AVIAN INFLUENZA PREVENTION IN JIANGSU PROVINCE

UNCLAS SECTION 01 OF 03 SHANGHAI 000035

SIPDIS

SIPDIS

STATE FOR EAP/CM
HHS FOR ELVANDER/BHAT
NSC FOR WILDER, TONG

E.O. 12958: N/A
TAGS: TBIO PGOV ECON CH
SUBJECT: AVIAN INFLUENZA PREVENTION IN JIANGSU PROVINCE

REF: 2005 SHANGHAI 3660

(U) This cable is sensitive but unclassified and for official
use only. Not for distribution outside of USG channels or via
the internet.


1. (SBU) Summary: Two confirmed cases of Avian Influenza (AI)
in Jiangsu Province have focused attention on Jiangsu's ongoing
efforts against AI. In meetings with Conoff, Jiangsu health
officials confirmed reports that a father and son both
contracted AI in December. Jiangsu CDC does not have any
evidence that this is a case of human-to-human infection nor
were they able to confirm the source of the infection. They did
provide details about their efforts to contain the disease and
informational campaign to alert the public. They assured Conoff
that Jiangsu is prepared to take prompt action on any future
outbreaks and is also maintaining a high state of vigilance to
prevent any future outbreaks. End summary.


2. (SBU) On January 16-17 Conoff and Environment, Population,
and Health (EPH) Assistant met in Nanjing with officials from
Jiangsu Center of Disease Control (CDC),Jiangsu Health
Department, and the Jiangsu Agriculture and Forestry Department
to discuss their roles in Jiangsu's Avian Influenza (AI)
prevention and emergency pandemic plans.

Death in Nanjing or the Beggars Chicken Mystery
-------------- --


3. (SBU) Jiangsu CDC officials were eager to discuss recent
reports of the infection of a son and father of AI in Nanjing,
Jiangsu Province's capital. Jiangsu CDC Director Wang Hua, a
nationally recognized expert on AI who serves on the board that
determines national AI policy, acknowledged the high level of
interest in the two recent Nanjing city confirmed cases of AI.
He said that Jiangsu CDC was proud of their response to this
recent health related emergency situation and provided a
detailed account of the case. Accompanying Wang to the meeting
were four members of the CDC Emergency Response team that
oversaw all aspects of this case. Vice Chief of Serious
Infections Doctor Bao Chongjun headed this team.


4. (SBU) According to Wang on December 1, Jiangsu Health
officials were notified that a 24 year old man was hospitalized
for AI. The Jiangsu CDC immediately implemented the provincial
emergency response plan. Working around the clock for the
entire month of December, the emergency response team carried
out an extensive outreach program and implemented an exhaustive
investigation.


5. (SBU) On December 3, the team blanketed the province with AI
informational brochures. A public service message ran 24 hours
each day on all television screens next to public elevators.
Altogether 556,000 informational tracts were distributed within
three days of notification.


6. (SBU) The young man died on December 2 and Nanjing CDC
officials supervised the disposal of the body on December 4.
Officials ensured that the body was disinfected, particularly
around the ears and nose. They cremated the remains then
disinfected the burn area. They also went to the deceased's
residence to destroy the young man's clothing and isolate the
area.


7. (SBU) In addition to the informational campaign, a team of
investigators gathered information about the young man's
activities for the last month of his life. A total of 62 people
were identified as having close contact with him during this
time. Of this number, ten were quarantined. On December 4,
those quarantined were given vaccines sent down from Beijing to
prevent them from contracting AI. This group included his
mother (herself a medical doctor),father, girlfriend, and the
seven doctors who had treated him since he had first sought
medical care on November 24. Because the father's health
condition was under such intense scrutiny, when he developed a
fever and was diagnosed with AI, he was immediately sent to the
Infectious Disease Hospital in Nanjing for treatment where he
was treated with oseltamivir, commonly known by the brand name
Tamiflu. The father recovered. However, thirteen days after
his fever returned to normal levels, the AI pathogen was still
found in his feces.


8. (SBU) Wang said he wanted to dispel several myths about the
cause of the young man's death. He said that the young man

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initially became ill with salmonella in August and his reaction
was so severe that he lost 5 kilograms. Later he was bitten by
a dog and underwent the rabies shot treatment regimen. At the
time of his death, he had received four out of five shots. The
dog that bit him is still under observation and it was verified
that he is not a carrier for rabies or any other infectious
disease bacteria.


9. (SBU) It was a well know fact that the young man especially
liked to eat chicken and the freezer in his home was well
stocked. In late November the family shared a celebratory
Beggars Chicken meal at a Nanjing temple restaurant but no one
else became ill. (NOTE: Beggars chicken is cooked inside a
shell of clay.) Wang said that to date, no contaminated chicken
has been identified.


10. (SBU) While Wang insisted repeatedly that there was no
evidence of human-to-human transmission, however it was his
opinion that the father's close contact with the son was a
factor. He said perhaps the father came into contact with the
same objects. To date, Jiangsu CDC still has not discovered the
source of the contamination. Wang speculates that only a small
population has the "special receptors" to contract AI. He
believes that the young man's weak immune system, his genetic
makeup and his exposure to the virus were the factors in his
contracting and dying from the disease.

