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### Viewing cable 05MANAGUA3257, AVIAN INFLUENZA: MANAGUA CONTINGENCY PLANNING AND

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Reference ID | Created | Released | Classification | Origin
--- | --- | --- | --- | ---
05MANAGUA3257 | 2005-12-30 16:48 | 2011-08-19 20:00 | UNCLASSIFIED | Embassy Managua

`

    VZCZCXYZ0013
    RR RUEHWEB

    DE RUEHMU #3257/01 3641648
    ZNR UUUUU ZZH
    R 301648Z DEC 05
    FM AMEMBASSY MANAGUA
    TO WHA CENTRAL AMERICAN COLLECTIVE

` `

    UNCLAS SECTION 01 OF 04 MANAGUA 003257

    SIPDIS

    SIPDIS

    OES FOR DSINGER AND RDALEY; S/ES-O/CMS

    E.O. 12958: N/A
    TAGS: AMGT ASEC CASC AMED KFLO AEMRS NU
    SUBJECT: AVIAN INFLUENZA:  MANAGUA CONTINGENCY PLANNING AND
    TRIPWIRES

    REF: A. STATE 183776

         ¶B. STATE 202102
         ¶C. BANGKOK 7157
         ¶D. STATE 220047
         ¶E. MANAGUA 03077
         ¶F. STATE 219189

    1)  SUMMARY:  This telegram responds to Reftel F request for
    post Avian Influenza pandemic contingency planning
    information.  Tripwire input officers are Regional Security
    Officer Michael W. Poehlitz, Assistant Regional Security
    Officer Keenan J. Smith, and Foreign Service Health
    Practitioner Paula J. Wilson.  Tripwire reporters have
    received access instructions for the online tripwire
    application and ClassNet log-on access information in order
    to input, modify, and delete post's tripwires.  The Embassy
    Managua Emergency Action Committee (EAC) met and discussed
    tripwires and post-specific responses.  The Health Unit staff
    has inventoried personal protective equipment (PPE) and
    ordered additional supplies.  A shipment of Tamiflu is
    expected to arrive in Managua at the beginning of next year,
    in accordance with Office of Medical Services instructions in
    Reftel A.  The task force reviewed and considered
    preparedness steps outlined in Reftel F and has posted
    tripwires to trigger Embassy Managua's actions to
    mitigate/counter a future Avian Influenza pandemic condition
    or threat.  END SUMMARY.

    2)  Nicaragua-relevant resource limitations were previously
    outlined in Reftel E.  Following the lead of Reftels C and D,
    we agree that the key tripwire event in a potential avian
    influenza outbreak is "efficient and sustained human-to-human
    transmission" and have listed responses under the assumption
    that an effective human vaccine will not be available and
    that tripwires may not be sequential.

    3)  Updated host country data:  Available medical treatment
    capability in the event of an outbreak includes 32
    respirators in Managua (26 for adults, 6 for children) and 74
    intensive care beds, distributed among 11 public and private
    hospitals in Managua.  When queried, some hospitals preferred
    not to divulge the numbers of ICU beds and respirators they
    possess.

    4)  The ability of Nicaragua's public health system to
    respond to and manage an AI outbreak or epidemic is balanced
    between good communication potential and limited treatment
    capability.  The AI threat ranks high among GON priorities
    and is an agenda item at the Ministry of Health's regular
    meetings.  Host country officials are engaged, cooperative
    and knowledgable.  They have responded immediately to
    Embassy/USAID requests for information with thoughtful,
    competent reports.  A lack of Tamiflu and other medication is
    problematic, however, and public health physicians have been
    conducting a strike for weeks.  Media reports suggest the
    strike will continue into the beginning of 2006.

    5)  Post's ability to shelter within Nicaragua will be
    determined by the severity of an outbreak and the specific
    tripwires crossed.  In this earthquake-, volcano- and
    hurricane-prone country, Embassy personnel are already
    advised to maintain a two-week supply of basic foodstuffs and
    water.  The Health Unit inventoried personal protective
    equipment (PPE) and has ordered additional supplies.

    6)  Tripwires, which will not necessarily be crossed in this
    order, are as follows as of late December 2005:

    --TRIPWIRE ONE:  A spike in the number and/or broadening
    geographic spread of animal to human cases or sustained
    human-to-human transmission in a neighboring country in
    Central America.

    Embassy Actions in response to Tripwire One

    --EAC meets to confirm tripwire has been crossed.

