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 -------------- ¶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