VZCZCXYZ0013
RR RUEHWEB

DE RUEHMU #3257/01 3641648
ZNR UUUUU ZZH
R 301648Z DEC 05
FM AMEMBASSY MANAGUA
TO WHA CENTRAL AMERICAN COLLECTIVE

UNCLAS SECTION 01 OF 04 MANAGUA 003257 
 
SIPDIS 
 
SIPDIS 
 
OES FOR DSINGER AND RDALEY; S/ES-O/CMS 
 
E.O. 12958: N/A 
TAGS: AMGT ASEC CASC AMED KFLO AEMRS NU
SUBJECT: AVIAN INFLUENZA:  MANAGUA CONTINGENCY PLANNING AND 
TRIPWIRES 
 
REF: A. STATE 183776 
 
     ¶B. STATE 202102 
     ¶C. BANGKOK 7157 
     ¶D. STATE 220047 
     ¶E. MANAGUA 03077 
     ¶F. STATE 219189 
 
1)  SUMMARY:  This telegram responds to Reftel F request for 
post Avian Influenza pandemic contingency planning 
information.  Tripwire input officers are Regional Security 
Officer Michael W. Poehlitz, Assistant Regional Security 
Officer Keenan J. Smith, and Foreign Service Health 
Practitioner Paula J. Wilson.  Tripwire reporters have 
received access instructions for the online tripwire 
application and ClassNet log-on access information in order 
to input, modify, and delete post's tripwires.  The Embassy 
Managua Emergency Action Committee (EAC) met and discussed 
tripwires and post-specific responses.  The Health Unit staff 
has inventoried personal protective equipment (PPE) and 
ordered additional supplies.  A shipment of Tamiflu is 
expected to arrive in Managua at the beginning of next year, 
in accordance with Office of Medical Services instructions in 
Reftel A.  The task force reviewed and considered 
preparedness steps outlined in Reftel F and has posted 
tripwires to trigger Embassy Managua's actions to 
mitigate/counter a future Avian Influenza pandemic condition 
or threat.  END SUMMARY. 
 
2)  Nicaragua-relevant resource limitations were previously 
outlined in Reftel E.  Following the lead of Reftels C and D, 
we agree that the key tripwire event in a potential avian 
influenza outbreak is "efficient and sustained human-to-human 
transmission" and have listed responses under the assumption 
that an effective human vaccine will not be available and 
that tripwires may not be sequential. 
 
3)  Updated host country data:  Available medical treatment 
capability in the event of an outbreak includes 32 
respirators in Managua (26 for adults, 6 for children) and 74 
intensive care beds, distributed among 11 public and private 
hospitals in Managua.  When queried, some hospitals preferred 
not to divulge the numbers of ICU beds and respirators they 
possess. 
 
4)  The ability of Nicaragua's public health system to 
respond to and manage an AI outbreak or epidemic is balanced 
between good communication potential and limited treatment 
capability.  The AI threat ranks high among GON priorities 
and is an agenda item at the Ministry of Health's regular 
meetings.  Host country officials are engaged, cooperative 
and knowledgable.  They have responded immediately to 
Embassy/USAID requests for information with thoughtful, 
competent reports.  A lack of Tamiflu and other medication is 
problematic, however, and public health physicians have been 
conducting a strike for weeks.  Media reports suggest the 
strike will continue into the beginning of 2006. 
 
5)  Post's ability to shelter within Nicaragua will be 
determined by the severity of an outbreak and the specific 
tripwires crossed.  In this earthquake-, volcano- and 
hurricane-prone country, Embassy personnel are already 
advised to maintain a two-week supply of basic foodstuffs and 
water.  The Health Unit inventoried personal protective 
equipment (PPE) and has ordered additional supplies. 
 
6)  Tripwires, which will not necessarily be crossed in this 
order, are as follows as of late December 2005: 
 
--TRIPWIRE ONE:  A spike in the number and/or broadening 
geographic spread of animal to human cases or sustained 
human-to-human transmission in a neighboring country in 
Central America. 
 
Embassy Actions in response to Tripwire One 
 
--EAC meets to confirm tripwire has been crossed. 
 
--Restrict travel to the affected country or affected areas 
within the country, except for personnel involved in possible 
investigation/containment efforts. 
 
--Coordinate with U.S. Mission in the affected county 
regarding that Mission's plans for possible public 
announcements, warden messages, or plans for evacuating 
personnel. 
 
