VZCZCXYZ0008
OO RUEHWEB

DE RUEHKT #2849/01 3531005
ZNR UUUUU ZZH
O 191005Z DEC 05
FM AMEMBASSY KATHMANDU
TO RUEHC/SECSTATE WASHDC IMMEDIATE 9572
INFO RUEHBJ/AMEMBASSY BEIJING PRIORITY 3762
RUEHLM/AMEMBASSY COLOMBO PRIORITY 4020
RUEHKA/AMEMBASSY DHAKA PRIORITY 9066
RUEHIL/AMEMBASSY ISLAMABAD PRIORITY 1989
RUEHNE/AMEMBASSY NEW DELHI PRIORITY 8933

UNCLAS KATHMANDU 002849 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR SA/INS, S/ES-O/CMS 
 
E.O. 12958: N/A 
TAGS: AMGT ASEC CASC AMED KFLO AEMR NP
SUBJECT: EMBASSY KATHMANDU PANDEMIC INFLUENZA TRIPWIRES AND 
RESPONSE PLAN 
 
REF: SECSTATE 219189 
 
SUMMARY 
------- 
 
¶1. (SBU) The Embassy has established an ad hoc interagency 
working group on avian influenza (AI) that meets regularly to 
discuss the Post Emergency Action Plan (EAP) specific to AI. 
The working group has recommended the following: to develop a 
section for Post's general EAP specific to a Pandemic 
Infectious Disease situation, which include tripwires and 
responses to AI; to put the MED avian influenza links on the 
Embassy website and the Consular Section's website; to 
incorporate the avian influenza issue into upcoming Town hall 
meetings with the American community; and, to continue to 
monitor the Government of Nepal's (GON) plan in response to 
the avian influenza threat.  This report highlight Post's 
action plans for AI and lists AI specific tripwires and 
responses.  END SUMMARY. 
 
EMBASSY ACTION PLAN 
------------------- 
 
¶2. (SBU) Post has established an interagency group, meeting 
every two weeks to review the AI issue and take appropriate 
action in the event that the situation changes.  The group 
consists of the following mission elements: CDC, MED, USAID, 
Consular, Political/Econ, Regional Environmental Office, and 
DCM. 
 
¶3. (SBU) Recognizing that new infectious diseases are 
evolving all the time and that AI is one of many potential 
threats to human health, the interagency group examined 
whether or not any plans put in place for AI could be 
generalized into a generic "Pandemic Infectious Disease 
Action Plan."  The working group felt this was advisable, but 
agreed that the plan might have to be modified for specific 
disease threats as diseases vary in incubation periods, modes 
of transmission and means of prevention. 
 
IMMEDIATE ACTIONS 
----------------- 
 
¶4. (SBU) Below are the specific actions being taken by the 
relevant sections of the Embassy. 
 
-  MED has established tripwires in Post's EAP specifically 
for AI.  Protective equipment is in place for Health Unit 
staff and for those who would need close contact with 
infected individuals.  Tamiflu is on hand for 25% of members 
of the Embassy community who have health unit access, in 
accordance with Washington guidance.  Post ordered yearly flu 
vaccines in July 2005, according to the 2004 demand levels. 
This year's vaccination campaign has proceeded as usual and 
the health unit has administered approximately 70 vaccines to 
date. 
 
-  Consular will include AI in the next Town Hall meeting. 
Consular will also link their Kathmandu web page with the MED 
and CDC AI info sites. 
 
-  PA will react with rumor control procedures, as outlined 
in the EAP, in the event of a reported human to human AI 
case, or development of a pandemic. 
 
-  The Community Liaison Office (CLO) has updated a survey of 
Embassy personnel and their families to locate additional 
health professionals among us. 
 
-  P/E, USAID and CDC are engaging with the GON on Nepal's AI 
preparedness plan.  Copies of the GON preparedness plan have 
been circulated and reviewed. 
 
TRIPWIRES AND RESPONSES 
----------------------- 
 
¶5. (SBU) Post discussed its tripwires and responses in an 
Emergency Action Committee (EAC) meeting on December 6.  Post 
has accomplished some of the responses outlined in tripwire 
one.  Post will publish these tripwires on the Tripwire 
Reporting and Integrated Planning System (TRIPS) by December 
31, per reftel.  Post's AI specific tripwires and responses 
are as follows: 
 
Tripwire One 
 
------------ 
 
Spike in number and broadening geographic spread of 
animal-to-human transmission cases in South Asia and/or 
bordering countries or Thailand, indicating an increase in 
the transmissibility of the virus and/or causing a serious 
strain on local medical facilities. 
 
AND/OR Closing of regional airports and border transit points 
due to reports of increasing animal to human transmission. 
 
General Actions: 
-  Establish working group to issue updates on AI to 
community as needed; consider town-hall meetings. 
-  Advise Mission personnel and private American citizens 
about the disease threat. 
-  Set-up reporting system with PAO. 
 
Consular: 
-  Coordinate closely with other diplomatic missions, 
Med/Washington, and desk officers etc. 
-  Keep Americans in country up to date on facts. Consider 
putting info on the Embassy Kathmandu internet site. 
-  Discuss shelter in place and quarantine plans. 
 
Medical: 
-  Send status reports on Avian Influenza to Washington and 
put in the Yank and Yeti as developments change. 
-  Communicate with local hospitals and clinics on their 
findings of possible AI cases. 
-  Ensure adequate hand washing supplies and tissues on desks. 
-  Review drug stocks and supplies. 
-  Train guards, Marines, LES and US community in home health 
care for Flu, use of thermometers, masks, and goggles. 
-  Put up signs on how to wash your hands and cough etiquette. 
 
