VZCZCXRO1755
PP RUEHCD RUEHGD RUEHHO RUEHNG RUEHNL RUEHRD RUEHRS RUEHTM
DE RUEHMC #0434/01 3221833
ZNR UUUUU ZZH
P 181833Z NOV 09
FM AMCONSUL MONTERREY
TO RUEHC/SECSTATE WASHDC PRIORITY 4120
INFO RUEHME/AMEMBASSY MEXICO PRIORITY 5205
RUEHXC/ALL US CONSULATES IN MEXICO COLLECTIVE
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHPH/CDC ATLANTA GA PRIORITY 0003
RUEHMC/AMCONSUL MONTERREY 9744

UNCLAS SECTION 01 OF 02 MONTERREY 000434 
 
SENSITIVE 
SIPDIS 
 
STATE PASS OES/IHB 
 
E.O. 12958: N/A 
TAGS: PGOV SOCI CASC ECON MX
SUBJECT: NUEVO LEON PROJECTS INCREASE IN H1N1 CASES 
 
REF: MONTERREY 178; MONTERREY 397 
 
MONTERREY 00000434  001.2 OF 002 
 
 
¶1.  (SBU) Summary:  Nuevo Leon Health officials are preparing 
for a sharp increase in H1N1 cases over the winter months that 
could be as high as 300%.  However, state government stocks of 
antiviral medication remain low and, in some private pharmacies, 
unavailable.  The state has yet to receive a supply of H1N1 
vaccinations and its priority list for them does not target 
those most at risk of contracting the disease.  End summary. 
 
 
 
State Preparing for Precipitous Rise in H1N1 Infections 
 
--------------------------------------------- ---------- 
 
 
 
¶2.  (SBU) On November 6, Dr. Nemecio Lopez Vargas, Under 
Secretary of Disease Control and Prevention at the Nuevo Leon 
Secretariat of Health, told EconOffs that his state was 
preparing for an increase of "up to 300 percent" in H1N1 cases 
during the winter months.  Of Mexico's 61,633 confirmed H1N1 
cases (as of 11/11), 3,582 have been in Nuevo Leon, resulting in 
46 deaths (as of 11/13) and 83 hospitalizations.  Of the state's 
51 municipalities, 34 have reported H1N1 cases.  Lopez cautioned 
that the number of actual H1N1 cases was probably much higher 
since state health authorities only count those with severe 
complications for infection.  (Comment:  Nuevo Leon, with around 
3.8% of Mexico's population has accounted for about 9.5% of the 
country's recorded H1N1 fatalities.  However, this could be a 
reflection of better disease monitoring systems in the 
relatively prosperous state.  End comment.) 
 
 
 
Sufficient Antivirals - For Now 
 
------------------------------- 
 
 
 
¶3.  (SBU) Lopez explained that, while many private pharmacies 
are currently out of antiviral medication, Nuevo Leon's public 
hospitals still had wide availability of the drugs.  The state 
hospitals were filling prescriptions for private patients who 
could not otherwise find these medications through local 
pharmacies. 
 
 
 
¶4.  (SBU) However, he held out the possibility of shortages of 
the drug if infections increase, explaining that pharmaceutical 
companies would not be able to supply enough antiviral 
medication to meet a large demand surge.  (Note:  The state 
currently has a shortage of children's liquid Tamiflu dosages - 
pharmacists are crushing the adult tablets to formulate an oral 
suspension suitable for children.  End note.)  Since April, the 
Secretariat has purchased around 36,000 antiviral treatments and 
currently has 4,000 doses remaining in its 'strategic reserve' 
with an outstanding order for 25,000 more doses, Lopez said. 
 
 
 
More Ventilators Ordered 
 
------------------------ 
 
 
 
¶5.  (SBU) Lopez recounted that the state's hospitals, most of 
which are located in Monterrey, have around 300 ventilators to 
accommodate the most severe cases.  To meet an expected rise in 
demand, the state has purchased 20 additional ventilators and 
has another 20 on order. 
 
 
 
Some Vaccines Expected in December 
 
---------------------------------- 
 
 
 
¶6.  (SBU) Lopez said Nuevo Leon should receive 700 - 800 
thousand H1N1 vaccine doses out of Mexico's total order of 30 
million (five million from Swiss pharmaceutical company Novartis 
and 25 million from the U.S. subsidy of Sanofi-Aventis).  He 
 
MONTERREY 00000434  002.2 OF 002 
 
 
expects the first vaccine shipments to arrive in mid-December. 
However, due to an expected rise in world demand, Lopez does not 
know how much the state (or Mexico) will receive in the first 
shipment.  As a result, per federal government guidelines, the 
state is prioritizing delivery to:  health care workers, 
diabetics, pregnant women, HIV/AIDS patients, those over 60 and 
children under five. 
 
 
 
Disconnect in Vaccination Priorities 
 
------------------------------------ 
 
 
 
¶7.  (SBU) Federal priorities for vaccination are at odds with 
actual H1N1 experience, Lopez explained.  He said that children 
and youths from 5 - 24 years old have accounted for around 64 
percent of H1N1 cases and have a higher mortality rate than 
other age groups.  Part of this higher susceptibility, Lopez 
noted, is because those in these age groups are usually 
concentrated together in schools, facilitating disease 
transmission.  Yet, federal authorities have, thus far, refused 
to change the vaccination priority to include these age groups, 
despite Lopez's suggestion that they do so. 
 
 
 
School Closing Policy 
 
--------------------- 
 
 
 
¶8.  (SBU) Nuevo Leon state policy calls for closing individual 
classes when two or more H1N1 cases occur in a classroom. 
Should two or more classes in any given school meet this 
criterion, the state Secretariat of Health, in coordination with 
the State Secretariat of Education, will shut down the school 
for a week.  According to Lopez, state schools have prescreeners 
stationed at each entrance to examine children for flu before 
they enter the facilities.  If a child exhibits symptoms, he/she 
is sent home.  In a worst case scenario, Lopez did not rule out 
an ordered closure of the state's 6,000 educational institutions 
until early-January (when they would be scheduled normally to 
reopen after the Christmas holiday break). 
 
 
 
Comment 
 
------- 
 
 
 
¶9.  (SBU) Nuevo Leon's health care infrastructure could be 
hard-pressed to handle a sharp rise in H1N1 cases, much less a 
worst case scenario.  Pharmacy executives have told post that 
their outlets have not been receiving supplies of anti-viral 
medications to handle even current demand.  Despite Lopez's 
assurances of drug availability at state hospitals, the state's 
current stock of 4,000 dosages looks meager should cases rise 
significantly (Nuevo Leon has a population of over 4 million), 
even with the additional supply on order.  In this scenario, 
those living outside of the Monterrey metropolitan area will 
most likely have a difficult time accessing medication and 
treatment.  Given worldwide demand for vaccines, it is probable 
that the state will wait some time before it receives sufficient 
doses to cover it's at risk population.  Even then, state 
adherence to the federal policy on vaccination priority appears 
misdirected, which could further complicate efforts to combat 
the disease. 
WILLIAMSONB