UZBEKISTAN AVIAN AND PANDEMIC INFLUENZA UPDATE

UNCLAS SECTION 01 OF 05 TASHKENT 000329 SIPDIS SENSITIVE SIPDIS DEPT FOR SCA/CEN, SCA/RE:AGOEL, EUR/ACE DEPT FOR OES/ETC, OES/PCI, OES/STC, OES/IHA USDA/FAS/BIG: JPPASSINO FAS/TTP:PSHEIKH DOE FOR NNSA EPA FOR OFFICE OF INTERNATIONAL AFFAIRS ALMATY FOR USAID ANDREW HOLMES ANKARA FOR AGATT E.O. 12958: N/A TAGS: SENV ETRD EAGR EAID TBIO UZ SUBJECT: UZBEKISTAN AVIAN AND PANDEMIC INFLUENZA UPDATE REF: 06 TASHKENT 2056 TASHKENT 00000329 001.2 OF 005 ¶1. (SBU) Summary: U.S. efforts are playing an important role in raising the profile of Avian Influenza (AI) in Uzbekistan, and improving the government's capabilities to detect and react to a possible AI outbreak. The Defense Threat Reduction Agency (DTRA) is conducting numerous programs that have strengthened the government's laboratory and surveillance capabilities. USAID is supporting AI programs implemented by the U.S. Centers for Disease Control and Prevention (CDC) and Winrock International, sub-contracted to Project Hope. A U.S. Naval Medical Research Unit Number 3 (NAMRU-3) influenza surveillance team also recently visited. The World Bank and UNICEF recently held well attended AI roundtables bringing together the main national and international players. The Ministry of Health seems to have had hesitations in designating which laboratory would be responsible for AI diagnosis, and is currently not making use of an ultra-modern DTRA-equipped laboratory for AI diagnostics. The AI epidemiological situation has not changed from our last report in November 2006. End summary. ¶2. (U) In November 2006 Post provided an assessment of Government preparedness to handle an AI outbreak (ref A). This report contains greater information on U.S. and international-funded efforts to prevent avian influenza (AI) in Uzbekistan and assist the government in improving its preparedness. The AI epidemiological situation in Uzbekistan has not changed from November. No cases of AI have been reported in animals or humans. WORLD BANK AND UNICEF EVENTS -------------- ¶3. (U) The World Bank has received $3 million in European Union funding to support the Ministry of Health and Ministry of Agriculture AI efforts. The Ministry of Agriculture's Rural Restructuring Agency will implement the World Bank project, which includes human health, animal health, and communication components. On January 25, USAID, CDC, DTRA and Poloff attended a World Bank-sponsored AI roundtable with video-conference participation from the Almaty-based USAID/CDC regional AI consultant. Ministry of Agriculture officials asserted that they have excellent relations with their counterparts at the Ministry of Health, and have established 24 hour communication capabilities in the event of a suspected AI outbreak. Veterinary Services and State Women's Committee representatives also participated in the meeting, in which a World Bank consultant presented an assessment report stressing the need to strengthen institutional capacity in the human and animal health sectors. The World Bank consultant highly praised DTRA's work in Uzbekistan and Azerbaijan. A visiting Food and Agriculture Organization (FAO) official announced that a regional AI workshop will be held in Ankara at the end of February with participation from Central Asia, Iran and Pakistan. ¶4. (U) UNICEF is assisting the Ministry of Health in developing a national communications strategy regarding AI, and supported the printing of 20,000 AI posters that were distributed in hospitals, schools, and other public areas. On February 19-21, in collaboration with the Ministry of Health, UNICEF held a training workshop on working with the media during health emergencies such as AI. The British trainers drew on lessons learned from outbreaks of Bovine TASHKENT 00000329 002.2 OF 005 Spongiform Encephalopathy (BSE) and foot-and-mouth disease. A wide range of government agencies participated. UNICEF is also planning to conduct a survey to identify the public's level of knowledge on safe practices related to poultry. DISCUSSION OVER SELECTION OF DIAGNOSIS LAB -------------- ¶5. (SBU) The Ministry of Health has told CDC that the Institute of Virology is responsible for diagnosing possible cases of AI, while the Republican Center for State Sanitary and Epidemiological Control (SES) is charged with networking with regional SES laboratories and re-testing specimens identified as suspicious by regional SES. DTRA believes that the Ministry is seeking to use international funds to renovate