YEMEN AVIAN INFLUENZA PREPARATIONS

UNCLAS SECTION 01 OF 03 SANAA 003527 SIPDIS FOR S/ES-O/CMS E.O. 12958: N/A TAGS: AMGT ASEC CASC AMED KFLO AEMR YM SUBJECT: YEMEN AVIAN INFLUENZA PREPARATIONS Ref: State 219189, Sanaa 3167, Sanaa 3290 ¶1. Post has addressed ref A and implemented its recommendations to the maximum extent possible. Further avian influenza preparation measures will also be taken over the next month. Paragraph 2 provides a general assessment of avian influenza (AI) preparedness. Paragraph 3 details post's trip wires, which will be added to the TRIPS site. Paragraph 4 details post's responses to the specific action items of ref A. ¶2. Yemen has limited general health care coverage, with major hospitals capable of handling mass casualties or disease outbreaks centered in half a dozen large cities. Outside these cities, health care consists of smaller clinics. Even in the large private and public hospitals of the major cities, stocks of medical supplies and equipment that may be used in the event of an AI outbreak - such as respirators, Tamiflu and personal protective equipment - are severely limited. Post was able to identify only one major hospital (outside the capital of Sanaa) with a Tamiflu supply and AI preparation plan. The Ministry of Public Health is in charge of the official ROYG management of potential human AI cases but has extremely limited response capabilities. For example, the Minister of Health told a meeting of international donors that Yemen's stockpile of Tamiflu is only enough for 2000 people. Yemen's international airports have small medical facilities but no AI planning yet, according to airline officials. The Ministry of Agriculture is in charge of surveillance, monitoring and testing of potential animal AI cases but has no resources to accomplish this goal. See ref B for additional information on ROYG preparations. Post itself could maintain American staff and their families within the Embassy compound for about five days. Post is working with staff to expand shelter-in-place preparations so that personnel could remain in their homes for extended periods, realistically not to exceed two weeks. Post has no DOD personnel not under COM authority. ¶3. RSO William Mellott and Vice Consul Michael Hankey are post's two personnel responsible for inputting AI tripwire data. Post's tripwires follow, which have been approved by post's EAC and will be entered into the TRIPS database. Tripwire 1: Broadening global concern or case found in bird in the region. Post considers the UN Food and Agricultural Organization's November report of a Kuwaiti H5N1 case as sufficient to trigger post response under this trip wire and has accordingly implemented these responses. a) Coordinate response with regional missions in the horn of Africa and the Persian Gulf as well as DC offices. Obtain response information from other missions in country, including the British, French, Germans and Japanese. b) Issue warden message with basic information and Q and A's on AI. Disseminate factual information about likely victims and resources. c) Incorporate AI information into regularly scheduled town hall meetings. d) Confirm local resources and contacts. e) Confirm air carrier plans in the event of an outbreak. f) Prepare Department information (including the translation of FAQ's) for future dissemination. g) Incorporate AI information into MED/USAID outreach to medical facilities. h) Continue to monitor the incidence and spread worldwide. i) Stock Tamiflu. j) Stock personal protective equipment. k) Provide information to the Embassy community, including updates of major changes. Encourage flu shots and general hygiene. Tripwire 2: Case of avian influenza discovered in bird/s in host country or bird-to-human transmission case found in the region or human-to-human transmissions occuring anywhere in the world. a) EAC meets to confirm tripwire has been crossed. b) Reconfirm local resources and air carrier plans. c) Confirm supplies of Tamiflu and personal protective equipment. d) Continue to provide information to the Amcit community via warden messages and town hall meetings. e) Confirm that any relevant travel warning relating to neighboring countries are disseminated with the American citizens in host country. f) Provide additional updates to the Embassy and Amcit community as the situation progresses. Tripwire 3: Bird-to-human case discovered in host country or human-to-human transmission cases discovered in the region. a) EAC meets to confirm tripwire has been crossed. b) Provide briefing for Embassy personnel. c) Restrict travel to suspected areas and consider recalling employees working in and near those areas. d) In coordination with the Department, issue public announcement, travel warning and warden message warning American citizens against travel in the suspected areas. e) Hold emergency town hall meetings, if possible. f) Work with MED, FMM and GSO to control possible transmission among and from the public visiting the consular section and the Yemeni-American Language Institute (YALI). g) Consider requesting authorized departure for family members and non-essential personnel. h) Establish a database tracking American citizens who have been quarantined or hospitalized. i) Request daily updates from host country government. Tripwire 4: Human-to-human transmission cases or sustained increase in bird-to-human transmissions occur in host country or sustained human-to-human transmission in the region. a) EAC meets to confirm tripwire has been crossed. b) Coordinate with CA/OCS on issuance of guidance requesting Americans to defer non-emergency travel to Yemen. c) In coordination with the Department, prepare press guidance. d) Cancel incoming official travel to host country except for personnel involved in investigative/containment efforts, or as otherwise deemed necessary by COM. e) Implement home quarantine of any staff or dependents who have been in contact with a person confirmed to have an AI infection. f) Restrict access to the consular section to emergency American citizen services and limit or temporarily close YALI. g) Restrict visitor access to the Embassy. h) Embassy staffs and equips situation room. i) Consular section continues monitoring the status of American citizens infected or suspected to be infected. j) Institute screening in Embassy lobby and mandatory sick leave for any personnel with flu-like symptoms and/or temperature over 38 degrees. k) Consider shelter in place or reduced movement for Embassy personnel. l) Consider requesting ordered departure for family members and non-essential personnel. Alternate Tripwire: Mission employee or eligible family member develops AI infection. a) Employee or family member begins Tamiflu treatment. b) Medevac if possible, use local facilities if necessary. c) Monitor personnel who were in close contact with infected person. Implement home quarantine for those persons until they have been deemed not infected. ¶4. The following points detail post's response to each item with paragraph 8 of ref A. a) Post is organizing a briefing for American and LES personnel on AI, MED guidance and post's contingency plans. b) Post has identified staff with medical skills, including staff outside the medical unit. c) Post has conducted an inventory of Tamiflu and medical supplies. Current Tamiflu supplies are only two boxes of expired medicine, but more are supposed to be arriving from MED in December. The medical unit is also procuring additional supplies of personal protective equipment. d) Post medical unit keeps Tamiflu locked within a cabinet within the medical unit. e) Post GSO has procured emergency supplies to the extent possible with current funding levels. f) Post is procuring the computing and communications supplies needed to remotely perform consular operations, including warden messages. g) Post has identified essential staff to remain through a possible authorized or ordered departure. h) Post medical unit has collected information on staff with medical issues to depart when authorized. i) Post has prepared travel packets and set aside funds for potential Mission evacuees under an authorized departure. j) Post has reached out to airlines, airport officials and border officials regarding possible border closures and flight restrictions in case of an AI outbreak. k) Post has organized a series of town hall meetings for the American community and distributed basic AI information via the warden system. l) Post has engaged and assisted ROYG officials and NGO staffers regarding the local AI response capacity. USAID and NAMRU are assisting the ROYG with surveillance, monitoring and testing of animal cases. KHOURY