EMBASSY KATHMANDU PANDEMIC INFLUENZA TRIPWIRES AND

UNCLAS KATHMANDU 002849 SIPDIS SENSITIVE SIPDIS DEPT FOR SA/INS, S/ES-O/CMS E.O. 12958: N/A TAGS: AMGT ASEC CASC AMED KFLO AEMR NP SUBJECT: EMBASSY KATHMANDU PANDEMIC INFLUENZA TRIPWIRES AND RESPONSE PLAN REF: SECSTATE 219189 SUMMARY -------------- ¶1. (SBU) The Embassy has established an ad hoc interagency working group on avian influenza (AI) that meets regularly to discuss the Post Emergency Action Plan (EAP) specific to AI. The working group has recommended the following: to develop a section for Post's general EAP specific to a Pandemic Infectious Disease situation, which include tripwires and responses to AI; to put the MED avian influenza links on the Embassy website and the Consular Section's website; to incorporate the avian influenza issue into upcoming Town hall meetings with the American community; and, to continue to monitor the Government of Nepal's (GON) plan in response to the avian influenza threat. This report highlight Post's action plans for AI and lists AI specific tripwires and responses. END SUMMARY. EMBASSY ACTION PLAN -------------- ¶2. (SBU) Post has established an interagency group, meeting every two weeks to review the AI issue and take appropriate action in the event that the situation changes. The group consists of the following mission elements: CDC, MED, USAID, Consular, Political/Econ, Regional Environmental Office, and DCM. ¶3. (SBU) Recognizing that new infectious diseases are evolving all the time and that AI is one of many potential threats to human health, the interagency group examined whether or not any plans put in place for AI could be generalized into a generic "Pandemic Infectious Disease Action Plan." The working group felt this was advisable, but agreed that the plan might have to be modified for specific disease threats as diseases vary in incubation periods, modes of transmission and means of prevention. IMMEDIATE ACTIONS -------------- ¶4. (SBU) Below are the specific actions being taken by the relevant sections of the Embassy. - MED has established tripwires in Post's EAP specifically for AI. Protective equipment is in place for Health Unit staff and for those who would need close contact with infected individuals. Tamiflu is on hand for 25% of members of the Embassy community who have health unit access, in accordance with Washington guidance. Post ordered yearly flu vaccines in July 2005, according to the 2004 demand levels. This year's vaccination campaign has proceeded as usual and the health unit has administered approximately 70 vaccines to date. - Consular will include AI in the next Town Hall meeting. Consular will also link their Kathmandu web page with the MED and CDC AI info sites. - PA will react with rumor control procedures, as outlined in the EAP, in the event of a reported human to human AI case, or development of a pandemic. - The Community Liaison Office (CLO) has updated a survey of Embassy personnel and their families to locate additional health professionals among us. - P/E, USAID and CDC are engaging with the GON on Nepal's AI preparedness plan. Copies of the GON preparedness plan have been circulated and reviewed. TRIPWIRES AND RESPONSES -------------- ¶5. (SBU) Post discussed its tripwires and responses in an Emergency Action Committee (EAC) meeting on December 6. Post has accomplished some of the responses outlined in tripwire one. Post will publish these tripwires on the Tripwire Reporting and Integrated Planning System (TRIPS) by December 31, per reftel. Post's AI specific tripwires and responses are as follows: Tripwire One -------------- Spike in number and broadening geographic spread of animal-to-human transmission cases in South Asia and/or bordering countries or Thailand, indicating an increase in the transmissibility of the virus and/or causing a serious strain on local medical facilities. AND/OR Closing of regional airports and border transit points due to reports of increasing animal to human transmission. General Actions: - Establish working group to issue updates on AI to community as needed; consider town-hall meetings. - Advise Mission personnel and private American citizens about the disease threat. - Set-up reporting system with PAO. Consular: - Coordinate closely with other diplomatic missions, Med/Washington, and desk officers etc. - Keep Americans in country up to date on facts. Consider putting info on the Embassy Kathmandu internet site. - Discuss shelter in place and quarantine plans. Medical: - Send status reports on Avian Influenza to Washington and put in the Yank and Yeti as developments change. - Communicate with local hospitals and clinics on their findings of possible AI cases. - Ensure adequate hand washing supplies and tissues on desks. - Review drug stocks and supplies. - Train guards, Marines, LES and US community in home health care for Flu, use of thermometers, masks, and goggles. - Put up signs on how to wash your hands and cough etiquette. Logistics: - Check all emergency supplies and have enough water on hand and MREs for essential staff for six weeks. - Ensure adequate supplies for essential operations. - Secure Tamiflu in