--Provide Mission briefings for staff (American and LES) and 
dependents. 
 
Actions to be taken immediately: 
 
--Provide Mission briefings for American and LES employees 
and dependents. 
 
--Refer to previously prepared draw-down list of minimum 
essential personnel. 
 
--Procure additional needed supplies, if needed, to 
supplement in-stock Tamiflu, masks, gowns, gloves, protective 
eyewear, alcohol-based cleansers, and N95 respirators. 
 
--Remind family members, who have previously been advised 
about contingency food and water supplies, to maintainkeep at 
least a two-week supply. 
 
--Consult established mechanism for conducting work from home 
if a pandemic limits access to Mission offices. 
 
--Form a working group to develop a plan of action to support 
potential embassy evacuees. 
 
--Prepare travel orders to avoid a last-minute backlog. 
 
--TRIPWIRE TWO:  A spike in the number and/or broadening 
geographic spread of animal to human cases or sustained 
human-to-human transmission through close, prolonged contact 
in an isolated section of Nicaragua. 
 
Embassy Actions in response to Tripwire Two: 
 
--EAC/AI Subcommittee meets to confirm that tripwire has been 
met. 
 
--Restrict travel to the affected region(s) of the country. 
 
--Encourage departure of non-essential personnel and 
dependents, with authorized departure of designated essential 
personnel on a case-by-case basis. 
 
--Suspension of some Embassy services and operations. 
 
--In coordination with the Dept., revise travel warning to 
add message advising Americans to leave country. 
 
--Update website and issue public announcements as necessary. 
 
--Per State 183776 (10/05/2005),  prophylactic treatment with 
Tamiflu will be considered only for staff who are required to 
be in direct contact with potentially infected persons. 
 
--Assist in evacuation of private American nationals.  (Note: 
 Managua is a medium-sized embassy, not far from the U.S.) 
 
--TRIPWIRE THREE:  A spike in the number and/or broadening 
geographic spread of animal to human cases or sustained 
human-to-human transmission through close, prolonged contact 
near the Mission offices. 
 
Embassy Actions in response to Tripwire Three 
 
--EAC Subcommittee meets to confirm that tripwire has been 
met. 
 
--Cancel incoming official travel, except for personnel 
involved in investigative/containment efforts, or as 
otherwise deemed necessary by COM. 
 
--In coordination with the Dept., issue updated warden 
message, travel warning and website, press guidance and 
releases.  Urge all American citizens to defer all 
non-emergency travel to Nicaragua. 
 
--Implement home quarantine of any staff or dependents who 
have been in contact with a person confirmed to have an AI 
infection. 
 
--Reduce Consular Section visa appointments to a minimum to 
reduce risk of spreading disease within the Embassy and to 
make more staff available to provide emergency assistance to 
American citizens. 
 
--Emergency Action Committee meets regularly to determine 
next steps as tripwire circumstances develop.  Next steps 
could include: 
 
--      Close and/or reduce Embassy to minimal staff, reduce 
services and operations to emergency consular services and 
other designated services and operations. 
 
--      Continue voluntary departure of dependents and 
non-essential staff. 
 
 
--TRIPWIRE FOUR:  Efficient and sustained human-to-human 
transmission in a neighboring country in Central America. 
 
Embassy Actions in response to Tripwire Four 
 
--EAC/AI Subcommittee meets to confirm that tripwire has been 
met. 
 
--Restrict travel to the affected country, except for CDC, 
FAS, AFRIMS or other personnel involved in possible 
investigation/containment efforts.  (Note:  Determine what 
type of quarantine/restriction by Nicaraguan authorities may 
be placed on these personnel returning to Nicaragua.) 
 
--Coordinate with U.S. Mission in the affected country 
regarding that Mission's plans for possible evacuation of 
personnel. 
 
--Provide Mission briefings for staff and dependents. 
 
--MED and designated EAC members meet with school 
administrators to assess school vulnerability. 
 
--Embassy staffs and equips a situation room.  Uses cleared 
press guidance to respond to press inquiries. 
 
--Maintain normal Consulate and Embassy operations, with 
close monitoring of the situation. 
 
--Embassy Emergency Action Committee meets regularly and 
coordinates closely to determine next steps as tripwire 
circumstances develop.  Next steps could include: 
 
--     Reduction of consular services and suspension of other 
designated services and operation. 
 
--     Close offices and/or reduce Embassy to minimal staff. 
 
