MGSF01: H1N1 FLU - INDIA'S RESPONSE

UNCLAS SECTION 01 OF 05 NEW DELHI 000860 SENSITIVE SIPDIS HHS FOR OGHA AND PASS TO ANNE CUMMINGS AND DANIEL MILLER CDC ATLANTA FOR CCID AND PASS TO NANCY COX, STEPHEN BLOUNT, ANN MOE AND STEVE REDD PASS TO NIH FOR ROGER GLASS, THOMAS MAMPILLY, JAMES HEDDINTON AND GRAY HANDLEY PASS TO FDA FOR MAC LUMPKIN AND MARY LOU VALEX PASS TO AIAG FOR AMBASSADOR ROBERT LOFTIS, HELEN REED ROWE, AND CRAIG SHAPIRO USDA PASS APHIS AND FAS DOT PASS SHATLEY FAA PASS TNASKOVIAK E.O. 12958: N/A TAGS: KFLU AEMR ASEC CASC KFLO TBIO KSAF KPAO PREL PINR AMGT, MG, EAGR, EAIR, ECON, PREL, SOCI, IN SUBJECT: MGSF01: H1N1 FLU - INDIA'S RESPONSE REF: STATE 042349 ¶1. (SBU) SUMMARY: At the close of business on April 29 in India, no cases of H1N1 infection in humans or livestock have been reported by the local press or government authorities. We expect India to achieve independent diagnostic capability within the next few days; CDC is providing technical assistance to the Indian Ministry of Health (MOH). As a precaution, the MOH has begun a screening program which is not yet uniformly in place at all international airports in India. Moreover, an anticipated airport strike on May 1 is not expected to significantly impact airport operations and flights to and from India will continue as normal. Agricultural trade activities have not been impacted. Mission India has instituted an interagency working group to coordinate activities, actions and responses. END SUMMARY NO H1N1 CASES IN DELHI, DEVELOPING A DIAGNOSTIC CAPABILITY ¶2. (SBU) No cases of H1N1 infection in humans or livestock have been reported by Embassy New Delhi contacts at the MOH, Ministry of Agriculture (MOA),or by Indian media outlets. India is in the process of developing a capability to detect H1N1 and expects to be able to conduct diagnostics on its own within the next three to four days. Embassy New Delhi's Health Attache provided the MOH with information on the virus sequence and instructions for ordering CDC's real-time PCR diagnostic kits on April 29. Embassy Health Officers remain in close contact with the MOH and other Government of India (GOI) contacts to provide any requested technical assistance. Within India, diagnostic tests will be conducted at two labs - the internationally recognized National Institute of Virology in Pune and the National Institute of Communicable Diseases in New Delhi. Disease surveillance is conducted by the MOH based on reporting from hospitals and state government boards of health. SCREENING PROCEDURES IMPLEMENTED FOR ALL INBOUND PASSENGERS ¶3. (SBU) The MOH and Airport Public Health Organization (APHO) have issued guidelines for screening of passengers to both Indian airports and airlines operating in India. The Ministry of External Affairs (MEA) America's Desk confirmed to Emboff today that all international passengers, including those holding official and diplomatic passports, will be required to fill out a questionnaire and be subjected to health screening before they reach immigration. Where passengers reveal symptoms of H1N1 flu, they will be quarantined by the MOH. Airport health officials will also rely on airlines to identify passengers that are not feeling well. Those passengers, along with any passengers seated in the same row or within three rows ahead or behind, will be taken to secondary facilities for further observation. Based on a copy of the guidelines provided by an airline contact, and conversations with the MOH and Delhi Airport Health Officers, Mission India believes screening procedures will be implemented at most airports by this NEW DELHI 00000860 002.2 OF 005 evening Delhi time. ¶4. (SBU) The draft questionnaire shared by MOH with the Health Attache includes the following questions: (1) Have you visited/transited above mentioned countries (i.e. US, Canada and Mexico) Yes/No; (2) If yes, kindly answer the following questions, (a) Do you have fever or experienced fever in the past 10 days Yes/No, (b) Is fever accompanied by any of the following symptoms; cough, shortness of breath, difficulty in breathing Yes/No, (c) Have you cared for or lived with or have had face to face contact with a case of flu or visited or worked in a hospital where cases of flu are being treated, or whether your family member has been a suspect or probable case of Swine Flu. The questionnaire also requires personal information such as name, passport number, flight number, seat number, date of arrival, port of embarkation, port of disembarkation, contact address, and telephone number in India. ¶5. (SBU) A survey of airports and airlines by MissionOffs suggests that screening implementation may not be uniform. Following is a summary of reported activities at airports across India: -- NEW DELHI: APHO officer Dr. Sujeet K. Singh told EmbOffs on April 29 that immigration staff informally screened some passengers flying into India from the U.S., Canada, and Mexico starting on April 28 evening. From 2000 hours local time onwards, all incoming passengers into India will be screened. The MOH, in coordination with airport officials, has put in place eight counters at which passengers will be required to submit a questionnaire and be screened by a medical doctor and paramedic. Passengers are expected to self-report any flu-like symptoms. Passengers who report they are healthy and pass a visual inspection will, upon review of the form by medical officials, receive a medical officer's signature and stamp to proceed to immigration. If further inquiry is required based on the passenger's responses or physical appearance, he/she will be sent to one of two screening rooms to undergo an examination involving a check on vital signs like temperature and pulse, as well as listening to the lungs with a stethoscope. At this time, more intrusive tests like blood sampling or urine specimens will not be conducted. A passenger who is still of concern will be transferred by ambulance to Ram Manohar Lohia hospital for additional observation and treatment. No airport disruptions are expected as a result of the anticipated May 1 strike by Airport Authorities of India (AAI) workers. -- MUMBAI: Airport contacts suggested that procedures will be very similar to those at New Delhi's airport and will be implemented starting at midnight tonight local time in accordance with the MOH directive. Passengers suspected of infection will be transported by ambulance to Kasturba Hospital and kept in quarantine. No disruptions are anticipated as a result of the