BURMA AI UPDATE: NO NEW OUTBREAKS, MORE HELP NEEDED

UNCLAS SECTION 01 OF 04 RANGOON 000272 SIPDIS SENSITIVE SIPDIS STATE FOR EAP/MLS, G/AIAG; PACOM FOR FPA; USDA FOR FAS/PECAD, FAS/CNMP, FAS/AAD, APHIS; BANGKOK FOR USAID:JMACARTHUR, APHIS:NCARDENAS, REO:JWALLER E.O. 12958: N/A TAGS: EAGR EAID AMED PGOV PREL CASC TBIO KFLU BM SUBJECT: BURMA AI UPDATE: NO NEW OUTBREAKS, MORE HELP NEEDED REF: A. RANGOON 247 ¶B. RANGOON 232 AND PREVIOUS RANGOON 00000272 001.2 OF 004 ¶1. (SBU) The government of Burma has reported no new outbreaks of AI since the culling of affected poultry in Rangoon was completed on March 2. The GOB has reported no suspected cases in humans. In the affected areas of Rangoon, officials continue to monitor the health of poultry and humans, and have restricted the movement and sale of poultry products. GOB officials publicly acknowledged the crucial role of FAO and WHO assistance in their successful containment of the February outbreak. Donors met to review the FAO request to the World Bank AI Trust Fund, but none of the potential donors had plans to fund additional AI programs in Burma. Visiting Bangkok USAID Health Advisors complimented the GOB's quick response to this outbreak, and noted areas that will require more attention in the future, including better communication between animal and human health officials, and shifting the focus of the search for the source of AI outbreak from wild birds to other possibilities. As urged by USAID visitors, the GOB publicly confirmed AI outbreaks in the government press. GOB cooperation and coordination with the international community remains strong. End summary. Update on Outbreaks and Measures Taken -------------- ¶2. (U) Officials from the Livestock Breeding and Veterinary Department (LBVD),WHO, and FAO briefed USAID Infectious Diseases Team Leader Dr. John MacArthur on the successful containment of the Rangoon AI outbreak in poultry, which occurred from February 23 through final culling on March 2. Officials reported no new outbreaks since then, and no suspected human cases. ¶3. (SBU) LBVD officials described the first outbreak at a chicken and duck farm, reported by the owner on February 27. After some poultry tested positive for HPAI, official teams culled all poultry on the farm on the night of February 28, and began to monitor all humans and backyard poultry within a one kilometer radius. At a visit to the farm on March 9, officials told us that they had not made any decision on compensation for the farmer's estimated $2,500 loss. The farmer said he was not willing to relocate his poultry operations to Rangoon's designated Livestock Zone, ten miles away. The site of the fourth and final outbreak, on February 26 through March 1, occurred at a small commercial farm where the owner kept 156 layers in cages. All birds were culled on March 2, and officials extended restricted and control zones around the farm. ¶4. (U) In the "restricted area" of one kilometer radius, protective measures include: testing of all poultry deaths; pathology testing in cases of high mortality rates; and prohibition of movement of poultry products, equipment, feed, manure, and fertile eggs into, within, and out of the restricted area. Measures taken in the "control area" of seven-kilometer radius include: passive surveillance; investigating the pathology of birds in cases of high mortality rates; daily telephone or personal surveillance of community and village poultry sites; and prohibition of movement of the same poultry-related products into, out of, and within the controlled area. ¶5. (U) The LBVD Director General described the GOB AI strategy as "Early Protection, Early Warning, Early Prevention," and emphasized that the government follows FAO and OIE guidelines. A Rangoon-based Task Force, headed by RANGOON 00000272 002.2 OF 004 the LBVD Director-General, includes members from Livestock Ministry from Nay Pyi Taw, the Rangoon office of LBVD, and Veterinary Science students. The Task Force fields two investigative teams, two culling teams, two disinfection teams, and four surveillance teams. Officials said they will continue to investigate possible sources of AI at the four outbreak sites, identified as: wild birds; the origins of recently purchased day-old chicks and feed; visits by an egg collector and a manure collector; visits by farm occupants to a live bird market; and the close proximity of a slaughterhouse. Concerns and Needs -------------- ¶6. (SBU) While praising the GOB's quick, effective response to the Rangoon outbreak, USAID Advisors identified several areas of concern during meetings with GOB, FAO and WHO officials, including: animal and human health coordination and communication; lack of strong epidemiology; inadequate lab technician capacity; uninformed risk communications; limited equipment supplies; lack of a compensation scheme; and lack of an operational plan to implement emergency vaccination. ¶7. (SBU) Animal/Human Health Coordination: The LBVD Director General told us that the Livestock Ministry had been given authority to act independently in accordance with FAO and OIE guidelines on AI. WHO AI Coordinator Jum Coninx told us that her Ministry of Health (MoH) colleagues, while included on Rapid Response Teams and in daily meetings, were not kept well informed about the results from the animal lab testing, and did not receive timely information on poultry cullers who should be kept under MoH surveillance. FAO plans to