US embassy cable - 05HANOI2430

UNCLAS SECTION 01 OF 03 HANOI 002430 
 
SIPDIS 
 
FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV; OES/STC (M.GOLDBERG); 
OES/IHA (D.SINGER AND N.COMELLA) 
BANGKOK FOR RMO, CDC 
STATE PASS HHS 
USDA FOR FAS/PASS TO APHIS 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN 
USAID FOR ANE AND GH 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, TBIO, VM, AFLU 
SUBJECT: VIETNAM  - REVISED AVIAN INFLUENZA TRIPWIRES 
 
REF: Hanoi 822 
 
1.  Mission Vietnam developed and submitted tripwires and 
possible actions for various Avian Influenza (AI) scenarios 
in March, 2005 (Reftel).  The Mission's AI Working Group 
(AIWG) recently met to revise tripwires and responsive 
actions in response to new assessment of the situation.  The 
following revised AI assumptions, tripwires, and possible 
actions have been approved by the Ambassador.  We invite and 
welcome feedback from relevant offices and agencies with 
expertise in emergency planning and/or influenza. 
 
Key Assumptions 
--------------------------- 
 
2. The AIWG make the following assumptions for planning 
purposes: 
 
a. The risk to USG personnel is currently low.  The 
contingent risk is that H5N1 begins to transmit actively 
between humans.  Risk would be manageable if human-to-human 
transmission occurred only in cases of extensive intimate 
contact.  Transmission by casual human-to-human contact 
would require rapid action to protect our personnel. 
 
b. There is a high probability that Vietnam would be at the 
center of any outbreak of human-to-human H5N1 infection. 
 
c. Vietnamese medical facilities would be unable to handle 
more than a handful of AI cases at any given time at an 
international standard of care.  Facilities to provide care 
at a lower standard, including mechanical ventilation 
capabilities, would also be overwhelmed at a level somewhere 
in the range of 5-10 cases in either Hanoi or Ho Chi Minh 
City. 
 
d. Depending on the speed of a human-to-human outbreak, U.S. 
citizens could be quickly cut off from air evacuation 
routes.  Evacuation by land or sea might also become 
impossible. 
 
e. The Mission would be unable to obtain essential medical 
and basic supplies in the event of a crisis and should 
stockpile adequate provisions. 
 
Tripwires and Recommended Actions 
--------------------------------------------- -------------- 
 
3. The Ambassador has approved the following revised 
Mission's tripwires and possible associated actions: 
 
Tripwire 1:  Spike in number and broadening geographic 
spread of animal-to-human transmission cases in Vietnam 
indicating an increase in the transmissibility of the virus 
and/or causing a serious strain on local medical facilities. 
 
Possible Actions: 
 
a. Restrict official and unofficial travel to rural areas. 
 
b. Release warning announcement to Mission personnel and 
issue corresponding warden message to private American 
citizens. 
 
c. Consider issuance of a travel warning for Vietnam. 
 
d. Consider authorized departure of family members and non- 
emergency American personnel. 
 
Tripwire 2:  Sustained human-to-human transmission, as 
evidenced by a cluster of cases (office, apartment building, 
etc.) in an urban area of one or more of the other six at- 
risk countries in the region (not Vietnam).  This is 
particularly significant if there are multiple, 
geographically diverse clusters, or a cluster occurs in a 
major transit hub. 
 
Possible Actions: 
 
a. Request Department authorize departure of family members 
and non-emergency personnel. 
 
b. Screen all visitors to USG facilities. 
 
c. Impose mandatory sick leave for any employee who exhibits 
any flu symptoms or has a family member with flu symptoms, 
monitored by MED Unit. 
 
d. Request Department issue a travel warning. 
 
e. Issue a public announcement to the American community. 
 
Tripwire 3:  Sustained human-to-human transmission, as 
evidenced by a cluster of cases (office, apartment building 
etc.) in Vietnam, but outside HCMC or Hanoi.  This is 
particularly significant if there are multiple, 
geographically diverse clusters, or a cluster occurs in an 
urban area and/or is not safely isolated. 
 
Possible Actions: 
a. Request Department authorize ordered departure of family 
members and non-emergency personnel.  Implement 
administrative leave for non-emergency FSNs. 
 
b. Limit consular services to emergencies only. 
 
c. Implement mandatory sick leave for any employee who shows 
flu symptoms or has a family member with flu symptoms, 
monitored by MED Unit. 
 
d. Implement screening of all visitors and use of 
protective gear (masks, gloves, clothing, etc.). 
 
e. Require mandatory prophylactic use of Tamiflu by 
emergency U.S. and FSN staff remaining on the job. 
 
f. Request Department issue a travel warning for Vietnam. 
 
g. Issue a public announcement to private American 
community. 
 
Tripwire 4:  Sustained human-to-human transmission, as 
evidenced by a cluster of cases (office, apartment building, 
etc) in HCMC or Hanoi.  This is particularly significant if 
there are multiple, geographically diverse clusters, or a 
cluster is not safely isolated. 
 
Possible Actions: 
 
a. Request Department authorize ordered departure from both 
posts.  Implement administrative leave for non-emergency 
FSNs.  Reduce staffing to absolute minimal level. 
 
b. Limit consular services to emergencies only. 
 
c. Close all Mission annexes and relocate remaining staff to 
Chancery/Consulate General. 
 
d. Impose mandatory sick leave for any employee who shows 
any flu symptoms or has a family member with flu symptoms, 
monitored by Med Unit. 
 
e. Implement screening of all visitors and use of protective 
gear (masks, gloves, clothing). 
 
f. Require mandatory prophylactic use of Tamiflu by minimal 
U.S. and FSN staff remaining on the job. 
 
g. Request Department issue a travel warning for Vietnam. 
 
h. Issue a public announcement to private American 
community. 
 
Alternative Tripwire:  A Mission employee develops Avian 
Influenza, in the absence of a broader outbreak described in 
tripwires 1, 2, 3, or 4 above. 
Possible Actions: 
 
a. Treat the victim.  Medevac if possible. 
 
b. Disinfect office. 
 
c. Administer Tamiflu to close contacts. 
MINIMIZE CONSIDERED 
MARINE