Identifier
Created
Classification
Origin
06BAKU444
2006-03-22 13:19:00
CONFIDENTIAL//NOFORN
Embassy Baku
Cable title:  

WHO CONFIRMS 5 AVIAN INFLUENZA CASES IN AZERBAIJAN

Tags:  KFLU EAID PGOV EAGR TBIO CASC AJ 
pdf how-to read a cable
VZCZCXRO8031
PP RUEHDBU
DE RUEHKB #0444/01 0811319
ZNY CCCCC ZZH
P 221319Z MAR 06
FM AMEMBASSY BAKU
TO RUEHC/SECSTATE WASHDC PRIORITY 9923
INFO RUCNCIS/CIS COLLECTIVE PRIORITY
RUEHAK/AMEMBASSY ANKARA PRIORITY 1554
RUEHRO/AMEMBASSY ROME PRIORITY 0202
RUEHLO/AMEMBASSY LONDON PRIORITY 0291
RHEHNSC/NSC WASHDC PRIORITY
RHMFISS/CDR USEUCOM VAIHINGEN GE PRIORITY
RUEHGV/USMISSION GENEVA SZ PRIORITY 0156
C O N F I D E N T I A L SECTION 01 OF 03 BAKU 000444 

SIPDIS

SENSITIVE
SIPDIS

DEPT FOR EUR/CARC AND EUR/PGI, ALSO OES AND MED
DEPT PLEASE PASS USAID FOR GLOBAL HEALTH MURRAY TROSTLE
ANKARA FOR AGRICULTURAL COUNSELOR
ROME FOR FAO REPRESENTATIVE
GENEVA FOR HEALTH ATTACHE
TBILISI FOR USAID; ALSO PASS A/S FRIED
HOMELAND SECURITY COUNCIL FOR RAJIV VENKAYYA AND KEN STALEY

E.O. 12958: DECL: 03/22/2016
TAGS: KFLU EAID PGOV EAGR TBIO CASC AJ
SUBJECT: WHO CONFIRMS 5 AVIAN INFLUENZA CASES IN AZERBAIJAN

REF: BAKU 402 AND PREVIOUS

Classified By: DCM JASON P. HYLAND; REASONS 1.4 (B,D)

C O N F I D E N T I A L SECTION 01 OF 03 BAKU 000444

SIPDIS

SENSITIVE
SIPDIS

DEPT FOR EUR/CARC AND EUR/PGI, ALSO OES AND MED
DEPT PLEASE PASS USAID FOR GLOBAL HEALTH MURRAY TROSTLE
ANKARA FOR AGRICULTURAL COUNSELOR
ROME FOR FAO REPRESENTATIVE
GENEVA FOR HEALTH ATTACHE
TBILISI FOR USAID; ALSO PASS A/S FRIED
HOMELAND SECURITY COUNCIL FOR RAJIV VENKAYYA AND KEN STALEY

E.O. 12958: DECL: 03/22/2016
TAGS: KFLU EAID PGOV EAGR TBIO CASC AJ
SUBJECT: WHO CONFIRMS 5 AVIAN INFLUENZA CASES IN AZERBAIJAN

REF: BAKU 402 AND PREVIOUS

Classified By: DCM JASON P. HYLAND; REASONS 1.4 (B,D)


1. (SBU) SUMMARY: On March 21, the World Health Organization
(WHO) announced that UK reference laboratory tests showed
that five deaths (reftel) in Azerbaijan were caused by H5N1
avian influenza. Testing confirmed two additional H5N1
infections; one patient recovered and has been discharged
from hospital, while a second girl remained hospitalized in
critical condition. Two additional patients from the Salyan
and Neftchala regions were also hospitalized with suspected
bilateral pneumonia; testing is underway. According to WHO,
a total of 19 cases of suspect illness, including the five
deaths, are under investigation. A five-person WHO team on
the ground has implemented an aggressive human surveillance
program and is working to improve the GOAJ's still weak
public education campaign. FAO has identified two of the
three experts it plans to field to Azerbaijan, a critical
step to mitigate the GOAJ's unacceptable veterinary response.
USAID has now begun a project with the State Veterinary
Committee, and has deployed a veterinary expert who is
recording a series of public service announcements on avian
influenza. Embassy AI working group reviewed post's AI
tripwires March 17; Post plans to release a warden notice
following WHO's March 21 announcement. END SUMMARY.


2. (SBU) On March 21, the WHO issued a statement indicating
that reference laboratory testing in the UK showed that H5N1
avian influenza caused five recent deaths in Azerbaijan (full
text at www.who.int). Four of the five deaths (17-year-old

female, 20-year-old female, 16-year-old male, and 17-year-old
female) were in Azerbaijan's Salyan region, while the fifth
(21-year-old female) was in Terter region. All of the Salyan
cases are reportedly from the same family unit, extended
family, or persons in close contact with the same family. In
addition, the WHO statement indicates two additional
confirmed H5N1 cases from Salyan region: a 10-year-old boy
who has recovered and a 15-year-old girl currently
hospitalized in critical condition. In addition, two other
patients, one from Salyan and one from adjacent Neftchala
region, are now hospitalized with symptoms of bilateral
pneumonia; testing on these cases is underway. The WHO
statement indicates that the source of the infections is
under investigation. Not surprisingly, there are multiple
stories depending on which source is consulted. The Minister
of Agriculture claimed to DCM March 15 that no large poultry
die-offs were reported in Salyan region. He indicated that
the family in question had been involved in illegal hunting
and harvested down from migratory birds as a family business.
He surmised that this was the source of infection. However,
a visiting FAO expert told Econoff March 16 that his visit to
Salyan had yielded reports of backyard poultry die-offs
throughout the area.


