ITALIAN PREPAREDNESS FOR AVIAN/PANDEMIC INFLUENZA

UNCLAS SECTION 01 OF 04 ROME 004113 SIPDIS SENSITIVE DEPT FOR OES/IHA (DR. DSINGER/RSDALEY),DHHS FOR OGHA (STEIGER) E.O. 12958: N/A TAGS: TBIO SENV ECON EAGR EAID PREL IT FAO SUBJECT: ITALIAN PREPAREDNESS FOR AVIAN/PANDEMIC INFLUENZA REFTEL: STATE 209622 SENSITIVE BUT UNCLASSIFIED - PROTECT ACCORDINGLY ¶1. (U) Information on avian/pandemic influenza preparedness in Italy is keyed to categories and questions in reftel. A) PREPAREDNESS/COMMUNICATION -------------- ¶2. (SBU) Does the government of Italy have a preparedness plan/strategy for preventing avian flu (AI) from becoming a pandemic and containing a pandemic once it occurs? If the country has a strategy, how capable is it of implementing it? -- (SBU) The GOI has established a Task Force for AI. Membership includes: the Ministry of Health, the Civil Protection Agency, medical experts, the Higher Institute of Health, selected university representatives, and the Italian Drug Agency - FDA equivalent. The GOI has a draft strategy dated November 30, a copy of which was furnished in confidence to the Embassy. After all of Italy's twenty regions approve the draft, it will be made public on the Ministry of Health's Internet website. ¶3. (U) How truthful will the government be in reporting the scope of any disease outbreak among people? Among animals? -- (U) Recent experience with AI has contributed to the GOI's open attitude on AI. Italy, like many poultry-producing countries, has had experience with avian influenza. A major outbreak of high-path AI occurred in Italy between 1999-2000, and this experience led the Ministry of Health to make a substantial investment in the Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe - Experimental Zooprophilactic Institute of the Veneto). IZSVe is a reference laboratory for AI for the World Animal Health Organization (OIE). An outbreak of low-path AI occurred on turkey farms in the region of Lombardy in April, ¶2005. Neither of these incidents involved H5N1, but both were reported in a timely manner and are listed on IZSVe's Internet website. When one of the over one thousand recent tests on avians tested positive for low-path AI in a wild duck, the Ministry of Health immediately issued a press release (on November 9); and the Minister of Health mentioned the finding to the U.S. Ambassador that same day during the Ambassador's introductory call. Further, the GOI is a member of the International Partnership on Avian and Pandemic Influenza (IPAPI),which includes core principles (number three) of "transparency in reporting influenza cases in humans and animals caused by strains that have pandemic potential" and (number four) "immediate sharing of epidemiological data and samples with the World Health Organization (WHO) and the international community...". The GOI works closely with the UN Food and Agriculture Agencies (FAO),whose headquarters are in Rome. The GOI supplies national virological data weekly to WHO (www.who.int/GlobalAtlas/home.asp, www.eiss.org). The GOI preparedness plan calls for daily dissemination of data in case of a pandemic. ¶4. (U) 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? Who is the key "go-to" person, office or department for USG officials? -- (U) The GOI considers AI a top priority. Italy became a member of IPAPI, and is also a member of the Global Health Security Action Group. Italian counterparts recently hosted the visit of Animal Plant and Health Inspection Service (APHIS) Administrator Dr. Ron De Haven. The "go-to" person for animal AI issues is Dr. Romano Marabelli, Chief Veterinary Officer for Italy (within the Ministry of Health) and the Italian delegate to OIE. The chief "go-to" person for human AI issues is Dr. Donato Greco, Director of Italy's Centers for Disease Control-equivalent within the Ministry of Health. ¶5. (U) Have national laws been reviewed to ensure that they are consistent with the International Health Regulations and do not pose barriers to avian influenza detection, reporting, containment, or response? -- (U) The GOI has reviewed laws and has issued two law decrees and four ordinances to enhance AI detection, containment and response. The legislation of August 26, and October 10, 18 and 22 mandate the following: - Registration of all national poultry farms and processing plans on ad hoc register (August 26); - Mandatory country of origin labeling on all domestic and imported poultry products for human consumption (August 26 - approved by the government on December 1); - Minimum standards for plants, including equipment and sanitary standards, such as cleaning procedures, disposal of dead animals, and waste management (October 10); - Measures for preventing contamination from wild birds (nets to avoid them flying into commercial flocks) and from other flocks (prohibition of live poultry shows or other gatherings (October 22); - Ad hoc National Surveillance Plans on wild birds and commercial flocks to be carried on by regional governments by January 2006 (October 22); - Creation of a national register of commercial hatcheries (October 18); - Creation of a Department of Public Veterinary Health at the Ministry of Health (August 26); - Creation of a specialized "Center for the Coordination of the Response to Animal Disease" under the new Ministry of Health Department -- in accordance with FAO recommendations, (August 26); - Mandated direct hiring of up to 110 new veterinarians and up to 96 veterinary police (Ministry of Health branch of the national "Carabinieri") (August 26); - Allows the Ministry of Agriculture to withdraw from the domestic market up to 17,000 tons of poultry meat in the event of an "AI scare;" - Suspends social security payments and loan repayments for poultry farms for a value of up to 8 million euros; and - Authorizes the Ministry of Health and regional governments to obtain stocks of vaccines in case WHO declares a pandemic. ¶6. (U) Is Italy already working with international organizations or other countries on the avian flu issue? Are GOI officials likely to ask for assistance from the U.S. or other countries? Would GOI leaders be receptive to messages from U.S. leaders through a bilateral approach or via multilateral fora such as WHO or FAO? What would Italy want from the U.S. in return for its efforts? -- (U) Italy works closely with international organizations. Italian Chief Veterinary Office Dr. Romano Marabelli has