    --Restrict travel to the affected country or affected areas
    within the country, except for personnel involved in possible
    investigation/containment efforts.

    --Coordinate with U.S. Mission in the affected county
    regarding that Mission's plans for possible public
    announcements, warden messages, or plans for evacuating
    personnel.

    --Provide Mission briefings for staff (American and LES) and
    dependents.

    Actions to be taken immediately:

    --Provide Mission briefings for American and LES employees
    and dependents.

    --Refer to previously prepared draw-down list of minimum
    essential personnel.

    --Procure additional needed supplies, if needed, to
    supplement in-stock Tamiflu, masks, gowns, gloves, protective
    eyewear, alcohol-based cleansers, and N95 respirators.

    --Remind family members, who have previously been advised
    about contingency food and water supplies, to maintainkeep at
    least a two-week supply.

    --Consult established mechanism for conducting work from home
    if a pandemic limits access to Mission offices.

    --Form a working group to develop a plan of action to support
    potential embassy evacuees.

    --Prepare travel orders to avoid a last-minute backlog.

    --TRIPWIRE TWO:  A spike in the number and/or broadening
    geographic spread of animal to human cases or sustained
    human-to-human transmission through close, prolonged contact
    in an isolated section of Nicaragua.

    Embassy Actions in response to Tripwire Two:

    --EAC/AI Subcommittee meets to confirm that tripwire has been
    met.

    --Restrict travel to the affected region(s) of the country.

    --Encourage departure of non-essential personnel and
    dependents, with authorized departure of designated essential
    personnel on a case-by-case basis.

    --Suspension of some Embassy services and operations.

    --In coordination with the Dept., revise travel warning to
    add message advising Americans to leave country.

    --Update website and issue public announcements as necessary.

    --Per State 183776 (10/05/2005),  prophylactic treatment with
    Tamiflu will be considered only for staff who are required to
    be in direct contact with potentially infected persons.

    --Assist in evacuation of private American nationals.  (Note:
     Managua is a medium-sized embassy, not far from the U.S.)

    --TRIPWIRE THREE:  A spike in the number and/or broadening
    geographic spread of animal to human cases or sustained
    human-to-human transmission through close, prolonged contact
    near the Mission offices.

    Embassy Actions in response to Tripwire Three

    --EAC Subcommittee meets to confirm that tripwire has been
    met.

    --Cancel incoming official travel, except for personnel
    involved in investigative/containment efforts, or as
    otherwise deemed necessary by COM.

    --In coordination with the Dept., issue updated warden
    message, travel warning and website, press guidance and
    releases.  Urge all American citizens to defer all
    non-emergency travel to Nicaragua.

    --Implement home quarantine of any staff or dependents who
    have been in contact with a person confirmed to have an AI
    infection.

    --Reduce Consular Section visa appointments to a minimum to
    reduce risk of spreading disease within the Embassy and to
    make more staff available to provide emergency assistance to
    American citizens.

    --Emergency Action Committee meets regularly to determine
    next steps as tripwire circumstances develop.  Next steps
    could include:

    --      Close and/or reduce Embassy to minimal staff, reduce
    services and operations to emergency consular services and
    other designated services and operations.

    --      Continue voluntary departure of dependents and
    non-essential staff.

    --TRIPWIRE FOUR:  Efficient and sustained human-to-human
    transmission in a neighboring country in Central America.

    Embassy Actions in response to Tripwire Four

    --EAC/AI Subcommittee meets to confirm that tripwire has been
    met.

    --Restrict travel to the affected country, except for CDC,
    FAS, AFRIMS or other personnel involved in possible
    investigation/containment efforts.  (Note:  Determine what
    type of quarantine/restriction by Nicaraguan authorities may
    be placed on these personnel returning to Nicaragua.)

    --Coordinate with U.S. Mission in the affected country
    regarding that Mission's plans for possible evacuation of
    personnel.

    --Provide Mission briefings for staff and dependents.

    --MED and designated EAC members meet with school
    administrators to assess school vulnerability.

    --Embassy staffs and equips a situation room.  Uses cleared
    press guidance to respond to press inquiries.

    --Maintain normal Consulate and Embassy operations, with
    close monitoring of the situation.

    --Embassy Emergency Action Committee meets regularly and
    coordinates closely to determine next steps as tripwire
    circumstances develop.  Next steps could include:

    --     Reduction of consular services and suspension of other
    designated services and operation.

