INDONESIA - JULY 3 AVIAN INFLUENZA (AI) UPDATE

UNCLAS SECTION 01 OF 03 JAKARTA 008259 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 - JULY 3 AVIAN INFLUENZA (AI) UPDATE REF: A) Jakarta 7626 and previous JAKARTA 00008259 001.2 OF 003 ¶1. (SBU) Summary: A Government of Indonesia (GOI) chaired AI experts group concluded on June 23 that limited human-to- human transmission took place during the May 2006 North Sumatra cluster. However, the group noted that the confinement of the human-to-human transmission to the affected family and the absence of a mutation in the H5N1 virus means there was no danger to the wider population. The group concluded that, based upon the findings from the Medan family cluster, the global pandemic alert level should remain at Phase 3. USAID signed a USD 350,000 pilot project on June 26 that aims to strengthen Indonesia's capacity to detect and respond to AI outbreaks in poultry in three high priority provinces using cellular technology and the internet. The WHO Influenza/H5N1 Reference Laboratory at the University of Hong Kong and the Indonesian National Institute of Health Research and Development (Litbangkes) have confirmed AI infection in a deceased, 5-year old boy, bringing the total number of confirmed H5N1 cases in Indonesia to 54, with 42 deaths. End Summary. WHO Technical Review and Expert Consultation -------------- ¶2. (U) Indonesia's National Committee for Avian Influenza Control and Pandemic Influenza Preparedness (KOMNAS) and the World Health Organization (WHO) co-hosted a AI "Technical Review and International Expert Consultation Meeting" on June 21-23 in Jakarta. AI experts from the WHO Geneva, the CDC, NAMRU-2, USDA/APHIS, the UN Food and Agriculture Organization (FAO),the World Bank, UNICEF, and the national public health institutes from Japan and France participated. KOMNAS Executive Director and Chair Bayu Krisnamurti and Coordinating Minister for Peoples' Welfare Aburizal Bakrie represented the GOI; neither Minister of Agriculture Anton Apriyantono nor Minister of Health Dr. Fadilah Supari participated. ¶3. (U) The general purpose of the meeting was to review the current status of AI infection among human and animal populations and to share findings with the GOI (i.e., KOMNAS) and donor agencies. Specific objectives included: --Review the status of the H5N1 virus in humans and animals in Indonesia. --Develop recommendations on how to control AI infection in both animals and humans. --Review lessons learned for rapid response and containment. --Develop an authoritative risk assessment of avian influenza in Indonesia in both human and animals. ¶4. (SBU) Not surprisingly, the experts group concluded that the H5N1 virus is endemic in avian populations in many areas across Indonesia and that sporadic human cases are likely to continue until the infection in poultry is reduced. The experts added that the full extent of AI infection in poultry remains unknown, and they recommended increased surveillance and more responsive compensation following JAKARTA 00008259 002.2 OF 003 culls. The committee credited Indonesia with making credible efforts to combat the disease in humans, but called for a more forceful effort in investigating cases, coordinating rapid responses and providing a clear public message. The committee said it found no evidence that viruses isolated from human samples in Indonesia had reverted to become more easily transmissible. ¶5. (SBU) The committee noted, however, that epidemiological and virological data from the North Sumatra family cluster supports the possibility of limited human-to-human transmission among infected blood relatives, a point Ministry of Health officials vigorously debated. (Note: This portion of the WHO's report on the North Sumatra cluster was quickly leaked to the press and received wide media attention, to the consternation of the GOI.) The experts group concluded that the global pandemic alert level had not advanced past phase 3, based upon the findings from the Medan family cluster. However, a senior WHO epidemiologist told us the WHO Geneva would review its system of pandemic alerts to reduce ambiguity and confusion. ¶6. (SBU) Minister Bakrie thanked the committee for acknowledging the positive responses of the GOI towards the AI crisis. He also stated that in order to control infection in Indonesia donors needed to use every means to provide full funding as soon as possible for the implementation of Indonesia's national AI and pandemic flu plan. USAID Pilot Project for AI Detection -------------- ¶7. (U) On June 26, USAID signed a USD 350,000, 9-month agreement with Winrock/Voxiva to implement a pilot project aimed at strengthening Indonesia's capacity to prepare for, detect and respond to outbreaks of HPAI in poultry in three high priority provinces. One of the three targeted provinces is Banten, location of the Indonesia - Singapore - U.S. trilateral project. Using cellular technology and the internet, Winrock/Voxiva will assist Ministry of Agriculture agents in collecting timely information on AI outbreaks through existing mobile phone networks. If successful, this activity could help accelerate early warning and reporting, and potentially be applied to other aspects of AI surveillance and response. Human AI Case Profile -------------- ¶8. (SBU) Over the July 1-2 weekend, the WHO Influenza/H5N1 Reference Laboratory at the University of Hong Kong and the Indonesian National Institute of Health Research and Development (Litbangkes) confirmed AI infection in a 5-year old boy who died on June 16 at Dr. Iskak Hospital in Tulungagung, East Java. NAMRU-2 data indicates the following AI-related case profile as of July 3: -- Number of laboratory confirmed (positive PCR and/or JAKARTA 00008259 003.2 OF 003 serology) human AI cases: 54, of which 42 have been fatal (case fatality rate of 78 percent). -- Number of probable AI cases: 4, with 2 deaths (fatality rate of 50 percent). -- Number of cases awaiting verification by the US CDC: 1. -- Number of possible AI cases under investigation (last 30 days): approximately 10. Pascoe