UZBEKISTAN AVIAN AND PANDEMIC INFLUENZA UPDATE

UNCLAS SECTION 01 OF 05 TASHKENT 000330

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

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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

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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

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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

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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.

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PURNELL