VZCZCXRO1873
RR RUEHAST RUEHCHI RUEHDH RUEHDT RUEHHM RUEHLN RUEHMA RUEHNH RUEHPB
RUEHPOD RUEHTM RUEHTRO
DE RUEHPF #0272/01 1191132
ZNR UUUUU ZZH
R 291132Z APR 09
FM AMEMBASSY PHNOM PENH
TO RUEHC/SECSTATE WASHDC 0643
RUEHBK/AMEMBASSY BANGKOK 2704
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEHGV/USMISSION GENEVA 1698
RUEKJCS/SECDEF WASHINGTON DC

UNCLAS SECTION 01 OF 03 PHNOM PENH 000272 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/MLS, G/AIAG, OES/IHA, MED, S/ES/MLIBBY 
STATE FOR USAID/ANE, OFDA AND GH 
BANGKOK FOR REO/HHOWARD 
BANGKOK FOR OFDA 
 
E.O. 12958: N/A 
TAGS: KFLU AEMR ASEC CASC KFLO TBIO KSAF KPAO PREL PINR
AMGT, MG, EAGR, CB 
SUBJECT: MGSF01: CAMBODIAN RESPONSE TO GLOBAL H1N1 OUTBREAK 
 
¶1. (SBU) SUMMARY.  There has not yet been any evidence suggesting 
cases of H1N1 in Cambodia.  The Royal Government of Cambodia (RGC) 
issued a statement April 27 outlining its activities since the 
outbreak in Mexico began, including increased animal and human 
health surveillance and inventories of medical supplies.  The RGC is 
considering banning imports of live pigs from H1N1-affected 
countries, but has not yet implemented such a ban.  The two 
international airports have implemented thermal screening procedures 
to monitor passengers arriving in-country.  On April 28, the 
Ministry of Health (MOH) convened a health sector swine influenza 
working group with donors to address the country's medical and 
public health responses. 
 
¶2. (SBU) Post's Emergency Action Committee (EAC) convened on April 
29 to review Post's contingency plans and tripwires, as well as the 
RGC's pandemic preparedness activities.  In addition to the EAC 
meeting, Post has taken the following actions:  1) obtained 
information on the actions taken by RGC; 2) coordinated with other 
donor organizations; 3) organized the development of a Management 
Notice and Warden Message that provide information about H1N1; 4) 
distributed the April 27 Office of Overseas Schools letter to the 
international schools in Phnom Penh; and 5) made preliminary contact 
with the USAID Office of Foreign Disaster Assistance's Regional 
Office in Bangkok.  Post is well positioned to respond to a 
potential pandemic outbreak due to the in-country presence of the 
Centers for Disease Control and Prevention (CDC), Naval Medical 
Research Unit (NAMRU-2), the Post Medical Officer, USAID Public 
Health Team, and other offices.  END SUMMARY. 
 
¶3. (SBU) In response to the H1N1 outbreak in Mexico and reported 
cases in the U.S., the Emergency Action Committee (EAC) convened 
April 29 to review Post's contingency plans and tripwires and the 
Royal Government of Cambodia's (RGC) pandemic preparedness 
activities.  Post's Medical Officer, CDC and NAMRU-2 briefed the EAC 
on current medical information available from the CDC and World 
Health Organization (WHO).  All Post preparations, including 
recommended levels of medical supplies, have been reviewed and are 
in order.  Post has issued a Management Notice to the embassy 
community, which has been shared with EAP/MLS.  The Consular Section 
sent a warden message to the broader American community with 
information about precautions to take and where to go for official 
updates and authoritative information.  A copy of the warden message 
has been sent to CA. 
 
NO EVIDENCE OF H1N1 IN CAMBODIA 
------------------------------- 
 
¶4. (U) There has been no epidemiologic or laboratory evidence 
suggesting H1N1 in Cambodia.  Influenza-like illness (ILI) 
surveillance conducted by the MOH at six provincial hospitals 
nationwide has not detected any recent increases in ILI activity or 
laboratory-confirmed influenza infections.  Based on recommendations 
from both the World Health Organization (WHO) and CDC, the MOH will 
increase laboratory testing of patients with ILI at all surveillance 
sites. 
 
RGC PREPARATION 
--------------- 
 
¶5. (U) On April 27, the RGC issued a joint MOH-WHO press release to 
the media, embassies, and provincial Health Departments, stating 
that Cambodia has increased its surveillance for unusual respiratory 
illnesses in hospitals, health centers, and airports.  It also 
advised individuals with a febrile respiratory illness returning 
from affected countries in the last seven days to seek medical 
attention, and provided hotline telephone numbers for medical 
personnel and the public to report such illnesses.  The MOH is 
currently assessing their inventory of medications (antiviral and 
antibiotic), laboratory materials such as viral transport medium, 
and personal protective equipment (PPE) at both the national and 
provincial levels.  As of April 28, the MOH revealed that 
approximately 15,700 five-day courses of TamiFlu are available in 
the national stockpile.  Other in-country sources of TamiFlu include 
all provincial Rapid Response Teams (100 tablets per team) and five 
hospitals (four provincial hospitals and Calmette Hospital), each 
with small isolation wards (100 tablets per hospital). 
 
