VIETNAM - REVISED AVIAN INFLUENZA TRIPWIRES

UNCLAS SECTION 01 OF 03 HANOI 002430

SIPDIS

FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV; OES/STC (M.GOLDBERG);
OES/IHA (D.SINGER AND N.COMELLA)
BANGKOK FOR RMO, CDC
STATE PASS HHS
USDA FOR FAS/PASS TO APHIS
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN
USAID FOR ANE AND GH

E.O. 12958: N/A
TAGS: AMED AMGT CASC EAGR TBIO VM AFLU
SUBJECT: VIETNAM - REVISED AVIAN INFLUENZA TRIPWIRES

REF: Hanoi 822


1. Mission Vietnam developed and submitted tripwires and
possible actions for various Avian Influenza (AI) scenarios
in March, 2005 (Reftel). The Mission's AI Working Group
(AIWG) recently met to revise tripwires and responsive
actions in response to new assessment of the situation. The
following revised AI assumptions, tripwires, and possible
actions have been approved by the Ambassador. We invite and
welcome feedback from relevant offices and agencies with
expertise in emergency planning and/or influenza.

Key Assumptions
--------------


2. The AIWG make the following assumptions for planning
purposes:

a. The risk to USG personnel is currently low. The
contingent risk is that H5N1 begins to transmit actively
between humans. Risk would be manageable if human-to-human
transmission occurred only in cases of extensive intimate
contact. Transmission by casual human-to-human contact
would require rapid action to protect our personnel.

b. There is a high probability that Vietnam would be at the
center of any outbreak of human-to-human H5N1 infection.

c. Vietnamese medical facilities would be unable to handle
more than a handful of AI cases at any given time at an
international standard of care. Facilities to provide care
at a lower standard, including mechanical ventilation
capabilities, would also be overwhelmed at a level somewhere
in the range of 5-10 cases in either Hanoi or Ho Chi Minh
City.

d. Depending on the speed of a human-to-human outbreak, U.S.
citizens could be quickly cut off from air evacuation
routes. Evacuation by land or sea might also become
impossible.

e. The Mission would be unable to obtain essential medical
and basic supplies in the event of a crisis and should
stockpile adequate provisions.

Tripwires and Recommended Actions
-------------- --------------


3. The Ambassador has approved the following revised
Mission's tripwires and possible associated actions:

Tripwire 1: Spike in number and broadening geographic
spread of animal-to-human transmission cases in Vietnam
indicating an increase in the transmissibility of the virus
and/or causing a serious strain on local medical facilities.

Possible Actions:

a. Restrict official and unofficial travel to rural areas.

b. Release warning announcement to Mission personnel and
issue corresponding warden message to private American
citizens.

c. Consider issuance of a travel warning for Vietnam.

d. Consider authorized departure of family members and non-
emergency American personnel.

Tripwire 2: Sustained human-to-human transmission, as
evidenced by a cluster of cases (office, apartment building,
etc.) in an urban area of one or more of the other six at-
risk countries in the region (not Vietnam). This is
particularly significant if there are multiple,
geographically diverse clusters, or a cluster occurs in a
major transit hub.

Possible Actions:

a. Request Department authorize departure of family members
and non-emergency personnel.

b. Screen all visitors to USG facilities.

c. Impose mandatory sick leave for any employee who exhibits
any flu symptoms or has a family member with flu symptoms,
monitored by MED Unit.

d. Request Department issue a travel warning.

e. Issue a public announcement to the American community.

Tripwire 3: Sustained human-to-human transmission, as
evidenced by a cluster of cases (office, apartment building
etc.) in Vietnam, but outside HCMC or Hanoi. This is
particularly significant if there are multiple,
geographically diverse clusters, or a cluster occurs in an
urban area and/or is not safely isolated.

Possible Actions:
a. Request Department authorize ordered departure of family
members and non-emergency personnel. Implement
administrative leave for non-emergency FSNs.

b. Limit consular services to emergencies only.

c. Implement mandatory sick leave for any employee who shows
flu symptoms or has a family member with flu symptoms,
monitored by MED Unit.

d. Implement screening of all visitors and use of
protective gear (masks, gloves, clothing, etc.).

e. Require mandatory prophylactic use of Tamiflu by
emergency U.S. and FSN staff remaining on the job.

f. Request Department issue a travel warning for Vietnam.

g. Issue a public announcement to private American
community.

Tripwire 4: Sustained human-to-human transmission, as
evidenced by a cluster of cases (office, apartment building,
etc) in HCMC or Hanoi. This is particularly significant if
there are multiple, geographically diverse clusters, or a
cluster is not safely isolated.

Possible Actions:

a. Request Department authorize ordered departure from both
posts. Implement administrative leave for non-emergency
FSNs. Reduce staffing to absolute minimal level.

b. Limit consular services to emergencies only.

c. Close all Mission annexes and relocate remaining staff to
Chancery/Consulate General.

d. Impose mandatory sick leave for any employee who shows
any flu symptoms or has a family member with flu symptoms,
monitored by Med Unit.

e. Implement screening of all visitors and use of protective
gear (masks, gloves, clothing).

f. Require mandatory prophylactic use of Tamiflu by minimal
U.S. and FSN staff remaining on the job.

g. Request Department issue a travel warning for Vietnam.

h. Issue a public announcement to private American
community.

Alternative Tripwire: A Mission employee develops Avian
Influenza, in the absence of a broader outbreak described in
tripwires 1, 2, 3, or 4 above.
Possible Actions:

a. Treat the victim. Medevac if possible.

b. Disinfect office.

c. Administer Tamiflu to close contacts.
MINIMIZE CONSIDERED
MARINE