--     Authorize voluntary departure for dependents and 
non-essential personnel.  (Note:  Authorized departure will 
be dependent on possible Government of Nicaragua restrictions 
on outgoing travel and on possible U.S. restrictions on 
incoming travel.) 
 
--     Except for designated essential American and LES 
staff, all others remain home (administrative leave) or on 
authorized departure; children remain home from school or on 
authorized departure. 
 
--     Continue to purchase additional supplies of food and 
water. 
 
--     Social restrictions:  restrict movements of all 
personnel in the city, restrict dinner parties, sporting 
events, etc.). 
 
 
--TRIPWIRE FIVE:  Efficient and sustained human-to-human 
transmission within Nicaragua. 
 
Embassy Actions in response to Tripwire Five: 
 
--EAC/AI Subcommittee meets to confirm that tripwire has been 
met. 
 
--Issue revised travel warning and update website advising 
American citizens to defer all non-emergency travel to 
Nicaragua. 
 
--Authorized voluntary departure of dependents and 
non-essential personnel.  (Note:  Authorized departure will 
be dependent on possible Government of Nicaragua restrictions 
on outgoing travel and on possible U.S. restriction on 
incoming travel.) 
 
--Cancel all incoming official travel, except for personnel 
involved in investigative/containment efforts, or as 
otherwise deemed necessary by COM. 
 
--Provide Mission briefings for staff (American and LES) and 
dependents and to school administrators at schools used by 
American staff; recommend schools) close. 
 
--Embassy at minimal staff, reduction to emergency consular 
services, suspension of designated services and operations. 
 
--Except for designated essential American and LES staff, all 
other remain home (administrative leave) or on authorized 
departure; children remain home from school or on authorized 
departure. 
 
--Ensure that staff purchase additional supplies of food and 
water. 
 
--Social restrictions:  restrict movements of all personnel. 
 
--Split the Marine Security Guard detachment into two 
separate and independent units.  (In the event individuals in 
one unit acquire the disease, the other unit can still ensure 
proper coverage of classified materials.) 
 
--Restrict visitor access to Mission buildings.  If entry 
into Mission buildings is necessary to conduct business, 
visitors must undergo screening procedures to include 
temperature monitoring and/or questionnaire related to 
symptoms/exposure.  (Note:  There are no studies that provide 
verification regarding effectiveness of these procedures. 
They also will not identify people who are contagious or 
asymptomatic or have minimal symptoms.  The level of 
restrictions on access to Mission facilities should depend on 
the particular circumstances at that moment.) 
 
--Embassy staffs and equips a situation room and a call 
center for inquiries from American public and the press. 
 
--Establish a database listing details of any American 
citizen, hospitalized, quarantined, or ill at home. 
 
--MED closely monitors availability of outgoing commercial 
flights. 
 
--Embassy Emergency Action Committee meets regularly and 
coordinates closely to determine next steps as tripwire 
circumstances develop.  Next steps could include: 
 
--     Restrict/prohibit visitor access to internal Mission 
facility offices. 
 
--     Ordered departure of non-essential personnel and 
dependents with authorized departure of designated essential 
personnel on a case-by-case basis.  (Note:  Ordered or 
authorized departure will be dependent on possible Government 
of Nicaragua restrictions on outgoing travel and on possible 
U.S. restrictions on incoming travel.) 
 
--     Suspension of additional Embassy services and 
operations. 
 
--     In coordination with the Dept., revise travel warning 
to advise Americans to leave Nicaragua. 
 
--     Update website and issue public announcements as 
necessary. 
 
--     Consider prophylactic treatment with Tamiflu for staff 
required to be in direct contact with potentially infected 
persons. 
 
--     Assist in evacuation of private American nationals. 
(Note:  Significant evacuation from Nicaragua may not be 
feasible for a variety of reasons, including the potential 
and added risk of acquiring influenza at crowded airports or 
on international flights during a true pandemic, travel 
restrictions and possible quarantine measures.  A complete 
evacuation of all Mission personnel and closure of Embassy 
Managua would be determined at a later stage in an AI 
pandemic.) 
 
7)  These preparedness measures include early contingency 
planning as of December 2005.  The characteristics of a 
human-to-human outbreak will of necessity change some of the 
details for both "shelter in place" and a possible drawdown 
of personnel.  The Emergency Action Committee will include an 
avian influenza item on its agendas as needed to evaluate the 
threat and report the disease's progress on other continents. 
 
 
TRIVELLI