Logistics: 
-  Check all emergency supplies and have enough water on hand 
and MREs for essential staff for six weeks. 
-  Ensure adequate supplies for essential operations. 
-  Secure Tamiflu in Health Unit. 
-  Collect and tally skill bank results. Who has a medical 
background?  Collect home e-mail addresses. 
-  Consider informing people to store enough food and water 
for 6 - 12 weeks. 
-  Teach cleaning staff how to disinfect an office. Teach 
employees how to keep their workspaces clean. 
 
Tripwire Two 
------------ 
 
Sustained human-to-human transmission, as evidenced by a 
cluster of cases (in an office, apartment building, etc.) in 
an urban area of one or more of the other at-risk countries 
in region, but not in Nepal. This is particularly significant 
if there are multiple, geographically diverse clusters, or if 
a cluster occurs in an urban area and/or is not safely 
isolated. 
 
General Actions: 
-  Call EAC to review current information regarding actions 
being taken in surrounding countries (Quarantines, airport 
closures, border closures). 
-  If appropriate, consider recommending authorized departure 
of family members and non-emergency personnel. 
-  Issue a public announcement to the American community. 
 
Consular: 
-  Provide all services to Americans. 
-  Send public announcement to private American community. 
-  Provide visa services for travel with Americans returning 
to the United States, and for official GON travel. 
-  Continue to work on all pending immigrant visa cases with 
appointments but make no new appointments. 
 
Medical: 
-  Review procedures, supplies, and readiness. 
-  Communicate with MED regarding current recommendations. 
-  Contact local epidemiologists and travel medicine experts 
regarding surveillance data and activities. 
 
Logistic: 
-  Check all emergency supplies and have enough food and 
water on hand. 
-  Ensure adequate supplies for essential operations. 
 
 
Tripwire Three 
-------------- 
 
Sustained human-to-human transmission, as evidenced by a 
cluster of cases (office, apartment building, etc.) in Nepal, 
but outside Kathmandu. 
 
General Actions: 
-  Consider requesting Department order departure of family 
members and non-emergency personnel. 
-  Implement administrative leave for non-emergency Direct 
hire employees, contractors and LES. 
-  Implement mandatory sick leave for any employee with flu 
symptoms or has a family member with flu symptoms, monitored 
by MED Unit. 
-  Implement screening of all visitors and use of protective 
gear. 
-  Request Department issue a travel warning for Nepal 
specific to Avian Flu. 
 
Consular: 
-  Provide emergency services only. 
-  Issue public announcement to private American community. 
 
Medical: 
-  Treat and possibly medevac (not likely possible) infected 
personnel and families. 
-  Distribute Tamiflu to confirmed cases and close household 
contacts. 
-  Provide psychological support to employees and families 
involved. 
-  Make home visits to sick individuals who have authorized 
embassy health unit access. 
 
Logistic: 
-  Continue to verify stock of food and water is adequate. 
-  Medical screening of remaining staff. 
-  Continue use of protective gear. 
-  Assign driver to Health Unit. 
-  Consider preparing travel authorizations for expedited 
return to home leave addresses of remaining staff. 
 
Tripwire Four 
------------- 
 
Sustained human-to-human transmission, as evidenced by a 
cluster of cases (in an office, apartment building, etc.) in 
Kathmandu. 
 
General Actions: 
-  Consider Requesting Department order departure of family 
members and non-essential personnel. 
-  Implement administrative leave for non-emergency LES. 
Reduce staffing to absolute minimal level. Consider Shelter 
in Place. 
-  Consider closing all mission annexes and relocate 
remaining staff to Chancery. 
-  Implement mandatory sick leave for any employee who shows 
any flu symptoms or has a family member with flu symptoms, 
monitored by Med Unit. 
-  Implement screening of all visitors using protective gear. 
-  Consider prophylactic use of Tamiflu by minimal U.S. and 
FSN staff remaining on the job on a case-by-case basis. 
-  Request Department issued travel warning specific to AI. 
-  Issue press releases as appropriate. 
 
Consular: 
-  Limit consular services to emergencies only. 
-  Institute latest recommendations for personal protective 
equipment for persons in direct contact with potentially ill 
members of the public community. 
-  Issue public announcement to private American community. 
 
Medical: 
-  Visit/treat sick people at home, wear personal protective 
equipment (PPE). 
-  Provide medications for secondary infections. 
-  Continue to inform Med/Washington of AI cases in US 
community. 
-  Maintain a working relationship with local medical 
facilities. May need to refer difficult patients to them for 
treatment. 
-  Observe the GON regulations regarding the prevention of 
the spread of the disease. 
 
-  Provide social and psychological support. 
 
Logistic: 
-  Dedicated vehicle for Health Unit for home visits; provide 
food and water if needed. 
-  Disinfect offices and other areas of Embassy. 
-  Consider providing delivery service for groceries and 
other essentials to residences. 
 
Alternate Tripwire 
------------------ 
 
Mission employee develops Avian Influenza, in the absence of 
a broader outbreak described in tripwires 1, 2, 3, or 4 above. 
 
General Actions: 
-  Treat the victim. 
-  Medevac if possible. 
-  Disinfect office. 
-  Administer Tamiflu to close contacts. 
MILLARD