VZCZCXRO2274
PP RUEHAST RUEHBI RUEHCI RUEHDBU RUEHLH RUEHNEH RUEHPW
DE RUEHKA #0844/01 2390955
ZNR UUUUU ZZH
P 270955Z AUG 09
FM AMEMBASSY DHAKA
TO RUEHC/SECSTATE WASHDC PRIORITY 9373
INFO RUCNCLS/ALL SOUTH AND CENTRAL ASIA COLLECTIVE PRIORITY
RUEHPH/CDC ATLANTA GA USA PRIORITY
RUEHRC/DEPT OF AGRICULTURE WASHDC
RUEHBJ/AMEMBASSY BEIJING 0687
RUCPDOC/DEPT OF COMMERCE WASHDC

UNCLAS SECTION 01 OF 02 DHAKA 000844 
 
STATE FOR M/PRI FOR RMORRITZ 
STATE FOR SCA/INSB, SCA/PPD 
STATE FOR S/ES-O/CMS FOR EPARRA 
STATE FOR OES/AIAG FOR AMBASSADOR LOFTIS, HELEN REED ROWE, AND 
CRAIG SHAPIRO 
STATE FOR OES/IHB, AAIT, MED 
HHS FOR OGHA STEIGER AND HICKEY 
CDC ATLANTA FOR CCID AND COGH 
USDA FOR APHIS 
 
SENSITIVE 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: KFLU TBIO PINR EAGR AMED CASC PGOV BG
SUBJECT: BANGLADESH H1N1 CASES INCREASING 
 
REF A: DHAKA 621 B: STATE 82155   C: STATE 85141 
 
SUMMARY 
------- 
 
¶1. (SBU) The number of H1N1 cases in Bangladesh is on the rise, with 
117 total confirmed cases by August 26 and early evidence of 
in-country community-level transmission.  Government actions to date 
seem appropriate.  The local press reported the spread of H1N1 and 
two private schools closed temporarily.  The Government of 
Bangladesh (GOB) is preparing a public information campaign, 
reviewing preparedness of public health facilities and considering 
raising its internal alert level.  Despite two Dhaka school 
closures, the GOB currently advises schools to remain open.  The 
main school serving U.S. Mission dependents remains open in 
accordance with CDC guidance, after officials confirmed one student 
(not a U.S. Mission EFM) had H1N1.  Mission Dhaka convened the 
Pandemic Influenza Working Group to review mission preparedness and 
issued updated internal and warden messages on H1N1. 
 
H1N1 SPREADS BEYOND TRAVELERS 
----------------------------- 
 
¶2. (SBU) The Ministry of Health confirmed 117 H1N1 cases by August 
26, up from the handful of cases first reported at the end of June 
(Ref A).  Scientists from the U.S. Centers for Disease Control (CDC) 
based in Bangladesh reported early evidence of in-country 
community-level transmission after surveillance in the Kamalpur 
community near Dhaka confirmed several H1N1 cases in patients who 
had no contact with recent travelers.  Since early August, cases 
have spread from the Dhaka region to ten districts around the 
country.  CDC reported there were no confirmed fatalities, though 
two suspected H1N1-related deaths could not be confirmed because 
doctors could not test the patients prior to the deaths and 
subsequent burials.  According to CDC, the low number of confirmed 
H1N1 cases in Bangladesh compared to neighboring countries is due 
largely to capacity limitations in testing and surveillance. 
Although the sample size currently is too small to precisely 
estimate H1N1 infection rates, surveillance results from Kamalpur 
suggest there were already thousands of H1N1 cases in this community 
by early August. 
 
¶3.  (U) Local media have publicized the rising case count and the 
closure of two private schools in Dhaka after H1N1 cases were 
confirmed in several students.  The American International School of 
Dhaka (AIS/D), the main school serving U.S. Mission children, 
informed parents August 23 that one student (not a Mission EFM) was 
diagnosed with a confirmed case of H1N1.  Citing CDC and GOB 
guidance, the school has remained open while urging parents to keep 
sick children home. 
 
GOB RESPONSE 
------------ 
 
¶4. (U) At an August 16 cabinet meeting, Prime Minister Sheikh Hasina 
directed the Ministry of Health (MOH) to coordinate pandemic flu 
preparedness with other Ministries.  The Minister of Health convened 
a meeting August 20 with representatives of the Ministry of Public 
Information, as well as UNICEF, WHO, and CDC advisors to coordinate 
pandemic flu preparedness.  At this meeting, CDC advisors relayed 
ref C information and discussed current CDC guidelines for schools 
and pandemic preparedness.  GOB officials agreed to coordinate 
dissemination of risk communication messages to the general public, 
schools, and the media.  In addition, Ministry of Health officials 
committed to preparing local hospitals for an increase in severe 
influenza cases; reviewing triaging, treatment and infection control 
guidelines; and mobilizing stockpiles of antivirals and personal 
protective equipment. 
 
¶5. (U) According to media reports, Bangladeshi delegates at an 
August 23-24 global pandemic flu conference in China pressed flu 
vaccine makers to donate vaccines to Bangladesh.  The companies had 
already pledged to produce and donate 150 million vaccines to the 
WHO for developing countries.  The MOH also has asked USAID to 
donate 2 million surgical masks.  MOH officials anticipate having 
sufficient oseltamivir (also known as Tamiflu) to treat severe cases 
and are exploring ways to urge local manufacturers to increase the 
supply to treat ambulatory patients at high risk of complications 
 
DHAKA 00000844  002 OF 002 
 
 
(e.g. pregnant women and those with diabetes or cardiovascular 
disease). 
 
MISSION ACTIONS 
--------------- 
 
¶6. (SBU) The U.S. mission convened its Pandemic Influenza Working 
Group to review tripwires and mission preparedness. Following 
consultation with MOH contacts, the management and consular sections 
updated internal and warden messages with information on H1N1 and 
reminders of preventive measures.  The working group will continue 
to review avian flu tripwires to adapt them to the less severe 
scenarios of an H1N1 pandemic.  Through its existing relationship 
with the International Centre for Diarrhoeal Disease Research, 
Bangladesh (ICDDR,B), CDC has consulted regularly with GOB 
counterparts to track the spread of H1N1 and coordinate preparedness 
for the upcoming flu season. 
 
COMMENT 
------- 
 
¶7. (SBU) The GOB and MOH appear to be taking appropriate steps to 
disseminate public information and review preparedness measures in 
advance of the upcoming flu season.  They are also maintaining sound 
guidelines against public school closures, though they may face 
increasing pressure to close schools and limit public gatherings as 
the case count rises and fatalities are reported, which is likely 
during the upcoming autumn flu season.  CDC and USAID will continue 
their regular consultations with MOH counterparts to support 
pandemic flu preparedness measures and encourage sound guidelines. 
Mission Dhaka's Pandemic Influenza Working Group will continue to 
meet regularly and monitor the situation. 
 
MORIARTY