URUGUAY: GOU INTERVENTIONS RE H1N1

UNCLAS MONTEVIDEO 000445

SIPDIS

E.O. 12958: N/A
TAGS: KFLU PGOV PREL SOCI TBIO UY
SUBJECT: URUGUAY: GOU INTERVENTIONS RE H1N1

REF: SECSTATE 73971


1. (U) Through contacts with local health practitioners and
the Uruguayan Ministry of Public Health, Post developed the
following timeline of interventions pertaining to the H1N1
pendemic, as requested in reftel:

-- First case: The first case of H1N1 in Uruguay was detected
on May 23, 2009. The patient had just returned from Buenos
Aires, where he had been infected.

-- Making influenza a notifiable disease: Government
officials first notified the public of H1N1 on April 27,
2009, as the epidemic was first starting to spread in the
United States and Mexico. The Ministry of Public Health
established a phone number for Uruguayan citizens to call if
they had the symptoms of H1N1.

-- Emergency declarations: The government has not declared
an emergency due to H1N1 flu.

-- Measures at borders/airports: Following the first
confirmation of H1N1 in Uruguay on May 23, the Uruguayan
government implemented a containment and mitigation plan
placing non-restrictive measures at the country's border
checkpoints, including Carrasco International Airport.
Travelers arriving from countries where the outbreak had
already occurred were requested to fill out a form listing
any symptoms as well as contact information so that their
health status could be monitored by the Ministry of Public
Health. The GOU also began screening incoming pasengers for
signs of illness due to the flu. This screening included the
use of thermal scanners, which did not detect fever in any
arriving passengers, leading the Ministry to conclude that
the technology was ineffective. The GOU deactivated all
border screening measures following the announcement of a
Phase 6 pandemic, with only sentinel surveillance systems
remaining operational.

-- Isolation policies: The Ministry of Public Health
recommends that those with symptoms stay at home, cover their
cough, and use disposable tissues instead of handkerchiefs.
They have also recommended that all Uruguayans regularly wash
their hands or use alcohol gel due to the spread of the
disease. Isolation of hospitalized patients follows WHO/CDC
recommendations. The Ministry also has recommended that
Tamiflu only be provided to patients hospitalized with H1N1,
as providing it to those who only require rest could
alleviate symptoms while the virus is still active, thereby
encouraging patients to return to work and inadvertently
spread the disease.

-- Quarantine of households where infection is identified:
Quarantine has not been declared or recommended.

-- School, theater, dance hall, and other closures: Local
governments in the departments of Soriano, San Jose, and Rio
Negro closed theaters and dance halls in response to the H1N1
outbreak. However, these closures were criticized as
unnecessary by the Ministry of Public Health. Local youth
soccer leagues were also suspended for the last two weeks of
July, to resume at the beginning of August.

-- Staggered business hours: Not recommended.

-- Mask ordinances: Recommended for patients with symptoms
(common surgical mask) and for health personnel caring for
H1N1 patients (N95 mask).

-- Rules forbidding crowding on streetcars: None issued.

-- Private funerals: No rules issued.

-- Ban on door-to-door sales: None.

-- Interventions designed to reduce transmissions in the
workplace: See "isolation policies" above.

-- Protective sequestration of children: None.

-- Ban on public gatherings: None, other than the
theater/dance hall closures mentioned above. Some
institutions (educational, religious, music concerts) have
voluntarily suspended scheduled events, often due to a low
expected turnout.

-- No-crowding rules in locations other than transit systems:
None.

-- Community-wide business closures: None.


2. (SBU) According to our contacts in the local health
practitioner community, the Uruguayan government has adopted
a measured and effective policy in response to the H1N1
epidemic by keeping calm, applying WHO and CDC
recommendations throughout the country, and coordinating its
efforts with the private sector. It has acted firmly to stem
anxiety, particularly though its response to the closures by
local governments mentioned above. Our contacts in the GOU
also confirmed that the health care system proved effective
in preparing for and responding to this public health
emergency. While the H1N1 outbreak produced a surge of
patients at both public and private hospitals, bed shortages
were never a problem.


3. (SBU) During the outbreak, the greatest strain was put on
the network of laboratories in Uruguay, which did not have
the capacity to keep up with testing. Uruguayan labs were
overwhelmed by the H1N1 crisis despite donations of equipment
by the CDC, including a PCR detection kit provided on June

26. Since the WHO's June 11 declaration of a Phase 6
pandemic, the government has stopped testing for H1N1 in all
but those patients hospitalized with severe respiratory
symptoms, easing the burden on labs. However, virus samples
are still sent to the CDC in Atlanta every two weeks for the
purposes of monitoring possible mutations.


4. (SBU) To date, the severity and fatality pattern in
Uruguay has been similar to that in the United States and
Europe. According to the Ministry of Public Health, H1N1 flu
represents 90% of flu cases in the country, with similar
symptoms and severity. As of July 28, 31 people have died,
with most of them already suffering from serious underlying
health conditions. Ministry sources report that the local
epidemic appears to have peaked, but, as in the United
States, a second wave is expected.
Schandlbauer