3. (SBU) For the past two weeks, the World Health
Organization has had a team of five international experts in
Azerbaijan. Reports indicate that they are working well with
the Azerbaijani Ministry of Health. Emboffs met on March 16
with two representatives of the WHO's international mission
to Azerbaijan. These representatives reported excellent
cooperation from Ministry of Health colleagues. Other areas
they highlighted:

-- In the Dayikend settlement of the Salyan Region, WHO has
implemented an active, aggressive human surveillance program.
To date, 4,200 people have been interviewed in door-to-door
searches. The active surveillance will continue until 14
days after the final suspect case is resolved. The WHO's
chief epidemiologist is working with local doctors, who
actually head the surveillance teams, to ensure a rigorous
process;

-- The WHO team planned to travel to the Terter region, where
the fifth H5 death was confirmed, to assess the local
response and determine what next steps are necessary;


BAKU 00000444 002 OF 003


-- As the Ministry of Agriculture's veterinary response had
posed significant challenges for their own work, the WHO
representatives said they would push FAO to dispatch
immediately to Azerbaijan at least two experts for a two
month term. (NOTE: FAO regional representative told Econoff
March 22 that FAO planned to send three experts to
Azerbaijan. A veterinary epidemiologist (already identified)
would serve for six months, a communications specialist
(already identified) would work for six weeks in cooperation
with UNICEF, and a laboratory technician (to be identified)
would serve four weeks in the GOAJ's veterinary lab. END
NOTE.);

-- One of the five members, a communications specialist, was
working directly with the MOH on a media strategy. The WHO
team noted that public communication was sorely lacking and
only fueled rumors and confusion. The goal was a daily
"bulletin" system to control rumors and to have a central
repository for information.

-- The WHO continued to work with on the sampling issue,
particularly with the supplies (i.e. packaging boxes) needed
to ship samples to international labs. Based on Post's
experience facilitating sample shipment, Emboffs stressed how
critical a large supply of sample containers was for rapid
testing of suspect cases.


4. (C) The WHO representatives reported a disturbing finding
that in Salyan, where multiple cases of H5N1 avian influenza,
including four deaths, were identified, Azerbaijani
veterinary officials were still telling people that there is
no avian influenza in birds. According to interviews done by
WHO with local residents, many were told by veterinary
authorities that absent AI in birds, the only way that the
virus could have been contracted in humans would be through
human-to-human transmission. The WHO representatives also
expressed a great deal of frustration with the Ministry of
Agriculture, specifically with the Veterinary Service.
(COMMENT: While there has been no definitive laboratory
finding on whether poultry or wild birds in Salyan have AI,
most of the anecdotal evidence Post has heard would make it
likely that fowl in Salyan are infected with avian influenza.
END COMMENT.)


5. (SBU) Although the WHO response is improving, the sole
impetus for public outreach on avian influenza continues to
be the international community. However, these efforts are
beginning to take hold. Combined UNICEF/MOH PSAs are now
running on television, with airings of these AI PSAs often
followed by a tantalizing GOAJ message promising free
treatment for tuberculosis cases. Whether simply happy
coincidence or ingenious design (we suspect the former),the
combination of messages may encourage the public not only to
protect itself properly, but also to come forward and seek
treatment immediately should a suspicious illness present
itself. At the same time, post continues to follow our
initial television and print campaign with more work to
increase public awareness. Most recently, USAID and its
implementing partner Pragma are filming a number of short
clips using a visiting U.S. veterinary specialist on how
farmers should properly handle poultry. Post plans to
disseminate these clips widely. Finally, the Ministry of
Education has already distributed to schools around the
country UNICEF-prepared information on avian influenza.


6. (SBU) Post's AI working group met March 17 to review our
AI action plan and tripwires. The working group determined
at that time that no further actions were required, but that
Post would continue to monitor the situation carefully. Post
had issued a warden notice and embassy-wide management notice
on March 14, following the first confirmation of H5 in
humans, which cautioned the American community on the human
cases and steps required to avoid contracting AI. Following
WHO's March 21 press release, Post will issue a follow-up
warden message to the American community March 22.


7. (SBU) COMMENT: We are greatly encouraged by the presence

BAKU 00000444 003 OF 003


of the WHO team; it includes people with both the technical
knowledge, experience, and acumen to make positive changes.
While FAO's response has been very slow, we are also
encouraged by the commitment to send long-term experts to
Azerbaijan. As the number of cases continues to grow, Post
strongly supports the deployment of more international
experts to a front line of the international community's
fight against avian influenza in a country whose government
response has been poor, and medium- and long-term needs for
capacity building are extensive. Given the ongoing weakness
of the GOAJ's veterinary response, and the challenge this
inaction poses for human health efforts, experts in
veterinary services are particularly useful. With people
continuing to fall ill, however, there is also great need for
clinicians that can augment the WHO presence, in Baku as well
as in the regions, to ensure patients receive proper
treatment quickly. Finally, in the midst of battling new
cases of AI in humans and fowl, there is still a need for
forensic epidemiologists to investigate regions, such as
Massali and Ganja, where large birds die-offs, and rumors of
human illness, have never been fully investigated. As the
WHO and FAO slowly come around, the reality in Azerbaijan
remains that much more money, supplies, and expertise are
needed. Post appreciates Department's ongoing efforts to
lobby FAO, WHO, EU (which has been surprisingly disengaged,
apart from contributing to a World Bank facility),and others
for the support Azerbaijan needs to meet this crisis. END
COMMENT.
HARNISH