Identifier
Created
Classification
Origin
09RABAT391
2009-05-08 06:56:00
UNCLASSIFIED//FOR OFFICIAL USE ONLY
Embassy Rabat
Cable title:
TFFLU01: MOROCCAN INFLUENZA PREPARATIONS
how-toVZCZCXRO9339 PP RUEHTRO DE RUEHRB #0391/01 1280656 ZNR UUUUU ZZH P 080656Z MAY 09 FM AMEMBASSY RABAT TO RUEHC/SECSTATE WASHDC PRIORITY 0086 INFO RUCNMGH/MAGHREB COLLECTIVE RUEHRO/AMEMBASSY ROME 1631 RUEHCL/AMCONSUL CASABLANCA 4586 RUEAUSA/DEPT OF HHS WASHDC RUCPDOC/DEPT OF COMMERCE WASHDC RHMFIUU/DEPT OF HOMELAND SECURITY WASHINGTON DC RUEHPH/CDC ATLANTA GA RUEWMFD/HQ USAFRICOM STUTTGART GE RUEHGV/USMISSION GENEVA 1150
UNCLAS SECTION 01 OF 03 RABAT 000391
SIPDIS
SENSITIVE
STATE FOR OES/IHB - JJONES AND CPATTERSON
STATE ALSO FOR EEB/TPP/MTAA/ABT - ARYAN AND NEA/MAG
AID/W FOR GBH
USDA FOR FAS, APHIS, AND OSTA
HHS FOR CDC
E.O. 12958: N/A
TAGS: ASEC AMED CASC TBIO PINR AMGT TF KFLU KFLO
KSAF, KPAO, MO
SUBJECT: TFFLU01: MOROCCAN INFLUENZA PREPARATIONS
REF: RABAT 0390 (NOTAL)
UNCLAS SECTION 01 OF 03 RABAT 000391
SIPDIS
SENSITIVE
STATE FOR OES/IHB - JJONES AND CPATTERSON
STATE ALSO FOR EEB/TPP/MTAA/ABT - ARYAN AND NEA/MAG
AID/W FOR GBH
USDA FOR FAS, APHIS, AND OSTA
HHS FOR CDC
E.O. 12958: N/A
TAGS: ASEC AMED CASC TBIO PINR AMGT TF KFLU KFLO
KSAF, KPAO, MO
SUBJECT: TFFLU01: MOROCCAN INFLUENZA PREPARATIONS
REF: RABAT 0390 (NOTAL)
1. (SBU) Summary: Morocco has reinforced its influenza
surveillance and response measures as H1N1 influenza cases
draw nearer to the Kingdom. The Government of Morocco (GOM)
has instituted surveillance of arriving travelers and is
purchasing more anti-viral medication to add to its current
stockpiles. Morocco's previous pandemic planning includes
pandemic influenza/avian influenza (PI/AI) committee chaired
by the Prime Minister, a national command structure for PI
response, and national response plans for individual agencies
and ministries. Although response plans and preventive
measures are well defined (with CDC assistance),Morocco's
health system would likely be overwhelmed by a full-blown
epidemic of any highly-lethal influenza strain. End Summary.
--------------
NO CURRENT H1N1 CASES IN MOROCCO
(OR IN SPANISH ENCLAVES)
--------------
2. (U) As of May 7, Moroccan authorities had registered no
suspected or confirmed cases of A/H1N1 type influenza in the
Kingdom. A May 6 public statement from the Spanish Ministry
of Health confirmed that an Italian tourist quarantined on
May 4 in the Spanish enclave of Ceuta on the northern
Moroccan coast did NOT/NOT have the A/H1N1 flu strain.
--------------
INFLUENZA COUNTERMEASURES IN PLACE
--------------
3. (SBU) Morocco has deployed thermal imagers supervised by
Ministry of Health (MOS) doctors to ports of entry to monitor
arriving passengers. (Note: As reported to the Task Force,
GOM contacts were unable to specify the model of imagers, but
EconOff believes based on visual comparison to published
photographs that the thermal imagers are identical to or
similar to SEMA WORLD product HFTCI TCS PCA5-8. End Note.)
The imaging devices are deployed at all international
airports, and at the larger marine ports, according to
Moroccan National Institute of Hygiene (INH) Influenza Chief
Dr. Amal Barakat. Barakat was unable to identify more
precisely the number or names of the marine ports.
