AVIAN INFLUENZA - POST-MORTEM ON ALLEGED AI OUTBREAK IN

1. (U) Summary. Embassy staff from USAID and the Centers for Disease
Control and Prevention (CDC) conducted a review and found that the
Indonesian response to the suspected avian influenza (AI) outbreak
in North Sumatra was mostly good, but still leaves room for
improvement. Surveillance and response teams generally followed
Ministries of Agriculture and Health guidelines, though human
samples could have been sent for analysis with greater speed.
Villagers in Air Batu were also slow to report poultry deaths, as
they attributed the deaths to normal causes. End Summary.



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Final Readout and Lessons Learned


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2. (U) Final readout and lessons learned are detailed below:

-- Most activities associated with animal and human surveillance and
response officers were conducted in compliance with Ministries of
Agriculture and Health surveillance and response guidelines. Human
samples could have been drawn and sent to Jakarta for analysis with
greater speed.

-- Villagers were late in reporting the poultry outbreak to
Participatory Disease Surveillance and Response (PDSR). Villagers
attributed the deaths to normal causes, despite having received
education from the agriculture office and having seen
USAID-sponsored television service announcements to report sudden
poultry death, to burn and bury dead poultry, and to wash hands with
soap after contact with dead poultry. Villagers did bury poultry
that died prior to the reported outbreak and they washed their hands
afterward.

-- Villagers expressed satisfaction with services provided by the
GOI, including the culling operation, the education provided by the
PDSR and the health office, the establishment of the health post in
the village, and the medical care received by hospitalized suspect
patients.

-- Villagers find it difficult to cull their poultry because of the
lost income and food. They also find it difficult to cage their
poultry because of the cost of feeding. They are willing to
participate in these activities because of the risk to their own
health. This indicates that U.S. Government (USG)-sponsored
activities have increased awareness.



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Chronology of Events


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3. (U) The following chronology from Air Batu has been verified by
multiple sources.

-- Mid-July - A villager brought four new chickens to the
sub-village and poultry began dying shortly thereafter. Poultry
deaths were sporadic in free-ranging poultry around the village.
Villagers did not suspect AI at first, attributing the cause to
normal poultry illness and snake bites. They did not immediately
report poultry die-off to authorities.

-- August 3 - When a third person died within one week, poli-clinic
staff told villagers to call the district agriculture office to
report poultry death. The sub-village head reported poultry deaths
to sub-district agriculture field officer who then reported to the
PDSR officer.

-- August 4 - PDSR investigated the poultry deaths within 24 hours
of report. PDSR recorded the case description, conducted a rapid
test and confirmed a highly pathogenic AI (HPAI) poultry outbreak.
They sprayed disinfectant in the area and conducted an education
meeting for the villagers. At the meeting, villagers agreed to cull
all remaining poultry and did not expect compensation. PDSR
instructed villagers to gather and cage all poultry and prepare a
pit for poultry disposal. PDSR notified police and DSO (human

JAKARTA 00001584 002 OF 002


health) of outbreak and culling to take place the following morning.
They conducted all activities in accordance with the Ministry of
Agriculture guidelines.

-- August 5 - PDSR returned to the village with police. PDSR culled
all poultry (257 chickens, ducks, geese, and other), sprayed
disinfectant on all cages, burned all poultry and cages in a
prepared pit, and buried the carcasses. Police shot the few poultry
that villagers had not been able to catch. They roped off the
culling area from village, and all participants, including witnesses
from other institutions wore personal protective equipment (PPE).
PDSR again sprayed disinfectant following the culling operation.
The DSO investigated for influenza-like-illness in villagers,
identified 12 people with high temperature and hospitalized the
patients. All suspected AI patients received treatment with
Tamiflu. They conducted all activities in accordance with the
Ministries of Agriculture and Health guidelines.

-- The Health Office established an AI post in the village to
provide information and monitor the village. The post was staffed
through the evening of August 13.

-- The PDSR officers have advised the villagers to refrain from
raising poultry for 3 months and will continue to monitor the
village until it is determined to be safe.

-- August 9 - (reftel C) WHO reported to CDC and USAID
representatives that all 12 of the human samples were negative for
H5N1 HPAI.

HUME