Cablegate: Bangladesh H1n1 Cases Increasing

VZCZCXRO2274
PP RUEHAST RUEHBI RUEHCI RUEHDBU RUEHLH RUEHNEH RUEHPW
DE RUEHKA #0844/01 2390955
ZNR UUUUU ZZH
P 270955Z AUG 09
FM AMEMBASSY DHAKA
TO RUEHC/SECSTATE WASHDC PRIORITY 9373
INFO RUCNCLS/ALL SOUTH AND CENTRAL ASIA COLLECTIVE PRIORITY
RUEHPH/CDC ATLANTA GA USA PRIORITY
RUEHRC/DEPT OF AGRICULTURE WASHDC
RUEHBJ/AMEMBASSY BEIJING 0687
RUCPDOC/DEPT OF COMMERCE WASHDC

UNCLAS SECTION 01 OF 02 DHAKA 000844

STATE FOR M/PRI FOR RMORRITZ
STATE FOR SCA/INSB, SCA/PPD
STATE FOR S/ES-O/CMS FOR EPARRA
STATE FOR OES/AIAG FOR AMBASSADOR LOFTIS, HELEN REED ROWE, AND
CRAIG SHAPIRO
STATE FOR OES/IHB, AAIT, MED
HHS FOR OGHA STEIGER AND HICKEY
CDC ATLANTA FOR CCID AND COGH
USDA FOR APHIS

SENSITIVE
SIPDIS

E.O. 12958: N/A
TAGS: KFLU TBIO PINR EAGR AMED CASC PGOV BG
SUBJECT: BANGLADESH H1N1 CASES INCREASING

REF A: DHAKA 621 B: STATE 82155 C: STATE 85141

SUMMARY
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1. (SBU) The number of H1N1 cases in Bangladesh is on the rise, with
117 total confirmed cases by August 26 and early evidence of
in-country community-level transmission. Government actions to date
seem appropriate. The local press reported the spread of H1N1 and
two private schools closed temporarily. The Government of
Bangladesh (GOB) is preparing a public information campaign,
reviewing preparedness of public health facilities and considering
raising its internal alert level. Despite two Dhaka school
closures, the GOB currently advises schools to remain open. The
main school serving U.S. Mission dependents remains open in
accordance with CDC guidance, after officials confirmed one student
(not a U.S. Mission EFM) had H1N1. Mission Dhaka convened the
Pandemic Influenza Working Group to review mission preparedness and
issued updated internal and warden messages on H1N1.

H1N1 SPREADS BEYOND TRAVELERS
-----------------------------

2. (SBU) The Ministry of Health confirmed 117 H1N1 cases by August
26, up from the handful of cases first reported at the end of June
(Ref A). Scientists from the U.S. Centers for Disease Control (CDC)
based in Bangladesh reported early evidence of in-country
community-level transmission after surveillance in the Kamalpur
community near Dhaka confirmed several H1N1 cases in patients who
had no contact with recent travelers. Since early August, cases
have spread from the Dhaka region to ten districts around the
country. CDC reported there were no confirmed fatalities, though
two suspected H1N1-related deaths could not be confirmed because
doctors could not test the patients prior to the deaths and
subsequent burials. According to CDC, the low number of confirmed
H1N1 cases in Bangladesh compared to neighboring countries is due
largely to capacity limitations in testing and surveillance.
Although the sample size currently is too small to precisely
estimate H1N1 infection rates, surveillance results from Kamalpur
suggest there were already thousands of H1N1 cases in this community
by early August.

3. (U) Local media have publicized the rising case count and the
closure of two private schools in Dhaka after H1N1 cases were
confirmed in several students. The American International School of
Dhaka (AIS/D), the main school serving U.S. Mission children,
informed parents August 23 that one student (not a Mission EFM) was
diagnosed with a confirmed case of H1N1. Citing CDC and GOB
guidance, the school has remained open while urging parents to keep
sick children home.

GOB RESPONSE
------------

4. (U) At an August 16 cabinet meeting, Prime Minister Sheikh Hasina
directed the Ministry of Health (MOH) to coordinate pandemic flu
preparedness with other Ministries. The Minister of Health convened
a meeting August 20 with representatives of the Ministry of Public
Information, as well as UNICEF, WHO, and CDC advisors to coordinate
pandemic flu preparedness. At this meeting, CDC advisors relayed
ref C information and discussed current CDC guidelines for schools
and pandemic preparedness. GOB officials agreed to coordinate
dissemination of risk communication messages to the general public,
schools, and the media. In addition, Ministry of Health officials
committed to preparing local hospitals for an increase in severe
influenza cases; reviewing triaging, treatment and infection control
guidelines; and mobilizing stockpiles of antivirals and personal
protective equipment.

5. (U) According to media reports, Bangladeshi delegates at an
August 23-24 global pandemic flu conference in China pressed flu
vaccine makers to donate vaccines to Bangladesh. The companies had
already pledged to produce and donate 150 million vaccines to the
WHO for developing countries. The MOH also has asked USAID to
donate 2 million surgical masks. MOH officials anticipate having
sufficient oseltamivir (also known as Tamiflu) to treat severe cases
and are exploring ways to urge local manufacturers to increase the
supply to treat ambulatory patients at high risk of complications

DHAKA 00000844 002 OF 002

(e.g. pregnant women and those with diabetes or cardiovascular
disease).

MISSION ACTIONS
---------------

6. (SBU) The U.S. mission convened its Pandemic Influenza Working
Group to review tripwires and mission preparedness. Following
consultation with MOH contacts, the management and consular sections
updated internal and warden messages with information on H1N1 and
reminders of preventive measures. The working group will continue
to review avian flu tripwires to adapt them to the less severe
scenarios of an H1N1 pandemic. Through its existing relationship
with the International Centre for Diarrhoeal Disease Research,
Bangladesh (ICDDR,B), CDC has consulted regularly with GOB
counterparts to track the spread of H1N1 and coordinate preparedness
for the upcoming flu season.

COMMENT
-------

7. (SBU) The GOB and MOH appear to be taking appropriate steps to
disseminate public information and review preparedness measures in
advance of the upcoming flu season. They are also maintaining sound
guidelines against public school closures, though they may face
increasing pressure to close schools and limit public gatherings as
the case count rises and fatalities are reported, which is likely
during the upcoming autumn flu season. CDC and USAID will continue
their regular consultations with MOH counterparts to support
pandemic flu preparedness measures and encourage sound guidelines.
Mission Dhaka's Pandemic Influenza Working Group will continue to
meet regularly and monitor the situation.

MORIARTY

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