4. (SBU) Passengers from all flights regardless of
provenance are screened for temperature via thermal imaging.
In addition, the MOS teams at the airports have requested
that carriers provide a list of transit passengers who joined
the flight to Morocco from a prior leg along with their
original point of departure, in order to identify the
countries visited by travelers on the arriving flight.
According to Barakat, if a passenger is found to have a
temperature above 38 degrees Celsius, he/she is detained
briefly to answer a questionnaire on travel and other
information, and requested to provide a specimen for
laboratory analysis. (Note: Morocco conducts influenza
analysis at the INH and the Pasteur Institute of Casablanca.
End Note.) The MOS also notes the names and contact
information for other passengers on that individual,s
flight. The MOS then recommends that the passenger remain at
home and rest for the next several days, while it maintains
telephone contact at least once per day. If the case is
confirmed positive for H1N1, the MOS will then follow up with
the other passengers to recommend they stay home, and test
them for influenza as well.
5. (SBU) Morocco's Ministry of Agriculture and Maritime
Fisheries instituted a ban on importation of pigs and pork
products on April 26. After Charge demarched Minister of
Agriculture Aziz Akhannouch on May 5 regarding the ban,
Akhannouch replied that the ban was only temporary to ease
public concerns (Reftel). Morocco has only a small domestic
pig-raising sector, comprised of six commercial pig farmers
near Agadir, with a total stock of only 4,000 animals. The
Ministry of Agriculture has been vocal in reassuring the
RABAT 00000391 002 OF 003
public that these pigs are not carriers of the H1N1 virus,
and the Ministry has stepped up veterinary surveillance of
the farms to tamp down fears.
6. (SBU) Minister of Health Yasmina Baddou announced on May
5 that the GOM has committed an additional USD 100 million to
influenza countermeasures. Ministry of Health Deputy
Director of Epidemiology Abderrahmane Benmamoun told EconOff
on May 6 that the majority of that sum will be used to
purchase 3 million courses of Tamiflu (in addition to the
current 1 million-course GOM stockpile) to bring the total
treatment courses to 4 million, sufficient for approximately
10 percent of the kingdom's population. The rest of the
money is intended to purchase additional personal protective
equipment (gloves, masks and suits for medical personnel),
and laboratory reagents for diagnostic tests. Benmamoun said
that the GOM preferred to stick with one type of anti-viral
medicine instead of alternating Tamiflu with other types of
medication, and expected that a "good part" of its 3 million
course order could be delivered with ten days or so despite
heavy demand on medication producer Roche.
--------------
NATIONAL PANDEMIC RESPONSE PLAN
--------------
7. (SBU) The GOM created in 2005 two principal bodies for
dealing with PI/AI. The Inter-Ministerial Committee for
Pandemic Influenza is chaired by the Prime Minister and
includes the Ministers of Agriculture, Health and Interior.
It is responsible for strategic oversight of GOM planning and
response to PI/AI. The Central Command Post (PCC) is the
operational committee for specific responses to PI. Members
of the PCC include representatives of the Ministries of
Agriculture, Health and Interior, as well as representatives
from the National Police, the Gendarmerie and the military.
The PCC meets weekly during normal periods and more
frequently during outbreaks, and it supervises the work of
Provincial Command Posts (PCPs) in each of Morocco's
provinces.
8. (SBU) The PCC developed a National Plan for PI, and each
constituent agency has developed an individual plan to
fulfill its mission as elaborated under the National Plan.
The U.S. Centers for Disease Control have assisted in
formulating the GOM's handbook for PI response, including
assisting in tabletop exercises to train PCC participants in
response.
9. (SBU) The National Plan guided spending of approximately
USD 25 to 30 million in 2007-2008, divided approximately
evenly among treatments (i.e., Tamiflu) and supplies (e.g.
personal protective equipment, much of it now prepositioned
around the country). The GOM has already stockpiled courses
of Tamilflu to treat 1 million influenza cases, in two forms,
gel and powder. Based on Ministry of Health planning
(borrowing from U.S. and French planning models for epidemic
propogation),a PI episode in Morocco would likely require
treatment for 7 million cases; the capability for 1 million
was a compromise based on available resources. The gel
dosage has an expiration date of 2011 (the powder expires in
2014),and the GOM is currently debating disposition/use and
replacement plans for the stockpile.