a fourth floor lab at the Republican SES which would then be designated the new center for AI diagnosis. The government has so far been unwilling to conduct testing at the cutting-edge Defense Threat Reduction Agency (DTRA)-equipped laboratory on the ground floor of the Republican SES. DTRA ) UPGRADING THE LABORATORIES -------------- ¶6. (U) The Defense Threat Reduction Agency's (DTRA) multi-year $100 million Biological Threat Reduction Program (BTRP) has greatly contributed to AI efforts. DTRA has conducted Biosafety/Biosecurity upgrades at Uzbek laboratories dealing with Especially Dangerous Pathogens (EDPs). The Threat Agent Detection & Response (TADR) System Development and Biological Weapons Infrastructure Elimination have been important programs in strengthening Uzbekistan's capacity and capabilities. DTRA works closely with the Ministry of Defense, Ministry of Emergency Situations, Ministry of Health, and Ministry of Water and Agriculture. ¶7. (U) DTRA has completed major renovation work at the Republican Center for State Sanitary and Epidemiological Control (RSES),Center for Prophylaxis of Quarantined and Most Hazardous Infections (CPQMHI),the Research Institute of Epidemiology, Microbiology, and Infectious Diseases (RIEMID), the Republican Special Veterinary laboratory of Especially Dangerous Infections of Animals (CVD-EDP),the Ministry of Defense Especially Dangerous Pathogen Laboratory, and the Samarkand Uzbek Veterinary Scientific Research Institute (UzSRIV). Additionally DTRA-funded renovation work has begun at the Samarkand Republican State Sanitary and Epidemiological Control Laboratory and will ultimately result in the modernization of thirteen EDP-related laboratories in Uzbekistan. ¶8. (U) DTRA's TADR program will eventually consolidate all dangerous pathogens/agents (human and animal) at a safe and secure Central Reference Laboratory in Tashkent. It also increases system disease response speed through the strategically located Epidemiological Monitoring Stations (EMS). The TADR program develops mobile epidemiological response teams to investigate outbreaks, and information technology to rapidly disseminate detection and response information. It also implements secure pathogen transportation capabilities, providing training in bio-safety, diagnostics, and epidemiology to help ensure a sustainable and self-sufficient TADR system. The Cooperative Biological Research (CBR) program promotes collaborative research projects between Uzbek and U.S. laboratories. DTRA's TASHKENT 00000329 003.2 OF 005 main in-country contractor is Bechtel International, Inc. CDC - TRAINING PROGRAMS FULL SPEED AHEAD -------------- ¶9. (U) USAID has provided the U.S. Centers for Disease Control and Prevention (CDC) with $200,000 in funding. CDC/Central Asia Region (CAR) is working with the Ministry of Health to develop and disseminate a policy on avian influenza, including appropriate case definitions and surveillance measures. In December 2006, 31 Uzbek epidemiologists, clinicians, and laboratory specialists participated in CDC,s Central Asia Regional Conference on "Practical Aspects of Avian Influenza Surveillance." During the conference, guidelines for epidemiology, laboratory and clinical practices were developed in working groups. These guidelines will further be introduced in Uzbekistan during fiscal year 2007. ¶10. (U) CDC is also training clinicians in AI diagnosis and medical care. During fiscal year 2006, CDC/CAR clinicians conducted nationwide trainings on &Standard Case Definitions for Specific Infectious Diseases,8 which included AI lectures. In these lectures, infectious disease specialists were provided with up-to-date information on epidemiology, diagnostics and AI treatment. Lectures also included World Health Organization (WHO) definitions for suspect and confirmed cases of AI. In 2006 CDC/CAR trained 225 infectious disease experts and epidemiologists from Uzbekistan. In fiscal year 2007, approximately 120-150 infectious disease specialists from the regions will be trained in AI detection and containment. ¶11. (U) CDC epidemiology training allows local epidemiologists to better understand how to introduce flu surveillance and to better analyze surveillance data for evidence-based decision making. CDC/CAR is training epidemiologists from the national, regional and local level Sanitary Epidemiology Stations (SES),to improve the ability of local epidemiologists to detect and respond to a possible human AI event. Should suspected outbreaks