AVIAN INFLUENZA - POST-MORTEM ON ALLEGED AI OUTBREAK IN

UNCLAS SECTION 01 OF 02 JAKARTA 001584 SIPDIS UNCLASSIFIED DEPT FOR EAP/MTS, G/AIAG, L/DL, EAP/EX, AND OES/IHA USAID FOR ANE/CLEMENTS AND GH/CARROLL DEPT ALSO PASS TO HHS/WSTEIGER/MSTLOUIS AND HHS/NIH DEPT ALSO PASS TO DOJ for OFL GENEVA FOR WHO/HOHMAN USDA/FAS/OSTA BRANT, ROSENBLUM USDA/APHIS ANNELLI E.O. 12958: N/A TAGS: TBIO EAGR AMGT PGOV ID KLIG SUBJECT: AVIAN INFLUENZA - POST-MORTEM ON ALLEGED AI OUTBREAK IN NORTH SUMATRA REF: A) Jakarta 1503, B) Jakarta 1512, C) Jakarta 1518 ¶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. -------------- Final Readout and Lessons Learned -------------- ¶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. -------------- Chronology of Events -------------- ¶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