Identifier
Created
Classification
Origin
09ASHGABAT975
2009-07-31 12:34:00
UNCLASSIFIED//FOR OFFICIAL USE ONLY
Embassy Ashgabat
Cable title:
PANDEMIC H1N1 INFLUENZA RESPONSE - TURKMENISTAN
how-toVZCZCXRO1202 PP RUEHAG RUEHAST RUEHBI RUEHCI RUEHDBU RUEHDF RUEHIK RUEHLH RUEHLN RUEHLZ RUEHNEH RUEHPW RUEHROV RUEHSK RUEHSL RUEHSR RUEHVK RUEHYG DE RUEHAH #0975/01 2121234 ZNR UUUUU ZZH P 311234Z JUL 09 FM AMEMBASSY ASHGABAT TO RUEHC/SECSTATE WASHDC PRIORITY 3236 INFO RUCNCLS/ALL SOUTH AND CENTRAL ASIA COLLECTIVE PRIORITY RUCNCIS/CIS COLLECTIVE PRIORITY RUCNMEM/EU MEMBER STATES COLLECTIVE PRIORITY RUEHAK/AMEMBASSY ANKARA PRIORITY 5497 RUEHBJ/AMEMBASSY BEIJING PRIORITY 3220 RUEHKO/AMEMBASSY TOKYO PRIORITY 3085 RUEHBS/USEU BRUSSELS PRIORITY RHMCSUU/CDR USCENTCOM MACDILL AFB FL PRIORITY RUEAIIA/CIA WASHDC PRIORITY RHEFDIA/DIA WASHDC PRIORITY RUEKJCS/JOINT STAFF WASHDC PRIORITY RHEHNSC/NSC WASHDC PRIORITY RUEKJCS/SECDEF WASHDC PRIORITY RUEAWJA/DEPT OF JUSTICE WASHDC PRIORITY RUEHIT/AMCONSUL ISTANBUL 3740 RUEKJCS/SECDEF WASHDC
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
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
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