INDONESIA - MARCH 2 AVIAN INFLUENZA UPDATE

UNCLAS SECTION 01 OF 04 JAKARTA 002915 SIPDIS SIPDIS SENSITIVE DEPT FOR EAP/IET, A/MED AND S/ES-O 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/BILL STEIGER AND AMAR BHAT PARIS FOR FAS/AG MINISTER COUNSELOR CANBERRA FOR APHIS/DHANNAPEL ROME FOR FAO NSC FOR JMELINE BANGKOK FOR RMO, CDC, USAID/RDM/A E.O. 12958: N/A TAGS: TBIO AMED CASC EAGR AMGT PGOV ID KFLU SUBJECT: INDONESIA - MARCH 2 AVIAN INFLUENZA UPDATE REF: A) Jakarta 02403 B) Jakarta 16939 JAKARTA 00002915 001.2 OF 004 ¶1. (SBU) Summary. The Jakarta city government carried out 24-26 February a series of actions to control Avian Influenza (AI) in birds, including door-to-door inspections, limited culling and vaccinations. Human and animal health officials in West Kalimantan told us that they are doing what they can to address the avian influenza (AI) threat. They claimed that while AI in poultry emerged in the province in 2004, there were no cases in 2005 and none so far in 2006. Surabaya officials acted decisively to a reported outbreak of bird flu in poultry, including the immediate culling of infected birds within a 1-kilometer radius of the affected area. The total number of confirmed human AI cases in Indonesia has risen to 28, with 20 deaths, indicating a mortality rate of 71 percent. Recent cases, or reports of recent cases, have emerged in and around Yogyakarta, Central Java, for the first time. End Summary. Jakarta Culling -------------- ¶2. (U) As noted ref A, Jakarta authorities sent a 500-person team to "scour" residential areas for AI in birds from February 24-26. The Jakarta city government, in conjunction with MOA officials, Indonesian Red Cross and Bogor Agriculture Institute volunteers, conducted the AI surveillance and limited stamping-out. Reportedly, the more than 500 individuals involved in this effort split up into teams of 10. The plan envisaged culling all birds within a one-kilometer radius of sick birds and vaccinating those within an additional three kilometers. ¶3. (U) Adnan Achmad, sub-Director for Animal Health at the Jakarta Provincial Livestock Services Office, told us on March 2 that 37 birds tested positive for AI following the rapid on-site tests, and that as a result, 5,026 birds were slaughtered. Achmad said that the team found AI positive birds in West, South, East, and Central Jakarta Districts, but none in North Jakarta. The team discovered most of the AI positive birds among small-scale backyard poultry flocks or among caged pet birds. However, Achmad said that they discovered some AI positive chickens in a large live chicken collection and distribution market in East Jakarta, and the team thus destroyed 4,000 chickens there. ¶4. (U) Achmad said Ministry of Health (MOH) officials plan to follow-up the February 24-26 campaign by disinfecting premises where infected birds were found. The MOH will also test humans in these areas. (Comment: There is no indication that teams involved in the February 24-26 campaign culled birds within a one kilometer radius of infected sites, which has been the most recently stated MOA policy. It is also unclear how soon after the culling the authorities would reimburse bird owners the promised Rp 10,000 (USD 1) per bird). AI in West Kalimantan? -------------- ¶5. (U) During a February 21-23 visit to West Kalimantan, JAKARTA 00002915 002.2 OF 004 human and animal health officials at the provincial, district, municipal levels told us that they are doing what they can to address the avian influenza (AI) threat. They claimed that while AI in poultry emerged in the province in 2004, there were no cases in 2005 and none so far in 2006. (Comment: These claims seem implausible and are probably due to a lack of systematic surveillance.) At a February 22 meeting co-chaired by Dr. Abdul Manaf and Dr. Oscar Primadi, heads of the provincial agricultural and health departments respectively, district, provincial and city officials described their efforts to fight bird flu. These include: a) an aggressive public awareness program; b) culling and vaccination of infected animals and zoning of affected area; c) surveillance; d) sanitation promotion; and e) establishment of an AI task force. ¶6. (U) Manaf admitted that illegal movements of poultry complicate biosecurity measures. He also warned that the constant high state of alert for AI without any recent incidence in poultry and humans breeds fatigue and complacency. In addition, the AI scare has caused a damaging