MGSF01: CAMBODIAN RESPONSE TO GLOBAL H1N1 OUTBREAK

UNCLAS SECTION 01 OF 03 PHNOM PENH 000272

SENSITIVE
SIPDIS

STATE FOR EAP/MLS, G/AIAG, OES/IHA, MED, S/ES/MLIBBY
STATE FOR USAID/ANE, OFDA AND GH
BANGKOK FOR REO/HHOWARD
BANGKOK FOR OFDA

E.O. 12958: N/A
TAGS: KFLU AEMR ASEC CASC KFLO TBIO KSAF KPAO PREL PINR
AMGT, MG, EAGR, CB
SUBJECT: MGSF01: CAMBODIAN RESPONSE TO GLOBAL H1N1 OUTBREAK


1. (SBU) SUMMARY. There has not yet been any evidence suggesting
cases of H1N1 in Cambodia. The Royal Government of Cambodia (RGC)
issued a statement April 27 outlining its activities since the
outbreak in Mexico began, including increased animal and human
health surveillance and inventories of medical supplies. The RGC is
considering banning imports of live pigs from H1N1-affected
countries, but has not yet implemented such a ban. The two
international airports have implemented thermal screening procedures
to monitor passengers arriving in-country. On April 28, the
Ministry of Health (MOH) convened a health sector swine influenza
working group with donors to address the country's medical and
public health responses.


2. (SBU) Post's Emergency Action Committee (EAC) convened on April
29 to review Post's contingency plans and tripwires, as well as the
RGC's pandemic preparedness activities. In addition to the EAC
meeting, Post has taken the following actions: 1) obtained
information on the actions taken by RGC; 2) coordinated with other
donor organizations; 3) organized the development of a Management
Notice and Warden Message that provide information about H1N1; 4)
distributed the April 27 Office of Overseas Schools letter to the
international schools in Phnom Penh; and 5) made preliminary contact
with the USAID Office of Foreign Disaster Assistance's Regional
Office in Bangkok. Post is well positioned to respond to a
potential pandemic outbreak due to the in-country presence of the
Centers for Disease Control and Prevention (CDC),Naval Medical
Research Unit (NAMRU-2),the Post Medical Officer, USAID Public
Health Team, and other offices. END SUMMARY.


3. (SBU) In response to the H1N1 outbreak in Mexico and reported
cases in the U.S., the Emergency Action Committee (EAC) convened
April 29 to review Post's contingency plans and tripwires and the
Royal Government of Cambodia's (RGC) pandemic preparedness
activities. Post's Medical Officer, CDC and NAMRU-2 briefed the EAC
on current medical information available from the CDC and World
Health Organization (WHO). All Post preparations, including
recommended levels of medical supplies, have been reviewed and are
in order. Post has issued a Management Notice to the embassy
community, which has been shared with EAP/MLS. The Consular Section
sent a warden message to the broader American community with
information about precautions to take and where to go for official
updates and authoritative information. A copy of the warden message
has been sent to CA.

NO EVIDENCE OF H1N1 IN CAMBODIA
--------------


4. (U) There has been no epidemiologic or laboratory evidence
suggesting H1N1 in Cambodia. Influenza-like illness (ILI)
surveillance conducted by the MOH at six provincial hospitals
nationwide has not detected any recent increases in ILI activity or
laboratory-confirmed influenza infections. Based on recommendations
from both the World Health Organization (WHO) and CDC, the MOH will
increase laboratory testing of patients with ILI at all surveillance
sites.

RGC PREPARATION
--------------


5. (U) On April 27, the RGC issued a joint MOH-WHO press release to
the media, embassies, and provincial Health Departments, stating
that Cambodia has increased its surveillance for unusual respiratory
illnesses in hospitals, health centers, and airports. It also
advised individuals with a febrile respiratory illness returning
from affected countries in the last seven days to seek medical
attention, and provided hotline telephone numbers for medical
personnel and the public to report such illnesses. The MOH is
currently assessing their inventory of medications (antiviral and
antibiotic),laboratory materials such as viral transport medium,
and personal protective equipment (PPE) at both the national and
provincial levels. As of April 28, the MOH revealed that
approximately 15,700 five-day courses of TamiFlu are available in
the national stockpile. Other in-country sources of TamiFlu include
all provincial Rapid Response Teams (100 tablets per team) and five
hospitals (four provincial hospitals and Calmette Hospital),each
with small isolation wards (100 tablets per hospital).

