BAHRAIN: AVIAN AND PANDEMIC INFLUENZA INFORMATION

UNCLAS MANAMA 001874 SIPDIS STATE FOR OES/DSINGER AND RDALEY, NEA/ARPI E.O. 12958: N/A TAGS: TBIO SENV ECON EAGR EAID PREL BA ECTRD ROW SUBJECT: BAHRAIN: AVIAN AND PANDEMIC INFLUENZA INFORMATION REF: A. SIMPSON-DALEY E-MAIL OF NOVEMBER 30 ¶B. STATE 209622 ¶C. MANAMA 1605 This cable responds to Ref B questions regarding local avian influenza and pandemic influenza preparedness. -------------- PREPAREDNESS AND COMMUNICATION -------------- Q: DOES THE GOVERNMENT HAVE A PREPAREDNESS PLAN/STRATEGY FOR PREVENTING AVIAN FLU FROM BECOMING A PANDEMIC AND CONTAINING A PANDEMIC ONCE IT OCCURS? A: Bahrain lies in the autumnal migratory path for birds from infected Asian regions and expects to confront cases of avian influenza bird infection. The GOB is deploying elements of a robust precautionary program (Ref. B),including restrictions on bird importation and inoculations of farm bird populations. In addition, the GOB has crafted a comprehensive national strategy to be approved and implemented by a committee headed by Undersecretary of Agriculture Affairs Kadhem Hashim Al Hashimi and composed of officials from the Ministries of Agriculture, Health, Interior, and Industry and Commerce. The government has thus far allocated BD 448 thousand (approximately $1.2 million) to combat Bird Flu and other animal diseases. Q: IF THE COUNTRY HAS A STRATEGY, HOW CAPABLE IS IT OF IMPLEMENTING IT? A: Bahrain is well situated to implement many precautionary aspects of its program at a pre-pandemic stage. Although the draft strategy has yet to be approved, several key elements have already been implemented. The Ministry of Agriculture has dispatched teams to inoculate farm poultry. It says it has already administered some 800,000 doses of H9N2 vaccine of the planned four million doses set to be administered to the nation's poultry stock, farms are being disinfected, and the importation of birds has been restricted. Q: PLEASE PROVIDE A COPY OF THE PLAN OR THE INTERNET ADDRESS FOR THE PLAN. A: Post provided an advance draft of the plan on November 30 (Ref A). The GoB has not yet established an avian influenza website, though officials plan to do so in the near future. Q: HOW TRUTHFUL WILL THE GOVERNMENT BE IN REPORTING THE SCOPE OF ANY DISEASE OUTBREAK AMONG PEOPLE AND/OR ANIMALS A: Post believes that Ministry of Health officials have been and will continue to be truthful in government-to-government contacts. Post's Avian Influenza Working Group assesses that there is some potential for the GOB to minimize public reporting of an outbreak if the scope were sufficient to lead to an erosion of public confidence. The greater danger would be that cases might not be diagnosed in a timely manner. (See Surveillance/ Detection below.) Q: WHAT INCENTIVES COULD BE OFFERED THAT WOULD LIKELY RESULT IN MORE TRANSPARENCY? A: Post will maintain working-level contact with Ministry of Health interlocutors to promote continued information access and exchange. To encourage public openness, the GOB has announced that it will establish a fund to compensate poultry farmers whose birds are culled as the result of an outbreak. This should help mitigate any economic disincentive to identify and report symptomatic birds. Q: WHERE DOES PREPARING FOR AN AVIAN FLU HUMAN PANDEMIC RANK AMONG GOVERNMENT PRIORITIES? WHO AND WHAT WOULD MOST INFLUENCE THE COUNTRY TO GIVE THE ISSUE A HIGHER PRIORITY? A: Because the GOB expects to see cases of avian influenza, it has taken the need to prepare quite seriously and the Prime Minister has explicitly stated that avian flu preparation ranks among the highest national priorities. GOB planning and preparations are also being developed in coordination with the GCC. Given its existing resources, Post assesses that the current level of priority assigned to the avian influenza threat is appropriate. Q: WHO IS THE KEY "GO-TO" PERSON, OFFICE OR DEPARTMENT (I.E. MINISTER FOR HEALTH, PRIME MINISTER, ETC.) FOR USG OFFICIALS TO ENGAGE ON THIS ISSUE? A: Ministry of Health Director of Public Health Dr. Samir Khalfan. Q: HAVE NATIONAL LAWS BEEN REVIEWED TO ENSURE THAT THEY ARE CONSISTENT WITH INTERNATIONAL HEALTH REGULATIONS AND DO NOT POSE BARRIERS TO AVIAN INFLUENZA DETECTION, REPORTING, CONTAINMENT, OR RESPONSE? A: The GOB has modeled its national strategy on WHO guidelines and has specifically evaluated its national laws with respect to the handling and disposal of infectious waste. Q: IS THE HOST COUNTRY ALREADY WORKING WITH INTERNATIONAL ORGANIZATIONS OR OTHER COUNTRIES ON THE AVIAN FLU ISSUE? A: