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

UNCLAS SECTION 01 OF 03 SANAA 003527 
 
SIPDIS 
 
FOR S/ES-O/CMS 
 
E.O. 12958: N/A 
TAGS: AMGT ASEC CASC AMED KFLO AEMR YM
SUBJECT: YEMEN AVIAN INFLUENZA PREPARATIONS 
 
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 
hygiene. 
 
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 
equipment. 
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 
region. 
 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 
    guidance. 
 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 
YALI. 
 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. 
 
KHOURY