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Cablegate: Avian Influenza: Managua Contingency Planning And

VZCZCXYZ0013
RR RUEHWEB

DE RUEHMU #3257/01 3641648
ZNR UUUUU ZZH
R 301648Z DEC 05
FM AMEMBASSY MANAGUA
TO WHA CENTRAL AMERICAN COLLECTIVE

UNCLAS SECTION 01 OF 04 MANAGUA 003257

SIPDIS

SIPDIS

OES FOR DSINGER AND RDALEY; S/ES-O/CMS

E.O. 12958: N/A
TAGS: AMGT ASEC CASC AMED KFLO AEMRS NU
SUBJECT: AVIAN INFLUENZA: MANAGUA CONTINGENCY PLANNING AND
TRIPWIRES

REF: A. STATE 183776

B. STATE 202102
C. BANGKOK 7157
D. STATE 220047
E. MANAGUA 03077
F. STATE 219189

1) SUMMARY: This telegram responds to Reftel F request for
post Avian Influenza pandemic contingency planning
information. Tripwire input officers are Regional Security
Officer Michael W. Poehlitz, Assistant Regional Security
Officer Keenan J. Smith, and Foreign Service Health
Practitioner Paula J. Wilson. Tripwire reporters have
received access instructions for the online tripwire
application and ClassNet log-on access information in order
to input, modify, and delete post's tripwires. The Embassy
Managua Emergency Action Committee (EAC) met and discussed
tripwires and post-specific responses. The Health Unit staff
has inventoried personal protective equipment (PPE) and
ordered additional supplies. A shipment of Tamiflu is
expected to arrive in Managua at the beginning of next year,
in accordance with Office of Medical Services instructions in
Reftel A. The task force reviewed and considered
preparedness steps outlined in Reftel F and has posted
tripwires to trigger Embassy Managua's actions to
mitigate/counter a future Avian Influenza pandemic condition
or threat. END SUMMARY.

2) Nicaragua-relevant resource limitations were previously
outlined in Reftel E. Following the lead of Reftels C and D,
we agree that the key tripwire event in a potential avian
influenza outbreak is "efficient and sustained human-to-human
transmission" and have listed responses under the assumption
that an effective human vaccine will not be available and
that tripwires may not be sequential.

3) Updated host country data: Available medical treatment
capability in the event of an outbreak includes 32
respirators in Managua (26 for adults, 6 for children) and 74
intensive care beds, distributed among 11 public and private
hospitals in Managua. When queried, some hospitals preferred
not to divulge the numbers of ICU beds and respirators they
possess.

4) The ability of Nicaragua's public health system to
respond to and manage an AI outbreak or epidemic is balanced
between good communication potential and limited treatment
capability. The AI threat ranks high among GON priorities
and is an agenda item at the Ministry of Health's regular
meetings. Host country officials are engaged, cooperative
and knowledgable. They have responded immediately to
Embassy/USAID requests for information with thoughtful,
competent reports. A lack of Tamiflu and other medication is
problematic, however, and public health physicians have been
conducting a strike for weeks. Media reports suggest the
strike will continue into the beginning of 2006.

5) Post's ability to shelter within Nicaragua will be
determined by the severity of an outbreak and the specific
tripwires crossed. In this earthquake-, volcano- and
hurricane-prone country, Embassy personnel are already
advised to maintain a two-week supply of basic foodstuffs and
water. The Health Unit inventoried personal protective
equipment (PPE) and has ordered additional supplies.

6) Tripwires, which will not necessarily be crossed in this
order, are as follows as of late December 2005:

--TRIPWIRE ONE: A spike in the number and/or broadening
geographic spread of animal to human cases or sustained
human-to-human transmission in a neighboring country in
Central America.

Embassy Actions in response to Tripwire One

--EAC meets to confirm tripwire has been crossed.

--Restrict travel to the affected country or affected areas
within the country, except for personnel involved in possible
investigation/containment efforts.

--Coordinate with U.S. Mission in the affected county
regarding that Mission's plans for possible public
announcements, warden messages, or plans for evacuating
personnel.

