EMBASSY BAGHDAD AVIAN INFLUENZA TRIPWIRES AND

UNCLAS SECTION 01 OF 05 BAGHDAD 000343 SIPDIS SIPDIS DEPT FOR CA/OCS/ACS/NEA; NEA/SA/EX; NEA/I; OES/STC (MGOLDBERG); OES/IHA (DSINGER and NCOMELLA) DEPT PASS TO USAID FOR ANE AND GH STATE PASS TO HHS USDA FOR FAS/PASS TO APHIS CAIRO PASS NAVY MEDICAL RESEARCH UNIT E.O. 12958: N/A TAGS: AMED AMGT CASC ASEC EAGR EAID TBIO KFLU KPAO, IZ SUBJECT: EMBASSY BAGHDAD AVIAN INFLUENZA TRIPWIRES AND RESPONSE PLAN REF A. 05 STATE 202102 ¶B. 05 STATE 219189 ¶C. STATE 1175 ¶1. The Embassy Baghdad Avian Influenza (AI) Working Group (AIWG, which included MED, ECON, Health Attache, IRMO, USAID, USDA/FAS, MGT, PAO, and MNF-I),met on January 18, 2006 to discuss Embassy tripwires and possible responses. Based on this meeting, the Embassy Health Unit drafted AI Tripwires and an Embassy response plan. References for these tripwires included tripwire reports prepared by other U.S. Missions in the region, an MNC-I draft AI response plan, and the DOS/MED http://med.state.gov/influ_plan.htm. The AIWG agreed that the location of a tripwire event - in a neighboring country, or near or within the city where an Embassy mission is located - is an important factor to consider. All tripwire responses have been formulated by the Health Unit under the assumption that an effective human vaccine will not be available, that evacuation may not be possible, and that Level III care may be inadequate in spite of MNF-I support. Personnel movement will be coordinated between MNF-I and JASG (who works jointly with the MNF-I and the Mission) Any of the tripwires could occur independently of another. It is also possible that two or more tripwires could occur sequentially or simultaneously. -------------- TRIPWIRE ONE -------------- ¶2. TRIPWIRE ONE: A spike in the number and/or broadening geographic spread of animal-to-human cases or sustained human-to-human transmission through close, prolonged contact in a neighboring country: Iran, Turkey, Saudi Arabia, Kuwait, Jordan, and Syria. Embassy Actions in response to Tripwire One: -- The AIWG meets to confirm that the tripwire has been met, assess the risk to the Mission in Iraq, review the tripwire responses and make recommendations to the Emergency Action Committee (EAC). -- The EAC considers restricting civilian travel to the affected country or affected areas within the country, except for CDC or other personnel involved in possible investigation/containment efforts. -- Mission Iraq coordinates with the U.S. Mission in the affected country regarding its plans for public announcements, warden messages, or plans for evacuating personnel. -- Mission Iraq Health Unit provides briefings for staff (Americans and FSNs) and prepares written notices, as appropriate. -- Mission Iraq Consular Section ensures that any public announcements or travel warnings issued by neighboring posts are transmitted to American citizens (AMCITS) and publishes the updates on the Consular BAGHDAD 00000343 002 OF 005 Section's web site. -------------- TRIPWIRE TWO -------------- ¶3. TRIPWIRE TWO: A spike in the number and/or broadening geographic spread of animal-to-human cases or sustained human-to-human transmission through close, prolonged contact in Iraq. Embassy Actions in response to Tripwire Two: -- The AIWG meets to confirm that tripwire has been met, assess the risk to the Mission in Iraq, review the tripwire responses and make recommendations to the EAC. -- The EAC meets regularly and coordinates closely with REOs to determine next steps as tripwire circumstances develop. -- The EAC considers restricting travel by civilians to Iraq or affected areas, except for CDC or other personnel involved in possible investigation/ containment efforts. -- The Mission Health Unit pushes additional Tamiflu to the affected REO or PRT areas. -- The Mission coordinates with MNF-I regarding their levels of support in the affected area. -- In coordination with the Department, the Consular Section issues public announcements, Warden Messages, or a travel advisory, and updates the Consular website. -- The Mission's Public Affairs Section provides press guidance for the potential use of the Mission, REOs, the Department, and concerned government agencies and coordinates public affairs and media activities with DOD. -- The Mission Health Unit provides briefings and written guidance for staff. -- The EAC recommends that the Mission maintain full service operations in some areas and consider authorized departure in posts that are near the reported areas, as appropriate. -- The Mission Health Unit implements home quarantine of any staff member who has been in close contact with a person confirmed to have an AI infection for a period of 10 days after exposure. -------------- Tripwire Three -------------- ¶4. TRIPWIRE THREE: Efficient and sustained human-to- human transmission in a neighboring country. Embassy Actions in response to Tripwire Three: -- Those responses mentioned in Tripwire Two as well as the following: BAGHDAD 00000343 003 OF 005 -- Embassy staffs and equips a situation room and a call center for inquiries from American public and the press using cleared material to respond to press inquiries. -- The Mission maintains normal Consulate and Embassy operations, but continues close monitoring of the