermedades transmitidas por vectores está en función del cambio climático, lo que pasa es que no es muy fácil hacer la narración causa-efecto
Doctor Alejandro Llanos, Universidad Peruana Cayetano Heredia
Y hasta los más cautos subrayan que el problema existe, aunque no puedan confirmar que el cambio climático sea el único factor que provoca la expansión de estas enfermedades.
"No hay duda de que las enfermedades están apareciendo a más altura. Pero hay que tener cuidado en no dar un mensaje equivocado: el área de una enfermedad puede expandirse por diversas razones y una de ellas es el cambio climático", le explicó a BBC Mundo Alejandro Llanos, del Instituto de Medicina Tropical Alexander von Humboldt, de la Universidad Peruana Cayetano Heredia.
"Yo estoy seguro de que mucho del crecimiento de las enfermedades transmitidas por vectores está en función del cambio climático, lo que pasa es que no es muy fácil hacer la narración causa-efecto" , agregó.
Llanos señala además que no sólo se ha expandido en altura la bartonellosis en Perú, sino que también se han reportado casos de malaria, por ejemplo, en el altiplano boliviano.
Más a favor que en contra
Mantener a la población informada y al personal de salud entrenado es crucial, dice Montoya.
Por su parte, tanto el Panel Intergubernamental de Cambio Climático (IPCC) como el Banco Mundial (BM) concuerdan en que el aumento de la temperatura está empujando a los mosquitos hacia arriba en los Andes.
"Tras completar estudios en la zona hemos concluido que muchos hábitats de los Andes que no estaban expuestos a estas enfermedades se verán ahora afectados", le dijo a BBC Mundo el especialista en Cambio Climático del BM Walter Vergara. Y el problema, agrega, es que "las poblaciones no están genéticamente preparadas para los cambios que puede provocar una mayor exposición (a estas enfermedades) ".
En respuesta a esta preocupación, el BM implementó un programa para evitar la propagación de las enfermedades transmitidas por vectores en Colombia, donde, según explicó Vergara, ya se ha registrado la presencia del mosquito transmisor de la malaria a más de 2.000 metros de altura.
De la teoría a la acción
La migración de mosquitos y de las enfermedades que acarrean es una amenaza que no se circunscribe a América Latina: cada vez se reportan más casos de malaria entre las comunidades rurales que habitan en tierras altas en África y Asia.
Si bien la discusión sobre si el cambio climático es o no la causa principal en el cambio demográfico de las enfermedades estimula la rigurosidad en la investigación científica, mientras el tema no abandone el terreno del debate, se corre el riesgo de que los gobiernos no pongan en marcha programas de salud para hacerle frente al problema, algo que Montoya ve con preocupación.
Hemos concluido que muchos hábitats de los Andes que no estaban expuestos a estas enfermedades se verán ahora afectados
Walter Vergara, Banco Mundial
"Es importante mantener educada a la población. Cuando surge una epidemia, la difusión de la información es masiva, pero cuando ya nos acostumbramos al problema, las medidas comienzan a relajarse".
"Si no se mantiene a la población constantemente informada y a los equipos de salud permanentemente capacitados, las epidemias serán inevitables" , concluyó el especialista.