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 ANKARA 006594 
 
SIPDIS 
 
M/MED DR. RIESLAND 
BRUSSELS FOR DR. DUMONT 
 
SENSITIVE 
 
E.O. 12958: N/A 
TAGS: AMED AMGT ASEC CASC CMGT
SUBJECT: AVIAN INFLUENZA:  EMBASSY ANKARA RESPONSE AND 
TRIPWIRES 
 
REF:      A) ANKARA 06232 
     B) ANKARA 06431 
     C) HANOI 02430 
     D) JAKARTA 09024 
     E) EMAIL TRIPLETT/MED FS 10/20/05- HANOI TRIPWIRES 
     F) ANKARA 06481 
     G) STATE 181885 
 
¶1.  (SBU) Summary: Since the emergence of Avian Influenza 
(AI) in Turkey in October 2005, Mission Ankara has taken 
steps to assess and deal with the possible risk to Mission 
Employees and American citizens living in Turkey.  As a 
contingency planning exercise, we have also developed 
tripwires as a response to the evolution of the AI situation 
in Southeast Asia, Central Asia, and Europe.  We invite and 
welcome feedback from relevant offices and agencies with 
expertise in emergency planning and/or Avian Influenza. 
Assumptions and tripwires follow in paragraphs 5, 6 & 7. 
End Summary. 
 
Background 
------------ 
 
¶2. (U) After the announcement of AI in Turkey on October 9, 
2005 (Ref A), the Mission EAC met on October 11, 2005. A 
small working group was established (ADCM, MGT, MED, FAS, 
CONS, ECON, PA, RSO, CLO) to follow developments of Avian 
Influenza in the region, and prepare the Mission's response 
to this pandemic threat. Per references A & B, an outbreak 
of H5N1 avian influenza (same strain as found in East Asia) 
was confirmed in western Turkey. The area around the 
outbreak was quarantined, domestic and wild fowl culled, and 
a limited number of poultry worker placed under 
precautionary observation. There have been no reported human 
cases of H5N1 influenza in Turkey. There have been no new AI 
outbreaks in Turkey. The GOT is currently seeking 
international assistance to increase their virology 
laboratory capacity, expertise in Avian Influenza, and 
monitoring/reporting systems for reportable diseases. 
 
¶3. (U) The Mission has no independent monitoring assets in 
Turkey, and is reliant on private industry and Ministry of 
Health (MOH) and Ministry of Agriculture and Rural Affairs 
(MARA) reporting. To date the GOT and private sector have 
been cooperative; however, their ability to monitor and test 
in case of a larger, multi-location outbreak is in question. 
 
¶4. (SBU) Mission Turkey is using the experience of South 
East Asian posts as a guide. FAS is sending regular reports 
to Washington. CONS has issued a Warden Notice, and updated 
the Mission website. ECON, FAS, and MED in Ankara are 
developing and maintaining close contact with sources (WHO, 
MOH, MARA) on new developments. The Mission has started 
preparations to counter the risk of a potential AI outbreak. 
Post Management has started informal discussions with 
counterparts at friendly missions. Post secured 270 5-day 
courses of Tamiflu locally, currently set aside for use as 
treatment (not prophylaxis) in the event of an outbreak. As 
no further Tamiflu supplies are available locally, post is 
waiting for additional supplies of Tamiflu from 
MED/Washington - expected in January 2006 (Ref G). Post has 
N-95 masks, gloves, and goggles in stock for medical 
providers. Electronic thermometers, coveralls and additional 
gloves, goggles, and masks are on order. As part of its 
annual cold/flu prevention campaign, post is encouraging 
staff to wash their hands frequently, including the use of 
alcohol hand gels. Personnel have been encouraged to review 
their personal contingency plans and to continue to maintain 
a 3 day supply of food and water as already recommended for 
earthquake planning. 
 
 
Tripwires -- Assumptions 
---------------------------- 
 
¶5. (SBU) The working group met on October 25, 2005 to 
discuss the tripwires outlined in this cable. 
 