RGC STEPS UP ANIMAL SURVEILLANCE, NOT YET BANNING 
 
PHNOM PENH 00000272  002 OF 003 
 
 
IMPORTS 
--------------------------------------------- ----- 
 
¶6. (U) Sem Sovann, Secretary of State at the Ministry of 
Agriculture, Forestry and Fisheries (MAFF), told Emboff that 
although there have not yet been any H1N1 cases in Cambodia, RGC 
officials are closely monitoring the outbreak and are reassuring the 
public that there is no need for panic.  He said that when the 
outbreak began, the RGC implemented procedures it had in place for a 
potential avian influenza outbreak, such as increasing the number of 
veterinary and farm sanitation inspections, working with NGOs to 
increase surveillance of animal and farm trade in rural areas, and 
distributing information on the disease to rural veterinarians. 
 
¶7. (U) The Cambodian Pig Raiser Association announced April 28 that 
it had recommended that the RGC ban all live pig imports.  Sem 
Sovann said that an inter-ministerial working group met on April 28 
to discuss potentially banning live pig imports (not pork products) 
from countries that had known cases of H1N1 only.  As of April 29, 
the RGC had not yet implemented a ban.  Sem Sovann said that RGC 
officials, including the Prime Minister, were also communicating to 
the public that pork products were still safe to eat if properly 
cooked. 
 
AIRPORTS IMPLEMENT SCREENING PROCEDURES 
--------------------------------------- 
 
¶8. (U) Airport authorities in Phnom Penh and Siem Reap installed 
thermal scanners April 28 to screen incoming passengers for elevated 
temperatures.  Officials at Phnom Penh International Airport told 
Emboffs April 29 that the scanners were online and functioning.  The 
equipment had been purchased for use in a potential avian influenza 
outbreak. 
 
DONOR COORDINATION 
------------------ 
 
¶9.  (U) On April 28, the MOH convened a health sector swine 
influenza working group to address the country's medical and public 
health responses.  Organizations present at the meeting included MOH 
(Communicable Diseases Control Division, Hospital Services 
Department, National Institute of Public Health), WHO, CDC, NAMRU-2, 
Institut Pasteur in Cambodia (IPC), and Calmette Hospital.  During 
the meeting, the MOH stated that it issued official letters to the 
provincial Health Departments instructing them to strengthen 
surveillance for acute respiratory illnesses, ILI, and abnormal 
respiratory events, to alert Rapid Response Teams (RRTs), and to 
disseminate information on H1N1 to public and private health 
facilities. 
 
CDC ACTIONS:  TESTING ASSISTANCE AND MEDICATION 
--------------------------------------------- -- 
 
¶10. (SBU) WHO and CDC will continue to provide updated guidance to 
the MOH on surveillance, case investigation and outbreak response 
procedures, laboratory testing, case management (including antiviral 
and antibiotic treatment guidelines), infection control, and 
screening procedures at airports.  CDC will provide both MOH and WHO 
with recently developed interim guidelines on antiviral treatment 
and community mitigation of H1N1. 
 
¶11. (SBU) On April 29, CDC notified IPC that real-time polymerase 
chain reaction (PCR) test kits to detect H1N1 have been developed by 
the CDC Influenza Division laboratory in Atlanta, and that these 
kits would be ready for distribution to external influenza 
laboratories by the end of this week.  IPC has subsequently placed 
orders to CDC Atlanta for test kits, and will share them with the 
NIPH molecular laboratory.  NAMRU-2 will also receive test kits 
directly from U.S. Navy counterparts. Once the kits arrive, all 
three laboratories should have testing capacity specifically for 
H1N1. 
 
¶12. (SBU) In addition to the TamiFlu medication, Post's CDC 
epidemiologist noted that deaths from flu traditionally occur due to 
secondary respiratory infection that is either viral or bacterial. 
Treatment of the secondary infection could require antiviral and/or 
antibiotic treatment in addition to or in place of TamiFlu.  An 
inventory of stocks of antiviral and antibiotic medication is 
 
PHNOM PENH 00000272  003 OF 003 
 
 
underway.  Post is concerned that the quantity and quality of 
antibiotics and antivirals available locally may be an issue. 
 
 
 
RODLEY