BIRD FLU IN MORRELGANJ - OUTBREAK MANAGEMENT CASE STUDY

UNCLAS SECTION 01 OF 05 DHAKA 000193 SIPDIS SENSITIVE NOFORN SIPDIS USDA FOR DEPUTY UNDER SECRETARY/ETERPSTRA USDA FOR OFSO/JDEVER USDA FOR FAS/OA/MYOST/WKMILLER USDA FOR FAS/OCRA/CALEXANDER/JCARVER USDA FOR FAS/OSTA/CHAMILTON USDA FOR APHIS/MFLEMINGS/TBURLESON USAID FOR GH/HIDN/DCARROLL/MTROSTLE USAID FOR ANE/SAA/FFULLER USAID FOR ANE/TS/ACLEMENTS SEOUL FOR APHIS/GEORGE ANDY BALL BANGKOK FOR USAID NEW DELHI FOR FAS STATE FOR SCA, OES, SA/INS, EB/TPP, AVIAN INFLUENZA ACTION GROUP DEPT PLS PASS CDC - COX AND BLOUNT AND HHS - STEIGER AND HICKEY E.O. 12958: N/A TAGS: KFLU EAGR PGOV PREL ECON ETRD WTO TBIO CASC AMED IN BG SUBJECT: BIRD FLU IN MORRELGANJ - OUTBREAK MANAGEMENT CASE STUDY REF: DHAKA 00131 DHAKA 00000193 001.2 OF 005 ¶1. (SBU) SUMMARY: An interagency assessment team (IAT) from State, DOD, and USAID has been in southern Bangladesh's Khulna and Barisal Divisions conducting an assessment of the Cyclone Sidr affected area in support of USG rehabilitation and reconstruction efforts. The IAT has been tasked to report on any suspected avian influenza (AI) outbreaks or AI prevention operations encountered. Based on observations of the IAT at one site (which corroborate second-hand reports from other locations) post is concerned about serious gaps and delays in the GOB's response to the current spate of AI outbreaks occurring across Bangladesh. Direct observations from the Morrelganj area indicate a general lack of bio-security measures and AI awareness at the ground level. Post has provided the IAT with applicable biosecurity directions. Post's Medical Officer has assessed the risk of the IAT contracting AI as low; the IAT is self-monitoring for symptoms of illness. END SUMMARY. ¶2. (SBU) Since January 20, an interagency assessment team (IAT) from State, DOD, and USAID, has been in Morrelganj Upazila (county), located in southern Bangladesh's Khulna Division, to conduct assessments following Cyclone Sidr. On the morning of February 3, a USAID-funded NGO notified the team that there was a possible outbreak of avian influenza (AI) in the area. The suspected AI outbreak occurred at a small-scale poultry farm located in Morrelganj. This location is approximately one mile from the IAT base. This area was significantly affected by the cyclone and is only now beginning to rebuild. The infected farm itself was located approximately 1/5 mile from the Khashiakhali River and 100 yards from a pond with a pond sand filter which serves as the main source of drinking water for the neighborhood. Farm-Level Observations -------------- ¶3. (U) On February 3 IAT members spoke with the farm owners and observed a poultry coop. The farmers stated that on February 1, they observed dead and sick birds on their farm. The farmers explained that they hired day laborers to remove the dead and sick birds: they removed approximately 900 birds, leaving 125 apparently healthy birds. (NOTE: The workers doing the bird removal wore no special clothing or protective equipment, and likely did not disinfect their shoes. END NOTE.) The dead birds were buried adjacent to the chicken coop. The farmers then notified the local authorities who dispatched a team to investigate. On February 2, the upazila (administrative unit like a county) livestock officer and a livestock team sprayed an unknown chemical disinfectant around the farm area. The livestock officer told the farmers that the birds likely died of Newcastle Disease (another common cause of poultry die-offs, distinct from AI) and not AI. Additionally, they said that they received no advice on to what to do next. ¶4. (U) The farmers told the IAT that they invested 450,000 taka (USD DHAKA 00000193 002.4 OF 005 6,600) to establish the farm shortly after Cyclone Sidr. The farmers had purchased 1,025 hens. The hens were being raised for eggs and were just starting (before the die-off) to lay enough eggs for commercial sale. The farmers added that they have not been compensated for their losses and they have received no commitment from the government to do so. ¶5. (U) During the farm visit, the IAT observed a stack of dead chickens in the coop. Other chickens appeared listless and their combs drooped. It was readily apparent that the birds not culled earlier (deemed healthy a day prior) were now dying. Farmers were handling these birds with bare hands and had no information about the potential hazards of handling AI-infected poultry. The farmers said that they have not sold any birds or eggs on the local market. In the local markets, poultry traders told