INDONESIA - NEW AVIAN INFLUENZA CASES IN WEST GARUT

UNCLAS SECTION 01 OF 03 JAKARTA 010492

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DEPT ALSO PASS TO USDA/FAS/FAA/DYOUNG AND USDA/APHIS
DEPT ALSO PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL
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ROME FOR FAO
NSC FOR JMELINE
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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

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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
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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.

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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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