hire an international project coordinator, who would manage animal health programs and coordinate with human health agencies, to improve communications. ¶8. (SBU) Human Health Issues: Coninx said that health officials were well prepared to respond to the Rangoon outbreak, but expressed concern about their capacity to respond to a wider emergency. She reported that the Ministry of Health has developed standard operating procedures and a case definition for suspected AI patients. Coninx said WHO imported equipment for medical personnel to monitor cases in health facilities, but noted that more Rapid Test Kits were needed. She expressed concern that human health labs were not busy testing specimens from humans as part of the surveillance effort. Priorities for WHO include epidemiology training for field personnel, more PPEs, operational costs for outbreak surveillance activities, building capacity at the National Health Lab, training for private General Practitioners, case management training, and bringing training down to district and local levels. ¶9. (SBU) Epidemiology: FAO and WHO representatives agreed that epidemiology capacity in Burma was weak. The FAO advisor urged GOB technicians to decrease the focus on wild birds, all of which have tested negative for HPAI, and has strained lab capabilities. Instead, the GOB should follow the "epidemiology trail" to and from the affected farms more aggressively to identify the source of the virus. Other assistance in this area of expertise will come when a new epidemiologist arrives at WHO to assist Coninx. Also, FAO will bring in Dr. Harvey Westbury for a month-long return visit to provide technical assistance for lab staff, and has requested funding in its World Bank proposal for training to strength diagnostic capacities. RANGOON 00000272 003.2 OF 004 ¶10. (SBU) Risk Communications: GOB-owned news outlets have reported daily on the official response to the outbreak and on the results of tests on domestic poultry and wild birds. Press announcements were highly technical in nature, however, and did not clearly confirm the presence of AI. Both USAID and FAO advisors urged GOB interlocutors to be clearer in their public announcements. On March 11, the government media confirmed the presence of AI, as recommended by the advisors. ¶11. (SBU) Personal Protective Equipment Sets: FAO and WHO requested additional PPEs to create an adequate stock to respond to a major outbreak, as well as to replace the PPEs used by cullers, Rapid Response Teams, investigators, health workers and disinfection teams in the current outbreak response. They want to ensure sufficient are on hand so that the protective equipment gets used routinely, rather than saved. ¶12. (U) Animal Health: FAO called donors together on March 9 to comment on a proposal to the World Bank AI Trust Fund. During the presentation, FAO reps identified the most pressing needs on the animal health side: implementing intensive surveillance; strengthening capacity of animal health workers, especially in epidemiology; improving coordination and communication with the private sector, human health officials, and the international community; developing the legal structure for compensation and emergency vaccination; making practical operational plans to implement contingency plans that now only exist only on paper; maintaining current surveillance, diagnostic and response activities; developing a knowledge and skills base of epidemiologists, veterinarians, and lab technicians; improving risk communications; and analyzing the socio-economic factors and impact of AI in the poultry sector. Foreign and Official Assistance -------------- ¶13. (SBU) The FAO proposal requests $1 million from the World Bank Animal and Human Influenza Trust Fund to support program planning, coordination, and management, and to enhance surveillance, diagnostic and outbreak containment activities. WHO's proposal to the World Bank AI Trust Fund for assistance on the human health side is under negotiation. At the FAO meeting, other donors were queried about their intention to provide emergency assistance for response efforts. AusAID, the Japanese Trust Fund, ADB, and JICA have ongoing programs, and China and Thailand have provided in-kind assistance, but no donors planned any new or additional support. WHO and FAO confirmed the need for additional PPEs, and Dr. MacArthur began discussions to identify other emergent needs and funding gaps in the preparedness plan. ¶14. (SBU) Burmese officials continue to welcome foreign expertise on AI. They willingly provide information about their activities and implement advice given by international experts. Ministry staff, including the Director-General of LBVD, personally accompanied USAID, World Bank and embassy visitors to the site of the first outbreak, and encouraged their questions. LBVD facilitated expedited visa and travel arrangements for USAID visitors. The GOB confirmed the presence of AI in Burma in the daily government press announcements two days after FAO urged such an announcement. Emboff described at a March 8 meeting the improper handling of chickens at local markets, and on March 11, LBVD conducted training sessions for shopkeepers at two major Rangoon markets. LBVD shares information on its surveillance RANGOON 00000272 004.2 OF 004 activities and lab results with the embassy on a daily basis. ¶15. (U) This cable was cleared by Dr. John MacArthur, USAID/RDMA. VILLAROSA