IAT members that since there were no AI outbreaks in the area there was nothing to worry about and they did not need to adopt any special procedures. Even if some individuals seemed concerned, they seemed unaware of safety precautions. ¶6. (U) IAT members spoke with neighbors located within a 200 yard radius from the affected farm. Some of the neighbors told the team that they knew about the outbreak but were not concerned. They added that the local government told them it was Newcastle Disease so there was nothing to fear. The team observed poultry in this immediate vicinity, in small backyard holdings. The owners told us that they were not instructed to do anything specific. One neighbor informed the team that they previously wanted to vaccinate their poultry but there was a problem with the vaccine. Upazila Officials Concerned -------------- ¶7. (SBU) IAT members visited the head of the Upazila administration (UNO),Krishna Kanta Biswas, to discuss the outbreak. Biswas told the team that the local government was taking the outbreak very seriously. He told the IAT that a checkpoint was established in the northern portion of the upazila to ensure that no poultry entered the area without a certificate of a being AI-free [COMMENT: No such certification process exists. END COMMENT] In addition, poultry from the affected area will not be allowed north of the river to prevent the potential spread of the disease to other unions (townships) in the upazila. However, he did not terminate poultry sales in Morrelganj town. ¶8. (SBU) On February 3 the local livestock officer sent samples to the nearest field test center in Barisal, about a 4-5 hour drive away. The evening of February 3 Biswas received an initial result from Barisal. Biswas stated that the news was not good, but the initial finding had to be re-confirmed in Dhaka, suggesting that AI needed to be evaluated by a subsequent test. ¶9. (SBU) Biswas told the team that they had previously received DHAKA 00000193 003.2 OF 005 instructions about what to do in case of a suspected outbreak. He noted that 5-6 months earlier, there was another suspected outbreak in the upazila, not far from the present farm, but that a test returned an inconclusive result due to a poor quality sample. Biswas also noted that his offices were prepared to deal with an outbreak and had seven sets of personal protective gear (PPE). Biswas stated that if AI is confirmed, additional measures would be taken. Some of these measures listed included culling birds within a 1KM radius of the farm as well as stopping all poultry and egg sales in the area. Also, a practice of using poultry waste (feces) as fish food would be terminated. He did express concern that this would have a significant economic impact in the area - which is still recovering from the cyclone. Biswas asked about getting USG assistance; he asked specifically for a technical expert. The IAT leader told him that the request would be passed to the Embassy in Dhaka. ¶10. (U) On February 4, national newspapers reported an AI outbreak in Morrelganj. The Bangla paper Shamokal reported the following: BEGIN TRANSLATED TEXT. At least 900 chickens of a farm died or culled Sunday due to infection of avian influenza in Morrelganj upazila of Bagerhat district. After hearing the news, fear spread among the poultry farmers of the district. District Livestock office said that red alert has been issued in Morrelganj upazila in order to prevent spread of the disease. Transfer of all kinds of poultry from or to Morrelganj has been banned. END TRANSLATED TEXT. ACTION: NOT TOO LITTLE, BUT POSSIBLY TOO LATE -------------- ¶11. (SBU) On February 5, Biswas received confirmation from Dhaka that the samples from Morrelganj were positive for AI. Although sale of chickens appears to have stopped in the local market, eggs continued to be sold. By 1800 hours, plans were underway to cull the infected farm and surrounding areas. ¶12. (SBU) During the February 5 meeting with Biswas, the local livestock officer told the IAT that he thought there were three main causes for the outbreak. These include: (1) the hens were at their first egg-laying stage and this results in lower immunity; (2) a recent cold and rain period further reduced immunity; and (3) vaccination management was poor. The livestock officer told us that the vaccination procedures and general farm management is not sufficient to prevent AI outbreaks. ¶13. (U) On the medical side, Biswas and the local medical officer noted that the local hospital, located in Hoglabunia, across the river from the affected area is