The GOB is currently coordinating with the GCC and the WHO. Q: ARE GOVERNMENT LEADERS LIKELY TO ASK FOR ASSISTANCE FROM THE US OR OTHER COUNTRIES? A: They have already done so. The Ministry of Health has requested USG information on currently available H5N1 vaccines for birds, including the advisability of the use of live-attenuated vaccine. Q: WOULD GOVERNMENT LEADERS BE RECEPTIVE TO MESSAGES FROM US LEADERS THROUGH A BILATERAL APPROACH, AT A MULTILATERAL FORUM SUCH AS THE UN WHO, FAO, ETC OR APEC, OR THROUGH BILATERAL CONTACTS BY A THIRD COUNTRY? A: GOB leaders are receptive to US messages, in particular on the subject of avian influenza. The Ambassador and Emboffs have engaged GOB officials on avian influenza preparedness on several recent occasions and have found them highly receptive. Minster of Health Dr. Nada Abbas Haffadh told the Ambassador November 27 that she welcomed future collaboration with USG officials on this topic. Multilateral cooperation with the WHO and the GCC is also in evidence. The US-GOB relationship is such that it would not be necessary to solicit third country intervention. The GOB consults closely with the UK on a range of issues. The draft Master Plan for Confronting Avian Influenza was drawn up with substantial assistance from UK experts under WHO auspices. Q: DOES THE COUNTRY CURRENTLY ADMINISTER ANNUAL FLU SHOTS? A: Seasonal flu shots are currently available at public and private hospitals for patients who seek them. With the exception of poultry workers, the GOB does not have a campaign in place to proactively immunize its population against seasonal flu. Q: IF NOT, MIGHT IT CONSIDER DOING SO? A: The GOB has considered and rejected any change to its standard practice on this question, believing its resources are better directed to other preventive aspects of its plan. Q: WHAT IS THE PRODUCTION CAPABILITY FOR ANNUAL TRIVALENT FLU VACCINE? A: Bahrain does not produce annual trivalent flu vaccine. It is currently imported from Malaysia. Q: DOES THE COUNTRY PRODUCE INFLUENZA VACCINE FOR POULTRY? A: Bahrain does not produce poultry vaccine. It is currently imported from Holland. Q: IS THERE A LIABILITY SHIELD FOR FOREIGN MAKERS/DONORS OF VACCINES? A: No. Q: IF NOT, ANY PROSPECTS OF ONE BEING ENACTED? A: At present, the GOB has not proposed such legislation. Unless it were to appear necessary as a condition for obtaining needed vaccine, such a measure is unlikely. Q: HOW WELL INFORMED IS THE POPULATION ABOUT THE AVIAN FLU THREAT AND ABOUT MEASURES THEY SHOULD TAKE TO MITIGATE THE THREAT? A: Much of the information currently available to the public from press and official sources focuses on publicizing precautionary measures being undertaken by the GOB. There is also an emphasis on advice for detecting symptoms in birds, e.g., production of soft-shelled eggs, hemorrhaging under the skin, etc. Preventative measures such as hand-washing are still under-emphasized at present. Q: WHAT MECHANISMS ARE AVAILABLE FOR PROVIDING ADDITIONAL INFORMATION TO THE POPULATION, PARTICULARLY IN RURAL AREAS, AND HOW EFFECTIVE ARE THESE MEASURES? A: The GOB initiated a fresh public awareness campaign December 5 to better educate its citizens on the nature of the threat. Officials are addressing students at schools and colleges and distributing leaflets in public places in support of the effort. The GOB has established a citizen hotline to answer questions regarding avian influenza and reports that after an initial rush, call volume has declined. -------------- SURVEILLANCE/DETECTION -------------- Q: HOW CAPABLE ARE THE MEDICAL AND AGRICULTURE SECTORS IN DETECTING A NEW STRAIN OF INFLUENZA AMONG ANIMALS OR PEOPLE RESPECTIVELY? A: The Ministry of Agriculture has begun testing for Bird Flu at farms throughout the country on a continuous basis. The Ministry of Health is reportedly ramping up its facilities to be able to test humans for Bird Flu. Q: HOW LONG MIGHT IT TAKE FOR CASES TO BE PROPERLY DIAGNOSED? A: Ministry of Health officials advise that their current laboratory tests would diagnose avian influenza within 36 hours. A test for the virus would be administered to any patient displaying symptoms consistent with avian influenza and who reported having exposure to poultry livestock within the past 10 days. Q: CAN INFLUENZA VIRUSES BE SUBTYPED IN THE COUNTRY? A: Yes Q: IF SO BY WHOM? A: The Ministry of Health has adopted an Integrated Capacity Development Program for laboratory specialists with direction from the WHO. The Ministry of Health has recently acquired laboratory equipment allowing local subtyping. Q: