INDONESIA - AUGUST 11 AVIAN INFLUENZA (AI) UPDATE

UNCLAS SECTION 01 OF 03 JAKARTA 010140 SIPDIS SIPDIS SENSITIVE DEPT FOR EAP/MLS, EAP/IET, A/MED AND S/ES-O DEPT FOR G/AIAG/JLANGE AND RFENDRICK DEPT FOR OES/FO, OES/EID, OES/PCI, OES/STC AND OES/IHA DEPT PASS TO USDA/FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG DEPT ALSO PASS TO USDA/FAS/FAA/DYOUNG AND USDA/APHIS DEPT ALSO PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL DEPT ALSO PASS TO HHS/WSTEIGER/ABHAT/MSTLOUIS AND HHS/NIH PARIS FOR FAS/AG MINISTER COUNSELOR CANBERRA FOR APHIS/DHANNAPEL ROME FOR FAO NSC FOR JMELINE BANGKOK FOR RMO, CDC, USAID/RDM/A USPACOM ALSO PASS TO J07 E.O. 12958: N/A TAGS: TBIO AMED CASC EAGR AMGT PGOV ID KFLU SUBJECT: INDONESIA - AUGUST 11 AVIAN INFLUENZA (AI) UPDATE REF: A) Jakarta 09914 and previous JAKARTA 00010140 001.2 OF 003 ¶1. (SBU) Summary. On August 9, Coordinating Minister for People's Welfare Aburizal Bakrie stated, according to the media, that Jakarta had yet to receive promised foreign aid to fight bird flu. Bakrie's statement was puzzling and frustrating to donors. The May 2006 Donor Coordination Meeting, hosted by the National Committee on Avian Influenza Management and Pandemic Alert (KOMNAS),identified over $30 million in donor assistance to Indonesia, with an additional $22 million in commitments of support. Post continues to explore implications of the surprise August 3 announcement by the Minister of Health Siti Fadilah Supari about testing all AI samples using local laboratories. Dr. Triono Soendoro, the Director of the National Institutes of Health Research and Development (NIHRD),provided permission to ship samples to the U.S. Centers for Disease Control (CDC) on August 10. Patients from the Medan H1N1 cluster recovered and several went home before being formally discharged on August 7. The Eijkman Institute continues to perform additional analyses on one sample from this cluster. NAMRU-2 and the MOH held a USAID- funded conference in Bali to train 40 instructors to teach provincial officials how to respond to newly emerging human cases of H5N1. According to the media, Government of Indonesia (GOI) officials acknowledged on August 7 that avian influenza has spread to poultry in Papua. NIHRD and NAMRU-2 identified two new fatal cases of H5N1. Both victims (a 16-year-old male and a 17- year-old female) were from the greater Jakarta area. Confirmed human cases of avian influenza in Indonesia are now at 58, with 46 confirmed deaths, a 79 percent fatality rate. End Summary. Bakrie Statement Puzzling -------------- 
¶2. (SBU) At a meeting with senior GOI Agriculture and Health officials on August 2, Coordinating Minister for the People's Welfare Aburizal Bakrie stated Jakarta had yet to receive promised foreign aid to fight bird flu. The statement was both puzzling and frustrating to donors. The May 2006 Donor Coordination Meeting, hosted by KOMNAS, identified over $30 million in donor assistance to Indonesia, with an additional $22 million in commitments of support. This assistance encompasses each of the goals identified in the National Strategy for Avian Influenza Control and Preparedness for Human Pandemic Influenza 2006-2008. The USG provides the greatest assistance with $14.65 million obligated plus an additional $4 million projected. Additional foreign donor contributions include: Japan ($5.5 million plus in-kind goods and services),Australia ($11.6 million),Canada ($3.5 million) and the World Bank ($280,000 obligated and finalizing a $10 million grant package.) KOMNAS plans to host a two-day donor coordination meeting in Jakarta August 23-24, 2006. GOI to Use Domestic Laboratories, Including NAMRU-2 -------------- ¶3. (SBU) Post continues to research the implications of the August 3 surprise announcement about the GOI's intentions to test all AI cases using local laboratories. Post is concerned that JAKARTA 00010140 002.2 OF 003 under this new procedure, the NAMRU-2 practice of sending samples to CDC might be jeopardized. On August 10, Dr. Triono Soendoro gave NAMRU-2 permission to ship samples from the two new cases (16 year-old male and 17 year-old female) to the U.S. CDC for testing. The MOH also encouraged the release of sequence information on Indonesian-derived viruses from the World Health Organization (WHO)-Reference Laboratories at CDC and the University of Hong Kong. In response, the CDC entered all data into GeneBank on August 4. Medan New Cluster -------------- ¶4. (SBU) Samples from seven patients from the second suspected Medan Cluster (Kabanjahe district, Karo regency, North Sumatra) demonstrate that all were infected with an H1N1 Influenza virus. The patients recovered and left the hospital prior to formal discharge. Some have joined in a lawsuit against the MOH and the President of Indonesia complaining of the stigma associated with suspected avian influenza. Tests from a ten-year-old female from the cluster are ongoing at the Eijkman Insitute. (Note: AI outbreaks in animals serve as a sentinel for possible human cases. Identification of people with influenza-like illnesses in connection with animal outbreaks is a goal of the USAID-funded animal surveillance and response program. It is necessary to identify human suspects early enough in their infection to receive proper health care, as well as to identify clusters. As the animal surveillance and response program expands, we expect it will identify larger numbers of human suspects.) NAMRU-2 Training Seminar -------------- ¶5. (SBU) NAMRU-2 and the MOH organized a five-day, USAID-funded conference in Bali to teach teams of trainers how to instruct provincial and district outbreak responders about Avian Influenza. Forty participants attended. Dr. Erna Tresnaningsih, the Deputy Director of the National Institutes of Health Research and Development, opened the conference. Both the WHO and USAID were represented. AI Infected Poultry in Papua -------------- ¶6. (U) According to local media, the Indonesian Ministry of Agriculture acknowledged on August 7 that the AI virus has spread to Papua. Based on laboratory analysis from the Bogor Veterinary Research Center conducted on July 19, three of 37 birds tested positive for H5N1. On July 11, a farmer from a Sempan village in Timika reported to the provincial animal husbandry office that his chickens were sick. Inspectors found birds with H5N1 symptoms at his farm and also at the local traditional market. The regency culled 414 chickens from the area. Human AI Case Profile -------------- ¶7. (SBU) NAMRU-2 has confirmed two new fatal cases in the greater Jakarta area since last reftel, a 16-year-old male from Bekasi JAKARTA 00010140 003.2 OF 003 and a 17-year-old female from Tangerang. NAMRU-2 data indicates the following AI-related case profile as of August 11: -- Number of laboratory confirmed (positive PCR and/or serology) human AI cases: 58, of which 46 have been fatal (case fatality rate of 79 percent). -- Number of probable AI cases (awaiting WHO Laboratory confirmation): 4, with 2 deaths (fatality rate of 50 percent). -- Number of cases awaiting sequencing at the U.S. CDC: 2. -- Number of possible untested AI cases under investigation (last 30 days): approximately 10. Note: NAMRU-2 data corresponds with Ministry of Health data but may vary at times with AI case figures presented on the official World Health Organization (WHO) website, which usually lags NAMRU- 2 data by one week. The WHO website, last updated on August 9, notes 56 human AI cases in Indonesia with 44 deaths. WHO figures can be accessed at www.who.int/csr/disease/avian_influenza. PASCOE