ready to establish an isolation ward. They also currently have a stockpile of approximately 100 AviFlu and TamiFlu capsules manufactured in Bangladesh by Square DHAKA 00000193 004.2 OF 005 Pharmaceuticals. Biswas has already asked for additional medication, though to date no patients have been admitted to the hospital from the affected area with any symptoms of AI. Moving forward, Biswas said he plans a large public information campaign about the dangers of AI. ¶14. (SBU) On February 5 culling in Morrelganj began at some point after 2100 hours and concluded on February 6 at approximately 0430. Based on second hand reports from villagers, culling within a 1 KM radius of the infected farm was conducted by 4 teams of 3 persons each, who wore full-body PPEs with masks. Culled chickens were placed in plastic bags and buried in holes throughout the area (not in one consolidated hole.) Biswas was previously aware that the holes should be approximately 8 feet deep. The IAT was unable to determine if any disinfection was completed on the infected farm during or after the culling, or on the culling teams' vehicles' tires. ¶15. (SBU) During the culling approximately 30 police and army personnel were also on hand, but they did not wear PPEs. The numbers and owners of culled birds were recorded in a register, with a promise for compensation (of 70 taka per bird - US$1) at a later time. No further safety or health monitoring information was provided to the farmers. ¶16. (SBU) On February 6, the IAT did not see any chickens in the immediate 1KM vicinity of the infected farm. In the poultry market 2-3 KMs away from the infected farm, traders stated they had been asked by Biswas to stop sales. Although there were no chickens for sale, eggs were for sale and one seller offered he could provide some chickens if the IAT wanted to buy some, albeit at higher prices. None of the persons encountered in the wet market displayed any concern about the potential health risks of the confirmed AI outbreak less than 3KM away. Within a 10 KM zone of the AI infected farm, free range chickens were observed in yards. ¶17. (SBU) While leaving Morrelganj on 06 February, the IAT could not identify any apparent monitoring or restrictions on poultry trade or movements of poultry into or out of the area (even between upazillas). Per the GOB plan, there is meant to be a restriction on poultry movements into or out of a 3KM radius of an infected farm. It is not evident if or how controls on the poultry trade in the vicinity of infected farm will be monitored. ¶18. (SBU) Given that at least three members of the IAT were on an AI-infected farm during their interviewing of farmers, Post provided applicable directions to the IAT for disinfecting their shoes, clothing and the vehicle's wheel rims and tires. Post's RMO has assessed the risk of the IAT contracting AI as low; the IAT is self-monitoring for symptoms of illness. Comment -------------- DHAKA 00000193 005.2 OF 005 ¶19. (SBU) The AI outbreak in the Cyclone Sidr-affected region adds yet another dimension of health risks and economic losses to an already devastated area. In the immediate vicinity of the Morrelganj outbreak many homes remain destroyed. Residents are seeking funds to rebuild their shelters before the upcoming rainy season. Poultry and fish are the main sources of protein. Poultry related work provides income for many of the people in the region. The government leadership in the areas visited by the IAT appear to be taking minimum steps necessary to address the AI outbreak. The entire AI response process appears top-down driven, with little available resources for local level initiatives or action. ¶20. (SBU) The manner in which the GOB investigated, responded, and managed the AI contaminated farm in Morrelganj does not demonstrate compliance with standard biosecurity protocols and safety practices and their own outbreak management protocol. AI-related information for farmers, traders, teams performing culling, and the general populaceis urgently needed at the local level. ¶21. (SBU) This is the first time that Post has directly observed the GOB's management of a poultry die-off and the corresponding response to a confirmed AI outbreak at a farm. Based on these findings, Post gives added credence to additional second-hand information received from other parts of the country reporting similar deficiencies in the GOB's ground-level response. Post will continue its focused efforts on augmenting the GOB's AI planning, testing, management and response capacity. Additional reporting will be provided SEPTEL.