INFORMATION ON AVIAN INFLUENZA

UNCLAS SECTION 01 OF 03 SAN SALVADOR 003433

SIPDIS

E.O. 12958: N/A
TAGS: TBIO SENV ECON EAGR EAID PREL ES AVIAN FLU
SUBJECT: INFORMATION ON AVIAN INFLUENZA

REF: A. SECSTATE 209622

B. USAID RAPID ASSESSMENT FOR AVIAN AND PANDEMIC
INFLUENZA PREPAREDNESS


1. Post, through USAID and the Regional Medical Officer
(RMO),is coordinating with Salvadoran authorities to support
local efforts to control avian influenza and assess their
capability to respond to an influenza pandemic. Responses to
Ref. A questions are included in paragraph 2; they are based
on information provided by USAID in response to a similar
tasking (Ref. B.) and also information gathered during a
seminar on avian influenza hosted by the RMO on November 29
that was attended by officials from the Ministry of Health
(MOH) and Ministry of Agriculture (MAG).


2. Begin survey response:

A) Preparedness/Communication

Does the government have a preparedness plan/strategy for
preventing avian flu from becoming a pandemic and containing
a pandemic once it occurs? If the country has a strategy,
how capable is it of implementing it? Please provide a copy
of the plan or the internet address for the plan.

--The Government of El Salvador (GOES),with MOH and MAG
taking the lead, has developed a preparedness strategy that
includes general anti-avian flu measures. It was developed
with support from the World Health Organization (WHO). Post
will forward a copy to OES. The GOES will face significant
resource and technical constraints in implementing its
strategy to prevent or contain a pandemic.

How truthful will the government be in reporting the scope of
any disease outbreak among people? Among animals? What
incentives could be offered that would likely result in more
transparency?

--The GOES will likely be forthcoming in reporting the scope
of any disease outbreak among people and animals. However, it
is likely that individual poultry farmers would hide cases
should they occur.

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 (i.e.,
Minister for Health, Prime Minister, etc.) for USG officials
to engage on this issue?

--This issue is not currently a national priority and is
unlikely to become one until it poses a more immediate threat
to public health. The MOH and MAG are the most active within
the GOES, but there this a national task force on avian
influenza that also includes the National Emergency
Committee, armed forces, Ministry of Governance (public
security),Ministry of Education, Ministry of Public Works
(transportation) Ministry of Foreign Relations, local
governments, and the parastatal water company. A vaccine
against H5N2 is used regularly by commercial poultry
producers. MAG officials believe this vaccine is also
effective against H5N1. El Salvador bans the import of raw
and live poultry from outside Central America.

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?

--There has been no formal legal review in response to this
issue, but Salvadoran laws are generally consistent with
international health regulations. Legal review would likely
occur only if a specific barrier to avian influenza
detection, reporting, containment, or response were
identified in practice.

Is the host country already working with international
organizations or other countries on the avian flu issue? Are
government leaders likely to ask for assistance from the
United States or other countries? Would government leaders
be receptive to messages from U.S. leaders through a
bilateral approach, at a multilateral forum such as the
United Nations (WHO, FAO, etc.) or APEC, or through bilateral
contacts by a third country? What would the country want
from the United States in return for its efforts?

--El Salvador is already working with the World Health
Organization (WHO) and Pan American Health Organization.
USAID has developed an effective coordinating group for
bilateral and multilateral donors that is active on this
issue. Officials in the Ministries of Health and Agriculture
are working with counterparts in other Central American
governments to develop a coordinated approach to the issue.

Does the country currently administer annual flu shots? If
not, might it consider doing so? What is the production
capability (i.e. how many doses of the annual Trivalent flu
vaccine can the country make) for human influenza vaccines in
the country? Does the country produce influenza vaccine for
poultry and if so how much? If the country is developing an
H5N2 vaccine, where is it in production and testing? Are
there any licensing issues? Is there a liability shield for
foreign makers/donors of vaccines? If not, any prospects of
one being enacted?

--The GOES administers free annual flu shots to children
under 5 and adults over 60. Funding constraints limit the
extension of this program to others outside these high-risk
groups. There is currently no human influenza vaccine
production in El Salvador, nor is there influenza vaccine
manufactured for poultry in El Salvador. Local pharmaceutical
companies are not capable of developing or manufacturing an
H5N1 vaccine in El Salvador.

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, particularly in
rural areas and how effective are these measures?

--Press reports on the spread of avian influenza in Asia and
Europe have featured prominently in print, radio, and
television news. The Ministers of Health and of Agriculture
and representatives of the WHO have appeared in television
interviews.

B) Surveillance/detection

How capable are the medical and agriculture sectors of
detecting a new strain of influenza among people or animals
respectively? How long might it take for cases to be properly
diagnosed, given other endemic diseases? Can influenza
viruses be subtyped in the country, if so by whom, and if not
where are they sent? Does the country send samples to a
WHO/EU/U.S. reference laboratory?

--Local laboratories can identify the virus but cannot
identify its genotype. To determine genotype, samples are
sent to CDC in Atlanta, and results are usually available
within 30 days. The CDC and U.S. Army have collaborated with
technical assistance and processing/analysis of blood samples
taken from avian stock at five sentinel sites.

What are the critical gaps that need to be filled in order to
enhance the country's disease detection and outbreak response
capabilities? What is the country's greatest need in this
area from the United States or international organizations?

--El Salvador lacks resources, both technical and financial,
needed to enhance the country's disease detection and
outbreak response capabilities. Post will continue to serve
as a source of information on the virus for the Salvadorans.
CDC's continued cooperation on genotype testing is important
as well.

C) Response/Containment

Does the country have a stockpile of medications,
particularly of antivirals, and if so how much? If some has
been ordered, how much and when is it expected?

--El Salvador has limited stockpiles of most medicines, but
does not have antiviral stockpiles. El Salvador hopes to
begin acquiring antivirals to treat humans in 2007, but has
not yet ordered any medicines.

Does the country have a stockpile of pre-positioned personal
protective gear?

--El Salvador has limited stockpiles of personal protective
gear.

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?

--The national task force on Avian Influenza is developing
guidelines for culling and vaccination of birds, disinfection
of facilities, and limitations on animal movement.

How willing and capable is the government of imposing
quarantines and social distancing measures (closing schools,
public gatherings, mass transit)? Would its military enforce
quarantines?

--If required, the government would attempt to impose
quarantines, but resource constraints would limit their
effectiveness in doing so. The military would support
quarantines.

End survey response.
Barclay