Pandemic Influenza Task Force/EAC Reviews Pandemic

UNCLAS NAIROBI 001257 SIPDIS E.O. 12958: N/A TAGS: KFLU ASEC AMGT CASC KE SUBJECT: Pandemic Influenza Task Force/EAC Reviews Pandemic Influenza Tripwires and Mission Response Ref: A. Nairobi 985 ¶1. (U) Summary. In light of June 11 decision by WHO to raise the global pandemic alert to Phase 6, Nairobi's Pandemic Influenza Preparedness Task Force/EAC, on June 16, reviewed its pandemic influenza tripwires and response. Given that the H1N1 strain is proving, thus far, to be less virulent than initially anticipated and that, thus far, there are no cases of human-to-human transmission in Kenya, the Task Force decided to re-issue previously circulated information on preventing, diagnosing and treating the H1N1 virus. This information will be circulated to all Embassy personnel as well as the non-official community. The Embassy's Internet website contains a link to CDC's authoritative public health guidance. Post will continue to monitor the situation on the prudent assumption that there will eventually be an H1N1 outbreak in sub-Saharan Africa, including Kenya. Post also reviewed its stocks of tamiflu and determined that we have sufficient stocks for all official American staff and their dependents and for FSN staff. End Summary. ¶2. Background: On June 11, the WHO announced its decision to raise the pandemic influenza global alert to phase 6. This designation is based on geographic spread of the illness, not on the severity of the illness. As of June 16, the WHO had reported 29,669 cases, including 145 deaths, in 74 countries. From the initial outbreak in North America, the novel H1N1 influenza A virus has spread to multiple continents. Most recently widespread outbreaks were reported in the Southern Hemisphere -- Australia and Chile. Although the virus continues to spread, the disease continues to be a "mild" one for the most part. ¶3. In Africa, Egypt is the only country that has reported cases of novel H1N1 virus. No cases have been reported in Sub-Saharan Africa. This may be the result of the lack of surveillance for influenza in many countries in Sub-Saharan Africa. Kenya and South Africa are two exceptions. Laboratories in Kenya have tested a total of 21 cases, including suspected cases from Seychelles and Tanzania. South Africa has an extensive sentinel surveillance system for influenza in place; the country has been testing many samples for seasonal surveillance, and a number of suspected H1N1 cases. All cases in Kenya and South Africa have tested negative. ¶4. With the beginning of the "winter" season in Kenya (June-August), we can assume that eventually the virus will reach Kenya, together with "seasonal influenza." The Task Force/EAC, therefore, is operating under the assumption that it is a question of "when" not "if" we are faced with a pandemic. ¶5. Government of Kenya Preparedness and Response: In Kenya, two laboratories - the National Influenza Center, which is part of the Kenya Medical Research Institute and partly staffed and equipped by USAMRU-Kenya, and the CDC-Kenya International Emerging Infections Laboratory, are able to test for the novel H1N1 virus. The Kenyan Ministry of Public HEALTH and Sanitation (MoPHS) has taken steps to better prepare the country for the pandemic, including convening two meetings of the national pandemic task force, and holding subcommittee meetings to develop case definitions, case management guidelines, and infection control recommendations for clinicians. Kenya recently received a supply of 50,000 treatment courses of tamiflu from WHO; the medications are currently being stored in Nairobi. Airport screening has been ongoing, although the approach may not be capturing all incoming travelers. ¶6. Nairobi at Tripwire Three (ref B, para 10): Tripwire Three addresses a situation where WHO announces phase 6 and "a pandemic influenza outbreak with human-to-human transmission in the host country has been confirmed." The Task Force/EAC discussed whether we had crossed this tripwire; while the pandemic, with human-to-human transmission, was declared by WHO to be at phase 6, there still has not been confirmation of the novel H1N1 pandemic influenza virus in Kenya. Nevertheless, the group decided that with the worldwide pandemic being official and the likely inevitability of the novel virus being introduced to Kenya, we should consider that tripwire three has been crossed. ¶7. Social distancing policies were considered. According to CDC's Pandemic Severity Index, the current pandemic falls in category 2, where most social distancing measures are discouraged. The task force reviewed the appropriate social distancing measures for a category 2 pandemic. ¶8. The Task Force/EAC reviewed host country quarantine information; the Government of Kenya currently does not have an official policy on quarantine for pandemic influenza. The proposal to restrict travel because of the current pandemic was rejected because of the moderate character of the pandemic; currently the WHO and the US Government have discouraged restriction of travel. ¶9. A decision was made to put out another management notice, along with an announcement in The Roar and a Warden Message, explaining the implications of WHO's phase six declaration, and reviewing recommendations on appropriate infection control precautions and social distancing measures. ¶10. During the meeting the Task Force/EAC reviewed the action points raised in tripwire ONE and two, as well as those in tripwire three and four: ¶11. Tripwire One: A management notice had been sent out following the February 2009 Task Force meeting which addressed issues of emergency supplies in the community. The EAC had also reviewed supplies of food, water and antivirals, as well as internal and external communications. Post has enough tamiflu for all official American staff and their dependents and for FSN staff. (Note: Per standing guidance from Washington, we are not in a position to administer tamiflu to dependents of FSNs. End Note). The warden system, F-77 documents, and post's internet link to CDC's website are routinely updated. In addition, CDC-Kenya and USAMRU-Kenya have routinely liaised with the host government about pandemic preparedness and response issues. [MK1] ¶12. Tripwire Two: This tripwire was crossed in May. A town hall meeting was held, with participation from the medical unit and CDC. Personnel lists were updated. ¶13. Review of Tripwire Four: Tripwire Four addresses a pandemic situation where it is difficult to get seats on flights. The Task Force/EAC concluded that this situation seems extremely unlikely during the current pandemic, although if the pandemic were to become more severe, such a situation may become a possibility. ¶14. Post will continue to monitor the situation and review its tripwires. Ranneberger