been for many years the Vice President and President of the OIE. The FAO, with which OIE has been at the forefront of international efforts to combat AI in the agricultural context, is headquartered in Rome. The GOI, a member of the G-8, has joined IPAPI and is a member of the Global Health Security Action Group. The GOI also works closely with the WHO. The IZSVe laboratory in Padua works with many other countries and with the OIE and FAO. -- (U) Post cannot predict at this time what Italy might want from the U.S. in return for its efforts. ¶7. (U) Does Italy currently administer annual flu shots? What is the production capability? -- (U) The GOI administers free annual flu shots for health care and primary public assistance (police, firemen) personnel, as well as to citizens over 65 years old and those suffering from chronic diseases. The draft AI preparedness plan envisions a register of persons over 65 and/or with chronic health problems in order to have a precise list on hand in case of a pandemic. In 2004, 17.5% of the Italian population received flu vaccinations. As of October 7, 2005, 17.7% of the population has already been vaccinated, an indication of higher public awareness of influenza. -- (SBU) Post has been told that the GOI has contracted to produce vaccines with the companies CHIRON, SANOFI-PASTEUR, and SOLVAY. -- (U) The IZSVe is in the process of developing an animal vaccination strategy, but for the N7H1 strain. Lab personnel indicated they are having success using an American vaccine. ¶8. (U) How well informed is the population about the avian flu threat and about measures they should take to mitigate the threat? What mechanisms are available for providing additional information to the population and how effective are these measures? -- (U) The GOI has started an influenza outreach campaign on television and in the newspapers. The Ministry of Health has published brochures, the text of which is posted on the Ministry's Internet website. -- (U) Italy's media are very capable of providing information in both urban and rural areas. B)SURVEILLANCE/DETECTION -------------- ¶9. (U) How capable are the medical and agriculture sectors of detecting a new strain of influenza among people or animals? Can influenza viruses be subtyped in Italy, if so by whom? -- (U) The Italian agriculture sector is very capable. The IZSVe was designated the National Reference Center for Newcastle disease and AI in October, 1999. In June 2001, it became a World Animal Health Organization (OIE) reference laboratory for those diseases. In 2005, it was designated an FAO Collaboration Center. Italy has other top-flight labs in addition to the IZSVe. -- (U) The Italian medical sector is equally capable. The National Influenza Center of the Higher Institute of Health is responsible for human virologic surveillance for the WHO world net. Surveillance is comprised of thirteen peripheral labs (first level),two central labs (second level),the National Influenza Center, and the Inter-University Research Center for Influenza and Other Viral Infections (CIRI-IV) at the University of Genoa. Post can furnish a list of the first level labs, if requested. ¶10. (U) What are the critical gaps that need to be filled in order to enhance Italy's disease detection and outbreak response capabilities? What is Italy's greatest need from the U.S. or international organizations? -- (SBU) The Director of IZSVe noted at least one instance in an AI-affected country where scientific data critical to producing a human vaccine were not shared openly, possibly because of the "profit motive." The data related in particular to the exchange of viral sequences and isolates. C) RESPONSE/CONTAINMENT -------------- ¶11. (U) Does Italy have a stockpile of medications, particularly antivirals, and if so, how much? How much has been ordered and when is it expected? -- (U) The GOI preparedness plan calls for immediate contracts to purchase 36 million doses of pandemic vaccine (when available) to cover 63 pct of the population. The GOI will later contract with other producers for a further ten million doses to eventually cover 80 pct of the population. Some 5.4 million euros have been allocated for vaccines. -- (U) The GOI would stockpile 155,000 doses, eventually possibly rising to one million doses, of the human H5N1 vaccine for use primarily among poultry workers in the containment response to a human pandemic. -- (U) The Ministry of Health has stockpiled 150,000 cycles of antiviral medications and is in the process of acquiring four or five million additional cycles within the next twelve months (NOTE: the draft plan lists four million in one place and five million in another). ¶12. (U) Does Italy have a stockpile of pre-positioned personal protective gear? -- (U) Post does not have information on PPE stockpile amount. After the SARS outbreak, each hospital and each region should have had its own stockpile, but there is not a national registry for PPE stockpiles. ¶13. (U) What is the rapid response capacity for animal and human outbreaks? Are guidelines in place for the culling and vaccination of birds, disinfection of facilities, and limitations on animal movement? -- (U) To fulfill EU Directive 2005/464/CE, the GOI must issue ad hoc National Surveillance Plans for wild birds and commercial flocks, to be carried out by regional governments, by January ¶2006. Guidelines for culling, vaccination, and limiting movements are noted in Part A in paragraph five (5) on reviewing national laws. ¶14. (U) How willing and capable is the GOI of imposing quarantines and social-distancing measures (closing schools, etc.)? Would its military enforce quarantines? -- (U) For animals, the GOI is capable and willing to impose measures such as quarantines and restriction of movement. In the regions of Lombardy and Veneto, where the concentration of poultry stock is the highest, veterinary authorities have access to technology tools based on the Geographic Identification System (GIS) to locate concentrations of animals and define quarantine areas. The GOI can also deploy measures for preventing contamination from wild birds (nets),and from other flocks (prohibition of live poultry markets or shows). -- (U) For humans, the GOI's preparedness plan describes surveillance, isolation, and quarantine measures within Italy, at borders, and at the international airports of Fiumicino (Rome) and Malpensa (Milan). SPOGLI