VZCZCXYZ0009
PP RUEHWEB

DE RUEHNR #1257/01 1741110
ZNR UUUUU ZZH
P 231110Z JUN 09
FM AMEMBASSY NAIROBI
TO SECSTATE WASHDC PRIORITY 9942

UNCLAS NAIROBI 001257 
 
SIPDIS 
 
E.O. 12958:  N/A 
TAGS: KFLU ASEC AMGT CASC KE
SUBJECT:  Pandemic Influenza Task Force/EAC Reviews Pandemic 
Influenza Tripwires and Mission Response 
 
Ref:  A. Nairobi 985 
 
¶1. (U) Summary.  In light of June 11 decision by WHO to raise the 
global pandemic alert to Phase 6, Nairobi's Pandemic Influenza 
Preparedness Task Force/EAC, on June 16, reviewed its pandemic 
influenza tripwires and response.  Given that the H1N1 strain is 
proving, thus far, to be less virulent than initially anticipated 
and that, thus far, there are no cases of human-to-human 
transmission in Kenya, the Task Force decided to re-issue previously 
circulated information on preventing, diagnosing and treating the 
H1N1 virus.  This information will be circulated to all Embassy 
personnel as well as the non-official community.  The Embassy's 
Internet website contains a link to CDC's authoritative public 
health guidance.  Post will continue to monitor the situation on the 
prudent assumption that there will eventually be an H1N1 outbreak in 
sub-Saharan Africa, including Kenya. Post also reviewed its stocks 
of tamiflu and determined that we have sufficient stocks for all 
official American staff and their dependents and for FSN staff. 
End Summary. 
 
¶2. Background:   On June 11, the WHO announced its decision to raise 
the pandemic influenza global alert to phase 6.  This designation is 
based on geographic spread of the illness, not on the severity of 
the illness.  As of June 16, the WHO had reported 29,669 cases, 
including 145 deaths, in 74 countries. From the initial outbreak in 
North America, the novel H1N1 influenza A virus has spread to 
multiple continents. Most recently widespread outbreaks were 
reported in the Southern Hemisphere -- Australia and Chile. Although 
the virus continues to spread, the disease continues to be a "mild" 
one for the most part. 
 
¶3. In Africa, Egypt is the only country that has reported cases of 
novel H1N1 virus. No cases have been reported in Sub-Saharan Africa. 
This may be the result of the lack of surveillance for influenza in 
many countries in Sub-Saharan Africa. Kenya and South Africa are two 
exceptions. Laboratories in Kenya have tested a total of 21 cases, 
including suspected cases from Seychelles and Tanzania. South Africa 
has an extensive sentinel surveillance system for influenza in 
place; the country has been testing many samples for seasonal 
surveillance, and a number of suspected H1N1 cases. All cases in 
Kenya and South Africa have tested negative. 
 
¶4. With the beginning of the "winter" season in Kenya (June-August), 
we can assume that eventually the virus will reach Kenya, together 
with "seasonal influenza."  The Task Force/EAC, therefore, is 
operating under the assumption that it is a question of "when" not 
"if" we are faced with a pandemic. 
 
¶5. Government of Kenya Preparedness and Response:  In Kenya, two 
laboratories - the National Influenza Center, which is part of the 
Kenya Medical Research Institute and partly staffed and equipped by 
USAMRU-Kenya, and the CDC-Kenya International Emerging Infections 
Laboratory, are able to test for the novel H1N1 virus. The Kenyan 
Ministry of Public Health and Sanitation (MoPHS) has taken steps to 
better prepare the country for the pandemic, including convening two 
meetings of the national pandemic task force, and holding 
subcommittee meetings to develop case definitions, case management 
guidelines, and infection control recommendations for clinicians. 
Kenya recently received a supply of 50,000 treatment courses of 
tamiflu from WHO; the medications are currently being stored in 
Nairobi. Airport screening has been ongoing, although the approach 
may not be capturing all incoming travelers. 
 
¶6. Nairobi at Tripwire Three (ref B, para 10): Tripwire Three 
addresses a situation where WHO announces phase 6 and "a pandemic 
influenza outbreak with human-to-human transmission in the host 
country has been confirmed."  The Task Force/EAC discussed whether 
we had crossed this tripwire; while the pandemic, with 
human-to-human transmission, was declared by WHO to be at phase 6, 
there still has not been confirmation of the novel H1N1 pandemic 
influenza virus in Kenya.  Nevertheless, the group decided that with 
the worldwide pandemic being official and the likely inevitability 
of the novel virus being introduced to Kenya, we should consider 
that tripwire three has been crossed. 
 
¶7. Social distancing policies were considered.  According to CDC's 
Pandemic Severity Index, the current pandemic falls in category 2, 
where most social distancing measures are discouraged. The task 
force reviewed the appropriate social distancing measures for a 
category 2 pandemic. 
 
¶8. The Task Force/EAC reviewed host country quarantine information; 
the Government of Kenya currently does not have an official policy 
on quarantine for pandemic influenza. The proposal to restrict 
travel because of the current pandemic was rejected because of the 
moderate character of the pandemic; currently the WHO and the US 
Government have discouraged restriction of travel. 
 
¶9. A decision was made to put out another management notice, along 
with an announcement in The Roar and a Warden Message, explaining 
the implications of WHO's phase six declaration, and reviewing 
recommendations on appropriate infection control precautions and 
social distancing measures. 
 
 
¶10. During the meeting the Task Force/EAC reviewed the action points 
raised in tripwire one and two, as well as those in tripwire three 
and four: 
 
¶11. Tripwire One:  A management notice had been sent out following 
the February 2009 Task Force meeting which addressed issues of 
emergency supplies in the community. The EAC had also reviewed 
supplies of food, water and antivirals, as well as internal and 
external communications. Post has enough tamiflu for all official 
American staff and their dependents and for FSN staff.  (Note:  Per 
standing guidance from Washington, we are not in a position to 
administer tamiflu to dependents of FSNs.  End Note). The warden 
system, F-77 documents, and post's internet link to CDC's website 
are routinely updated.  In addition, CDC-Kenya and USAMRU-Kenya have 
routinely liaised with the host government about pandemic 
preparedness and response issues. [MK1] 
 
¶12. Tripwire Two:  This tripwire was crossed in May.  A town hall 
meeting was held, with participation from the medical unit and CDC. 
Personnel lists were updated. 
 
¶13. Review of Tripwire Four:  Tripwire Four  addresses a pandemic 
situation where it is difficult to get seats on flights. The Task 
Force/EAC concluded that this situation seems extremely unlikely 
during the current pandemic, although if the pandemic were to become 
more severe, such a situation may become a possibility. 
 
¶14. Post will continue to monitor the situation and review its 
tripwires. 
 
Ranneberger