INDONESIA - NEW AVIAN INFLUENZA CASES IN WEST GARUT

UNCLAS SECTION 01 OF 03 JAKARTA 010492 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 - NEW AVIAN INFLUENZA CASES IN WEST GARUT REF: A) Jakarta 10140 and previous JAKARTA 00010492 001.2 OF 003 ¶1. (SBU) Summary. Indonesian press has featured a series of alarming articles over the weekend of August 18-20 concerning up to ten possible human cases of avian influenza (AI) occurring in the Cikelet village of the Garut district of West Java. NAMRU-2 and the Ministry of Health (MOH) tested the ten suspected cases and confirmed that three of these cases (two fatal) are positive for Avian Influenza. The remaining seven cases tested negative, with three being positive for Human A or H1N1 (ordinary flu) only. The positive cases are from different hamlets and suggest point-source (poultry) not human-to-human transmission. As of August 23, data from NAMRU-2 and the Ministry of Health show 62 human AI cases with 48 fatalities. End Summary. Remote Village and Purchased Chickens -------------- ¶2. (U) Cikelet village, with its population of 5,000-6,000 people, is located in a remote area of the Garut district, in West Java. The village is really a collective of twenty-five hamlets, each with a population of between 200-400 people. The hamlets are separated by one to three kilometers of rocky and steep paths. Travelers enter the village by traveling approximately nine hours from Jakarta on progressively more difficult roads. The final two hours of the journey consists of steep, winding, rocky paths, probably best traveled on horseback. Cikelet village sits in a basin surrounded by steep mountains, where slash and burn agriculture supports a subsistence economy. Large extended families live in the villages and commonly keep chickens and ducks underneath their homes, which are raised above ground. 3.(U) According to local residents, in preparation for a late June religious holiday, villagers purchased birds from a market located outside of Cikelet village. Residents integrated the purchased poultry into existing flocks. Within days, poultry began to die off. Residents noticed increased poultry deaths through July and the first seven to ten days of August, spreading from one hamlet to the next. Onset of Human Cases -------------- ¶4. (SBU) International attention focused on Garut when a 17 year- old man was hospitalized with pneumonia in Dr. Slamet Hospital in Garut on August 9. The man first showed symptoms on July 25, after handling sick chickens. Local health authorities sent samples to the MOH laboratory in Jakarta, which shared them with NAMRU-2. Both laboratories promptly confirmed the samples as positive for avian influenza. The patient's parents requested that he be released from the hospital and he is now recovering at home. The patient's 20 year-old cousin died weeks before with AI symptoms but was buried before tests could be taken. ¶5. (U) Indonesian press then ran alarming stories over the August 18-20 weekend describing up to ten suspected new cases of Avian Influenza among the hamlets. NAMRU-2 and MOH tested these cases and confirmed two additional (both fatal) as positive for H5N1. JAKARTA 00010492 002.2 OF 003 NAMRU-2 reports the remaining cases as testing negative; three were positive for human A or H1N1 (ordinary flu). Details on the two additional positive cases are as follows: --A 9 year-old female from Jojok hamlet who became sick on August 3 after handling sick birds. She was admitted to the Dr. Slamet Hospital and died on August 14. --A 35 year-old female from Pasir Gambir hamlet who became sick on August 8, was admitted to Dr. Slamet Hospital and died on August 17. Her nine year-old daughter had died the week before but was buried before samples could be taken. ¶6. (U) Although the cases are in the greater Garut area, they are from different hamlets and evidence appears to suggest point- source (poultry) transmission. ¶7. (SBU) Immediately upon learning of the human cases in Garut, USAID-trained animal health teams began investigating avian influenza in poultry, sending their first report to the Local Disease Control Center on August 11. In accordance with the Food and Agriculture Organization (FAO) guidelines, the Ministry of Agriculture's animal health response has included culling with immediate compensation, vaccination, and disinfection. Animal health teams are reporting approximately 2,000 poultry culled as of August 22. Additional support teams are scheduled to arrive on August 24. While response efforts are underway, the surveillance team is investigating the boundaries of the outbreak and the role of the local market in the outbreak. The FAO, with USAID support, is assisting the Ministry of Agriculture in the investigation and working to increase efforts to contain the outbreak. Human AI Case Profile -------------- ¶8. (SBU) NAMRU-2 has confirmed four new cases including the three Garut cases and an unrelated case from Bekasi since last reftel. NAMRU-2 data indicates the following AI-related case profile as of August 23: -- Number of laboratory confirmed (positive PCR and/or serology) human AI cases: 62, of which 48 have been fatal (case fatality rate of 77 percent). -- Number of probable AI cases 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 22. 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 17, notes 58 human AI cases in Indonesia with 45 deaths. WHO figures can be accessed at www.who.int/csr/disease/avian_influenza. 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