Ongoing AI Prevention Steps
--------------


11. (SBU) Wang explained that since the SARS scare in 2003,
Jiangsu provincial health offices have invested substantial
efforts and resources on infectious disease prevention and the
refinement of their emergency pandemic protocols. In the past
four years, Jiangsu CDC has spent more than 165 million RMB to
build four dedicated infectious disease laboratories, raise AI
awareness through education programs and implement monitoring
and reporting programs throughout the province. The Jiangsu CDC
staff of 415 oversees health care issues for a population of
75,000,000 people.


12. (SBU) According to Wang, Jiangsu adheres to the "Humans
Infected with Avian Influenza Emergency Response Protocol Plan".
This National plan has been revised 3 times and a fourth
revision is expected in 2008. (Comment: National level
provincial and municipal AI plans are virtually identical.
However, implementation varies depending on budget and local
conditions. End Comment) The two-pronged plan addresses routine
and emergency issues. Part one includes all routine
surveillance of agriculture, livestock, migratory birds and
humans. Part two focuses on potential emergency pandemic
situation plans.

Bird Watching
--------------


13. (SBU) On January 17th, Jiangsu Agriculture and Forestry
Department, Senior Engineer Section Chief Shen Quanming outlined
his department's AI emergency protocol. To monitor the
migrating bird population, 82 surveillance spots are maintained
along two identified main bird routes. Appointees from
designated villages, towns and cities must submit monthly
samples from dead birds. They are also tasked to report all
suspicious bird deaths. In this event, they collect the dead
bird's tissue samples and send it to the Jiangsu CDC
laboratories for testing. If the sample is confirmed as AI
infected, the specimen must be forwarded to national
laboratories in Beijing within 2 hours. Beijing laboratories
must reconfirm the findings before the results are released to
the Chinese public and other international health agencies.


14. (SBU) An area of 5 kilometers in circumference surrounding
the area where the AI infected bird died is isolated. If it is
the site of a poultry farm, all birds must be destroyed. People
living in this area are quarantined for 21 days. This method
has been used effectively in the past, according to Shen.


15. (SBU) Shen stressed that it is essential that all poultry
farmers are proactive and vaccinate livestock. The Central
Government provides vaccines free of charge and it is mandatory
that all farmers vaccinate their poultry flocks. The effect of
the drug on the antibodies in the chicken is monitored by the
Jiangsu Animal CDC. If the antibody level is low, the dose is

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increased. Farmers are told that in the event that they must
destroy their animals due to AI, the Chinese Government makes up
the loss and compensates them for all their losses. This income
guarantee assures farmer cooperation.


16. (SBU) Altogether Jiangsu has 186 animal monitoring points.
Included in this number are 82 spots where Agriculture and
Forestry employees monitor birds. The animal monitoring points
include airports, water stops for migrating birds and pig farms.
The responsible persons must report every month what they have
observed. Other monitoring spots include wet markets that are
licensed to sell live chickens. Observers there must report
weekly. In addition to the regularly scheduled monitoring,
there is a random monitoring program that is conducted in May
and October.


17. (SBU) CDC Director Wang pointed out that Jiangsu's key
monitoring point is located in the Gaoyou Lake District. This
district is one of the largest poultry producing centers in
China. This area also requires extra scrutiny because it
borders Anhui Province where there have been several confirmed
AI cases.

People Watching
--------------


18. (SBU) Routine surveillance of the human population is also
an important part of the program. Health care providers are
trained to take an extra look at all pneumonia and influenza
patients' symptoms. If an unexplainable death occurs, samples
must be collected and tested in CDC laboratories. Wang said
Jiangsu Province recently launched a pilot program to monitor
student absenteeism that is modeled on successful U.S., European
and Japanese programs. Designated schools are required to
report absentee statistics that reach specific benchmarks. The
"hygiene" teacher must report to the community doctor when 15
per cent of the students fail to go to school. If more than 20
per cent of the students are absent, this information must be
reported directly to the Jiangsu CDC. Pilot cities
participating in this program include Nanjing, Xuzhou, Yangzhou,
Zhenjian, Wuxi, and Yancheng. Future programs that monitor
designated shop sales of toilet paper and flu/fever medicines
are being considered.

Comment: Regional Coordination?
--------------


19. (SBU) Jiangsu Province appears to have taken on board some
of the lessons of the SARS outbreak. Jiangsu CDC officials were
eager to demonstrate their openness to discussing AI and also
provided detailed information on the late 2007 cases and the
government's response. One area where there is less information
is coordination among provinces. There was no mention of
coordinating with neighboring provinces or Shanghai health
authorities. It appeared that the Jiangsu CDC official take
their cues directly from Beijing. Better regional coordination
will be needed if a widespread outbreak occurs. Anhui Province,
which is much poorer and less efficient than Jiangsu Province,
has had AI outbreaks in the past and shares some of the same
migratory paths as Jiangsu.
JARRETT