    --     Close offices and/or reduce Embassy to minimal staff.

    --     Authorize voluntary departure for dependents and
    non-essential personnel.  (Note:  Authorized departure will
    be dependent on possible Government of Nicaragua restrictions
    on outgoing travel and on possible U.S. restrictions on
    incoming travel.)

    --     Except for designated essential American and LES
    staff, all others remain home (administrative leave) or on
    authorized departure; children remain home from school or on
    authorized departure.

    --     Continue to purchase additional supplies of food and
    water.

    --     Social restrictions:  restrict movements of all
    personnel in the city, restrict dinner parties, sporting
    events, etc.).

    --TRIPWIRE FIVE:  Efficient and sustained human-to-human
    transmission within Nicaragua.

    Embassy Actions in response to Tripwire Five:

    --EAC/AI Subcommittee meets to confirm that tripwire has been
    met.

    --Issue revised travel warning and update website advising
    American citizens to defer all non-emergency travel to
    Nicaragua.

    --Authorized voluntary departure of dependents and
    non-essential personnel.  (Note:  Authorized departure will
    be dependent on possible Government of Nicaragua restrictions
    on outgoing travel and on possible U.S. restriction on
    incoming travel.)

    --Cancel all incoming official travel, except for personnel
    involved in investigative/containment efforts, or as
    otherwise deemed necessary by COM.

    --Provide Mission briefings for staff (American and LES) and
    dependents and to school administrators at schools used by
    American staff; recommend schools) close.

    --Embassy at minimal staff, reduction to emergency consular
    services, suspension of designated services and operations.

    --Except for designated essential American and LES staff, all
    other remain home (administrative leave) or on authorized
    departure; children remain home from school or on authorized
    departure.

    --Ensure that staff purchase additional supplies of food and
    water.

    --Social restrictions:  restrict movements of all personnel.

    --Split the Marine Security Guard detachment into two
    separate and independent units.  (In the event individuals in
    one unit acquire the disease, the other unit can still ensure
    proper coverage of classified materials.)

    --Restrict visitor access to Mission buildings.  If entry
    into Mission buildings is necessary to conduct business,
    visitors must undergo screening procedures to include
    temperature monitoring and/or questionnaire related to
    symptoms/exposure.  (Note:  There are no studies that provide
    verification regarding effectiveness of these procedures.
    They also will not identify people who are contagious or
    asymptomatic or have minimal symptoms.  The level of
    restrictions on access to Mission facilities should depend on
    the particular circumstances at that moment.)

    --Embassy staffs and equips a situation room and a call
    center for inquiries from American public and the press.

    --Establish a database listing details of any American
    citizen, hospitalized, quarantined, or ill at home.

    --MED closely monitors availability of outgoing commercial
    flights.

    --Embassy Emergency Action Committee meets regularly and
    coordinates closely to determine next steps as tripwire
    circumstances develop.  Next steps could include:

    --     Restrict/prohibit visitor access to internal Mission
    facility offices.

    --     Ordered departure of non-essential personnel and
    dependents with authorized departure of designated essential
    personnel on a case-by-case basis.  (Note:  Ordered or
    authorized departure will be dependent on possible Government
    of Nicaragua restrictions on outgoing travel and on possible
    U.S. restrictions on incoming travel.)

    --     Suspension of additional Embassy services and
    operations.

    --     In coordination with the Dept., revise travel warning
    to advise Americans to leave Nicaragua.

    --     Update website and issue public announcements as
    necessary.

    --     Consider prophylactic treatment with Tamiflu for staff
    required to be in direct contact with potentially infected
    persons.

    --     Assist in evacuation of private American nationals.
    (Note:  Significant evacuation from Nicaragua may not be
    feasible for a variety of reasons, including the potential
    and added risk of acquiring influenza at crowded airports or
    on international flights during a true pandemic, travel
    restrictions and possible quarantine measures.  A complete
    evacuation of all Mission personnel and closure of Embassy
    Managua would be determined at a later stage in an AI
    pandemic.)

    7)  These preparedness measures include early contingency
    planning as of December 2005.  The characteristics of a
    human-to-human outbreak will of necessity change some of the
    details for both "shelter in place" and a possible drawdown
    of personnel.  The Emergency Action Committee will include an
    avian influenza item on its agendas as needed to evaluate the
    threat and report the disease's progress on other continents.

    TRIVELLI

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