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

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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:

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-- 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

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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.

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-- 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