VZCZCXRO4493
RR RUEHROV
DE RUEHNR #0985/01 1341446
ZNR UUUUU ZZH
R 141446Z MAY 09
FM AMEMBASSY NAIROBI
TO RUEHC/SECSTATE WASHDC 9537
RUCNIAD/IGAD COLLECTIVE

UNCLAS SECTION 01 OF 02 NAIROBI 000985 
 
DEPT FOR AF/E Driano, Please pass to CDC Atlanta 
 
SIPDIS 
 
E.O. 12958:N/A 
TAGS: PGOV PREL KE
SUBJECT:  USG Influenza Surveillance, Preparedness, and Response in 
Kenya and East Africa 
 
UNCLASSIFIED - ENTIRE TEXT. 
 
 
¶1. SUMMARY: Most Sub-Saharan African countries including Kenya have 
lacked proper laboratories and public health infrastructure to 
conduct influenza surveillance in support of outbreak response.  In 
2006, CDC - Kenya, and the US Army Medical Research Unit - Kenya 
(USAMRU-K) initiated a collaborative project with the Kenya Ministry 
of Public Health and Sanitation (MoPHS) and the Kenya Medical 
Research Institute (KEMRI) to conduct influenza surveillance in 
Kenya.  As a result of these new surveillance systems, Kenya leads 
the continent in the ability to detect and respond to the current 
outbreak of H1N1 Flu. Although to date the virus has not been 
identified in Kenya, this cable outlines our interagency programs at 
post relevant to the detection and treatment of pandemic influenza 
should it spread to the region. END SUMMARY. 
 
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Influenza Surveillance and Response Activities 
-------------- 
 
¶2. CDC-Kenya supports in three surveillance systems for influenza in 
Kenya. In addition, USAMRU-K supports an expansive human sentinel 
influenza surveillance system and gives significant technical and 
financial support to the Kenya National Influenza Centre -- the 
national influenza reference laboratory.  All USG-funded 
surveillance work has built capacity and the knowledge base within 
the Kenya public health community, which is essential for them to 
respond successfully to the threat of 2009 influenza A (H1N1) virus. 
These surveillance systems have been and will continue to be a 
critical way to monitor the potential introduction of influenza A 
(H1N1) virus into Kenya and the region, especially now at the 
beginning of the annual influenza season in Kenya and the southern 
hemisphere. 
 
-------------- 
National Sentinel Surveillance for Influenza 
-------------- 
 
¶3. CDC-K, together with the Kenyan Ministry of Public Health and 
Sanitation (MoPHS), operates a sentinel surveillance system for 
influenza at 10 sites in Kenya - seven provincial hospitals, two 
refugee camp hospitals and the national referral hospital in 
Nairobi. Surveillance officers are stationed at all 10 sites, and 
take samples from patients who present to the hospitals with acute 
respiratory illness. Samples are tested at two laboratories: the 
National Influenza Center, a KEMRI laboratory jointly equipped and 
staffed by CDC, USAMRU-Kenya, and KEMRI; and the CDC-Kenya 
International Emerging Infections Program laboratory at CDC-Kenya. 
Since national sentinel surveillance was initiated in October 2006, 
over 13,000 samples have been tested. 
 
-------------- 
DoD sponsored Human Influenza Sentinel Surveillance System 
-------------- 
 
¶4. USAMRU-K has developed a complementary sentinel surveillance 
system for ILI.  Cases are identified through their geographically 
diverse surveillance site network of eight District Hospitals within 
Kenya.  Specimen collection has been ongoing since July 2006. 
Nasopharyngeal samples are taken from Kenyan volunteers who present 
to the participating health facilities with acute upper respiratory 
symptoms.  Samples are tested at the National Influenza Center in 
Nairobi. To date, nearly 8,000 specimens have been tested. 
 
-------------- 
Population-Based Surveillance for Influenza 
-------------- 
 
¶5. The CDC operates population-based surveillance for a number of 
diseases at two sites in Kenya --- Kibera, a dense informal urban 
settlement in Nairobi, and Lwak, a rural area in Western Kenya. In 
Kibera and Lwak, households are visited every two weeks by community 
interviewers who ask about illnesses in the home, and collect data 
on illnesses and health care seeking practices. The surveillance 
population in Kibera is 28,000, and there are 25,000 people in Lwak. 
 In both sites, field workers go to each household every two weeks 
recording illnesses and deaths. Participants within the surveillance 
system are allowed free access to the field clinic for any acute 
medical condition Samples from patients with acute respiratory 
illnesses are collected daily. To date, no patients with influenza A 
(H1N1) have been identified in either of the tw population-based 
sites. 
 
