H1N1 -- UPDATE AND GUIDANCE

UNCLAS SECTION 01 OF 04 STATE 050285 SIPDIS AID FOR AIDAA, DCHAOFDA, DCHAFFP, DCHAOMA, AADCHA, AFRAA, ANEAA, EEAA, LACAA, EGATAA, GHAA PASS TO USAID/DIRECTORS/REPS, AMEMBASSY DCMS PASS TO MISSION DISASTER RELIEF OFFICERS OMB FOR NSCHWARTZ GENEVA FOR NKYLOH ROME FOR HSPANOS NEW YORK FOR DMERCADO BRUSSELS FOR PBROWN E.O. 12958: N/A TAGS: REF SOCI EAID SUBJECT: H1N1 -- UPDATE AND GUIDANCE REF: STATE 116623 ¶1. Summary: This is a joint cable to provide an update and guidance regarding the H1N1 situation from USAID's Global Health Bureau's Avian and Pandemic Influenza Unit and the Bureau for Democracy, Conflict, and Humanitarian Assistance's Office of U.S. Foreign Disaster Assistance. ¶2. The identification in the United States and Mexico in early April of cases of humans infected with the novel influenza A/H1N1 virus led to conerns about a pending influenza pandemic. By April 29th, 2009, the virus had spread to three continents, and the U.N. World Health Organization (WHO) raised its pandemic alert level to Phase Five. The virus continues to spread efficiently between humans. Further characterization of the virus, however, indicated that the virus is largely responsible for mild cases of influenza. Scientists are concerned about the possible occurrence of large outbreaks of novel influenza H1N1 as the seasonal influenza season commences in the southern hemisphere. ¶3. USAID is working closely with other U.S. Government agencies and international partners to monitor for any changes in the virulence of the novel influenza H1N1 virus and is encouraging missions to assist national authorities to strengthen their pandemic readiness capacities. At this stage of the outbreak, a disaster declaration is not/not the recommended course of action. In addition, missions are requested to postpone until further notice any additional requests for personal protective equipment (PPE) kits and other commodities. This communique is intended to provide an update and guidance to missions regarding next steps in planning and preparation should the virus mutate to a more virulent form. Further updates will be provided once more information is available. End summary. -------------- CURRENT STATUS OF THE H1N1 VIRUS -------------- ¶4. Since early April, cases of human infection with the influenza A/H1N1 virus have been confirmed in 30 countries. On April 29th, 2009, WHO raised its pandemic alert level to Phase Five, indicating sustained human- to-human spread of a novel virus in two countries in one WHO region. As of May 13 at 0600 hours GMT, 33 countries had officially reported 5,728 cases of 2009 H1N1 influenza, including newly confirmed cases in Argentina, Australia, Brazil, mainland China, Cuba, Finland, Panama, and Thailand, according to WHO. ¶5. As of May 13, WHO had reported 61 deaths associated with 2009 H1N1 influenza, including the first 2009 H1N1 influenza-related deaths in Canada and Costa Rica. ¶6. To date, the following observations can be made, specifically about the H1N1 virus, and more generally about the vulnerability of the world population: STATE 00050285 002 OF 004 ¶A. The novel H1N1 virus strain causing the current outbreaks is a new virus that has not been seen previously in either humans or animals. The influenza experts believe that pre-existing immunity to the novel H1N1 virus will be low or non-existent. This means that more people will be susceptible to novel H1N1 virus than to the usual seasonal influenza viruses. ¶B. The spectrum of illness from infection with novel influenza H1N1 is still being studied. It appears to be similar to seasonal influenza. Complications from novel H1N1 influenza are though to occur more frequently among the same groups in which complications of seasonal influenza occur (i.e., very young, very old, persons with underlying chronic medical conditions, pregnant women). ¶C. Although cases of novel H1N1 influenza have been confirmed in all age groups, from infants to the elderly, the most highly affected age group has been 5- 24 year olds. ¶7. Scientists are concerned about the possible occurrence of large outbreaks of novel influenza H1N1 as the sasonal influenza season commences in the southern hemisphere. ¶8. While there is no certainty that this virus will ever pose a larger threat, should a more deadly virus emerge in the coming months it will be critical that countries in the Northern Hemisphere and the equatorial regions of the world have plans and capabilities to respond to a pandemic threat already in place. ¶9. Regular updates on the H1N1 virus can be found on the WHO website: http://www.who.int/csr/disease/swineflu/en/in dex.html or the CDC website: http://www.cdc.gov/h1n1flu/index.htm -------------- USAID RESPONSE -------------- ¶10. As we have seen previously in the 1918 influenza pandemic, and then more recently in SARS, viruses may cause mild illness in the first wave and then re-emerge in a more virulent form in a subsequent wave. In other influenza pandemics, the virus has not become more virulent. Therefore, USAID's Global Health (GH) Bureau Avian and Pandemic Influenza Unit and the Bureau for Democracy, Conflict, and Humanitarian Assistance (DCHA) Office of U.S. Foreign Disaster Assistance (OFDA) are working closely with the appropriate regional bureaus and USG and international partners to be able to quickly ascertain any possible emergence of a more virulent virus, particularly in the Southern Hemisphere. ¶11. In coordination with other USG agencies and international partners, GH and DCHA are also currently developing a comprehensive plan for the provision of emergency support should the virus mutate to a more virulent strain. This plan will include support for the prevention of infection, procurement and distribution of anti-viral medications for treatment of influenza and antibiotics for treatment of secondary bacterial STATE 00050285 003 OF 004 infections, support for training and community awareness, support for improved surveillance of the disease, and provision of access to food. -------------- GUIDANCE TO MISSIONS -------------- ¶12. For the moment, the virus appears to be mild and does not pose an imminent public health threat. However, because the possibility exists that a more virulent strain might emerge in the coming months, missions are urged to use this period to assist countries with updating and exercising pandemic preparedness plans. Practical guides, tools and training materials, as well as links to USAID's pandemic planning partners that provide technical assistance, are available at www.pandemicpreparedness.org. ¶13. As part of GH's and DCHA's preparations for the possible emergence of a more virulent virus, we are conducting a comprehensive strategic review of commodity needs and resource availability with other USG and international partners. To assist this review, missions are requested to postpone until further notice any additional requests for personal protective equipment kits and other commodities in response to the H1N1 outbreak. This will allow GH and DCHA to be optimally responsive and ensure access and availability to life- saving commodities should this virus become a more virulent threat. -------------- DISASTER DECLARATIONS -------------- ¶14. Disaster declarations are not/not the recommended course of action at this stage of the outbreak. If WHO raises the pandemic alert level to Phase Six but the virus remains mild, then we will continue to remain vigilant, but we will not consider the virus to be an imminent threat. USAID/OFDA regional advisors should be the first point of contact if assistance is requested in response to the pandemic influenza. USAID/OFDA maintains regional offices in several locations worldwide to assist in disaster response and to develop risk management strategies. USAID/OFDA/Washington strongly advises posts, especially Mission Disaster Relief Officers (MDROs),to maintain regular communication with the USAID/OFDA regional advisors. Contact information for the USAID/OFDA regional offices is as follows: East and Central Africa regional office ++ 254-(0) 20-862- 2711; Southern Africa regional office, ++ 27-12-452- 2000; West Africa regional office ++ 221-33-869-6164; Asia and the Pacific regional office ++66-2-263-7979; Europe, Middle East, Central Asia regional office ++ 1- 703-981-1726; Latin America and the Caribbean regional office ++506-2296-3554. ¶15. In the event that the regional advisor can not be contacted, missions/embassies may call the USAID Pandemic Influenza Response Management Team (RMT) at 202-712-0031 in Washington, D.C., for assistance. After business hours, evenings and weekends, and holidays, the USAID/OFDA duty officer may be contacted by phone at 301-675-5933 or by email at ofdadutyofficer@usaid.gov. Alternatively, the USAID/OFDA Duty Officer may be STATE 00050285 004 OF 004 reached by calling the State Department's operations center at 202-647-1512. USAID/OFDA's fax numbers are 202-216-3706/3191. ¶16. For further information, please contact Dr. Dennis Carroll, Director of the Avian and Pandemic Influenza Unit 202-712-5009, dcarroll@usaid.gov, or Peter Morris, Response Manager of the USAID RMT 202-712-1095, pmorris@usaid.gov. ¶17. Minimize considered. CLINTON