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

UNCLAS  ALMATY 000001 
 
SIPDIS 
 
 
SENSITIVE BUT UNCLASSIFIED 
 
FOR S/ES-O/CMS, EUR/CACEN (JMUDGE) 
 
E.O. 12958: N/A 
TAGS: 
SUBJECT:  AVIAN INFLUENZA TRIPWIRES 
 
REF:  STATE 219189 
 
¶1. (SBU) Summary: The Embassy Almaty Emergency Action 
Committee Pandemic Influenza (PI) Subcommittee has met to 
develop tripwires and responses per Action Request in 
Reftel.  Participants in the PI Subcommittee include the 
DCM and representatives from MED, CDC, ADM, CON, RSO, 
USAID, PEACE CORPS, PAS AND DAO. 
 
¶2. (SBU) Introduction: 
 
-Host country medical facilities in the event of an 
outbreak: For the purpose of planning for pandemic 
influenza, post considers that Kazakhstan's medical 
treatment facilities will not be available for use by 
official Americans.  This is due to anticipated heavy use 
by host country citizens affected by the pandemic and a 
standard of care in local facilities that falls so far 
below that of the USA that its use should not be 
considered. 
 
-General assessment of host country's public health 
system's ability to respond to an AI/PI outbreak: The KZ 
medical, veterinary and wildlife sectors are capable of 
detecting suspected  disease based upon clinical signs and 
history. However, the medical sector is not capable of 
detecting a new strain of influenza by laboratory testing. 
Current diagnostic procedures and equipment can detect 
cases of influenza, but cannot differentiate particular 
strains. Many of the GOK Ministries, including 
Agriculture, Education and Science, and Health have 
polymerase chain reaction (PCR) equipment; but PCR tests 
specific to H5N1 are not yet approved by FDA or USDA (or 
Kazakh entities) for diagnosis of disease in people or 
animals. During the poultry outbreak in August 2005 
(Golubovka village in Pavlodar oblast), the Kazak 
Scientific Research Agricultural Institute in Otar 
provided animal specimens; the Republican Sanitary 
Epidemiological Service provided human specimens of 
possible exposed individuals to the NAMRU-3 laboratory in 
Cairo.  CDC collected 175 specimens from individuals in 
the village where H5N1 was identified.  These specimens 
were subsequently sent to CDC in Atlanta through an 
agreement with the Government of Kazakhstan. 
 
-Post's ability to shelter in place: Post has addressed 
all items listed in REF, para 8 in preparing for pandemic 
influenza.  As such, post has determined that it can 
shelter in place for a period of two to four weeks. 
 
¶3. (SBU) Tripwires and responses: 
 
Tripwire 1: Spike in number and broadening geographic 
spread of animal-to-human transmission cases in 
Kazakhstan. 
 
     Actions: 
  a.   EAC Pandemic Influenza Subcommittee convenes to 
     confirm that the tripwire has been crossed. 
b.   Release warning announcement to Mission personnel and 
warden message to American citizens. 
  c.   Restrict mission personnel from  travel to affected 
     geographic regions. 
  d.   Have evacuation plans for  both the well and ill. 
e.   Prepare talking points for domestic and international 
press. 
  f.   Provide detailed briefing to Embassy/Consulate staff. 
  g.   Communicate pertinent information to the embassy 
     community by way of venues such as town hall meetings, the 
     embassy web site and newsletter articles. 
 
Tripwire 2: Confirmed, sustained human-to-human 
transmission anywhere in the world indicating a mutation 
in the virus.  This is particularly significant if there 
are multiple, geographically diverse clusters, or if a 
cluster occurs in a major transit hub. 
 
     Actions: 
  a.   EAC Pandemic Influenza Subcommittee convenes to 
    confirm that the tripwire has been crossed. 
  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. 
    This will be monitored by the Health Unit. 
  d.   Issue public announcement to the American community. 
  e.   Prepare talking points for domestic and international 
    press. 
f.   Department of State makes public announcement 
regarding risks of travel to the region. 
  g.   Restrict official and unofficial travel to affected 
    countries or areas. 
 
 
Tripwire 3:  Sustained human-to-human transmission in 
Kazakhstan.  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. 
 
     Actions: 
  a.   EAC Pandemic Influenza Subcommittee convenes to 
    confirm that the tripwire has been crossed. 
b.   Provide Mission briefings for American and LES staff 
and dependents, by email or telephone. 
  c.   Consular section to reduce operations to emergency 
    services only. 
  d.   Coordinate with CA/OCS on issuance of guidance 
    (public announcement or travel warning) urging American 
    citizens to defer all non-emergency travel to Kazakhstan. 
  e.   Consider authorized or ordered departure at the 
    discretion of the Chief of Mission and the EAC  Implement 
    administrative leave for non-emergency FSNs. 
  f.   If AD/OD is not permissible, instruct all non- 
    emergency American and LES staff to remain at home on 
    administrative leave. 
  g.   Mandatory sick leave for any employee who shows any 
    flu symptoms or has a family member with flu symptoms. 
    This will be monitored by the Health Unit. 
  h.   Consider home quarantine of any staff and dependents 
    who have been in contact with a person confirmed to have 
    pandemic influenza infection and implement home 
    monitoring. 
  i.   Limit venues of human to human contact (implement 
    social distancing), such as school closures and the 
    cancellation of community gatherings. 
j.   Consider delivery of groceries and other essentials 
to quarantined residences. 
  k.   Strong statement and enforcement that ill employees 
    must not come to work. 
  l.   Divide MSG detachment into two separate and 
    independently quartered entities to help ensure continued 
    perimeter security and safeguarding of  classified 
    materials. 
  m.   Plan for home visits to sick individuals who receive 
    care under the Embassy Health Unit. 
  n.   Restrict visitor access to Mission facilities. 
    Screening to consist of posters and written questionnaires 
    that deny entry to visitors with symptoms of influenza. 
  o.   Public announcement to the American community.  In 
    coordination with the department, prepare talking points 
    for domestic and international press. 
  p.   Mission personnel restricted to essential in-country 
    travel only. 
  q.   Deny country clearance for international visitors, 
    unless specifically cleared by the COM. 
r.   Post will make provisions for sheltering in place for 
official visitors stranded at post. 
 
Alternative Tripwire:  A Mission employee or eligible 
family member develops Avian Influenza, in the absence of 
a broader outbreak per tripwires 1, 2, or 3 above. 
 
     Actions: 
     a. Treat the victim.  Medevac if possible. 
     b. Disinfect victim's place of work. 
     c. Administer oseltamivir (Tamiflu) to close 
     contacts. 
 
 
ORDWAY 
 
 
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