--------------
SURVEILLANCE
--------------
10. (SBU) The Ministry of Health has a nationwide integrated
surveillance system for influenza-like illness (ILI),in
which hospitals are required to report ILI cases to the
Ministry, which follows the cases to conclusion. Hospitals
send virus samples to the 16 regional laboratories, which
then send suspect cases, including any suspected AI samples,
to the National Institute of Hygiene (INH) for confirmation.
RABAT 00000391 003 OF 003
11. (SBU) The Ministry of Agriculture, the High Commission
for Water and Forests, and the Gendarmerie share
responsibility for animal surveillance. Industrial livestock
and poultry companies are required to have veterinarian
inspections, and local authorities are responsible for
surveillance of other domesticated animals. The GOM pays
farmers and private livestock owners for providing samples of
dead animals, resulting in very high incidence of reporting
and testing of dead animals. Under recent regulatory
reforms, now over 85 percent of poultry raising takes place
under some sort of organized capacity subject to regulatory
control (as opposed to unregulated raising in private homes).
The High Commission for Water and Forests traps and samples
migratory birds during each seasonal migration, and forestry
employees and rural gendarmes are trained and required to
collect dead wild birds and send them to laboratories for
testing.
--------------
PI RESPONSE PLANS
--------------
12. (SBU) The GOM Pandemic Influenza response plans assume
that the Ministry of Interior will be primarily responsible
for any actions involving quarantine or other restrictions on
movement. The MOI will also be responsible for providing
supplies to households or communities under quarantine. As
noted above, although modeling of PI suggests that
approximately 7 million persons would benefit from Tamiflu
treatment under a pandemic situation, the GOM currently
possesses only sufficient stocks to treat 1 million people
(with more purchases planned as noted above). MOS officials
suggested that a triage would identify patients likely to
recover without assistance of medication, allowing treatment
of more severe cases with Tamiflu.
13. (SBU) Individual ministries and agencies (Interior,
police forces, transportation industries, etc.) have
participated in formulating response plans, and are each
responsible for developing their own response plan to carry
out actions that may be required. The PCC has also developed
a communication plan for internal and public communications
to convey instructions to government officials and the
general public in case of an emergency; MOS officials note
that the communications planning has been the most beneficial
outcome of PI planning, as the capabilities can be used in
response to any other type of emergency.
--------------
GOOD PLANS BUT LIMITED RESOURCES
--------------
14. (SBU) Comment: The GOM has worked out serious and
credible response plans to pandemic influenza, including
several simulations in the past three years for personnel who
would be responsible for any response. The CDC's liaison for
collaboration with Morocco told EconOff that Morocco is far
ahead of any other developing country in the Mediterranean
region in planning and capacity for handling pandemic
influenza. That said, the Mission assesses that in a
pandemic situation, the number of victims would likely
overwhelm the limited number of medical personnel and
facilities, leaving most affected persons to be cared for by
relatives. Post is highly cognizant of these infrastructure
and personnel limitations in evaluating our own options in
responding to an epidemic in Morocco. End Comment.
*****************************************
Visit Embassy Rabat's Classified Website;
http://www.intelink.sgov.gov/wiki/Portal:Moro cco
*****************************************
Jackson
SIPDIS
SENSITIVE
STATE FOR OES/IHB - JJONES AND CPATTERSON
STATE ALSO FOR EEB/TPP/MTAA/ABT - ARYAN AND NEA/MAG
AID/W FOR GBH
USDA FOR FAS, APHIS, AND OSTA
HHS FOR CDC
E.O. 12958: N/A
TAGS: ASEC AMED CASC TBIO PINR AMGT TF KFLU KFLO
KSAF, KPAO, MO
SUBJECT: TFFLU01: MOROCCAN INFLUENZA PREPARATIONS
REF: RABAT 0390 (NOTAL)
1. (SBU) Summary: Morocco has reinforced its influenza
surveillance and response measures as H1N1 influenza cases
draw nearer to the Kingdom. The Government of Morocco (GOM)
has instituted surveillance of arriving travelers and is
purchasing more anti-viral medication to add to its current
stockpiles. Morocco's previous pandemic planning includes
pandemic influenza/avian influenza (PI/AI) committee chaired
by the Prime Minister, a national command structure for PI
response, and national response plans for individual agencies
and ministries. Although response plans and preventive
measures are well defined (with CDC assistance),Morocco's
health system would likely be overwhelmed by a full-blown
epidemic of any highly-lethal influenza strain. End Summary.
