VZCZCXRO6654
RR RUEHAG RUEHAST RUEHDF RUEHDH RUEHHM RUEHLN RUEHLZ RUEHMA RUEHPB
RUEHPOD RUEHSL RUEHTM RUEHTRO
DE RUEHRL #0847/01 1950954
ZNR UUUUU ZZH
R 140954Z JUL 09
FM AMEMBASSY BERLIN
TO RUEHC/SECSTATE WASHDC 4599
INFO RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUCNFRG/FRG COLLECTIVE
RUEHLO/AMEMBASSY LONDON 0019
RUEHME/AMEMBASSY MEXICO 0375
RUEHFT/AMCONSUL FRANKFURT 8098
RUEHRC/DEPT OF AGRICULTURE USD FAS WASHINGTON DC 0139
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC
RUCNDT/USMISSION USUN NEW YORK 0793
RUEHGV/USMISSION GENEVA 1506

UNCLAS SECTION 01 OF 02 BERLIN 000847 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EUR/CE PETER SCHROEDER 
STATE FOR OES/IHB 
STATE FOR AID/GH/HIDN 
USDA PASS TO APHIS 
HHS PASS TO CDC 
HHS FOR OGHA 
 
E.O. 12958: N/A 
TAGS: TBIO KFLU ECON PREL SOCI CASC EAGR MX GM
SUBJECT: ROBERT-KOCH-INSTITUTE DESCRIBES FLU SITUATION IN 
GERMANY 
 
REF:  A) Berlin 844, B) Berlin 839 and previous. 
 
 
¶1. (SBU)  Summary.  On July 8, ECON Berlin met with officials 
from the Robert-Koch-Institute (RKI) to discuss the current 
H1N1 outbreak in Germany. RKI experts believe there could be 
ten times the number of confirmed cases (691) in Germany due 
to the often mild symptoms experienced by many of those 
infected by H1N1.  RKI officials believe that H1N1 infections 
in Germany will rise this fall in connection with seasonal 
influenza.  RKI representatives expressed concern that 
antiviral-resistant strains of H1N1 could develop that could 
strain public health responses.   End Summary 
 
 
Fall Outbreak Could Be More Serious 
----------------------------------- 
 
¶2. (SBU)  EconOff met with Prof Dr. Reinhard Burger, vice 
president of RKI and head of the Department of Infectious 
Diseases, and Dr. Brunhilde Schweiger, RKI's top virologist, 
to discuss the evolution of the H1N1 virus in Germany.  RKI 
provides the German government with information about pandemic 
situations, pandemic influenza preparedness, and response 
planning.  Burger and Schweiger agreed that there is no doubt 
that the world is facing a pandemic and both assessed that the 
numbers of confirmed cases in Germany (691) dramatically 
understates the actual extent of the pandemic.  Burger 
cautioned that the number of infections could be at a minimum 
ten times higher than the confirmed virus cases factoring in 
the mild symptoms of the virus.  Since it is so mild, many 
people often do not know they have it. 
 
 
¶3. (SBU)  RKI expects a sharp rise in the levels of H1N1 
influenza activity in the fall when it could potentially be 
much more serious as seasonal influenza cases increase.  It is 
impossible to predict the extent or severity of the H1N1 
illness this fall, only that the virus will circulate and most 
people will have no immunity, Burger indicated.  RKI's major 
concern is that the new virus could become stronger, 
circulating not only with the viruses that typically cause 
seasonal influenza but other types such as H5N1.  Burger 
mentioned that H5N1 did not disappear and that there are more 
infected animals than ever living with humans, which increases 
the risk of exchanges of virus elements.  However, RKI 
anticipates it is more likely that the new flu will circulate 
with the seasonal flu rather than with H5N1. 
 
 
Antiviral Medication and Vaccine 
-------------------------------- 
 
¶4. (SBU)  At present, there is no clear indication of a 
certain group of people that is more vulnerable to become 
infected with the new virus than other groups, RKI said.  The 
institute seemed generally dubious about the utility of 
antiviral medication such as Tamiflu or Relenza as large-scale 
solutions in Germany.  Although, considering that there are 
already Tamiflu-resistant strains, RKI sees it as the best 
available alternative before a vaccine is produced.  RKI 
indicated that a change in the form of the H1N1 virus over the 
next few months could set current investments made in the 
vaccine at risk, shifting it from a scientific issue to a 
political decision on how well prepared each federal state 
plans to be.  The responsibility for vaccination of the 
population lies in the hands of the federal states' 
governments. 
 
 
¶5. (SBU)  RKI pointed out that Germany's national pandemic 
influenza plan allows all federal states to be on the same 
preparedness level.  However, uneven financial resources among 
the states hinder them from implementing measures.  RKI seemed 
concerned that not all federal states follow its 
 
BERLIN 00000847  002 OF 002 
 
 
recommendation to stockpile 20 percent of antiviral medication 
because of budget constraints (Schleswig-Holstein currently 
has 11 percent of antivirals on stock while North Rhine- 
Westphalia can supply 30 percent of its population with 
antiviral medications). 
 
 
Laboratories testing H1N1 
------------------------- 
 
¶6. (SBU)  RKI said that Germany has over 20 laboratories that 
are able to detect and test the new flu using certain 
standards enabling findings to be entered into a database 
without prior approval by RKI.  Virological analyses are being 
performed through universities, state health authority 
laboratories, and local laboratories.  All certified 
laboratories are obliged to report findings via local health 
authorities to RKI.  RKI is in direct contact with all public 
health officials across the states to coordinate and make sure 
that there is timely reporting, ensuring that if new cases 
come up they are being track effectively. 
 
 
Coordination at International Level 
----------------------------------- 
 
¶7. (SBU)  Unlike military personnel in Germany who are 
required to report new infections of H1N1 though the German 
Ministry of Defense to RKI, non-Germans tested positive for 
the virus are not actively advised to contact their respective 
embassy, RKI indicated.  However, RKI said that a dialogue 
with foreign embassies should take place through the ministry 
of health and not through the states. 
 
 
¶8. (SBU)  RKI said it maintains a close relationship to other 
international organizations dealing with the new virus to 
ensure rapid response to the global threat.  Thus, it reports 
directly to the World Health Organization and the European 
Center for Disease Control to coordinate universal testing 
measures such as the Polymerase Chain Reaction, PCR.  RKI has 
a direct connection to the US Center for Disease Control and 
actively engages in meetings. 
 
 
POLLARD