Health Unit. - Collect and tally skill bank results. Who has a medical background? Collect home e-mail addresses. - Consider informing people to store enough food and water for 6 - 12 weeks. - Teach cleaning staff how to disinfect an office. Teach employees how to keep their workspaces clean. Tripwire Two -------------- Sustained human-to-human transmission, as evidenced by a cluster of cases (in an office, apartment building, etc.) in an urban area of one or more of the other at-risk countries in region, but not in Nepal. This is particularly significant if there are multiple, geographically diverse clusters, or if a cluster occurs in an urban area and/or is not safely isolated. General Actions: - Call EAC to review current information regarding actions being taken in surrounding countries (Quarantines, airport closures, border closures). - If appropriate, consider recommending authorized departure of family members and non-emergency personnel. - Issue a public announcement to the American community. Consular: - Provide all services to Americans. - Send public announcement to private American community. - Provide visa services for travel with Americans returning to the United States, and for official GON travel. - Continue to work on all pending immigrant visa cases with appointments but make no new appointments. Medical: - Review procedures, supplies, and readiness. - Communicate with MED regarding current recommendations. - Contact local epidemiologists and travel medicine experts regarding surveillance data and activities. Logistic: - Check all emergency supplies and have enough food and water on hand. - Ensure adequate supplies for essential operations. Tripwire Three -------------- Sustained human-to-human transmission, as evidenced by a cluster of cases (office, apartment building, etc.) in Nepal, but outside Kathmandu. General Actions: - Consider requesting Department order departure of family members and non-emergency personnel. - Implement administrative leave for non-emergency Direct hire employees, contractors and LES. - Implement mandatory sick leave for any employee with flu symptoms or has a family member with flu symptoms, monitored by MED Unit. - Implement screening of all visitors and use of protective gear. - Request Department issue a travel warning for Nepal specific to Avian Flu. Consular: - Provide emergency services only. - Issue public announcement to private American community. Medical: - Treat and possibly medevac (not likely possible) infected personnel and families. - Distribute Tamiflu to confirmed cases and close household contacts. - Provide psychological support to employees and families involved. - Make home visits to sick individuals who have authorized embassy health unit access. Logistic: - Continue to verify stock of food and water is adequate. - Medical screening of remaining staff. - Continue use of protective gear. - Assign driver to Health Unit. - Consider preparing travel authorizations for expedited return to home leave addresses of remaining staff. Tripwire Four -------------- Sustained human-to-human transmission, as evidenced by a cluster of cases (in an office, apartment building, etc.) in Kathmandu. General Actions: - Consider Requesting Department order departure of family members and non-essential personnel. - Implement administrative leave for non-emergency LES. Reduce staffing to absolute minimal level. Consider Shelter in Place. - Consider closing all mission annexes and relocate remaining staff to Chancery. - Implement mandatory sick leave for any employee who shows any flu symptoms or has a family member with flu symptoms, monitored by Med Unit. - Implement screening of all visitors using protective gear. - Consider prophylactic use of Tamiflu by minimal U.S. and FSN staff remaining on the job on a case-by-case basis. - Request Department issued travel warning specific to AI. - Issue press releases as appropriate. Consular: - Limit consular services to emergencies only. - Institute latest recommendations for personal protective equipment for persons in direct contact with potentially ill members of the public community. - Issue public announcement to private American community. Medical: - Visit/treat sick people at home, wear personal protective equipment (PPE). - Provide medications for secondary infections. - Continue to inform Med/Washington of AI cases in US community. - Maintain a working relationship with local medical facilities. May need to refer difficult patients to them for treatment. - Observe the GON regulations regarding the prevention of the spread of the disease. - Provide social and psychological support. Logistic: - Dedicated vehicle for Health Unit for home visits; provide food and water if needed. - Disinfect offices and other areas of Embassy. - Consider providing delivery service for groceries and other essentials to residences. Alternate Tripwire -------------- Mission employee develops Avian Influenza, in the absence of a broader outbreak described in tripwires 1, 2, 3, or 4 above. General Actions: - Treat the victim. - Medevac if possible. - Disinfect office. - Administer Tamiflu to close contacts. MILLARD