UNCLAS SECTION 01 OF 02 ZAGREB 001868

SIPDIS

SIPDIS

DEPT PLEASE PASS TO DS/DSS, DS/IP, M/MED/JCTRIPLETT
FAS/CMP/DLP WETZEL AND MAGGINNIS
FAS/ITP/EAMED POMEROY AND FLEMING
CA/OCS/ACS RICK DOWELL
USAID FOR E&E/ECA/B/ANNE CONVERY

E.O. 12958: N/A
TAGS: TBIO SENV ECON EAGR PREL HR
SUBJECT: CROATIA: AVIAN INFLUENZA UPDATE: NOVEMBER
23 AND RESONSE TO INFORMATION REQUEST

REF: A) STATE 209622 B) ZAGREB 1836 AND PREVIOUS

SUMMARY: As of November 23, no additional cases of
H5N1 have been confirmed in Croatia. In response to
ref A, Post is providing responses to questions
concerning the GOC's efforts to control avian
influenza (AI) and capability to respond to an
influenza pandemic in its weekly update report. END
SUMMARY

A) Preparedness and Communications

The GOC has a strategy for preventing and containing
pandemic influenza, which is outlined in their
national preparedness plan. This plan was prepared
using WHO and EU guidelines and is available online
at http://www.vlada.hr/Download/2005/10/26/2.pdf
Post believes the GOC is capable of implementing the
plan. Post will forward an English translation of
the plan when it becomes available. Dr. Gjenero-
Margan, Director of Epidemiology and Infectious
Disease at the Croatian Institute for Public Health,
said that national laws would not pose barriers to
detection, containment or response measures.

To date, the GOC has been very transparent in
reporting cases of avian influenza (AI) in animals
and Post expects that transparency would continue in
the event of an outbreak in people. Croatia is a
small country with a good telecommunications
infrastructure and a free and vocal press. Post
feels these factors also contribute to continued
transparency related to AI.

Avian influenza is a priority for the GOC. Top
leaders including the Prime Minister and the
Ministers for Health and Agriculture have spoken
publicly about the need to be vigilant against the
threat of AI. The Ministry of Agriculture currently
has the lead on AI in Croatia and Agricultural
Minister Petar Cobankovic is an appropriate high-
level political interlocutor. Currently, the
technical lead is Assistant Minister Mate Brstilo,
Veterinary Directorate, Ministry of Agriculture.

The GOC is working with international organizations
such as FAO, OIE, WHO and EU (specifically the
Dutch) on AI. The GOC informally asked for and is
receiving technical assistance from the Netherlands.
Post believes the GOC would be receptive to US
assistance offers through either a bilateral or
multilateral approach.

Gjenero-Margan said that Croatia purchases
approximately 550,000 trivalent flu shots per year
from foreign vaccine producers. Flu shots are
elective and are recommended to high-risk patients
(such as the elderly). In the case of an adverse
reaction to a mandatory vaccine, cases are referred
to the Ministry of Health for investigation and
compensation. Gjenero-Margan was unsure of the
protocol for adverse reactions to voluntary vaccines
such as the flu shot. Nor did she know whether
Croatia provides liability shields to foreign
vaccine producers.

The public appears to be well-informed about AI,
although media interest in AI has waned since the
initial discovery of H5N1. For the most part,
headlines and photos are sensationalistic, but
reporting is largely factual. GOC officials
including the PM and Ministers of Health and
Agriculture have also spoken publicly about the risk
of AI. The Ministry of Agriculture has published AI
pamphlets for the agricultural sector and uses a
network of field offices and veterinarians to
disseminate information on animal diseases to rural
areas. The City of Zagreb published an AI pamphlet
for the general public, but it is unclear whether

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this pamphlet reached a broader audience outside of
the capital.

B) SUREVEILLANCE AND DETECTION
The GOC feels it has demonstrated its ability to
quickly detect a new strain of influenza among
animals. The PM was quoted in the press touting the
speed with which the GOC identified H5N1 in
migratory birds and responded, thereby preventing
the virus from spreading to domestic poultry.
Croatia does not have any endemic infectious
diseases that consume a majority of its resources.
Currently, the Veterinary Directorate uses old but
accurate technology to subtype viruses found in
samples. If the H5 subtype is identified, the
samples are then sent to the EC reference lab for
further testing. Croatia is a member of WHO's
FluNet. Croatia's National Influenza Center
collects an average of 1200 samples and forwards
approximately four to five representative isolates
to WHO reference labs a season.

The GOC is expecting a new real time reverse
transcription-polymerase chain reaction (RT-PCR)
machine in the next few weeks. The RT-PCR machine
will help them more rapidly test the thousands of
samples from the field. The GOC is also interested
in obtaining a DNA purifier machine to identify
virus subtypes.

C) RESPONSE AND CONTAINMENT

In response to the three initial instances of H5N1,
the GOC's response was very rapid and the guidelines
for culling and increasing biosafety measures were
quickly implemented. Post will report on antiviral
and personal protective equipment supplies in
septel.

Gjenero-Margan said that while quarantine and social
distancing are options for response, they are not
considered very effective measures. She considers
the use of anything but voluntary isolation highly
unlikely in the event of a pandemic and stated that
who would carry out these measures has not been
decided.


DELAWIE