--Provide Mission briefings for staff (American and LES) and
dependents.

Actions to be taken immediately:

--Provide Mission briefings for American and LES employees
and dependents.

--Refer to previously prepared draw-down list of minimum
essential personnel.

--Procure additional needed supplies, if needed, to
supplement in-stock Tamiflu, masks, gowns, gloves, protective
eyewear, alcohol-based cleansers, and N95 respirators.

--Remind family members, who have previously been advised
about contingency food and water supplies, to maintainkeep at
least a two-week supply.

--Consult established mechanism for conducting work from home
if a pandemic limits access to Mission offices.

--Form a working group to develop a plan of action to support
potential embassy evacuees.

--Prepare travel orders to avoid a last-minute backlog.

--TRIPWIRE TWO: A spike in the number and/or broadening
geographic spread of animal to human cases or sustained
human-to-human transmission through close, prolonged contact
in an isolated section of Nicaragua.

Embassy Actions in response to Tripwire Two:

--EAC/AI Subcommittee meets to confirm that tripwire has been
met.

--Restrict travel to the affected region(s) of the country.

--Encourage departure of non-essential personnel and
dependents, with authorized departure of designated essential
personnel on a case-by-case basis.

--Suspension of some Embassy services and operations.

--In coordination with the Dept., revise travel warning to
add message advising Americans to leave country.

--Update website and issue public announcements as necessary.

--Per State 183776 (10/05/2005), prophylactic treatment with
Tamiflu will be considered only for staff who are required to
be in direct contact with potentially infected persons.

--Assist in evacuation of private American nationals. (Note:
Managua is a medium-sized embassy, not far from the U.S.)

--TRIPWIRE THREE: A spike in the number and/or broadening
geographic spread of animal to human cases or sustained
human-to-human transmission through close, prolonged contact
near the Mission offices.

Embassy Actions in response to Tripwire Three

--EAC Subcommittee meets to confirm that tripwire has been
met.

--Cancel incoming official travel, except for personnel
involved in investigative/containment efforts, or as
otherwise deemed necessary by COM.

--In coordination with the Dept., issue updated warden
message, travel warning and website, press guidance and
releases. Urge all American citizens to defer all
non-emergency travel to Nicaragua.

--Implement home quarantine of any staff or dependents who
have been in contact with a person confirmed to have an AI
infection.

--Reduce Consular Section visa appointments to a minimum to
reduce risk of spreading disease within the Embassy and to
make more staff available to provide emergency assistance to
American citizens.

--Emergency Action Committee meets regularly to determine
next steps as tripwire circumstances develop. Next steps
could include:

-- Close and/or reduce Embassy to minimal staff, reduce
services and operations to emergency consular services and
other designated services and operations.

-- Continue voluntary departure of dependents and
non-essential staff.


--TRIPWIRE FOUR: Efficient and sustained human-to-human
transmission in a neighboring country in Central America.

Embassy Actions in response to Tripwire Four

--EAC/AI Subcommittee meets to confirm that tripwire has been
met.

--Restrict travel to the affected country, except for CDC,
FAS, AFRIMS or other personnel involved in possible
investigation/containment efforts. (Note: Determine what
type of quarantine/restriction by Nicaraguan authorities may
be placed on these personnel returning to Nicaragua.)

--Coordinate with U.S. Mission in the affected country
regarding that Mission's plans for possible evacuation of
personnel.

--Provide Mission briefings for staff and dependents.

--MED and designated EAC members meet with school
administrators to assess school vulnerability.

--Embassy staffs and equips a situation room. Uses cleared
press guidance to respond to press inquiries.

--Maintain normal Consulate and Embassy operations, with
close monitoring of the situation.

--Embassy Emergency Action Committee meets regularly and
coordinates closely to determine next steps as tripwire
circumstances develop. Next steps could include:

-- Reduction of consular services and suspension of other
designated services and operation.

-- Close offices and/or reduce Embassy to minimal staff.

