THAILAND'S SECOND HUMAN AVIAN INFLUENZA DEATH IN

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E.O. 12958: N/A
TAGS: TBIO EAGR KFLU PGOV SOCI TH
SUBJECT: THAILAND'S SECOND HUMAN AVIAN INFLUENZA DEATH IN
THE PAST TWO WEEKS

REF: A. BANGKOK 4530 B. BANGKOK 4612 C. BANGKOK 4613

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1. (U) Summary: Thailand's Ministry of Public Health (MOPH)
confirmed by laboratory testing that a second human avian
influenza death in as many weeks occurred on August 3 in
Uthaithani, a province in west-central Thailand. Testing of
veterinary samples from the man's home returned negative
results, prompting an exchange of barbs between officials
from the Department of Livestock Development (DLD) and MOPH.
On August 6, livestock officials culled 20,000 chickens on a
poultry farm in another district of Uthaithani Province after
200 chickens reportedly died there en masse. Meanwhile, on
July 31, DLD veterinary laboratory testing did detect H5N1
avian influenza in a poultry outbreak in Nakhon Phanom
Province in Thailand's far northeast. End Summary.

Thailand's Second Human Avian Influenza Death in 2006
-------------- --------------

2. (U) Dr. Thawat Suntrajarn, the Director-General of the
MOPH's Department of Disease Control, told Bangkok-based CDC
personnel that Thailand's second human influenza death of the
year was a 27-year-old patient admitted to the Uthaithani
provincial hospital on July 30 with fever and shortness of
breath. He died at the hospital on August 3. (Thailand's
first human avian influenza death of 2006 occurred on July

24. See Ref A.) The 27-year-old reportedly had buried a
dead chicken in his backyard on July 17. Laboratory tests
for avian influenza undertaken at the hospital were
inconclusive, but the results of Polymerase Chain Reaction
(PCR) DNA testing on specimens sent to both the Thai National
Institute of Health and Bangkok's Siriraj hospital on August

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5 were positive for H5N1 avian influenza.


3. (U) On August 7, the Bangkok Post reported that veterinary
samples taken from both dead and live chickens at the man's
home all tested negative. The article quoted Kamnuan
Ungchusak, Director of MOPH's Bureau of Epidemiology as
saying, "I'm not surprised that the (DLD's) test could not
find the H5N1 virus in poultry samples from the house because
the test was conducted long after the man was infected by the
virus, and most of the chickens were already dead."


4. (U) The article quoted the DLD's Disease Control Bureau
Director Nirundorn Aungtragoolsuk as saying, "Since the H5N1
bird flu virus was not detected at the victim's house and in
the nearby vicinity, public health officials should find out
how and where the man contracted the virus."


5. (SBU) The frustration expressed by these officials to the
Bangkok Post hints at a deeper tension between MOPH and the
Ministry of Agriculture's DLD. Privately, MOPH officials
have expressed to us in harsher words a growing frustration
with DLD. Theoretically, surveillance of poultry should be
the first indicator of the presence of H5N1, leading to
increased public health surveillance of humans in
poultry-affected areas. But in Thailand, just the opposite
scenario is occurring - detection of H5N1 in humans is
preceding reports of H5N1 in poultry. To be fair, in
comparison to MOPH, the DLD has less manpower, less
experience, and less funding to conduct disease surveillance.
DLD is also frustrated that farmers continue to neglect
reporting or even hide poultry deaths from officials, causing

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them to arrive too late on the scene to obtain good
laboratory specimens.

Poultry Die-Off in Uthaithani Province...
--------------

6. (U) The Bangkok Post also reported on August 7 that DLD
officials culled approximately 20,000 chickens on a farm in
another district of Uthaithani Province after 200 chickens
reportedly died there "en masse." Embassy Bangkok-based
Regional Environmental and Health Officer was unable to reach
DLD officials in Bangkok to inquire whether veterinary
samples were taken from the affected flock for laboratory
testing. The province, which is further south than Phichit,
Phitsanulok, Sukothai, and Uttaradit provinces, where large
numbers of poultry die-offs were reported in July,
nevertheless lies in the broad belt that runs north from
Bangkok to the Lao border where there is a heavy
concentration of chicken farming, as well as the raising of
fighting cocks.

...And Another Way Out in the Northeast
--------------

7. (U) Meanwhile, from July 16 to July 24, 2241 layer
chickens died on 78 farms and households in Nakhon Phanom
Province in Thailand's extreme northeast corner. On July 29,
DLD's Upper Northeastern Regional Veterinary Research and
Development Center, detected H5 avian influenza virus in
samples taken from the dead birds. On August 1, the National
Institute of Animal Health in Bangkok confirmed the full
identification of the virus as H5N1. DLD made a preliminary
report to the World Organization for Animal Health (OIE) on

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July 31 with a follow-up report on August 2. DLD also culled
more than 300,000 poultry in the province, made arrangements
to compensate owners 75 percent of the value of the culled
birds, and took samples from nearly 12,000 poultry within a
5-km radius of the infected farm, including more than 10,500
chickens and more than 900 ducks from 734 farms or
households. CDC-Bangkok has conducted active surveillance
for severe pneumonia in Nakhon Phanom since 2003, and is
deeply integrated into the outbreak response.


8. (U) Various Thai media reported that Thai officials
believed the virus arrived in Nakhon Phanom on contaminated
egg trays from Laos, but gave no evidence for their
conclusions. In its official report to the OIE, the DLD
stated that the source of the outbreak in Nakhon Phanom was
"unknown or inconclusive." Thailand has since restricted
cross-border transport of poultry and poultry products from
Laos.
ARVIZU