situation. -- The Health Unit identifies and trains personnel to prepare for possible screening of Post visitors for flu-like symptoms. -------------- Tripwire Four -------------- ¶5. TRIPWIRE FOUR: Efficient and sustained human-to- human transmission in Iraq. Embassy Actions in response to Tripwire Four: -- In addition to tripwire two and three responses: -- The EAC examines the feasibility of Mission personnel working from remote locations, as well as a reduction of Embassy services and operations. -- The EAC considers having employees remain in their quarters or implements authorized or ordered departure for all but those American and FSN staff designated essential. -- The EAC considers restricting movement of Mission personnel to mission-critical activities only. -- The Mission provides meals, MREs, and water at trailers. -- The RSO splits the Marine Security Guard Detachment into two separate and independent units. (In the event individuals in one unit acquire the disease, the other unit can still ensure proper coverage of classified materials.) -- The Mission restricts visitors' access to Mission buildings. If entry is necessary to conduct business, visitors must be screened for Avian Flu symptoms including the taking of temperature, and completion of a questionnaire- by personnel designated and trained during Tripwire number three. -- The Health Unit maintains and updates its database of Embassy American employees hospitalized, quarantined, or ill at home. -- The HU staff reviews with MNF-I the availability of medical/hospital facilities and support available should the Mission become affected. -- The EAC considers a recommendation to the COM to request NEO operations from MNF-I. In order to consider an evacuation, assuming transportation is available, the destination country must be willing to accept the persons and have no pandemic of its own. -- In coordination with MNF-I, the EAC considers BAGHDAD 00000343 004 OF 005 closure of all or some of the REOs with special consideration of those closest to the involved areas of reported cases. -- The Mission coordinates with ISU Amman the preparation of all required travel documents in anticipation of an authorized departure. -- The Health Unit considers administering Tamiflu to staff that is likely to come in direct contact with potentially infected persons and those who have had close contact with those potentially infected persons. -------------- Tripwire Five -------------- ¶6. TRIPWIRE FIVE: Human AI infection-affected patients in the Mission. Embassy Actions in response to Tripwire Five: -- HU personnel will take immediate action to provide appropriate care and isolation to the affected patient(s). -- The senior HU staff member evaluates if the case definition of AI illness has been met and discusses the case(s) with the AIWG to confirm that the tripwire has been met. -- Management will coordinate meetings with the EAC and MNF-I and the Operations Center for Crisis Management. -- The RMO or senior DOS HU provider will inform MED in Washington and provide input as requested. -- The EAC determines avenues of communication, including MNF-I, which will play a key role in patient care and disposition, and confers with the appropriate agencies. The following will be options: A) Closure of Embassy with Shelter-in-Place. B) Operation of the remaining posts in Iraq. C) Evacuation of non-affected members after a 5-10 day observation in an isolated setting period if logistically possible and medically indicated. -------------- IMMEDIATE ACTIONS AND ACTIONS COMPLETED -------------- ¶7. During the AIWG meeting, it was apparent that certain actions need to take place now, before any tripwires are established. This report lists (A) actions that require immediate attention and (B) actions completed. (A) Actions to be taken immediately: -- AIWG and EAC review Tripwire plan with: (i) USAID representatives: Due to USAID's presence in northern Iraq, it may have early opportunity for detection of changing AI Activity. (ii) RSO, CA, and GSO to assure that the specific issues are incorporated in the Tripwire responses. BAGHDAD 00000343 005 OF 005 -- The Health Unit develops a skills bank. --Mission prepares a draw-down list and a list of minimum essential personnel. -- Regional Embassy Offices(REOs): Coordinators integrate the specific needs of the REOs. -- The Consular Section posts an AI advisory and Wardens message on the Baghdad Website -- The Health Unit receives the DOS-promised Tamiflu, Oseltamivir to increase coverage for Mission personnel to 40 percent. (B) Actions already taken by the Mission Health Unit: -- Updated Administrative Memo to Mission personnel. -- Inventoried and secured 9500 Tamiflu doses at the HU and 100 doses at each of the REOs. -- Procured 500 N95 masks. -- Fit-tested all HU personnel for the N95 masks. -- Provided in-service training to HU regarding the management of suspected AI cases. -- Posted trilingual hand washing and cough etiquette posters (English, Spanish, Arabic). -- Briefed the medical staff at the 10th CSH on January 27, 2006. -- Gave a presentation at the IZ town hall meeting held January 28, 2006. ¶8. We look forward to the Department's comments on Mission Baghdad's strategy for responding to a possible outbreak of Avian Flu. Best regards. KHALILZAD