VZCZCXRO5781
RR RUEHAST RUEHDH RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD RUEHSL RUEHTM
RUEHTRO
DE RUEHRO #1004/01 2440815
ZNR UUUUU ZZH
R 010815Z SEP 09
FM AMEMBASSY ROME
TO RUEHC/SECSTATE WASHDC 2599
INFO RUEHFL/AMCONSUL FLORENCE 3771
RUEHNP/AMCONSUL NAPLES 3980
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHRC/USDA FAS WASHDC 4640
RUEHRC/USDA WASHDC
RUEAUSA/HHS WASHDC
RUEKJCS/SECDEF WASHDC

UNCLAS SECTION 01 OF 02 ROME 001004 
 
SENSITIVE 
 
SIPDIS 
 
EUR/WE FOR HARTMANN 
EUR/PGI FOR OSTFIELD AND PARKER-BURNS 
OES/IHB FOR BOGGESS 
STATE PASS TO 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 IT
SUBJECT:  ITALY H1N1 UPDATE:  1800 CONFIRMED CASES, NO DEATHS 
 
ROME 00001004  001.2 OF 002 
 
 
¶1. (SBU) SUMMARY:  The number of confirmed A(H1N1) infections in 
Italy reached the total of 1800 as of August 26.  So far, only a few 
hospital admissions and no deaths are reported.  However, a 
24-year-old man is currently in an intensive care unit; his case 
strengthened calls for a nation-wide delay in the return to school, 
but the GOI has said school closures will be considered on a 
school-by-school basis.  Budget constraints may be limiting the 
GOI's purchases of antiviral medication.  The GOI is planning to 
vaccinate 40 percent of the population.  END SUMMARY. 
 
¶2. (U) According to an August 26 Labor, Social Policies and Health 
Ministry press release, the total number of confirmed A(H1N1) 
infections in Italy is now 1800, with no deaths reported.  On August 
30, the press reported the first severe case in Italy: a 24-year-old 
man, without a history of international travel, was admitted to an 
intensive care unit suffering from pulmonary distress.  His clinical 
condition is still severe but doctors have stated that "he is 
improving."  A Labor/Health Ministry graph dated August 11 shows 
that 50 percent of cases have been among the 10-to-19-year-old 
population.  According to the Ministry, "a very limited" number of 
confirmed infections in Italy have resulted from domestic 
transmission; the majority were caused by international travel 
(mainly in the U.K., U.S. and Spain). 
 
¶3. (U) According to press reports, the Italian Pediatricians' 
Federation has called for the opening of schools to be postponed, 
but Education, Universities and Research Minister Gelmini has stated 
that schools will open as planned.  Italian health authorities also 
have stated that this would be an overreaction at this time; they 
will examine the possibility of school closings case-by-case over 
the course of the fall.  Health authorities have stressed instead 
the importance of an effective medical surveillance network, to 
identify and treat cases as soon as possible. 
 
¶4. (U) On July 22, the Labor/Health Ministry distributed a circular 
letter to health care providers providing new instructions on 
antiviral therapy, following World Health Organization (WHO) 
guidelines.  The Ministry called for "a rational use of antivirals", 
in order to save drugs for an "unexpected outbreak of a more severe 
pandemic."  According to the circular, antivirals should be 
administered only when the clinical presentation is severe or 
progressive, or to "the at-risk" population (e.g. infants and 
children under five years of age, the elderly (over 65 years of 
age), pregnant women, patients with chronic co-morbid conditions 
such as cardiovascular, respiratory or liver disease, diabetes, and 
those with immunosuppression related to malignancy, HIV infection or 
other diseases). 
 
¶5. (U) On July 24, the Labor/Health Ministry distributed a circular 
letter providing new instructions for prevention and surveillance of 
A(H1N1) cases.  Due to the rapid increase of cases, the lab virus 
confirmation for suspected cases is no longer compulsory, the 
circular states.  Instead, it should be reserved for severe 
hospitalized cases and in case of domestic transmission (e.g. with 
no history of international travel or of contact with confirmed 
cases).  Currently the diagnosis is just based on clinical symptoms, 
not on lab tests. 
 
¶6.  (SBU) NOTE: During a conversation with a representative from the 
pharmaceutical company which produces Tamiflu, the U.S. Consulate in 
Milan was told that the Italian Labor/Health Ministry did not buy 
enough drug stocks, due to budget constraints.  According to this 
source, Italy does not have enough Tamiflu (Oseltamivir) to even 
cover 20 percent of the population.  Post does not have information 
about the amount of Relenza (Zanamivir), the other antiviral drug 
recommended for use in treating severe A(H1N1), that the Italian 
Government may have purchased.  (While cases of resistance to 
Tamiflu have been documented in other countries, no cases of 
resistance to Relenza have yet been reported.)  According to the 
GOI's 2005 pandemic influenza plan, the national government is 
responsible for buying antivirals for 10 percent of the population, 
and the regional health authorities are responsible for buying 
antivirals to cover another 10 percent of the population.  Purchases 
may increase to cover a total of 30 percent of the population if 
that proves necessary. END NOTE. 
 
 
ROME 00001004  002.2 OF 002 
 
 
¶7. (U) Italian health authorities plan to vaccinate 40 percent of 
the population against A(H1N1) flu this year, according to a press 
statement released on August 26.  The vaccinations will take place 
in two tranches.  The first, "likely" to begin in mid-November, will 
include 8.5 million doses and will be aimed at at-risk groups and 
medical and other critical service providers (e.g. police and 
telecommunications workers).   The second, to include 16 million 
doses, will begin "during the first months of 2010" and will be 
aimed at children and young adults 2-27 years of age.  The vaccine 
will be voluntary and not be available in pharmacies, but will be 
distributed free of charge by family doctors and in public health 
institutions.  NOTE:  In 2005 the GOI purchased from drug companies, 
for about 5.5 million euros, pre-emption rights to obtain at least 
35 million doses of anti-pandemic-influenza vaccine.  Under the 
provisions of the contracts, which were signed after the outbreak of 
the H5N1 (Avian) flu in 2005, the vaccines will be available within 
three months following the WHO declaration of a pandemic.  The 
pre-emption rights are good for five years, and thus will expire in 
about September 2010.  END NOTE. 
 
THORNE