INDONESIA - AUGUST 4 AVIAN INFLUENZA (AI) UPDATE

UNCLAS SECTION 01 OF 03 JAKARTA 009914 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 - AUGUST 4 AVIAN INFLUENZA (AI) UPDATE REF: A) Jakarta 09515 and previous JAKARTA 00009914 001.2 OF 003 ¶1. (SBU) Summary. On August 3, the Minister of Health Siti Fadilah Supari announced that, effective immediately, the GOI would no longer send samples to the WHO-Influenza Reference laboratory in Hong Kong. Supari considers domestic laboratories, including U.S. NAMRU-2, sufficiently qualified to analyze samples. The Ministry of Health (MOH) reported on August 3 that preliminary tests from an MOH laboratory were negative on seven individuals suspected of infection with avian influenza. However, U.S. NAMRU-2 tested samples from these same cases and found that one tested positive for H5N1 infection. On August 2, the GOI announced that Avian Influenza (AI) has infected poultry in 29 of the 33 provinces in Indonesia, including Bali. On July 7, USAID started a new community-based program to combat AI via improved surveillance through volunteers that will reach villages in the most populated areas of Indonesia. Teams are expected to be fully mobilized within three months. As of August 4, data from the NAMRU-2 and the Ministry of Health (MOH) show a single new probable H5N1 case in humans since reftel A. Confirmed human cases of avian influenza in Indonesia remain at 56, with 44 confirmed deaths, a 79 percent fatality rate. End Summary. GOI to Use Domestic Laboratories, Including NAMRU-2 -------------- ¶2. (SBU) The Minister of Health Siti Fadilah Supari announced at an August 3 press conference that the GOI would stop sending samples to a World Health Organization (WHO)- sanctioned laboratory in Hong Kong, effective immediately. Supari considers that local laboratories, including the U.S. Naval Medical Research Unit-2 (NAMRU-2),laboratory are sufficiently qualified. She also referred to the Eijkman Institute, a semi-autonomous institute that falls under the Ministry of Research and Technology. NAMRU-2 will continue to send samples to the U.S. Centers for Disease Control (CDC). Medan New Cluster -------------- ¶3. (SBU) Samples from seven ill residents of the Kabanjahe district, of the Karo regency, North Sumatra, the same site as the eight-member AI cluster in May, were tested for H5N1 by both Ministry of Health and NAMRU-2 laboratories. (GOI routinely splits and shares samples of suspected AI cases with both laboratories.) The MOH reported on August 3 that preliminary laboratory tests completed were negative. However, NAMRU-2 data indicates that one of the cases tested positive for H5N1. NAMRU-2 will send this sample to CDC for confirmation. Four of the seven individuals, all children remain hospitalized in Medan. AI Infected Poultry Discovered in Bali and Other Provinces -------------- -------------- JAKARTA 00009914 002.2 OF 003 ¶4. (U) The Indonesian Ministry of Agriculture acknowledged that the AI virus has spread to 203 districts/cities in 29 of the 33 provinces in Indonesia. The GOI reported AI infected poultry in Bali on August 1. Bali officials believe the source of transmission was poultry smuggled onto the island. "The H5N1 strain of avian flu began sickening chickens on Bali about three weeks ago," said Memet Zulkarnain, an official at the Ministry of Agriculture's avian flu center. Although the Bali provincial government has banned poultry imports, smuggling remains a problem due to the higher costs of purchasing poultry in Bali versus other areas. For example, a duck purchased for ceremonial purposes in Bali would cost ten times the price (about USD 5.10) of a duck acquired in Java (51 cents). The provincial government conducted a culling of 273 ducks and native chickens. The government is also spraying disinfectant around infected areas, slaughtering and burning the dead poultry. The GOI has also reported outbreaks among poultry in Kupang (East Sumba) and East Nusa Tenggara. So far, no cases have been found in West Nusa Tenggara. ¶5. (U) The recent poultry outbreaks in Bali and North Sumatra were identified through USAID's animal surveillance program with the United Nations Food and Agriculture Organization (FAO). The FAO teams began searching for AI in poultry and found it in Bali in late June and in Karo, North Sumatra in mid-July. We have suspected that AI poultry outbreaks have been occurring on a regular basis in much of Indonesia and additional resources are helping to find them. When FAO identifies outbreaks, GOI response teams move in to contain with culling and other measures. USAID Assistance -------------- ¶6. (U) As of July 21, 2006, USAID/Indonesia has fully obligated all Avian Influenza (AI) resources, including $11.5 million announced by Secretary Rice in March. The total amount USAID/Indonesia has committed to fighting AI in Indonesia is $14.65 million. USAID's comprehensive program for AI supports the Government of Indonesia National Strategy for Avian Influenza Control and Preparedness for Human Pandemic Influenza 2006-2008. The program includes integrated public-and-private-sector AI surveillance and response for both animals and humans. Other implementing partners include the U.N. Food and Agriculture Organization for animal sector surveillance and control; NAMRU-2 for human surveillance and support of vaccine development; WHO for human surveillance; and Winrock International for internet and mobile-phone-based rapid reporting and response. New USAID Community-Based Program -------------- ¶7. (U) USAID has established a new Community-Based Avian Influenza Control (CBAIC) program through a contract with Development Alternatives Inc. (DAI). CBAIC will support a number of USAID initiatives, including assistance to JAKARTA 00009914 003.2 OF 003 Indonesia's National Committee for AI Control and Influenza Pandemic Preparedness to facilitate coordination among all levels and sectors of the GOI. The program will build upon existing community-based volunteer organizations whose members are already working in villages throughout the country. The program will educate volunteers on AI preparedness, surveillance, prevention and containment, and on behavior change communications. The CBAIC start-up team has been working in Indonesia since July 21. Human AI Case Profile -------------- ¶8. (SBU) NAMRU-2 reports a single new probable case since last reftel. NAMRU-2 data indicates the following AI- related case profile as of August 4: -- Number of laboratory confirmed (positive PCR and/or serology) human AI cases: 56, of which 44 have been fatal (case fatality rate of 79 percent). -- Number of probable AI cases (awaiting WHO Laboratory confirmation): 5, with 2 deaths (fatality rate of 40 percent). -- Number of cases awaiting verification by the US CDC: 1. -- Number of possible AI untested cases under investigation (last 30 days): approximately 11. 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 July 26, notes 54 human AI cases in Indonesia with 42 deaths. WHO figures can be accessed at www.who.int/csr/disease/avian_influenza. PASCOE