East Java: Suspected AI Death Exposes Local

UNCLAS SECTION 01 OF 03 JAKARTA 007614 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 USPACOM ALSO PASS TO J07 E.O. 12958: N/A TAGS: TBIO AMED CASC EAGR AMGT PGOV KFLU ID SUBJECT: East Java: Suspected AI Death Exposes Local Underreporting JAKARTA 00007614 001.2 OF 003 ¶1. (SBU) Summary: A 10 month old child in Tulungagung, East Java is suspected to have died June 4 of Avian Influenza. The inexperienced local hospital doctor did not recognize the AI symptoms and released the child's body for burial prior to taking any blood samples. Regency health officials are treating the death as though caused by AI. A Surabaya newspaper reported June 8 that local animal husbandry officials were not disclosing the full extent of the AI outbreak in the Tulungagung poultry population, motivated by fears of "public panic" if the full extent of the outbreak were made public. End Summary. Possible AI Death in East Java -------------- ¶2. (SBU) Jawa Pos reported June 6 that Aditya Bima Saputra (10 months old) of Sukowiyono village, Tulungagung Regency, East Java died June 4 at Dr Iskak Hospital in Tulungagung of suspected Avian Influenza (AI). The child was reportedly sick for three days with AI symptoms before dieing. The article also stated that approximately 100 chickens recently died not far from the child's house and a goat that lived next to his house collapsed and died instantly the previous day. ¶3. (SBU) ConGen Surabaya staff followed up with local hospital officials that treated the child and Tulungagung Regency human health and animal husbandry officials. Tri Widyo Agus Basuki, Public Affairs Director of Dr. Iskak Hospital in Tulungagung stated that the child died and the child's body was removed from the hospital for burial before any medical tests were done. According to Basuki, hospital staff on duty at the time the child was admitted did not consider testing for AI. Apparently, Aditya was admitted on a Sunday and the medical lab was closed. The inexperienced duty doctor decided to wait until the lab opened Monday morning at 8:00 am to draw blood samples. Aditya died at 5:00 am Monday morning and, as is local custom, his parents took him home for burial half an hour later. It was not until a neighbor noticed the victim's older brother Rizal Prasdana Efendi (7 years old) was ill with similar symptoms that anyone thought to test for AI. By then, it was too late because Aditya was already buried. ¶4. (SBU) Rizal was admitted to the local hospital on June 7 with a high fever and respiratory infection symptoms. Basuki informed ConGen staff that Rizal was in much better condition than his brother at the time of admission but is being isolated and was tested for AI. Basuki confimed on June 12 that Rizal's AI tests were negative, relieving the suspicion of an AI cluster in Tulungagung. JAKARTA 00007614 002.2 OF 003 ¶5. (SBU) Affandi, head of Technical Operation Unit of Basic Health Office in Tulungagung, confirmed that local government is treating Aditya's death like an AI case and conducted a large disinfectant spraying campaign in the patient's neighborhood and some of bird shops in Tulungagung. His office has distributed Tamiflu tablets to 28 local medical clinics in Tulungagung and doctors were briefed on AI symptoms and when to use the drug. Affandi admitted it is standard procedure to draw blood on any patient with a high fever as soon as they are admitted and that the hospital did not properly follow procedure. Animal Health Official Spills the Beans -------------- ¶6. (SBU) In a June 7 interview with ConGen staff, Danduk Sudarham, head of Tulungagung Animal Husbandry Department, disputed the facts presented in the Jawa Pos article claiming that only 43 chickens in the regency had perished from AI in the regency in the past month. He stated that the deaths now were nothing compared to the 600,000 poultry that died from AI in the regency from October 2003 to February 2004. He seemed defensive and concerned that ConGen was taking an interest in the case. On June 8, Surya newspaper published a story that the Tulungagung Animal Husbandry Department was withholding information that thousands of birds had recently died from AI in the regency. Surya claims to have read confidential information from a file on Sudarham's desk when he left the room during an interview, revealing a much more serious AI problem in the Tulungagung poultry population that had been publicly reported. The story also claims that when confronted with the stolen information, Sudarham admitted to underreporting the problem and pleaded with the journalists to not publish the data for fear of a public panic. ¶7. (SBU) The following day both Surya and Jawa Pos newspapers reported hundreds of AI related poultry deaths in Tulungagung regency and Surya published a photograph of a pit filled with several hundred dead birds being cremated. The story published remarks by Sudarham downplaying the situation stating that the incidents were isolated and not indicative of a more widespread problem. After repeated efforts, ConGen was able to make contact again with Sudarham on June 13. He claimed that the information uncovered by the reporters was from 2005 and that what he had told us was accurate. Sundarham was at a loss to explain the photograph of the dead birds or his previous statement to ConGen staff that there were no reported AI poultry deaths in Tulungagung in JAKARTA 00007614 003.2 OF 003 ¶2005. Health Expert Calls For Transparency -------------- ¶8. (SBU) East Java AI expert, Dr. C.W. Nidom, PhD, publicly called for government officials to be more transparent in reporting the AI situation in Indonesia to the public in a June 12 interview published in the Jakarta Post. Nidom is a leading researcher on AI at the Tropical Disease Center of Airlangga University, Surabaya's largest public university, and a longstanding and vocal critic of local, provincial and the national governments' attempts to "cover-up" or downplay the severity of the AI problem in Indonesia. Nidom is working on research at the University of Tokyo, based on samples taken from Indonesian swine, he claims shows the H5N1 virus in East Java has mutated to become transmittable to humans. Comment -------------- ¶9. (SBU) In light of the economic and social damage facing the North Sumatra village caused by the Medan cluster, local animal husbandry officials may be sorely tempted to not report or underreport AI outbreaks in their districts. The motivation to "not cause a public panic" is strong because the public is likely to panic if facing a serious AI outbreak. By the time Aditya was taken to the hospital, he was too weak to have blood taken. However, had local health officials and doctors been aware of the extent of the AI outbreak in Tulungagung's poultry population, they would have certainly tested Aditya for AI prior to releasing his body to the parents. AMSELEM