--------------
NO CURRENT H1N1 CASES IN MOROCCO
(OR IN SPANISH ENCLAVES)
--------------
2. (U) As of May 7, Moroccan authorities had registered no
suspected or confirmed cases of A/H1N1 type influenza in the
Kingdom. A May 6 public statement from the Spanish Ministry
of Health confirmed that an Italian tourist quarantined on
May 4 in the Spanish enclave of Ceuta on the northern
Moroccan coast did NOT/NOT have the A/H1N1 flu strain.
--------------
INFLUENZA COUNTERMEASURES IN PLACE
--------------
3. (SBU) Morocco has deployed thermal imagers supervised by
Ministry of Health (MOS) doctors to ports of entry to monitor
arriving passengers. (Note: As reported to the Task Force,
GOM contacts were unable to specify the model of imagers, but
EconOff believes based on visual comparison to published
photographs that the thermal imagers are identical to or
similar to SEMA WORLD product HFTCI TCS PCA5-8. End Note.)
The imaging devices are deployed at all international
airports, and at the larger marine ports, according to
Moroccan National Institute of Hygiene (INH) Influenza Chief
Dr. Amal Barakat. Barakat was unable to identify more
precisely the number or names of the marine ports.
4. (SBU) Passengers from all flights regardless of
provenance are screened for temperature via thermal imaging.
In addition, the MOS teams at the airports have requested
that carriers provide a list of transit passengers who joined
the flight to Morocco from a prior leg along with their
original point of departure, in order to identify the
countries visited by travelers on the arriving flight.
According to Barakat, if a passenger is found to have a
temperature above 38 degrees Celsius, he/she is detained
briefly to answer a questionnaire on travel and other
information, and requested to provide a specimen for
laboratory analysis. (Note: Morocco conducts influenza
analysis at the INH and the Pasteur Institute of Casablanca.
End Note.) The MOS also notes the names and contact
information for other passengers on that individual,s
flight. The MOS then recommends that the passenger remain at
home and rest for the next several days, while it maintains
telephone contact at least once per day. If the case is
confirmed positive for H1N1, the MOS will then follow up with
the other passengers to recommend they stay home, and test
them for influenza as well.
5. (SBU) Morocco's Ministry of Agriculture and Maritime
Fisheries instituted a ban on importation of pigs and pork
products on April 26. After Charge demarched Minister of
Agriculture Aziz Akhannouch on May 5 regarding the ban,
Akhannouch replied that the ban was only temporary to ease
public concerns (Reftel). Morocco has only a small domestic
pig-raising sector, comprised of six commercial pig farmers
near Agadir, with a total stock of only 4,000 animals. The
Ministry of Agriculture has been vocal in reassuring the
RABAT 00000391 002 OF 003
public that these pigs are not carriers of the H1N1 virus,
and the Ministry has stepped up veterinary surveillance of
the farms to tamp down fears.
6. (SBU) Minister of Health Yasmina Baddou announced on May
5 that the GOM has committed an additional USD 100 million to
influenza countermeasures. Ministry of Health Deputy
Director of Epidemiology Abderrahmane Benmamoun told EconOff
on May 6 that the majority of that sum will be used to
purchase 3 million courses of Tamiflu (in addition to the
current 1 million-course GOM stockpile) to bring the total
treatment courses to 4 million, sufficient for approximately
10 percent of the kingdom's population. The rest of the
money is intended to purchase additional personal protective
equipment (gloves, masks and suits for medical personnel),
and laboratory reagents for diagnostic tests. Benmamoun said
that the GOM preferred to stick with one type of anti-viral
medicine instead of alternating Tamiflu with other types of
medication, and expected that a "good part" of its 3 million
course order could be delivered with ten days or so despite
heavy demand on medication producer Roche.
--------------
NATIONAL PANDEMIC RESPONSE PLAN
--------------
7. (SBU) The GOM created in 2005 two principal bodies for
dealing with PI/AI. The Inter-Ministerial Committee for
Pandemic Influenza is chaired by the Prime Minister and
includes the Ministers of Agriculture, Health and Interior.
It is responsible for strategic oversight of GOM planning and
response to PI/AI. The Central Command Post (PCC) is the
operational committee for specific responses to PI. Members
of the PCC include representatives of the Ministries of
Agriculture, Health and Interior, as well as representatives
from the National Police, the Gendarmerie and the military.