-- Authorize voluntary departure for dependents and
non-essential personnel. (Note: Authorized departure will
be dependent on possible Government of Nicaragua restrictions
on outgoing travel and on possible U.S. restrictions on
incoming travel.)

-- Except for designated essential American and LES
staff, all others remain home (administrative leave) or on
authorized departure; children remain home from school or on
authorized departure.

-- Continue to purchase additional supplies of food and
water.

-- Social restrictions: restrict movements of all
personnel in the city, restrict dinner parties, sporting
events, etc.).


--TRIPWIRE FIVE: Efficient and sustained human-to-human
transmission within Nicaragua.

Embassy Actions in response to Tripwire Five:

--EAC/AI Subcommittee meets to confirm that tripwire has been
met.

--Issue revised travel warning and update website advising
American citizens to defer all non-emergency travel to
Nicaragua.

--Authorized voluntary departure of dependents and
non-essential personnel. (Note: Authorized departure will
be dependent on possible Government of Nicaragua restrictions
on outgoing travel and on possible U.S. restriction on
incoming travel.)

--Cancel all incoming official travel, except for personnel
involved in investigative/containment efforts, or as
otherwise deemed necessary by COM.

--Provide Mission briefings for staff (American and LES) and
dependents and to school administrators at schools used by
American staff; recommend schools) close.

--Embassy at minimal staff, reduction to emergency consular
services, suspension of designated services and operations.

--Except for designated essential American and LES staff, all
other remain home (administrative leave) or on authorized
departure; children remain home from school or on authorized
departure.

--Ensure that staff purchase additional supplies of food and
water.

--Social restrictions: restrict movements of all personnel.

--Split the Marine Security Guard detachment into two
separate and independent units. (In the event individuals in
one unit acquire the disease, the other unit can still ensure
proper coverage of classified materials.)

--Restrict visitor access to Mission buildings. If entry
into Mission buildings is necessary to conduct business,
visitors must undergo screening procedures to include
temperature monitoring and/or questionnaire related to
symptoms/exposure. (Note: There are no studies that provide
verification regarding effectiveness of these procedures.
They also will not identify people who are contagious or
asymptomatic or have minimal symptoms. The level of
restrictions on access to Mission facilities should depend on
the particular circumstances at that moment.)

--Embassy staffs and equips a situation room and a call
center for inquiries from American public and the press.

--Establish a database listing details of any American
citizen, hospitalized, quarantined, or ill at home.

--MED closely monitors availability of outgoing commercial
flights.

--Embassy Emergency Action Committee meets regularly and
coordinates closely to determine next steps as tripwire
circumstances develop. Next steps could include:

-- Restrict/prohibit visitor access to internal Mission
facility offices.

-- Ordered departure of non-essential personnel and
dependents with authorized departure of designated essential
personnel on a case-by-case basis. (Note: Ordered or
authorized departure will be dependent on possible Government
of Nicaragua restrictions on outgoing travel and on possible
U.S. restrictions on incoming travel.)

-- Suspension of additional Embassy services and
operations.

-- In coordination with the Dept., revise travel warning
to advise Americans to leave Nicaragua.

-- Update website and issue public announcements as
necessary.

-- Consider prophylactic treatment with Tamiflu for staff
required to be in direct contact with potentially infected
persons.

-- Assist in evacuation of private American nationals.
(Note: Significant evacuation from Nicaragua may not be
feasible for a variety of reasons, including the potential
and added risk of acquiring influenza at crowded airports or
on international flights during a true pandemic, travel
restrictions and possible quarantine measures. A complete
evacuation of all Mission personnel and closure of Embassy
Managua would be determined at a later stage in an AI
pandemic.)

7) These preparedness measures include early contingency
planning as of December 2005. The characteristics of a
human-to-human outbreak will of necessity change some of the
details for both "shelter in place" and a possible drawdown
of personnel. The Emergency Action Committee will include an
avian influenza item on its agendas as needed to evaluate the
threat and report the disease's progress on other continents.


TRIVELLI

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