UPDATE 2: AVIAN INFLUENZA IN DJIBOUTI

UNCLAS DJIBOUTI 000615 SIPDIS CORRECTED COPY - CAPTION ADDED SENSITIVE SIPDIS LONDON, PARIS FOR AFRICA WATCHER ADDIS AND ASMARA FOR CONSULAR SECTION E.O. 12958: N/A TAGS: AMED CASC TBIO KFLU EAID EAGR DJ SUBJECT: UPDATE 2: AVIAN INFLUENZA IN DJIBOUTI REF: DJIBOUTI 564 DJIBOUTI 578 ¶1. (U) Summary. Since our last update, very little new information has been confirmed. In reftel we referred to a confirmed case in an eight-year-old girl. Since then we have learned that the child in question was only two-years-old. She has since recovered nicely. We believe she may be one of the youngest survivors of H5N1 to recover without Tamiflu being administered within the first 48 hours of symptom onset. Two of her siblings and her health-care provider have fallen ill and samples from the three individuals were sent to NAMRU-3 in Cairo for testing, as well a sick chicken that the family owned. All returned negative. It is still not clear how the two-year-old girl became infected. The Government of Djibouti (GoD) was offering daily briefings at the Ministry of Health. These briefings have been canceled until further notice because of the lack of results in carrying out activities that are planned during these meetings, in particular the culling of chickens in the capital. End Summary. What Djibouti is doing: -------------- ¶2. (U) When H5N1 was confirmed in a person in Damerjog, the GoD announced that all chickens in the Damerjog area should be culled and that bird owners would be recompensed for their loss. The GoD sent representatives to Damerjog, to initiate the culling, but when the birds were presented they announced the compensation would be given at a later (undetermined) date. Most bird owners took their chickens and left the area. The GoD has since been trying to cull chickens in Damerjog but no official reports have been released with details of results. ¶3. (U) Comment. This policy has the potential to bring together infected and uninfected birds in one area, as upon finding they will not be paid, the owners return them to their homes, possibly having cross-contaminated previously healthy birds. However, the 26 samples that were collected all tested negative in tests performed locally in the French Military hospital and official confirmation will come from NAMRU-3. ¶4. (U) At the urging of USAID, the World Health Organization (WHO) and the French military the Ministry of Agriculture announced through a communique, on May 21 that it would soon begin culling operations in the capital, but needed full cooperation of the population in order to succeed. The communique, did not provide details such as date or methodology for carrying out this operation. What the French are doing: -------------- ¶5. (U) The French military hospital has the capability to test to identify H5N1 in both birds and people. The hospital does not have a level-3 approved laboratory, so samples with positive findings are sent to Cairo to be confirmed by NAMRU-3. The French also provided Tamiflu to Djiboutian health officials to administer to the three patients that had been awaiting test results as well as the index case of the two year old. ¶6. (SBU) Reportedly the French military got fed up with the daily Djiboutian briefing at the Ministry of Health after indications that the GoD was doing little and providing no new information. The French announced that they would attend no more meetings until the GoD or WHO had something to report. The meetings have therefore been suspended until further notice. ¶7. (U) ConOff also met with representatives from the French Consulate to share information about the situation in Djibouti. The French representatives seemed poorly informed, and hungry for reliable information. Comment: USAID representative has heard doubts expressed by the French that Avian Flu really exists in Djibouti. End Comment. What the U.S. is doing: -------------- ¶8. (U) USAID and Embassy representatives attended the daily briefings until they were suspended. We continue to communicate one on one with our immediate counterparts in the French embassy/consulate and with local WHO representatives. Also, USAID is working with WHO to develop the communication plan which WHO will execute. USAID will provide $50,000 in funding to WHO to support this activity which includes production of print and television/radio materials as well as dissemination of these materials, technical support and general awareness-raising in the population. USAID is also providing Personal Protective Equipment (PPE) to GoD and US Military, having distributed 50 sets thus far. Fifty more have arrived and another 2000 are on the way as well as two lab specimen kits and one decontamination kit. USAID/Washington has said that it could make available up to another $100,000 as needed. ¶9. (U) The U.S. military sent several medical personnel to the area of Damerjog to look for and sample sick people. However, they expected the Ministry of Agriculture to be sampling chickens. When it became clear that the Ministry was not, the U.S. medical personnel attempted to locate chickens and test them. The military considered it essential to identify the source or the infected child' illness. If H5N1 cannot be traced to a chicken with which the girl had direct contact, new questions are raised. As yet, all fowl samples from that area have tested negative, and the source has not been definitively identified. ¶10. (U) On May 14 ConOff held a Warden Meeting. It was well attended, with all but one Warden appearing. USAID rep for health issues presented what we know about AI in Djibouti, as well as basic information about the virus, and how to protect oneself. Information pamphlets were distributed. On May 17 Ambassador held a Town Hall meeting in which CJTF-HOA and USAID participated. This meeting was poorly attended by AmCits, but several called ahead of time to inquire as to the content of the meeting, so we are confident the message got out through Wardens. Contact with several AmCits after the Town Hall confirmed that they were aware, but did not feel sufficient anxiety over H5N1 to warrant attending the meeting. However, the meeting was attended by several non-AmCits who wanted to know what information we had to share (specifically: the panel physician, a CDC representative and the French Consulate.) ¶11. (U) Embassy Djibouti will continue to transmit to Washington and the American community information as it becomes available. RAGSDALE