occur, CDC will support travel expenses of Ministry of Health epidemiologists who have been trained in CDC/CAR,s two-year Applied Epidemiology Training Program, and who participated in the regional AI strategy planning meeting. CDC is also providing limited quantities of personal protective equipment and disinfectants to the Ministry of Health. ¶12. (U) CDC/CAR directly supports DTRA's BTRP project by providing advanced diagnostic training for Ministry of Health laboratory specialists to improve their skills in conducting tests using modern techniques such as ELISA and PCR (Polymerase Chain Reaction). CDC/CAR is providing PCR laboratory equipment and training workers to use the new equipment. PCR laboratory equipment is being provided to the Ministry of Health to improve capabilities to confirm AI in samples. This will include light cycler equipment along with basic renovations necessary to operate the equipment. CDC/CAR also assists the Ministry of Health to implement improved bio-safety practices in laboratories. PROJECT HOPE ) EDUCATING FARMERS -------------- ¶13. (U) Following the GOU-forced closure of Winrock International's country office, its $100,000 USAID-funded AI TASHKENT 00000329 004.2 OF 005 project was sub-contracted to Project Hope. The program focuses on veterinary training, communications and public awareness. Project Hope's Farmer-to-Farmer (FTF) program provides voluntary technical assistance to farmers and agri-businesses to promote sustainable improvements in food processing and marketing. This mechanism was identified by the USAID/Washington AI team for improving bio-security and minimizing human exposure to AI in animals. Volunteers include retired and active farmers and agricultural professionals. (Note: The U.S. Department of Agriculture has also offered to train Uzbek veterinarians, pending the Uzbek government's agreement to finance the program. End note.) ¶14. (U) The FTF program in Uzbekistan cooperates closely with the Ministry of Agriculture's Veterinary Service. Initial steps will include a review of agricultural aspects of each country,s AI preparedness plan. FTF will also supply technical assistance to existing coordination councils for farm surveillance and response capabilities at the district level. Project Hope has informed the Ministry of Agriculture that it intends to begin implementing these activities this month. ¶15. (U) Project Hope plans to assess Veterinary Services' ability to undertake an effective AI rural surveillance campaign aimed primarily at small and backyard producers. It will also review the national testing laboratory capability and equipment needs. Twenty to thirty Veterinary Service department staff will be trained in rural surveillance and rapid reporting in a pilot district area. The process used by the Veterinary Service to educate the public on response to a potential avian influenza outbreak will be reviewed. Communications specialists will advise Uzbek officials on the development of an AI mass media education program. NAMRU-3 TRAINING AT VIROLOGY INSTITUTE -------------- ¶16. (U) In late January a Cairo/Kabul-based NAMRU-3 influenza surveillance team visited Tashkent and held meetings at the Institute of Virology. The NAMRU team conducted training at the Institute on surveillance detection methods, which is also applicable to AI. In February another Cairo-based NAMRU-3 team participated in Ministry of Health-sponsored epidemiology seminars in Samarkand. CLEARLY DEFINED LAB RESPONSIBILITIES NEEDED -------------- ¶17. (SBU) Comment: While the activities described will help Uzbekistan track outbreaks of AI in birds or humans, very few preparations have been made for consequence management of an actual widespread outbreak of pandemic influenza, which would likely overwhelm the country,s emergency-response and healthcare system. Hospital preparedness needs significant improvement, particularly in isolation capabilities, number of masks, gloves, and hand washing facilities. There continues to be some uncertainty over the government's commitment to the Institute of Virology as its lead laboratory for AI diagnostics. The Ministry of Health seems to want to use international funds to renovate a fourth floor laboratory at the Republican SES that would duplicate an existing DTRA-equipped laboratory. The DTRA-equipped lab is currently the only modern fully equipped facility in the country ready to fulfill all the necessary tasks for human health diagnostics. TASHKENT 00000329 005.2 OF 005 PURNELL