AI: SOUTH KOREA MULLS CHANGES IN H5N1 SURVEILLANCE SYSTEM,

UNCLAS SEOUL 001379 SENSITIVE SIPDIS STATE FOR G/AIAG, OES/IHA, CA/OCS/EAP, AND EAP/K HHS FOR OGHA/STEIGER HHS PASS NIH/FIC AND NIH/NIAID CDC FOR NCID PASS USAID FOR GLOBAL HEALTH USDA FOR FAS/OSTA - WETZEL AND MFLEMING GENEVA FOR USMISSION WHO BEIJING FOR HEALTH ATTACHE ROME FOR FODAG E.O. 12958: N/A TAGS: TBIO EAGR ECON KFLU KS SUBJECT: AI: SOUTH KOREA MULLS CHANGES IN H5N1 SURVEILLANCE SYSTEM, PLANS TO EXPAND STOCKS OF ANTIVIRALS REFS: A) 05 SEOUL 1342 B) 04 SEOUL 549 C) SEOUL 951 D) 05 SEOUL 4983 ¶1. (U) Summary: In 2008, highly pathogenic avian influenza (H5N1) arrived later in the year, spread further and moved faster than in Korea's previous episodes in 2003-2004 and 2006-2007. It was also eradicated more quickly. The Ministries of Agriculture and Health, at the request of the Prime Minister, are working on one or more White Papers to distill some of the lessons from Korea's recent experience. Initial thinking is that surveillance for avian influenza should be maintained year-round rather than only during the usual flu season, and one official argues that more aggressive testing of domestic ducks is also warranted. A silver lining from the scare presented by AI's spread to the capital is that it energized the government to step up procurement of Tamiflu. End summary. ¶2. (U) Between April 1 and May 12, Korea suffered a series of 33 confirmed outbreaks of H5N1 among poultry. Samples from nine additional farms, where culling had already occurred, showed the presence of the virus. This episode followed similar episodes in 2003-2004, with 19 outbreaks, and in 2006-2007, with 7 outbreaks. The Agriculture Ministry's epidemiological investigation suggests that the likely source was migratory birds, though they have not been able to rule out the possibility of introduction by travelers or workers from China or Vietnam. ¶3. (U) Despite vigorous quarantine efforts according to Korea's standard procedures (see Refs A and B),the 2008 infection spread rapidly and far from the initial outbreak site in southwestern Korea. Eventually it touched every province except Jeju Island, and caused alarm by even reaching poultry being kept in the capital city of Seoul. ¶4. (U) Although one culler fell ill, his illness was later shown to be pneumonia, not influenza (Ref C). To date Korea has had no human cases of H5N1, although several cullers working in Korea's earlier outbreaks (who had taken antiviral medications as prophylaxis) later tested positive for H5N1 antibodies while remaining asymptomatic. ¶5. (SBU) ESTH Chief met July 7 with Lee Duk-hyoung, Director General for Disease Control Policy in the Ministry of Health, to explore whether Korea had derived any lessons from the 2008 outbreak among poultry. Recalling that the 2008 episode began after the end of the usual avian flu season, and that it had caused more alarm by spreading to the capital, Lee reported that Prime Minister Han Seung-soo had instructed the Ministries of Agriculture and Health to prepare a White Paper, in English, for eventual transmittal to international organizations. The White Paper (or perhaps two, one for each Ministry) will be finished by the end of 2008. ¶6. (SBU) One lesson that is being drawn from Korea's experience in 2008, Lee said, is the need for year-round surveillance of poultry for avian influenza. (Current procedures emphasize surveillance during the standard November to March season). The Korean experience proves that outbreaks can occur at unexpected times. Speaking personally (protect),Lee added that in his view, surveillance should become more active. Whereas currently the system depends on reporting of poultry deaths to flag the presence of the virus, Lee argued that the Agriculture Ministry should randomly test domestic ducks and migratory birds looking for reservoirs of infection. Lee said that he had not discussed these matters directly with the Agriculture Ministry (MIFAFF),but he thought it likely that MIFAFF was coming to similar conclusions. ¶7. (SBU) Embassy APHIS officer has also been in contact with the office of the Chief Veterinary Officer (CVO) at the Ministry of Agriculture (MIFAFF). The CVO pointed out that, while there were more cases of H5N1 in the 2008 episode, the total length of the outbreak (at 42 days) was shorter than previous episodes, which each lasted more than 100 days. The CVO commented that eradication was completed more quickly thanks to the implementation of additional control measures beyond those employed in previous episodes. The additional measures targeted traditional wet markets and vehicles transporting poultry. ¶8. (SBU) Asked whether MIFAFF planned any changes to its surveillance or quarantine practices as a result of the 2008 experience, the CVO confirmed that the Ministry plans to expand surveillance to year-round. ¶9. (SBU) In terms of protection for cullers and others in contact with infected poultry, DG Lee opined that no changes were needed in Korea's so-far-successful practices, including prophylaxis with Tamiflu. ¶10. (SBU) DG Lee noted that the scare generated by the appearance of bird flu in Seoul energized political levels of the government to move on a previously-stalled recommendation (see Ref D) that Korea increase its stocks of antiviral medication. As a result, the Lee Administration has taken a firm decision to raise Korea's stockpile of Tamiflu from 1.2 million courses currently to 2.5 million courses by the end of 2009, and to 5 million courses by the end of 2010. There are also (more tentative) plans to continue augmenting the stockpile through 2012, to 10 million courses. ¶11. (SBU) Asked about reported plans to stockpile human H5N1 vaccines, Lee indicated that is still under discussion. In any case, procurement would be limited, for use only by first-responders. Korea hopes somehow to leverage a planned purchase of human H5N1 vaccine from a multinational company into a commitment by that company to license the technology to the Korean vaccine manufacturer Green Cross, which is currently constructing a vaccine production plant for seasonal flu vaccines. The scope for bargaining is limited by the fact that the Korean government must procure its supplies through competitive bidding, including by importers. ¶12. (U) On June 29, MIFAFF finally lifted all AI-related restrictions on the poultry trade. After the requisite three months have passed since the last outbreak reported on May 12 (i.e., in mid-August),MIFAFF plans to notify the International Animal Health Organization (OIE) that Korea is AI-free. ¶13. (SBU) Comment: The 2008 outbreak led to the culling of more than 8.2 million poultry. Poultry consumption held steady at the outset. However, the rapid spread of the disease, and especially its appearance in the capital, led to a significant decrease in demand, and therefore in the price, for both poultry and eggs, damaging the farm economy despite the government's commitment to compensate for culled birds. (Prices have since rebounded.) A silver lining out of this episode is that, seeking to calm the fears of the politically-powerful Seoul constituency, the government finally committed to increasing significantly its procurement of antivirals. (The small stocks currently available would severely hamper the ROK's response to an eventual pandemic.) The move to a year-round AI surveillance program will also be salutary. End comment. VERSHBOW