-------------- 
Laboratory Support at the Kenya National Influenza Center (NIC) by 
USAMRU-K 
-------------- 
 
 
NAIROBI 00000985  002 OF 002 
 
 
¶6. Though in existence prior to DoD involvement, USAMRU-K has 
greatly enhanced the capacity of the Kenya NIC to serve Kenya in the 
diagnosis of influenza infections.  All activities are conducted in 
close consultation and with KEMRI leadership and results are jointly 
reported.  All influenza diagnostic work is done by a joint team of 
KEMRI, USAMRU-K, and CDC staff with USAMRU-K providing quality 
assurance and safety guidance to ensure that the Kenya NIC meets 
international standards.  Since 2006, USAMRU-K has invested over $2 
million in laboratory equipment purchases and two major 
refurbishments which have doubled the size of the NIC.  CDC-Kenya 
also supports the NIC with laboratory equipment purchases in 
conjunction with USAMRU-K.  The NIC now has the capacity to reliably 
diagnose influenza within hours with a number of modern laboratory 
techniques. 
 
-------------- 
CDC Laboratory Diagnostics in Nairobi 
-------------- 
 
¶7. The Biosafety Level 3 CDC-IEIP Laboratory located on the KEMRI 
main campus, Nairobi, Kenya provides invaluable surge capacity in 
the event of a larger outbreak.  Also, the CDC laboratory 
cross-pollinates with the NIC staff by lending manpower, supplies, 
and expertise. 
 
-------------- 
Regional Sentinel Surveillance 
-------------- 
 
¶8. CDC-Kenya has provided technical epidemiologic and laboratory 
support to help establish influenza sentinel surveillance in at 
least 10 countries in Africa. CDC-Kenya has sent epidemiologists and 
laboratorians to Ethiopia, Rwanda, Tanzania, Uganda, Democratic 
Republic of Congo, and Nigeria, and has trained epidemiologists, 
clinicians, and laboratorians in a number of other countries on 
issues related to influenza surveillance. 
 
¶9. USAMRU-K through its Global Emerging Infections System (GEIS) 
Program is developing and supporting surveillance programs in 
Uganda, Cameroon, Tanzania, and the Seychelles.  Great effort is 
made to coordinate these regional activities with the CDC presence 
there to the benefit of the host nations. 
 
-------------- 
Outbreak Response 
-------------- 
 
¶10. CDC-Kenya and USAMRU-K have been closely involved in the 
national and regional response to the 2009 influenza A (H1N1) 
worldwide outbreak. CDC-Kenya and USAMRU-K epidemiologists have 
helped the GoK to develop case definitions for possible cases in 
Kenya and reporting cases forms for Kenyan clinicians, and 
communications messages for the public. The CDC-Kenya IEIP 
laboratory tested all specimens from persons under investigation for 
the first week of the activity. CDC-Kenya expects to get the 
specific H1N1 diagnostic assays from CDC-Atlanta this week, at which 
point Kenya will have full H1N1 testing in country. 
 
¶11. CDC-Kenya has also helped coordinate the African regional 
response, working with partners at the African Regional Office of 
WHO, WHO-Geneva, and CDC-Atlanta, and working with countries 
throughout the continent. Likewise the USAMRU-K is coordinating 
preparedness and response initiatives with public health colleagues 
in Uganda, Cameroon, Tanzania, and the Seychelles. 
 
-------------- 
USG Interagency Cooperation and Response 
-------------- 
 
¶12. The CDC-Kenya Influenza Program Director has lead the US Embassy 
Pandemic Task Force in Kenya, which met on April 28 to discuss the 
US Embassy response to the H1N1 outbreak and the implications for US 
mission employees and their families, Foreign Service Nationals, and 
US citizens living in Kenya. The meeting led to a meeting of the 
EAC, where pandemic tripwires were further discussed, and a town 
hall meeting at the US embassy earlier this week. 
 
 
RANNEBERGER