decline in poultry and egg consumption (as much as 60 percent in some areas). Manaf said the province also suffers from other animal diseases such as New Castle, Hog Cholera, Nipah Disease, and Foot and Mouth disease, which complicate AI preparedness. Primadi praised the coordination between his department and Dr. Manaf's, noting that it was much better than at the national level. He said the provincial AI Task Force includes staff from both offices and has prepared an AI contingency plan that features aggressive public awareness and advocacy campaigns in affected districts and cities, as well as close collaboration with hospitals and health centers. Like their counterparts in East Kalimantan (Ref B),Manaf and Primadi believe the central government will only take notice of their requests for funding when AI strikes humans in their jurisdictions, by which time it could be too late. The Soedarso Hospital -------------- ¶7. (U) During a February 23 visit to Soedarso Hospital in Samarinda (one of the 44 national AI referral hospitals and the only one in the province),Director Mohammad Subuh revealed that hospital staff have prepared an isolation room in the infectious disease ward equipped with one ventilator and personal protective equipment (PPE). However, he admitted that the 300-bed hospital would be overwhelmed with more than one AI human case. He said the hospital has only 300 Tamiflu capsules in stock, or 30 treatment courses. Subuh and his staff said they need medical equipment (e.g., influenza rapid testing kits and respirators) and trained staff (particularly nurses) to cope with a large outbreak of AI and other infectious diseases. Subuh acknowledged that the central government has provided extra financial and technical help (e.g., PPE's like goggles, gloves, masks and head and shoe covers) to the province and his hospital to prepare for AI, but in amounts inadequate for the challenges ahead. AI Efforts in Surabaya. JAKARTA 00002915 003.2 OF 004 -------------- ¶8. (U) The Governor of Surabaya, the nation's second largest city and capital of East Java, declared a status of "Alert One" for the city following the finding of bird flu case at Kedurus area recently. Five chickens in Kedurus of Karangpilang district, Surabaya, died on February 15, 2006. Laboratory tests conducted by the Veterinary Center in Yogyakarta confirmed that the five chickens were infected with AI. Surabaya Mayor Bambang DH then ordered an immediate cull of all birds found within a radius of 1 km from Kedurus. He also vowed to vaccinate all chickens and birds in every sub-district. ¶9. (SBU) Dr. Nidom of Tropical Disease Center (TDC) of Airlangga University in Surabaya stated that AI may have already been present in Surabaya for some time prior to the announced outbreak. Nidom told us that in the last two months he had been conducting random research at bird markets around Surabaya and had found birds infected with AI. He said that he reported his findings to the Surabaya Health office, but his reports did not elicit any immediate action by the City. ¶10. (U) Despite the confirmation of the AI incident in Kedurus, authorities consider the Surabaya City Zoo, located only 2.5 kilometers from the affected area, as safe and it remains open to the public. "Up to now, the zoo is still free from the avian influenza virus and we will do our utmost to protect the zoo's animals from the virus. We are preventing the virus from affecting the animals by spraying disinfectants and closely checking their state of health," Liang Kaspe, manager of the Surabaya Zoo's conservation department, reportedly told the press. Human AI Case Profile -------------- ¶11. (U) NAMRU-2 data indicates the following AI-related case profile as of March 6. -- Number of laboratory confirmed (positive PCR and/or serology) human AI cases: 28, of which 20 have been fatal (fatality rate of 71 percent). -- Number of probable AI cases: 5, with 4 deaths (fatality rate of 80 percent). -- Number of cases awaiting verification by the US CDC: 1. -- Number of possible AI cases under investigation: approximately 36. -- Number of excluded AI cases: 211. ¶12. (SBU) Comment: Although a very welcome first step, the Jakarta city government's culling and vaccination program fell far short of a meaningful assault on AI among poultry in this enormous city. We will encourage the authorities to follow up systematically in order to begin to build momentum in grappling with AI. JAKARTA 00002915 004.2 OF 004 AMSELEM