AVIAN INFLUENZA RE-SURFACES IN THAILAND; ONE HUMAN DEATH

UNCLAS SECTION 01 OF 08 BANGKOK 004530 SIPDIS SENSITIVE SIPDIS DEPARTMENT FOR G/AIAG/JLANGE DEPARTMENT FOR EAP/MLS DEPARTMENT FOR OES/STC/MGOLDBERG AND PBATES DEPARTMENT FOR OES/PCI/ASTEWART DEPARTMENT FOR OES/IHA/DSINGER AND NCOMELLA DEPARTMENT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL DEPARTMENT PASS CDC FOR COGH SDOWELL AND NCID/IB AMOEN DEPARTMENT PASS HHS/OGHA/WSTEIGER AND MSTLOUIS DEPARTMENT OF AGRICULTURE FOR OSEC AND APHIS DEPARTMENT OF AGRICULTURE FOR FAS/DLP/HWETZEL AND DEPARTMENT OF AGRICULTURE FOR FAS/ICD/LAIDIG, PETTRIE DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN PARIS FOR FAS/AG MINISTER COUNSELOR/OIE ROME FOR FAO E.O. 12958: N/A TAGS: TBIO KFLU SOCI PGOV EAID EAGR KPAO XE SUBJECT: AVIAN INFLUENZA RE-SURFACES IN THAILAND; ONE HUMAN DEATH AMID NUMEROUS POULTRY DIE-OFFS BANGKOK 00004530 001.2 OF 008 ¶1. (U) Summary: Numerous die-offs of poultry have occurred in Thailand over the past month, concentrated mostly in the central and north-central provinces. Despite testing of samples taken from the dead birds over the month-long period, government veterinary laboratories failed to detect the virus until July 24 when they isolated H5N1 virus from the carcass of a single fighting cock. Today, July 26, all doubts about the cause of the poultry die-offs vanished when the Minister of Public Health confirmed that the death of a 17-year-old boy in a province with heavy poultry fatalities was caused by H5N1 avian influenza. Although the Minister's quick confirmation and open communication is commendable, serious questions remain why the virus was not detected earlier in the veterinary laboratories. End summary. Poultry Die-Offs in July -------------- ¶2. (U) The Bangkok Post reported on July 4 that "more than 2000 poultry have died... within the Phichit Province" about 200 miles north of Bangkok. The article said that local livestock officials were running tests on the dead poultry, but that they suspected E. Coli (a species of bacteria) to be the cause of the die-off. ¶3. (U) During the month of July, numerous other poultry die-offs occurred in Phichit, Phitsanulok, Sukothai, and Uttaridit Provinces in north-central Thailand as well as in other provinces in the country. The Department of Livestock Development (DLD),under the Ministry of Agriculture and Cooperatives, reported on July 16, that BANGKOK 00004530 002.2 OF 008 large numbers of fowl had recently died in 430 tambons [sub districts] in 50 provinces. Although a DLD official told the Bangkok Post that "the department did not rule out the possibility of a re-emergence of the [avian influenza] virus," laboratory tests had yielded negative results. ¶4. (U) On July 22, Professor Prasert Thongcharoen, a microbiologist at Bangkok's Siriraj Hospital, told The Nation newspaper in a telephone interview after returning from Phitsanulok Province that he had strong doubts about the accuracy of official reports of avian-flu tests on dead birds by livestock authorities. "To be fair, they might have checked the samples and simply could not detect the virus," said Prasert. "Yet, once again, things are so obvious." Avian Influenza Detected in a Single Poultry Sample -------------- -------------- ¶5. (U) Finally, on the morning of July 24, using Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) methodology, the DLD's Lower Northern Regional Veterinary Research and Development Center in Phitsanulok Province detected avian influenza H5 virus in a sample taken from a household in Phichit Province's Bang Mun Nak District where 31 fighting cocks and free-range chickens had died over several days beginning July 16. The authorities took immediate and stringent containment measures, including culling of the remaining 295 chickens on the Phichit farm, putting a 10-km radius quarantine and surveillance zone around the farm, and imposing a BANGKOK 00004530 003.2 OF 008 total ban on the transport of poultry in the province to prevent villagers from trying to smuggle out potentially infected birds. On the same day, the DLD submitted a formal report to the World Organization for Animal Health (OIE),notified the UN's Food and Agriculture Organization (FAO),and the Minister of Agriculture and Cooperatives called a news conference to inform the public. Human Death Attributed to Avian Influenza -------------- ¶6. (U) Since July 22, at least seven persons in Phichit Province and two persons in nearby Uttaridit Province (where poultry have succumbed in large numbers over the past three weeks) have been admitted to the provincial hospitals with flu-like symptoms. All of the patients had contact with sick or dead poultry or with wild birds. Laboratory testing performed on samples taken from all of the patients, including from the 17-year-old boy, tested negative for avian influenza virus. Further testing of samples taken from the dead teenager, however, confirmed the presence of H5N1 avian influenza. ¶7. (U) The young man had buried between 10 and 20 chickens that had died of unknown causes in his village on July 10. He became ill July 15 and went to the district hospital with heavy coughing on July 18. A rapid test carried out that day was negative for influenza, and a chest x-ray was normal. He was sent home, but returned to the hospital on July 20 with a high temperature. The BANGKOK 00004530 004.2 OF 008 first diagnosis was dengue fever and he was admitted for treatment. His conditions deteriorated, and he was sent to Phichit provincial hospital on July 22 where he died on July 24. ¶8. (U) At 11:30 a.m. on July 26, the Ministry of Public Health (MOPH) confirmed via press release that a sputum specimen from the 17-year-old boy had tested positive for H5N1 virus. The announcement included a clinical history of the boy's illness, but specified neither the laboratory