Turkey Avian Influenza Update - January 7

UNCLAS SECTION 01 OF 03 ANKARA 000118

SIPDIS

USAID FOR TROSTLE, BLANCHET AND CARROLL
HHS FOR WSTEIGER/PBUDASHEWITZ
FAS FOR ITP/MACKE/THOMAS, CMP/DLP/WETZEL, FAS/JDEVER
FAS PASS FSIS AND APHIS
VIENNA PASS APHIS
BRUSSELS PASS APHIS/FERNANDEZ
GENEVA PASS HEALTH ATTACHE

SIPDIS

E.O. 12958:N/A
TAGS: TBIO AMED EAID CASC SENV EAGR KPAO TU
SUBJECT: Turkey Avian Influenza Update - January 7

Ref: ANKARA 104 AND PREVIOUS

This is an Action Request.

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1. Summary. As of mid-day January 7 there are no new deaths
or additional confirmations of human cases. Nine or ten sub-
provinces are under animal quarantine. Though there are
multiple reports of dead birds in other regions, none have
been confirmed as AI, with the possible exception of two
wild ducks in Nallihan, west of Ankara. Press reports the
GOT has banned bird hunting throughout Turkey. The WHO/ECDC
team departed for the affected region in eastern Turkey
morning of January 7. The Turkish authorities are fully
cooperating with the team, which aims to make a preliminary
assessment of critical needs and recommendations by Tuesday,
January 10. Personal protective gear, bird incineration
equipment, laboratory equipment, surveillance and public
information materials seem to be critical needs. Embassy
requests Washington agencies assess capacity to respond to
Turkey's needs, in coordination with international agencies.
End Summary.

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Cases in Humans
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2. There are no new deaths from Avian Flu beyond the deaths
confirmed on January 6. Nor are there new confirmations of
H5N1. The Istanbul laboratory told us that it had results
on 24 samples (representing 12 cases) received from eastern
Turkey, all of which came out negative for AI. The Ankara
laboratory is processing 26 samples, representing 5 cases in
Erzurum and 17 new cases from Van. There are reports of
people with flu-like symptoms but none yet confirmed to have
AI. Of these, only a group of cases in Yalova (near
Istanbul) are outside eastern Turkey and these people
recently came from eastern Turkey.

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Poultry Outbreaks and Government Actions
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3. Press is reporting that 10 sub-provinces are now under
animal quarantine (we have not yet been able to confirm the
tenth sub-province from official sources.) Outside these sub-
provinces, there continue to be new reports of sick birds
however they have not been confirmed as AI, with the
possible exception of two migratory ducks found dead in
Nallihan (in Ankara province about an hour west of Ankara).
Press is reporting that the Agriculture Minister has said
that the two ducks in Nalihan were confirmed as AI.
According to a visiting WHO official, authorities are now
actively going around looking for and culling poultry in the
affected regions. Press has also reported that the
Environment Ministry has banned bird hunting throughout
Turkey.

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International Cooperation
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4. We spoke early January 7 with the lead WHO official,

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Caroline Brown, just before she and the rest of the team
left from the Van region. In addition to ECDC and WHO
officials, Brown confirmed the team included a
representative FAO/OIE (Office of International Epizootics).
Overall, the team was pleased with the cooperation they are
receiving, including extensive briefings from government
ministries and time spent with the Ankara laboratory. Brown
had a generally positive view of the quality of the
laboratories and was pleased the GOT had agreed to have a
WHO H5 specialist come to Ankara to begin running tests in
parallel. The Ankara lab is running RT-PCR (real time
polymerase chain reaction) tests and Brown thought the
results looked reliable. WHO has offered-and Turkey has
accepted-setting up an incident command center in Van.


5. Brown said it was too early for WHO to draw conclusions
on case definitions (i.e. criteria used in determining
whether a case is AI). She felt strongly that there was
room for improvement on surveillance. The small backyard
flocks are a particular challenge. Human surveillance has
been mostly self-referrals up to this point (sick patients
seeking treatment). The MOH has distributed brochures to
the affected areas but WHO did not yet have a translation to
evaluate the text. (Note: Press is reporting that Turkish
students report cards, sent home Friday, included a message
on how to prevent AI). Separately, Mr. Gunel Rodier from
WHO/Copenhagen is due in Ankara to work on elaborating and
mobilizing an emergency assistance budget. Prime Minister
Erdogan announced January 6 that the GOT would allocate an
additional 7 million New Turkish Lira (about $5.2 million)
to address the AI problem. Brown said that, for now, Turkey
has adequate Tamiflu supplies having recently ordered
additional shipments. Press is reporting that Roche has
shipped an additional 100,000 full courses of treatment, of
which 10,000 are a donation.

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Critical Needs
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6. Though preliminary, Brown identified a number of areas in
which she believed there were critical needs for assistance:

--Public Education. Getting the message out to people
including remote farm populations on appropriate measures.
(Note: Post understands USAID has developed community
communication materials which could be available for
translation and dissemination at village level. End Note.)

--Hospital equipment, particularly ventilators.

--Personal protective equipment(PPE),such as gowns masks
goggles gloves, for both animal and healthcare workers.

--Training for epidemiology. WHO has been working with
Turkey on a project to establish improved laboratory
epidemiology capacity, but this is not in place yet.

From our earlier conversations with Ministry of Agriculture
officials, there is a need for portable incinerators for
disposable of culled animals. Given the vast numbers now

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requiring culling, this need has undoubtedly increased.

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Action Request
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7. Embassy requests Washington agencies assess USG capacity
to respond to Turkey's needs, so that the USG can join the
assistance efforts of international organizations. We
propose that the Department make a public statement of
support for the Turkish authorities' efforts to address this
problem along with a commitment to provide critical
assistance.


McEldowney