INDONESIA - APRIL 27 AVIAN INFLUENZA (AI) UPDATE

UNCLAS SECTION 01 OF 03 JAKARTA 005308

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SUBJECT:INDONESIA - APRIL 27 AVIAN INFLUENZA (AI) UPDATE

REF: A) Jakarta 4467 B) Jakarta 3896

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1. (SBU) Summary: The April 19 appointment of a new Director
General (DG) for the National Institute for Health Research
and Development (LITBANGKES) bodes well for improved
relations with the Mission's Naval Medical Research Unit
(NAMRU-2). The Executive Director and Chair of the newly
created National Committee for AI Control (ref),Dr. Bayu
Krisnamukti, told us the Committee plans to hold a workshop
in the coming weeks to clarify the role of donor assistance.
In addition, the Committee will seek help from the World
Bank on the Government of Indonesia's (GOI) AI master plan.
The local Department of Animal Husbandry in East Java
reports that AI outbreaks in poultry continue in the Kediri
District of East Java. The Ministry of Health concluded
that one of the victims of a recent family cluster in
Lampung was infected with an H3 virus, although NAMRU-2
disagrees with this finding. NAMRU-2 reports no new human
H5N1 cases over the past two weeks. End summary.

New Head at Litbangkes
--------------

2. (SBU) On April 19, the GOI appointed Dr. Triono Soedoro
as the new Director General (DG) for the National Institute
for Health Research and Development (LITBANGKES),a position
that had been vacant since January 2006. Soedoro previously
served as Chief of the Bureau of Social Welfare, Health and
Nutrition in the National Development Planning Agency
(BAPPENAS) from 1996-2006. He graduated in 1979 from the
Medical Faculty of the University of Airlangga, Surabaya and
obtained a Doctoral Degree from Yale University. In one of
his first acts as the new DG, Soedoro paid a 2-hour visit to
NAMRU-2 facilities and indicated that he wants to enhance
cooperation between Litbangkes and NAMRU-2. (Comment: Given
tension between some LITBANGKES officials and NAMRU-2, this
is a very favorable development.)

The National AI Committee
--------------

3. (U) In a recent meeting with NAMRU-2 Commander Mark
Wooster and other NAMRU-2 and USAID health officials, the
Executive Director and Chair of the newly-created National
Committee for AI Control Dr. Bayu Krisnamukti provided
details on the Committee's structure. Bayu said the
Committee has two main functions: a) coordination; and b)
establishment of strong linkages between the central and
local level governments in both the animal and human health
sectors. Bayu said that as Chair, he oversees six
interagency subcommittees with distinct "specialty areas" or
areas of focus, each of which will be headed by the most
senior GOI official working in that area. For instance, Dr.
Nyoman Kandun, Director General for Disease Control and
Environmental Health in the Ministry of Health, will chair
the health subcommittee and Dr. Delima Ashari, Special
Advisor to the Minister of Agriculture for Inter-agency and
International Relations will chair the agriculture
subcommittee. The Ministry of Finance, Indonesian Armed
Forces (TNI) and the Indonesian Red Cross (PMI) will also

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chair subcommittees.

4. (U) Bayu confirmed that Dr. Emil Agustiono, Senior
Advisor to Coordinating Minister for People's Welfare will
serve as his deputy. The Committee's Secretary is Dr. Tri
Satya Putri Naipospos (Dr. Tata),the former Director of
Animal Health in the Ministry of Agriculture who was fired
in 2005. In addition to the subcommittee chairs, an Experts
Panel of approximately 16-17 veterinarians and medical
doctors will support the national committee. Bayu insisted
that the National AI Committee will not act without the
blessing of the expert panel. He also invited NAMRU-2 to
share its expertise with the panel.

5. (U) Bayu added that in the interest of coordination, the
Committee has asked for support from the World Bank to
scrutinize the GOI's Master AI Plan to "make it more
operational". The Committee will then organize a 1-2 day
workshop in May to bring together GOI ministries and donors
to help identify who will take the lead and support the
different aspects of the Master Plan.

AI in East Java
--------------

6. (U) Abriyanti Dwiwin of the Office of Animal Health in
the Kediri Department of Animal Husbandry in East Java told
Congen Surabaya officials about two recently reported avian
influenza outbreaks in poultry in her district. Most
recently, the Department of Animal Husbandry confirmed that
four dead chickens found in Kanyoran Village on March 23
were infected with AI. Dwiwin noted that the Animal
Husbandry Department culled birds in the immediate area only
and did not do a mass culling because no other chickens died
following the death of the four birds. She claimed Kediri
authorities followed Ministry procedures by vaccinating and
disinfectant spraying in a larger radius around the
outbreak. She added that the Department managed to borrow
automatic spuits from local commercial poultry farmers to
more quickly administer vaccinations to protect local
flocks. Dwiwin noted that it takes around two months for
the central government to process and distribute
compensation to farmers for culled birds.

Human AI Case Profile
--------------

7. (U) NAMRU-2 reports no new H5N1 cases in humans since we
transmitted Ref A on April 6. The Ministry of Health
concluded that one of the victims of a recent family cluster
in Lampung was infected with an H3 virus. However, NAMRU-2
does not support this finding, having found both the sample
from the MOH and a separate sample to be negative.

8. (SBU) NAMRU-2 data indicates the following AI-related
case profile as of April 24:

-- Number of laboratory confirmed (positive PCR and/or
serology) human AI cases: 35, of which 26 have been fatal
(fatality rate of 74 percent).

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-- Number of probable AI cases: 3, with 2 deaths (fatality
rate of 66 percent).

-- Number of cases awaiting verification by the US CDC: 0.

-- Number of possible AI cases under investigation:
approximately 54.

-- Number of excluded AI cases: 257.

PASCOE