nor the testing method. MOPH officials in Bangkok told Bangkok-based CDC personnel that these tests were performed in provincial or regional laboratories, and have not yet been confirmed by Thai National Institute of Health (NIH). The Bangkok CDC personnel have not yet received any requests for assistance with confirmatory testing. Until Thai the NIH confirms the laboratory results, they must be considered preliminary. ¶9. (U) In the same press release, MOPH also announced that 20 specimens from human cases have been tested for H5N1; in addition to the one positive, half have tested negative for H5N1 but positive for another common respiratory pathogen, and the rest are pending or inconclusive. The release also stated that more than 2000 specimens from poultry have been tested, with H5N1 found only in the sample taken in Bang-Moon-Nak District (near to the Tubklor District where the single human laboratory-positive case resided). Shortly after the press release, Minister of Public Health Phinij Jarusombat briefed the media at a press conference in Bangkok. BANGKOK 00004530 005.2 OF 008 Serious Questions for the Agriculture Ministry -------------- - ¶10. While the Minister of Public Health's quick confirmation and open communication is commendable, serious questions remain why the virus was not detected earlier among the 2000 poultry specimens tested by the Agriculture Ministry's veterinary laboratories. Earlier detection and public knowledge of H5N1 as the cause of the poultry die-offs would have put health authorities, as well as the general population, on higher guard, possibly preventing the death of the 17-year-old. ¶11. (SBU) On July 24, Senator Nirun Phitakwatchara publicly called on the Minister of Agriculture to resign for his mismanagement of bird flu monitoring. The Senator had earlier accused the ministry of covering up the re-emergence of bird flu for fear the country's poultry exports would be hit. He recalled that the ministry had tried to cover up bird flu outbreaks when the virus first came to Thailand in late 2003 and early 2004. ¶12. (SBU) Officials at the World Health Organization (WHO) office in Thailand said they were aware of allegations of cover up, but saw no reason to doubt the integrity of the responsible Thai authorities at this stage. Privately, however, an FAO official told Embassy Regional Environmental Officer that he was concerned about the possibility of politicians trying to hide the cause of the poultry outbreaks in the hopes the die-offs would subside quickly and BANGKOK 00004530 006.2 OF 008 without human illness. ¶13. (SBU) Comment: The Ministry of Agriculture and Cooperatives likely did try to hide the presence of avian influenza in poultry in Thailand in late 2003. However, since January 2004, Thailand has worked hard to become a model of exemplary and timely reporting of avian influenza to the OIE, FAO, and WHO. It works closely with CDC, the U.S. Embassy, and other international entities, and has been subject to close international scrutiny. That said, USAID has been hearing "rumors" for some time about ongoing outbreaks in private commercial farms. And there are strong and obvious economic incentives to Thailand's politically powerful commercial poultry industry to maintain an "avian influenza-free" Thailand that can begin re-exporting raw chicken meat. ¶14. (U) Comment Continued: Assuming there has been no intentional cover-up, there still remains the question of why the H5N1 virus is not being detected in veterinary laboratory testing of poultry we now believe to have been infected with the virus. It is possible that the problem is technical in nature. During the visit to Thailand last May of Special Representative for Avian and Pandemic Influenza Ambassador John Lange, the Deputy Director-General of the Department of Livestock Development (DLD) said that the DLD routinely pools samples when conducting surveillance. There is a long history of pooling specimens as a cost effective way of performing screening with expensive reagents. Moreover, RT-PCR methodology is extremely sensitive, capable of detecting and BANGKOK 00004530 007.2 OF 008 amplifying viral DNA in the tiniest amounts. Pooling of large numbers of samples, however, could theoretically dilute the virus and at some point decrease the sensitivity of the test. FAO currently recommends pooling specimens in batches of 5-10, and mathematical models support that recommendation. Post was unable today to confirm whether the DLD complies with FAO's 5-10 specimens per batch recommendation. Post also points out that improper collection, storage, and transport of samples can negatively impact laboratory testing. ¶15. (U) Comment Continued: Thailand has a well-deserved reputation for good public awareness and education campaigns, good community-based surveillance, rapid outbreak investigation and control, and prompt laboratory confirmation related to avian influenza. The USG and other international donors and organizations have been instrumental in assisting Thailand achieve these competencies. The re-surfacing of avian influenza in Thailand, then, shows that the virus can only be controlled, and not totally eliminated. Moreover, the re-surfacing of the virus in Thailand, along with the negative laboratory tests on specimens from poultry die-offs, the misdiagnosis of the first human case of avian influenza in Thailand in over six months, and the reported continued human contact with sick and dead poultry in affected areas demonstrates the continuing need for basic public awareness, education and hygiene messages, better animal husbandry practices, improved disease surveillance among birds and humans, practical training of animal and human health providers, and improved capacity BANGKOK 00004530 008.2 OF 008 of technicians in specimen collection and laboratory procedures. Arvizu