H1N1 -- UPDATE AND GUIDANCE

UNCLAS SECTION 01 OF 04 STATE 050285

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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.

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CURRENT STATUS OF THE H1N1 VIRUS
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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:


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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

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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

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infections, support for training and community
awareness, support for improved surveillance of the
disease, and provision of access to food.

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GUIDANCE TO MISSIONS
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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.

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DISASTER DECLARATIONS
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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

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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