¶6.  The following assumptions were made for planning 
purposes: 
 
-- The risk to USG personnel is currently low. 
Transmissibility and pathogenicity are unknown variables at 
this time, and are contingent risks if H5N1 begins to 
transmit actively between humans. Risk would be manageable 
if human-to-human transmission occurred only in cases of 
extensive intimate contact.  Transmission by casual human-to- 
human contact could change the local and global situation 
very quickly, requiring rapid action to protect our 
personnel and American citizens in Turkey. 
 
-- Turkish private, military, and university-based 
government medical facilities in large urban areas are 
equipped to provide care to a limited number of AI cases 
(negative pressure isolation rooms, ventilators, and trained 
medical staff). However, the quality of nursing services can 
be low, and the number of beds limited. In the event of 
widespread human-to-human transmission of a highly 
pathogenic AI strain, the Turkish medical system would 
quickly become overwhelmed. 
 
-- Depending on the speed of a human-to-human outbreak, U.S. 
citizens could be cut off from air evacuation routes. 
 
 
-- Mission would not be able to obtain essential supplies in 
the event of a crisis and therefore should stockpile 
adequate supplies for the duration. 
 
-- The efficacy of Tamiflu and other anti-viral medications 
in the treatment and prophylaxis of H5N1 influenza is 
unknown at this time. Animal models suggest Tamiflu might be 
helpful, however at this time there is at least one human 
case of documented resistance. 
 
 
Tripwires and Possible Actions 
------------------------------ 
 
¶7.  The Charg d'Affaires has approved the following four 
tripwires and possible associated actions: 
 
Tripwire 1: Recurrence of AI in fowl in Turkey. 
 
Possible Actons: 
a.   Consider release of warden message to Mission personnel 
  and American citizens. 
b.   Offer additional USG assistance to GOT if needed. 
c.   Provide detailed briefing t Embassy/Consulate staff. 
 
Tripwire 2:  Occurrence and broadening geographic spread of 
animal-to-human transmission cases in Turkey indicating an 
increase in the transmissibility of the virus and/or causing 
a serious strain on local medical facilities. 
 
Possible Actions: 
a.   Consider restriction of official and/or unofficial 
  travel to rural areas and wet markets. 
b.   Consider release of public announcement to Mission 
personnel and American citizens through the warden system. 
c.   Provide detailed briefing to Embassy/Consulate staff. 
d.   Conduct Town Hall meetings for American citizens. 
 
Tripwire 3:  Sustained human-to-human transmission, as 
evidenced by a cluster of cases (office, apartment building, 
etc.) in an urban area of South East Asia or other regions. 
This is particularly significant if there are multiple, 
geographically diverse clusters, or a cluster occurs in a 
major transit hub. 
 
Possible Actions: 
a.   Consider authorized departure of U.S. family members 
  and non-emergency personnel. 
b.   Institute screening practices for all visitors to USG 
  facilities. 
c.   Mandatory sick leave for any employee who shows any flu 
  symptoms or has a family member with flu symptoms. 
  Monitoring by MED Unit. 
d.   Consider request to Department to issue Travel Warning. 
 
Tripwire 4:  Sustained human-to-human transmission, as 
evidenced by a cluster of cases (office, apartment building, 
etc.) in Turkey.  This is particularly significant if there 
are multiple, geographically diverse clusters, or a cluster 
occurs in an urban area and/or is not safely isolated. 
 
Possible Actions: 
a.   Consider reduction of services to emergencies only. 
b.   Consider ordered departure.  Consider administrative 
  leave for non-emergency LES. 
c.   Mandatory sick leave for any employee who shows any flu 
  symptoms or has a family member with flu symptoms. 
  Monitoring by MED Unit. 
d.   Screening of all visitors and use of protective gear as 
  needed for personnel interacting with the public. 
e.   If supplies sufficient, prophylactic use of Tamiflu by 
  minimal U.S. and LES staff remaining on the job. 
f.   Travel Warning to the American public. 
 
Alternative Tripwire:  A Mission employee develops Avian 
Influenza, in the absence of a broader outbreak per 
tripwires 2, 3,or 4 above. 
 
Possible Actions: 
a.   Treat the victim.  Medevac if possible. 
b.   Disinfect office. 
c.   Administer Tamiflu to close contacts. 
 
 
MCELDOWNEY