The PCC meets weekly during normal periods and more
frequently during outbreaks, and it supervises the work of
Provincial Command Posts (PCPs) in each of Morocco's
provinces.
8. (SBU) The PCC developed a National Plan for PI, and each
constituent agency has developed an individual plan to
fulfill its mission as elaborated under the National Plan.
The U.S. Centers for Disease Control have assisted in
formulating the GOM's handbook for PI response, including
assisting in tabletop exercises to train PCC participants in
response.
9. (SBU) The National Plan guided spending of approximately
USD 25 to 30 million in 2007-2008, divided approximately
evenly among treatments (i.e., Tamiflu) and supplies (e.g.
personal protective equipment, much of it now prepositioned
around the country). The GOM has already stockpiled courses
of Tamilflu to treat 1 million influenza cases, in two forms,
gel and powder. Based on Ministry of Health planning
(borrowing from U.S. and French planning models for epidemic
propogation),a PI episode in Morocco would likely require
treatment for 7 million cases; the capability for 1 million
was a compromise based on available resources. The gel
dosage has an expiration date of 2011 (the powder expires in
2014),and the GOM is currently debating disposition/use and
replacement plans for the stockpile.
--------------
SURVEILLANCE
--------------
10. (SBU) The Ministry of Health has a nationwide integrated
surveillance system for influenza-like illness (ILI),in
which hospitals are required to report ILI cases to the
Ministry, which follows the cases to conclusion. Hospitals
send virus samples to the 16 regional laboratories, which
then send suspect cases, including any suspected AI samples,
to the National Institute of Hygiene (INH) for confirmation.
RABAT 00000391 003 OF 003
11. (SBU) The Ministry of Agriculture, the High Commission
for Water and Forests, and the Gendarmerie share
responsibility for animal surveillance. Industrial livestock
and poultry companies are required to have veterinarian
inspections, and local authorities are responsible for
surveillance of other domesticated animals. The GOM pays
farmers and private livestock owners for providing samples of
dead animals, resulting in very high incidence of reporting
and testing of dead animals. Under recent regulatory
reforms, now over 85 percent of poultry raising takes place
under some sort of organized capacity subject to regulatory
control (as opposed to unregulated raising in private homes).
The High Commission for Water and Forests traps and samples
migratory birds during each seasonal migration, and forestry
employees and rural gendarmes are trained and required to
collect dead wild birds and send them to laboratories for
testing.
--------------
PI RESPONSE PLANS
--------------
12. (SBU) The GOM Pandemic Influenza response plans assume
that the Ministry of Interior will be primarily responsible
for any actions involving quarantine or other restrictions on
movement. The MOI will also be responsible for providing
supplies to households or communities under quarantine. As
noted above, although modeling of PI suggests that
approximately 7 million persons would benefit from Tamiflu
treatment under a pandemic situation, the GOM currently
possesses only sufficient stocks to treat 1 million people
(with more purchases planned as noted above). MOS officials
suggested that a triage would identify patients likely to
recover without assistance of medication, allowing treatment
of more severe cases with Tamiflu.
13. (SBU) Individual ministries and agencies (Interior,
police forces, transportation industries, etc.) have
participated in formulating response plans, and are each
responsible for developing their own response plan to carry
out actions that may be required. The PCC has also developed
a communication plan for internal and public communications
to convey instructions to government officials and the
general public in case of an emergency; MOS officials note
that the communications planning has been the most beneficial
outcome of PI planning, as the capabilities can be used in
response to any other type of emergency.
--------------
GOOD PLANS BUT LIMITED RESOURCES
--------------
14. (SBU) Comment: The GOM has worked out serious and
credible response plans to pandemic influenza, including
several simulations in the past three years for personnel who
would be responsible for any response. The CDC's liaison for
collaboration with Morocco told EconOff that Morocco is far
ahead of any other developing country in the Mediterranean
region in planning and capacity for handling pandemic
influenza. That said, the Mission assesses that in a
pandemic situation, the number of victims would likely
overwhelm the limited number of medical personnel and
facilities, leaving most affected persons to be cared for by
relatives. Post is highly cognizant of these infrastructure
and personnel limitations in evaluating our own options in
responding to an epidemic in Morocco. End Comment.
*****************************************
Visit Embassy Rabat's Classified Website;
http://www.intelink.sgov.gov/wiki/Portal:Moro cco
*****************************************
Jackson