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

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PREPAREDNESS STEPS
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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.

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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