INDONESIA - FEB 16 AVIAN INFLUENZA (AI) UPDATE

UNCLAS JAKARTA 000431

SIPDIS

SENSITIVE
SIPDIS

DEPT FOR EAP/MLS, EAP/IET, MED/DASHO/EMR AND MED
DEPT FOR G/AIAG AND OES
DEPT PASS TO USDA/FAS/HWETZEL
DEPT ALSO PASS TO USDA/FAS/FAA/DEVER AND USDA/APHIS/ANNELLI
DEPT ALSO PASS TO USDA/FAS/OTCB/ROSENBLUM AND USDA/APHIS AUSTGEN
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
BANGKOK FOR APHIS/CARDENAS, RMO, CDC, USAID/RDM/A
CANBERRA FOR APHIS/EDWARDS
ROME FOR FAO
NSC FOR JMELINE

E.O. 12958: N/A
TAGS: TBIO AMED CASC EAGR AMGT PGOV ID
SUBJECT: INDONESIA - FEB 16 AVIAN INFLUENZA (AI) UPDATE

REF: A) Jakarta 00310 B) Jakarta 00264 and previous


1. (SBU) Summary: The Ministry of Health (MOH) has announced four
new AI cases since Ref A, including two fatalities, but NAMRU-2
tested samples from two of these cases as negative for H5N1
infection. The discrepancy has forced local WHO authorities to
wrestle with the classification of official AI case numbers for
Indonesia given absence of credible confirmation. While some
hospitals are blocking access, NAMRU-2 continues to receive samples
from the majority of hospitals in its surveillance network. The
Ministry of Agriculture (MOA) turned down a request from a USDA
research lab for AI virus isolate sharing, as well as an offer to
conduct collaborative research. The Indonesian press continues to
run stories about the standoff between the Government of Indonesia
(GOI) and the World Health Organization (WHO) over AI sample
sharing. According to REDI Center Director Dr. Rodney Hoff,
officials from the Singaporean Ministry of Health claim the
Indonesian MOH has named a Project Director for the Tangerang
trilateral project. However, a key official from the National
Committee on Avian Influenza Management and Pandemic Alert (KOMNAS)
told Hoff that MOH has not notified KOMNAS of the appointment. End
Summary.

New AI Cases and Conflicting Tests Results
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2. (SBU) During the week of February 5, the MOH confirmed two new AI
cases involving an 11 year-old female from Jakarta and a 30 year-old
male from Bandung. However, NAMRU-2 ran several molecular tests on
separate samples from the two patients, as well as serologic tests
on the samples taken over four time points, but did not find
evidence of H5N1 infection in either patient. Both patients
survived and their cases' general clinical and epidemiological
features are inconsistent with earlier H5N1 patients. NAMRU-2
identified a human AH3 virus (normal human influenza) in the 48
year-old mother of the 11 year-old female.


3. (SBU) On February 11, the MOH announced two additional deaths
attributed to infection from AI. The first involved a 22 year-old
woman, and the second, a nine-year-old boy. Officials report that
the woman had contact with dead chickens a week before she died.
However, investigators at the National Institute of Health Research
and Development (NIHRD) did not share samples from these cases with
NAMRU-2 nor report the infection in the nine year-old male during
discussions with NAMRU-2 on February 14.


4. (SBU) Given the lack of corroboration on the four cases, the
Jakarta WHO office is wrestling with how to classify them. The WHO
and NAMRU-2 are reporting 81 cases and 63 deaths in Indonesia
pending additional sampling, while the MOH is now claiming 85 human
H5N1 cases, with 65 deaths. NAMRU-2 has continued to receive
greater then 90% of potential AI samples from hospitals within its
surveillance network. A few hospitals have ceased sending samples
pending clarification of GOI sample sharing policy but are banking
the samples with the hope of sharing them later if the MOH grants
permission. Meanwhile, MOH is no longer sharing with NAMRU-2
samples from suspected H5N1 patients picked up outside the
surveillance hospital system.

GOI Turns Down USDA Research Opportunity
--------------


5. (U) On January 24, USDA's South East Poultry Research Laboratory
in Athens, Georgia requested that Indonesia's chief veterinary
officer Dr. H. Musny Suatmodjo release recent H5N1 isolates to the
laboratory for vaccine efficacy studies and challenge tests. USDA
also offered to provide 2-3 months of training for an Indonesian
scientist to participate in research at the laboratory and co-author
any research related journal articles. On February 14, Dr. Musny
refused the collaboration opportunity, noting in his response that
"a memorandum of understanding between Indonesian Government and a
veterinary-based private company has been currently established to
conduct a similar project in Indonesia" and thus he was unable to
accept the offers. WE are unaware of the identity of the private
company.

Press Discusses AI Sample Impasse
--------------


6. (U) The Indonesian press continues to run stories about the
controversy surrounding sample sharing. The recent re-emergence of
AI in Indonesia generated 11 stories in local media during the past
week. Stories have included WHO concern about the lack of sample
sharing and also the Baxter-MOH Memorandum of Understanding. The
Minister of Health continues to make accusations about misuse of
past samples. One press story quotes her as saying "we sent the
samples to Hong Kong and the CDC on the recommendation of WHO for
further diagnosis but apparently they were used for other purposes
without our approval. It's enough." The press has been quiet about
implementation of Jakarta's municipal decree on eliminating backyard
chickens by February 1, presumably due to serious flooding in
Jakarta.

Tangerang Trilateral Project Update
--------------


7. (U) During a two-day visit to Indonesia, Dr. Rodney Hoff,
Director of the REDI Center briefed us on the latest developments in
the Tangerang Trilateral project. According to Hoff, officials at
the Singaporean Ministry of Health claim the Indonesian MOH has
named Gindo M. Simanjuntak as Director for the project. However, in
later discussions, KOMNAS Secretary Dr. Tri Satya Putri Naipospos
told Hoff she was unaware of this development. Hoff also noted that
Singapore and Indonesia have not yet finalized the Tangerang
Trilateral Project MOU.

PASCOE