May 1 airport strike. NEW DELHI 00000860 003.2 OF 005 -- HYDERABAD: Airline contacts indicated that they expect the GOI to promulgate information on procedures this evening, and that until then Rajiv Gandhi International Airport staff (employed by the private developer, the GMR group) are closely holding all information. The anticipated screening procedures closely follow those at New Delhi's airport, although in this case the APHO is expected to actually meet all international flights and direct those passengers needing additional attention to the medical screening stations for further evaluation. Since the airport has no onsite quarantine facility, arrangements have been made with the Sir Ronald Ross Institute for Tropical and Communicable Diseases (Fever Hospital) in Nallakunta to conduct further observation of passengers of concern if warranted. No disruptions are anticipated as a result of the May 1 airport strike. -- CHENNAI: Airport officials in Chennai's consular district - including Bangalore, Cochin and Chennai - are confused at what the Central Government expects. As of this evening, these airports have not established screening procedures or identified which medical facilities will be used for quarantine or treatment. Post expects these airports to follow procedures spelled out by the central government, with perhaps a slight delay in implementation as procedures are clarified. Bangalore and Cochin are not expected to be impacted by the May 1 airport strike, and it is not clear whether staff at Chennai airport will participate. (Note: Both Bangalore and Cochin are privatized airports while Chennai is being modernized as a public private partnership by AAI and a private developer. END NOTE) -- KOLKATA: Airport personnel in Kolkata are not sure what is going on and have been moving slowly to implement any screening policy. Some airlines - including Druk Air (Bhutan),GMG (Bangladesh),and Biman Bangladesh Airlines - were not even aware of any screening requirements. Air India is talking to the health inspectors, and Emirates, Thai, Singapore and Lufthansa are aware of screening requirements and making arrangements to screen incoming passengers arriving later this evening/overnight. There are no direct flights from North America landing in Kolkata International Airport. Kolkata consulate staff anticipates that the May 1 strike will cause delays in baggage screening and handling services, but expects flights will continue. POSSIBLE AIRPORT STRIKE NOT LIKELY TO DISRUPT OPERATIONS ¶6. (SBU) A strike by AAI workers is anticipated to take place on May 1 across Indian airports. Based on conversations with airport and airline contacts, MissionOffs expect that the impact of the strike, if it takes place at all, will be rather minimal for most airports and that neither incoming nor outgoing flights will be effected. A Continental Airlines representative did express concern to EmbOff about possible "serious" impact on airport services and flights operations if the air traffic controllers decide to join the strike; NEW DELHI 00000860 004.2 OF 005 though he said that "seems pretty unlikely." Most importantly, MissionOffs do not see an impact on airport security and screening operations by agitating and on strike employees. NO IMPACT ON AGRICULTURE TRADE ¶7. (SBU) On April 28, the Chief Animal Health Officer told EmbOff that India does not have H1N1 flu in animals. Further, he expressed irritation at the use of the term "swine flu" in the media, saying that the World Animal Health Organization had it correct when they announced that this was not a swine disease. The Animal Health Officer also noted that they had received the Food and Agriculture Organization alert and the MOA was participating in GOI meetings on the subject. Finally, he said that contrary to media reports, the MOA was not conducting extra-ordinary surveillance of pig farms in India. India has taken no trade actions against countries reporting H1N1 human flu outbreaks. India imports only small amounts of pork meat - mainly from the EU - totaling less than $400,000 in value in ¶2008. The MOA has not made an official announcement on H1N1 nor posted any notice on their official web site. MISSION INDIA PREPARED AND PROACTIVELY RESPONDING ¶8. (SBU) Relying on our Avian Influenza action plan, Mission India has instituted a core interagency working group across the Embassy and Consulates to discuss worldwide developments and their impact on India and the Mission, and formulate and coordinate Mission activities, actions and responses. Officers at all posts are engaged with appropriate government and commercial contacts to stay apprised of H1N1-related activities on the ground. ¶9. (SBU) Embassy New Delhi's Medical Unit advises that Tamiflu, Relenza, and personal protective equipment are fully stocked at the Embassy, and that adequate influenza medications and supplies are also accounted for in all Consulate medical units. The Medical Unit will continue to monitor the situation in country and provide updated guidance to the Mission community as needed. On April 27, the Management Section provided Mission personnel with basic health and hygiene instructions to reduce the spread of germs like H1N1. ¶10. (SBU) Excepting press inquiries, Mission India has seen no significant increase in calls regarding H1N1 flu and no increase in American Citizen Services requests due to H1N1, but has received a few inquiries via email. The Embassy Consular Section disseminated two warden messages based on the new airport screening procedures and will continue to provide timely updates to the American Citizen community in India. The Public Affairs Office has created a direct link to the H1N1 warden messages from Embassy New Delhi's public webpage (newdelhi.embassy.gov). ¶11. (SBU) Several diplomatic missions in New Delhi contacted the NEW DELHI 00000860 005.2 OF 005 Embassy about our H1N1 activities, and the GOI's response, screening methods, and travel advisories; they are awaiting official GOI announcements and the US course of action before issuing their own guidance. The H1N1 point of contact at the Mexican Embassy said that they were providing information to their government about the Indian reaction but not notifying their citizens already in India. The Embassy's consular section has taken the lead in communicating with our diplomatic counterparts, and will continue to coordinate with them as needed. ¶12. (U) Post will continue to report relevant developments as they occur. BURLEIGH