PANDEMIC H1N1 INFLUENZA RESPONSE - TURKMENISTAN

UNCLAS SECTION 01 OF 02 ASHGABAT 000975 SENSITIVE SIPDIS STATE FOR SCA/CEN E.O. 12958: N/A TAGS: KFLU PREL AEMR CASC PINR AMGT SOCI TX SUBJECT: PANDEMIC H1N1 INFLUENZA RESPONSE - TURKMENISTAN ¶1. (U) Sensitive but unclassified. Not for public Internet. ¶2. (SBU) SUMMARY: To date, there have been no officially documented cases of H1N1 in Turkmenistan. However, it appears that the country would be unprepared, if there was an outbreak. Primary health care is limited in the capital and even more limited in rural areas. Post is not aware of any known stockpile or government warehouse with supplies of antiviral medications in Turkmenistan for its population. Rapid testing for H1N1 is available but is not sensitive or specific for H1N1. Ashgabat has an Infectious Disease Hospital, and its staff has been trained in isolation techniques and has personal protective equipment familiarization. Nevertheless, given the GOTX's lack of transparency, obsession with secrecy, and slow bureaucratic response will mean that an H1N1 outbreak will almost certainly be mismanaged. END SUMMARY. ¶3. (SBU) Health care in Turkmenistan, as reported in the European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicines' 2009 assessment, is limited in the capital, Ashgabat and even more limited in rural areas. Primary health care is scarce throughout the country, although there are many specialty clinics in Ashgabat that have up-to-date medical equipment. However, there is insufficient trained medical staff to use it. If a Pandemic Influenza (PI) epidemic occurs in Turkmenistan, the country's already inadequate health system will be quickly overwhelmed. ¶4. (SBU) There are no officially documented cases of H1N1 influenza in Turkmenistan as noted by the World Health Organization's (WHO) most recent report (6 July 2009). Current unofficial reports from the Central Hospital, located in Ashgabat, note that there are no documented cases of H1N1. As has been noted from several independent resources, official documentation of illnesses and diseases, amongst other health issues, is rarely accurate. ¶5. (SBU) WHOs latest update (6 July 2009) on global pandemic rates shows that the countries surrounding Turkmenistan - Kazakhstan, Uzbekistan, Afghanistan, Pakistan, Azerbaijan, have no documented lab confirmed cases. Iran has 1 confirmed case; Russia 3; India 129; Turkey 40; Iraq 12 and China 2040. None of these countries has any deaths associated with H1N1 influenza. The United Kingdom has ;7447 lab confirmed cases with 3 deaths. In comparison, the United States has 33,902 confirmed lab cases and 170 deaths. As has been reported, actual rates of infection are under-reported due to not all cases being laboratory confirmed. ¶6. (SBU) Ashgabat has an Infectious Disease Hospital that has been present in the community for many decades. It was established during the Soviet era and likely is not as up-to-date according to western standards. This hospital has been designated specifically to accept infectious disease cases. Previous sources note that the staff has been trained on isolation techniques and has personal protective equipment (PPE) familiarity. ¶7. (SBU) The Post Health Unit is not aware of any known stockpile or government warehouse with supplies of antiviral medications in Turkmenistan for its population. The health unit at post has enough Oseltamivir (Tamiflu) for adequate coverage for 478 people. The ability for Amcits to mail order personal supplies of this prescription Tamiflu is possible, but with the expense and the limited shelf life, a reliable personal supply is not dependable. ¶8. (SBU) Rapid testing for H1N1 is available but is not sensitive or specific for H1N1. The test relies upon the fact that H1N1 is an Influenza A type of virus. More specific and sensitive testing would require specialized lab tests which are highly sensitive and specific. The Post Health Unit is unsure whether Turkmenistan has either the rapid tests or the more specialized lab tests. The Post Health Unit is in the process of ordering rapid Influenza tests. ¶9. (SBU) Tamiflu is only effective if used within 48 hours of the time when symptoms develop. For lab confirmed documentation ASHGABAT 00000975 002 OF 002 purposes there is no quick, easy way to diagnose and confirm the presence of swine (H1N1) flu. Countries without sophisticated labs, and without quick distribution methods, may not be able to use their small stocks properly (if the Turkmen government has a stockpile). Tamiflu is completely ineffective if it's too late. ¶10. (SBU) The GOTX's lack of transparency, obsession with secrecy, and slow bureaucratic response will mean that a PI outbreak will almost certainly be mismanaged. This type of behavior was reported by local sources in 2005 when the Avian Flu was emerging. ¶11. (SBU) The unpredictable nature of PI, and how specifically an outbreak would begin in Turkmenistan is not known. Given the restrictions with visa and border security, spreading through international travel is less likely here than with other countries. The most likely scenario would be the possible significant human to human transmission which may begin in some places without reports of individual clusters of illness due to the poor medical system. ¶12. (SBU) COMMENT: The most effective response to PI requires both good planning and flexibility to depart from the plan when necessary. The State Department Medical Unit is maintaining a high level of involvement in disseminating information and updates regarding the progress of the H1N1 PI. The plans are evolving regarding the use of a vaccine that will not be available until, at the earliest, late September or October 2009. END COMMENT. MILES