CROATIA: AVIAN INFLUENZA POST CONTINGENCEY

UNCLAS SECTION 01 OF 03 ZAGREB 001985 SIPDIS SIPDIS DEPT PLEASE PASS TO DS/DSS, DS/IP, M/MED/JCTRIPLETT S/ES-O/CMS - OFFICE OF CRISIS MANAGEMENT SUPPORT FAS/CMP/DLP WETZEL AND MAGGINNIS FAS/ITP/EAMED POMEROY AND FLEMING CA/OCS/ACS RICK DOWELL USAID FOR E&E/ECA/B/ANNE CONVERY E.O. 12958: N/A TAGS: TBIO PREL AMGT ASEC AMED AEMR HR SUBJECT: CROATIA: AVIAN INFLUENZA POST CONTINGENCEY PLANNING, TRIPWIRES AND WEEKLY UPDATE: DECEMBER 22 REF: A) STATE 219189 B) ZAGREB 1946 AND PREVIOUS 1) SUMMARY: As of December 22, no additional cases of H5N1 have been confirmed in Croatia. In response to Ref A, Croatia has a developed, but strained public health care system with limited resources. There are fourteen specialized hospitals, including an infectious disease hospital, located in Zagreb. It is unlikely that the Croatian public health system could handle a full-scale influenza pandemic. Depending on circumstances, post believes it could maintain a shelter in place posture for a period of four to six weeks. In addition to existing emergency radio systems, post recognizes that new technologies such as the OpenNet Everywhere (ONE) program and wireless email (Blackberry) could facilitate continuity of operations and distribution of essential information during a pandemic. END SUMMARY -------------- PREPAREDNESS STEPS -------------- ¶2. Post is providing the following status information on our preparedness steps per request in Ref A: a) RMO Vienna held a briefing on avian and pandemic influenza for all employees and dependents on October 27, 2005. b) Management and MED identified 5 employees with medical backgrounds and will offer training to non- medical personnel in caring for those suffering from influenza as needed. c) Post currently has 800 doses of Tamiflu, 10 boxes of hand sanitizer wipes, 147 N95 masks, 200 surgical masks, 56 goggles, 100 head and foot covers, and 50 gowns. d) Tamiflu stockpiles are securely stored in the Health Unit. e) Post has stockpiles of emergency supplies at the embassy and Chief of Mission Residence (CMR). We distributed a health unit notice advising all employees to stockpile emergency supplies. f) Post's Emergency Action Plan (EAP) includes a plan for an alternate command post and the continuation of operations in the case of reduced staff. We have the ability to disseminate warden messages from an alternative location. g) Post's existing EAP Drawndown list of emergency ;personnel will be used in the case of possible authorized or ordered departure. h) MED has identified staff with medical issues or risk of severe disease to depart when authorized. i) Management has prepared pre-planned departure packets for potential Mission evacuees. j) The EAC discussed strategies, such as sheltering in place, for responding to border and airport closures. k) We plan to hold Town Hall meetings in early 2006. Pandemic influenza information will be provided to American citizens at these meetings. l) Post continues to engage Croatian officials on the GOC's response strategy and health care capabilities. -------------- Embassy Zagreb's Pandemic Influenza Tripwires -------------- ¶3. Tripwire One: Confirmed case(s) of animal to human transmission in Croatia or neighboring countries or sustained human-to-human transmission in any country. Tripwire One Responses: a) EAC meets to confirm tripwire has been crossed and decide on further action. b) Provide Mission briefings for American and LES ZAGREB 00001985 002 OF 003 employees and dependents. Confirm and update personal email addresses of employees to facilitate dissemination of information. c) Ensure that any public announcements or travel warnings issued relating to other countries are disseminated to American citizens in Croatia. d) In coordination with the Department, issue public announcement, warden message, or travel warning cautioning American citizens against nonessential travel to the affected region and to suspected areas within Croatia. e) In coordination with the Department, prepare press guidance. f) Prepare guidance for American citizen community on treatment options. g) EAC considers limiting consular services with CA consultation prior to taking such steps. h) EAC restricts official and unofficial travel to suspected areas. i) EAC reviews drawdown section of EAP and considers requesting authorized departure of non-essential staff and family members. Note: Under certain scenarios, drawdown of personnel may not be possible, safe, or medically advisable due to factors such as: closure of borders and other travel restrictions; establishment of quarantines at ports of entry; rapid curtailment of commercial travel; and surge in demand for medicine and related services. j) EAC accounts for and considers recalling all persons falling under Chief of Mission authority who are currently in remote areas. k) EAC considers instituting mandatory sick leave for employees who exhibit flu-like symptoms or have a family member exhibiting flu-like symptoms. l) EAC considers implementing use of protective equipment (gloves, masks, etc.) according to MED guidance. m) EAC reviews and revises tripwires, as necessary. ¶4. Tripwire Two: A spike in the number and/or broadening geographic spread of animal to human cases or sustained human-to-human transmission in neighboring countries or within Croatia. Tripwire Two Responses: a) EAC meets to confirm tripwire has been crossed and decide on further actions. b) Provide Mission briefings (perhaps by phone or email) for American and LES staff and dependents. c) EAC reviews EAP section for evacuation. d) Cancel incoming official travel to host country, except for personnel involved in investigative/containment efforts, or as otherwise deemed necessary by COM. e) Coordinate with CA/OCS on issuance of guidance (public announcement or travel warning, as appropriate) urging American citizens to defer all non-emergency travel to Croatia and particularly the affected regions. f) Depending on level of public inquiries, Embassy staffs and equips a situation room. Consular officers should establish a database tracking American citizens who have been quarantined, hospitalized, or are ill at home. Distribute guidance for American citizen community on treatment options. g) Limit consular services as necessary with CA approval prior to taking such steps. h) In coordination with the Department, prepare press guidance. i) Institute mandatory sick leave for employees who exhibit flu-like symptoms or have a family member exhibiting flu-like symptoms. j) Implement use of protective equipment (gloves, masks, etc.) according to MED guidance. k) Implement home quarantine of any staff or ZAGREB 00001985 003 OF 003 dependents who have been in contact with a person confirmed to have an AI infection and implement at home monitoring procedure. l) If authorized departure/ordered departure is not permissible, instruct all non-emergency American and LES staff to remain home on administrative leave. Children should remain home from school. m) Implement social distancing (limit movements of all personnel and dependents in the city). n) Plan for home visits to sick individuals who receive care under the Embassy health unit. o) Consider relocation of Embassy personnel to designated residences. p) Consider delivery service of groceries and other essential items to residences. q) Consider dividing the Marine Security Guard detachment into two separate and independent entities to decrease the risk of the spread of the disease and ensure proper coverage of classified materials. r) Restrict visitor access to Mission. s) Consider prophylactic Tamiflu treatment only for staff who are required to be in direct contact with potentially infected persons. ¶5. Parallel Tripwire: Mission employee or eligible family member develops AI infection. Parallel Tripwire Response: a) Employee or eligible family member begins Tamiflu treatment. b) Medevac if possible. FRANK