DOES THE COUNTRY SEND SAMPLES TO A WHO/EU/US REFERENCE LABORATORY? A: In the event of an avian influenza outbreak in Bahrain, samples will be sent to the WHO. Q: WHAT ARE THE CRITICAL GAPS THAT NEED TO BE FILLED IN ORDER TO ENHANCE THE COUNTRY'S DISEASE DETECTION AND OUTBREAK RESPONSE CAPABILITIES? A: MED Emboff, who has worked in Manama for many years as a health practitioner, evaluates that the GOB real world ability to detect new influenza strains is limited. Emboff cautions that in the past, limitations of personnel, expertise and technology have limited the Ministry of Health's ability to implement plans as laid out on paper. Emboff observes that one important medical facility, the Salmaniya Hospital complex, is already straining to meet current demand, with insufficient beds or staff to meet daily needs. However, local private hospitals currently have excess capacity and could absorb some increased activity. Q: WHAT IS THE COUNTRY'S GREATEST NEED IN THIS AREA FROM THE US OR INTERNATIONAL ORGANIZATIONS? A: Assistance in acquiring more fast-reacting diagnosis kits would be useful. Though some Tamiflu capsules are expected to arrive soon, the GOB has expressed apprehension that ordered supplies may not materialize. In that event, officials have requested US assistance in identifying alternative licensed sources of the oseltamivir phosphate antiviral (Tamiflu). See Response Containment below. -------------- RESPONSE/CONTAINMENT -------------- Q: DOES THE COUNTRY HAVE A STOCKPILE OF MEDICATIONS, PARTICULARLY OF ANTIVIRALS, AND IF SO HOW MUCH? A: Bahrain presently has no antiviral stockpiles, but expects delivery of one million capsules of adult dosage Tamiflu and 500 thousand capsules of child dose Tamiflu in coming days. Q: IF SOME HAS BEEN ORDERED, HOW MUCH AND WHEN IS IT EXPECTED? A: Additional capsules have been ordered but are not expected to be delivered until February 2006. Q: DOES THE COUNTRY HAVE A STOCKPILE OF PRE-POSITIONED PERSONAL PROTECTIVE GEAR? A: Bahrain does have a stockpile of disposable N-95 respirator face pieces, face shields, goggles, and disposable blood pressure cuffs. Q: WHAT IS THE RAPID RESPONSE CAPACITY FOR ANIMAL AND HUMAN OUTBREAKS? A: In conjunction with its Integrated Capacity Development Program, Bahrain is currently working to enhance the expertise of key laboratory personnel to quickly identify emerging subtypes, including biosecure facilities. Q: ARE GUIDELINES IN PLACE FOR THE CULLING AND VACCINATION OF BIRDS, DISINFECTION OF FACILITIES, AND LIMITATIONS ON ANIMAL MOVEMENT? A: Upon detection of a single infected bird, all birds within a three kilometer radius are to be disposed of. A nationwide bird vaccination program is already under way. The Ministry of Agriculture's animal and avian quarantine center is currently under expansion. The center presently has the capacity to house twenty thousand birds. Only those countries certified as free of Bird Flu by the WHO are allowed to export poultry meat to Bahrain and the Prime Minister has issued a decree banning the importation of live birds from any country. Ministry of Agriculture officials are stationed at all major national entry points, including the Bahrain International Airport, the King Fahad Causeway and all sea ports. Any live birds intercepted are killed on the spot or returned to their country of origin. However, the GOB acknowledges these measures to be ineffective in stemming the entry of wild birds into Bahrain, though the Ministry of Agriculture has begun testing wild bird populations in the Al Areen Wildlife Preserve. Q: HOW WILLING AND CAPABLE IS THE GOVERNMENT TO IMPOSE QUARANTINES AND SOCIAL DISTANCING MEASURES (CLOSING SCHOOLS, PUBLIC GATHERINGS, MASS TRANSIT)? A: The draft national strategy indicates a willingness to impose appropriate quarantines and social distancing measures, including the curtailment of public gatherings and the closure of land, sea and air transport. It is unclear how public prayers and mosque services would be affected. The GOB plans to quarantine Avian Influenza patients in airborne isolation rooms (AIR) and has a detailed symptom and vulnerability assessment plan. However, only 60 AIR rooms have been built. Q: WOULD ITS MILITARY ENFORCE QUARANTINES? A: The draft national strategy makes no mention of military or law-enforcement quarantine support. However, GOB working level officials advise Emboffs that the Ministry of Interior, including law-enforcement personnel, would support quarantine efforts. Posts assesses that if military support became necessary, it would be available. ZIADEH