BURMA AI OUTBREAK SITE ASSESSMENT

UNCLAS SECTION 01 OF 02 RANGOON 000437 SIPDIS SENSITIVE SIPDIS STATE FOR EAP/MLS; PACOM FOR FPA; UDSA FOR FAS/PECAD, FAS/CNMP, FAS/AAD, APHIS; BANGKOK FOR USAID (JOHN MACARTHUR),APHIS E.O. 12958: N/A TAGS: EAGR EAID AMED PGOV PREL CASC TBIO KFLU BM SUBJECT: BURMA AI OUTBREAK SITE ASSESSMENT REF: RANGOON 399 ¶1. (SBU) SUMMARY. A joint FAO/WHO team, accompanied by a USAID Regional Infectious Diseases advisor and a FSN from the Foreign Agricultural Service (FAS),assessed an AI outbreak in Sagaing and Mandalay Divisions, Burma, on March 17-18. Government of Burma (GOB) officials reported cases to the OIE promptly and allowed full access to outbreak sites by FAO/WHO/USG. Numerous concerns exist about the preparedness of the GOB to respond to this outbreak. Urgent needs include: rapid response team supplies, technical assistance to contain spread of infection and increase surveillance, and diagnostic strengthening. END SUMMARY. ¶2. (U) In February 2006, poultry die-offs, originally ascribed to non-H5N1 causes, occurred in Shwebo, Kanbalu, and Zigon townships in Sagaing Division, northern Burma. In early March, these die-offs expanded to 4 townships in Mandalay Division. ¶3. (U) GOB Livestock Breeding and Veterinary Department (LBVD) officials were alerted to the outbreak on March 8. LBVD officials initiated an investigation. Specimens from the farms initially tested positive by rapid tests for influenza type A on March 9. Local PCR tests confirmed sub-type H5 on March 12, at which time the suspected H5N1 infection was reported to OIE. FAO and WHO were briefed on the outbreak by GOB officials on March 13 and LBVD made an informal request to them for assistance. Specimens were submitted to the National Institute of Animal Health laboratories in Thailand for H5N1 confirmation. H5N1 was confirmed by the Thai laboratory on March 16 and specimens were sent to Australia for genetic sequencing. ¶4. (U) The GOB response included the collection of specimens, active case surveillance for other unusual poultry die-offs, quarantine of affected farms, a temporary ban on the sale of poultry products in affected areas, and restriction of movement of poultry products and equipment. Depopulation activities were initiated on all 56 infected farms in the two divisions. ¶5. (U) As of March 18, 14 chicken farms, 10 quail farms, and 1 quail hatchery had been affected with high mortality in the greater Mandalay area. A total of 49,598 chickens and quail died or were culled. The GOB planned to cull all farm and backyard poultry in a 3 km radius of infected farms (approx. 20,000 birds) in Sagaing Division by March 24. Mandalay Division culled birds on non-affected farms if they were found to have had any contact with affected farms. ¶6. (U) GOB Ministry of Health (MOH) officials initiated active and passive surveillance for human cases in health facilities and local communities, disseminated a standard case definition to health workers, and designated a special hospital for suspected human cases. The designated hospital has a small number of PPEs, one ventilator, and few medicines. There are a total of 10 Tamiflu treatment doses in Mandalay Division. The GOB disseminated public awareness posters produced by MOH, UNICEF, and WHO, and state television reported the outbreak on March 15. The state-run newspaper, "The New Light of Myanmar," reported the outbreak on March 16 in both their Burmese and English editions, and other print media followed suit. ¶7. (SBU) After reporting the outbreak to OIE and communicating with the FAO regional office, the GOB agreed to allow FAO, WHO, and USAID access to the outbreak sites. The joint UN team, including the USAID Regional Infectious Diseases Advisor and the FAS FSN representative in Burma, departed for Mandalay on March 17. GOB officials welcomed the team's presence and assistance. LBVD and MOH officials were open with information and provided the team with regional and local maps of the affected areas and farms. The team was taken to the farms, including one that was in the process of being depopulated and disinfected. The assessment team noted numerous deficiencies in the quality of the GOB response team's activities. GOB officials were receptive to the team's constructive suggestions and took corrective action. ¶8. (SBU) WHO and USAID staff met with the Department of Health officials in Mandalay for a briefing on current human health response activities. Again, health officials were open and willing to answer all questions. The assessment team was then able to access the local hospital designated for receiving Avian Influenza cases. ¶9. (SBU) USAID funds, provided directly to FAO, have purchased 200 PPEs, 500 liters of disinfectant, 50 backpack sprayers, and a small number of bio-secure specimen shipping containers. Technical assistance was provided by the USAID-funded FAO Regional Advisor for Avian Influenza and the USAID RDMA Infectious Diseases Advisor. The Government of Japan, through JICA, provided funding for a Thai senior virologist for a 2-week consultancy in laboratory diagnostics, as well as for dissemination in Burma of a small number of public awareness posters on AI. The Royal Thai Government will fund diagnostic reagents for 1,000 samples. FAO/Rome has released $45,000 of emergency funds to the Burma country FAO office to assist with containment activities, and WHO/SEARO provided $20,000 to the WHO Burma country office. ¶10. (SBU) COMMENT: Burma is a risk country for H5N1 infections. The current outbreak highlights that the surveillance for Highly Pathogenic Avian Influenza is sensitive enough to detect unusual die-offs. When H5N1 is suspected, the GOB has shown unusual willingness to report the cases to the international community and to allow free access to affected sites. The GOB response to this outbreak also highlights that many challenges remain in making the National Plan operational. Burma urgently needs strengthening of surveillance and diagnostics, including collection, processing, and testing of both animal and human specimens. Medium to long-term in-country presence of international human and animal health experts in Avian Influenza is crucial to assist the technical ministries with coordination and enhancement of preparedness and control activities, and to sustain the open information-sharing shown in response to this outbreak. END COMMENT. STOLTZ