PAKISTAN: INDEPENDENT TESTING CONFIRMS ONE HUMAN FATALITY OF

C O N F I D E N T I A L ISLAMABAD 005349 SIPDIS E.O. 12958: DECL: 11/21/2017 TAGS: KFLU TBIO EAGR AMGT PK SUBJECT: PAKISTAN: INDEPENDENT TESTING CONFIRMS ONE HUMAN FATALITY OF AVIAN INFLUENZA, OTHERS CASES IN DOUBT REF: ISLAMABAD 5302 Classified by: Ambassador Patterson for reasons 1.4 (b) and (d) ¶1. (C) Summary: Independent testing conducted by microbiologists from the U.S. Naval Medical Research Unit 3 (NAMRU3) confirms that one individual who died from respiratory failure tested positive for H5N1 Avian Influenza (AI). NAMRU is unable to obtain viable samples from two other cases, of which one was a fatality. All other suspected cases have tested negative for AI. Pakistani health authorities had previously announced that six individuals, out of eight suspected cases, had tested positive for avian influenza. There is not a consensus among Pakistani and international health experts as to whether or not human-to-human transmission of the virus has occurred. End Summary. ¶2. (SBU) The Pakistan National Institute of Health (NIH) publicly stated on December 15 that six individuals tested positive for H5N1 Avian Influenza (AI). Included in the six was one fatality, Pakistan's first confirmed human case of AI (Reftel). The World Health Organization (WHO) announced on December 15 that Pakistan had informed the WHO of eight suspected cases. ¶3. (SBU) Investigation of the outbreak focused on nine individuals. The first, also known as the Index case, was hospitalized in Peshawar with flu-like symptoms in late October 2007. He had been involved in the culling of diseased chickens in a poultry farm near Abbottabad, north of Islamabad. The patient recovered and was discharged. Pakistani health authorities reported that he tested positive for an H5 influenza strain. Three of his brothers, all of whom had close contact with the index patient during his illness, were hospitalized with respiratory ailments in November. The first brother died on November 19 and was not tested prior to his burial. The second brother died on November 28 and tested positive for H5N1. A third brother reportedly tested positive for AI but recovered and was released from the hospital. Pakistani health authorities also reported that a doctor who cared for the brothers, as well as a male cousin of the diseased, both tested positive for the virus. Active surveillance of chicken farms around the site of the October culling indicated three additional individuals suffering from flu-like symptoms, all of whom suffered mild symptoms are reportedly tested positive for the virus. ¶4. (SBU) A team of three WHO epidemiologists, two from WHO headquarters in Geneva and one from the WHO's Eastern Mediterranean Regional Office, traveled to Islamabad to assist the Pakistani National Institute of Health in investigating the cases. A medical epidemiologist from the influenza division of the U.S. Centers for Disease Control (CDC),coincidently in Islamabad at the time of the outbreak, also joined the team. Following a direct WHO request, a Cairo-based team from the U.S. Naval Medical Research Unit 3 (NAMRU3) arrived in Pakistan on December 20 to re-test all available samples. ¶5. (C) NAMRU 3 researchers reported to EconOff that H5N1 was confirmed in one of the cases, the second brother of the index patient, who died of respiratory failure on November 28. NAMRU was unable to test viable samples from the index case or the November 19 fatality. Samples from all other suspected cases tested negative for H5N1 avian influenza. A WHO-collaborating lab in London also retested the samples and confirmed NAMRU 3 findings on December 25. Samples are being forwarded to the NAMRU 3 lab in Cairo for full genetic sequencing. Neither the WHO nor NAMRU will release this data until the Pakistan Ministry of Health announces the test results. As of December 26, the Government of Pakistan has not released a statement on the WHO/NAMRU findings. ¶6. (C) Comment: NAMRU microbiologists report that there is no consensus among the NIH and WHO as to whether human-to-human transmission occurred in this instance. According to the NAMRU team, there is no scientific evidence to indicate that the virus was transmitted between individuals. However, according to the NAMRU team, the one confirmed AI fatality did not have prolonged contact with diseased poultry and may have been infected by his brother, the index case. Without viable samples from the index case or the November 19 fatality, it will be difficult for health officials to ascertain whether or not limited human-to-human transmission of the virus occurred. Local and international health experts currently on the ground in Pakistan agree that there have been no new recent cases. According to health authorities, the outbreak seems to have been limited and did not spread to neighboring poultry farms, nor did it spread directly from family to family. Post remains in contact with all relevant parties and will report any new findings or public statements on the case. End Comment. PATTERSON