RGC STEPS UP ANIMAL SURVEILLANCE, NOT YET BANNING

PHNOM PENH 00000272 002 OF 003


IMPORTS
-------------- --------------


6. (U) Sem Sovann, Secretary of State at the Ministry of
Agriculture, Forestry and Fisheries (MAFF),told Emboff that
although there have not yet been any H1N1 cases in Cambodia, RGC
officials are closely monitoring the outbreak and are reassuring the
public that there is no need for panic. He said that when the
outbreak began, the RGC implemented procedures it had in place for a
potential avian influenza outbreak, such as increasing the number of
veterinary and farm sanitation inspections, working with NGOs to
increase surveillance of animal and farm trade in rural areas, and
distributing information on the disease to rural veterinarians.


7. (U) The Cambodian Pig Raiser Association announced April 28 that
it had recommended that the RGC ban all live pig imports. Sem
Sovann said that an inter-ministerial working group met on April 28
to discuss potentially banning live pig imports (not pork products)
from countries that had known cases of H1N1 only. As of April 29,
the RGC had not yet implemented a ban. Sem Sovann said that RGC
officials, including the Prime Minister, were also communicating to
the public that pork products were still safe to eat if properly
cooked.

AIRPORTS IMPLEMENT SCREENING PROCEDURES
--------------


8. (U) Airport authorities in Phnom Penh and Siem Reap installed
thermal scanners April 28 to screen incoming passengers for elevated
temperatures. Officials at Phnom Penh International Airport told
Emboffs April 29 that the scanners were online and functioning. The
equipment had been purchased for use in a potential avian influenza
outbreak.

DONOR COORDINATION
--------------


9. (U) On April 28, the MOH convened a health sector swine
influenza working group to address the country's medical and public
health responses. Organizations present at the meeting included MOH
(Communicable Diseases Control Division, Hospital Services
Department, National Institute of Public Health),WHO, CDC, NAMRU-2,
Institut Pasteur in Cambodia (IPC),and Calmette Hospital. During
the meeting, the MOH stated that it issued official letters to the
provincial Health Departments instructing them to strengthen
surveillance for acute respiratory illnesses, ILI, and abnormal
respiratory events, to alert Rapid Response Teams (RRTs),and to
disseminate information on H1N1 to public and private health
facilities.

CDC ACTIONS: TESTING ASSISTANCE AND MEDICATION
-------------- --


10. (SBU) WHO and CDC will continue to provide updated guidance to
the MOH on surveillance, case investigation and outbreak response
procedures, laboratory testing, case management (including antiviral
and antibiotic treatment guidelines),infection control, and
screening procedures at airports. CDC will provide both MOH and WHO
with recently developed interim guidelines on antiviral treatment
and community mitigation of H1N1.


11. (SBU) On April 29, CDC notified IPC that real-time polymerase
chain reaction (PCR) test kits to detect H1N1 have been developed by
the CDC Influenza Division laboratory in Atlanta, and that these
kits would be ready for distribution to external influenza
laboratories by the end of this week. IPC has subsequently placed
orders to CDC Atlanta for test kits, and will share them with the
NIPH molecular laboratory. NAMRU-2 will also receive test kits
directly from U.S. Navy counterparts. Once the kits arrive, all
three laboratories should have testing capacity specifically for
H1N1.


12. (SBU) In addition to the TamiFlu medication, Post's CDC
epidemiologist noted that deaths from flu traditionally occur due to
secondary respiratory infection that is either viral or bacterial.
Treatment of the secondary infection could require antiviral and/or
antibiotic treatment in addition to or in place of TamiFlu. An
inventory of stocks of antiviral and antibiotic medication is

PHNOM PENH 00000272 003 OF 003


underway. Post is concerned that the quantity and quality of
antibiotics and antivirals available locally may be an issue.



RODLEY