UPDATE 4: H5N1 IN DJIBOUTI

UNCLAS DJIBOUTI 000656 SIPDIS SIPDIS LONDON, PARIS FOR AFRICA WATCHER E.O. 12958: N/A TAGS: AMED CASC TBIO KFLU EAID EAGR DJ SUBJECT: UPDATE 4: H5N1 IN DJIBOUTI REF: DJIBOUTI 564 DJIBOUTI 578 DJIBOUTI 615 DJIBOUTI 633 ¶1. Summary. Since the last update (Djibouti 633),expert consultants from the Centers for Disease Control (CDC) in Atlanta, the World Health Organization (WHO) Headquarters in Geneva as well as the Food and Agriculture Organization (FAO) have come to Djibouti to help complete a comprehensive epidemiologic evaluation. The focus of the search has continued to be confirmation of the exact source of the human sample that tested positive for H5N1. The Government of Djibouti (GoD) conducted chicken culling operations in the capital city and in a village believed to be home to the index human case. The GoD willingness to accept consultation by CDC, WHO, FAO, USAID and military experts provides an indication of their intent to minimize spread of H5N1 in Djibouti. End summary. ¶2. In an effort to correctly identify and track the human index case of H5N1, the ten individuals who were originally sampled in the village of Damerjog are being sought for retesting. The index case is still believed to have come from the Damerjog Clinic samples (see Djibouti 633). Of the ten original samples, seven of the donors have been identified and six have been retested, including the originally-presumed index case. Parents of the seventh case refused to have blood drawn, but her current healthy appearance leads investigators to believe she did not have H5N1. The six samples will be sent to CDC Atlanta via NAMRU-3 for testing for H5N1 antibodies to ascertain if one of them was the index case. ¶3. On May 26, GoD conducted a chicken culling operation in the capital city. Reportedly, the cullers did not use the Personal Protective Equipment (PPE) donated by USAID, wearing only gloves and facemasks from the equipment. Estimates of how many chickens vary greatly between 50 and 1500, but Post believes more than 900 birds were destroyed. The birds were culled on a voluntary basis, with people who wanted their birds killed bringing them to a central location. They were then given a coupon for future compensation. The compensation plan, which had never been defined, is now taking shape. Instead of monetary compensation, the GoD is considering replacing culled chickens with new chickens (which presumably will be vaccinated). This plan is intended to counter the practice of importing chickens specifically for culling. Rumors indicate that when people believed they would be paid for chickens, they started bringing in new birds from Ethiopia. The total number culled in Djibouti including the villages around Damerjog and French Military bases is estimated to around 1120. ¶4. After two days of discussion with FAO and GoD Ministry of Agriculture, four broad areas of need were identified for assistance: (1) Disease management, including culling, compensation, disinfection, bio-security and restocking of flocks; (2) Lab capacity, including establishing local lab to do preliminary testing; (3) Epidemiology and surveillance, including establishing a national surveillance plan with a Djiboutian rapid response team; and (4) Communication, including dissemination of specific agriculture / veterinary information to the public at all levels, wit appropriate community response guidelines. ¶5. Additional assistance is being offered in a variety of forms. FAO is discussing the possibility of vaccinating living birds, and providing GoD Ministry of Agriculture with the vaccines. US Military will work with MOH to update the training video for health providers who take samples from suspected cases, based on a refined and stricter case definition. USAID Washington has sent an additional 2,000 PPEs to Djibouti, due to arrive within one week. Other lab and testing equipment and decontamination kits will arrive at a later date. RAGSDALE