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 SHANGHAI 00000035 002 OF 003 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 SHANGHAI 00000035 003 OF 003 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