Cablegate: Yemen Avian Influenza Preparations

This record is a partial extract of the original cable. The full text of the original cable is not available.




E.O. 12958: N/A

Ref: State 219189, Sanaa 3167, Sanaa 3290

1. Post has addressed ref A and implemented its
recommendations to the maximum extent possible. Further
avian influenza preparation measures will also be taken over
the next month. Paragraph 2 provides a general assessment
of avian influenza (AI) preparedness. Paragraph 3 details
post's trip wires, which will be added to the TRIPS site.
Paragraph 4 details post's responses to the specific action
items of ref A.

2. Yemen has limited general health care coverage, with
major hospitals capable of handling mass casualties or
disease outbreaks centered in half a dozen large cities.
Outside these cities, health care consists of smaller
clinics. Even in the large private and public hospitals of
the major cities, stocks of medical supplies and equipment
that may be used in the event of an AI outbreak - such as
respirators, Tamiflu and personal protective equipment - are
severely limited. Post was able to identify only one major
hospital (outside the capital of Sanaa) with a Tamiflu
supply and AI preparation plan.

The Ministry of Public Health is in charge of the official
ROYG management of potential human AI cases but has
extremely limited response capabilities. For example, the
Minister of Health told a meeting of international donors
that Yemen's stockpile of Tamiflu is only enough for 2000
people. Yemen's international airports have small medical
facilities but no AI planning yet, according to airline
officials. The Ministry of Agriculture is in charge of
surveillance, monitoring and testing of potential animal AI
cases but has no resources to accomplish this goal. See ref
B for additional information on ROYG preparations.

Post itself could maintain American staff and their families
within the Embassy compound for about five days. Post is
working with staff to expand shelter-in-place preparations
so that personnel could remain in their homes for extended
periods, realistically not to exceed two weeks. Post has no
DOD personnel not under COM authority.

3. RSO William Mellott and Vice Consul Michael Hankey are
post's two personnel responsible for inputting AI tripwire
data. Post's tripwires follow, which have been approved by
post's EAC and will be entered into the TRIPS database.

Tripwire 1: Broadening global concern or case found in bird
in the region. Post considers the UN Food and Agricultural
Organization's November report of a Kuwaiti H5N1 case as
sufficient to trigger post response under this trip wire and
has accordingly implemented these responses.

a) Coordinate response with regional missions in the horn
of Africa and the Persian Gulf as well as DC offices.
Obtain response information from other missions in country,
including the British, French, Germans and Japanese.
b) Issue warden message with basic information and Q and
A's on AI. Disseminate factual information about likely
victims and resources.
c) Incorporate AI information into regularly scheduled
town hall meetings.
d) Confirm local resources and contacts.
e) Confirm air carrier plans in the event of an outbreak.
f) Prepare Department information (including the
translation of FAQ's) for future dissemination.
g) Incorporate AI information into MED/USAID outreach to
medical facilities.
h) Continue to monitor the incidence and spread worldwide.
i) Stock Tamiflu.
j) Stock personal protective equipment.
k) Provide information to the Embassy community, including
updates of major changes. Encourage flu shots and general

Tripwire 2: Case of avian influenza discovered in bird/s in
host country or bird-to-human transmission case found in the
region or human-to-human transmissions occuring anywhere in
the world.

a) EAC meets to confirm tripwire has been crossed.
b) Reconfirm local resources and air carrier plans.
c) Confirm supplies of Tamiflu and personal protective
d) Continue to provide information to the Amcit community
via warden messages and town hall meetings.
e) Confirm that any relevant travel warning relating to
neighboring countries are disseminated with the American
citizens in host country.
f) Provide additional updates to the Embassy and Amcit
community as the situation progresses.

Tripwire 3: Bird-to-human case discovered in host country or
human-to-human transmission cases discovered in the region.

a) EAC meets to confirm tripwire has been crossed.
b) Provide briefing for Embassy personnel.
c) Restrict travel to suspected areas and consider
recalling employees working in and near those areas.
d) In coordination with the Department, issue public
announcement, travel warning and warden message warning
American citizens against travel in the suspected areas.
e) Hold emergency town hall meetings, if possible.
f) Work with MED, FMM and GSO to control possible
transmission among and from the public visiting the consular
section and the Yemeni-American Language Institute (YALI).
g) Consider requesting authorized departure for family
members and non-essential personnel.
h) Establish a database tracking American citizens who
have been quarantined or hospitalized.
i) Request daily updates from host country government.
Tripwire 4: Human-to-human transmission cases or sustained
increase in bird-to-human transmissions occur in host
country or sustained human-to-human transmission in the
a) EAC meets to confirm tripwire has been crossed.
b) Coordinate with CA/OCS on issuance of guidance
requesting Americans to defer non-emergency travel to Yemen.
c) In coordination with the Department, prepare press
d) Cancel incoming official travel to host country except
for personnel involved in investigative/containment efforts,
or as otherwise deemed necessary by COM.
e) Implement home quarantine of any staff or dependents
who have been in contact with a person confirmed to have an
AI infection.
f) Restrict access to the consular section to emergency
American citizen services and limit or temporarily close
g) Restrict visitor access to the Embassy.
h) Embassy staffs and equips situation room.
i) Consular section continues monitoring the status of
American citizens infected or suspected to be infected.
j) Institute screening in Embassy lobby and mandatory sick
leave for any personnel with flu-like symptoms and/or
temperature over 38 degrees.
k) Consider shelter in place or reduced movement for
Embassy personnel.
l) Consider requesting ordered departure for family
members and non-essential personnel.

Alternate Tripwire: Mission employee or eligible family
member develops AI infection.
a) Employee or family member begins Tamiflu treatment.
b) Medevac if possible, use local facilities if necessary.
c) Monitor personnel who were in close contact with
infected person. Implement home quarantine for those
persons until they have been deemed not infected.

4. The following points detail post's response to each item
with paragraph 8 of ref A.

a) Post is organizing a briefing for American and LES
personnel on AI, MED guidance and post's contingency plans.
b) Post has identified staff with medical skills, including
staff outside the medical unit.
c) Post has conducted an inventory of Tamiflu and medical
supplies. Current Tamiflu supplies are only two boxes of
expired medicine, but more are supposed to be arriving from
MED in December. The medical unit is also procuring
additional supplies of personal protective equipment.
d) Post medical unit keeps Tamiflu locked within a cabinet
within the medical unit.
e) Post GSO has procured emergency supplies to the extent
possible with current funding levels.
f) Post is procuring the computing and communications
supplies needed to remotely perform consular operations,
including warden messages.
g) Post has identified essential staff to remain through a
possible authorized or ordered departure.
h) Post medical unit has collected information on staff with
medical issues to depart when authorized.
i) Post has prepared travel packets and set aside funds for
potential Mission evacuees under an authorized departure.
j) Post has reached out to airlines, airport officials and
border officials regarding possible border closures and
flight restrictions in case of an AI outbreak.
k) Post has organized a series of town hall meetings for the
American community and distributed basic AI information via
the warden system.
l) Post has engaged and assisted ROYG officials and NGO
staffers regarding the local AI response capacity. USAID
and NAMRU are assisting the ROYG with surveillance,
monitoring and testing of animal cases.


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