Uzbekistan: Suspected Case of Anthrax Puts USG-Funded

UNCLAS SECTION 01 OF 02 TASHKENT 001507

SENSITIVE
SIPDIS
DEPARTMENT FOR SCA/CEN

E.O. 12958: N/A
TAGS: PREL PGOV TBIO TSPL CDC UZ
SUBJECT: Uzbekistan: Suspected Case of Anthrax Puts USG-Funded
Biological Threat Capabilities to Use

REF: STATE


1. (SBU) Summary: In the month of August, media in Uzbekistan
reported a suspected case of Anthrax in the Toytepi region near
Tashkent, Uzbekistan. The man suspected with Anthrax was believed
to have been exposed during the slaughtering of his cows. The
Biological Threat Reduction Program laboratories and personnel
funded by the United States Government were reportedly used for the
analyses of Anthrax. The Ministry of Health later reported the
sample results from the lab as "negative" for anthrax and the cases
were identified as "an infected ulcer." End summary.



Background

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1. (U) The Biological Threat Reduction Program (BTRP) currently
being implemented by the Defense Threat Reduction Agency (DTRA) is
a United States Government (USG) funded project to assist in the
enhancement of a Threat Agent Detection and Response (TADR) system
in Uzbekistan.




2. (U) The BTRP currently has constructed and trained eight (8)
out of the twelve (12) planned Regional Diagnostic Laboratories
(RDLs) throughout Uzbekistan. The RDLs are equipped with the means
necessary to detect and respond to Especially Dangerous Pathogens
(EDPs). In the near future, DTRA will construct a limited capacity
Biological Safety Level Three (BSL-3) Laboratory and thirty-five
(35) Epidemiological Support Units (ESUs) to further enhance the
TADR system.



The Suspected Case

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3. (SBU) In the Toytepi region, an Uzbekistan citizen became sick
after slaughtering his cattle to sell the meat at a local market.
After three to four days, lesions appeared on the man's arms and he
immediately began treating the lesions with vinegar. The lesions
continued to appear and grow and he began to incur other symptoms
such as fever and acute abdominal pain. His wife, a local nurse,
began intravenous injections after diagnosing him with Acute
Respiratory Viral Infection (ARVI). The man stayed at home for
another three days, without seeing a doctor, before his son brought
him to the Republican Center of Emergency Aid in Tashkent. He was
then diagnosed as having Hepatomegalia and fever by a Biological
Threat Reduction Program (BTRP)- trained Chief Infectious Disease
Doctor of the Tashkent Oblast, Dr. Saidalieva. The case was
reported to the Ministry of Health by Dr. Saidalieva.




4. (SBU) The patient was hospitalized in the Isolation ward and
was examined further by the following BTRP-trained specialists: Dr.
Mamatkulov (Republican Epidemiologist for the MOH),Dr. Azimov
(Director of the Research Institute of Epidemiology, Microbiology,
and Infectious Diseases (REIMID)),Dr. Musabaev (Director of the
Tashkent Institute of Virology (IoV)). The patient was then
diagnosed with septic anthrax and samples were sent for analysis to
the BTRP Regional Diagnostic Laboratory (RDL) at the Republican
Center for State Sanitary and Epidemiological Surveillance (RSES).
The patient died six hours after arriving at the hospital.




5. (SBU) The team then notified the Anti-epidemic committee of a
suspect case of Anthrax and an investigation commenced of the area
where the patient's home was located. The investigation revealed
twelve patients with symptoms for the cutaneous form of Anthrax and
all samples taken were sent to the RSES for analysis. One of the
patients who had cutaneous vesications revealed that he had
recently traveled to the Kashkadaryo region before falling ill,

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however no other information was given on the investigation. It was
reported that all patients were treated and cured in the Toytepi
District Infectious Disease Hospital (IDH).




6. (SBU) All samples drawn were analyzed at the RSES and the
Center for Prophylaxis and Quarantine of Most Hazardous Infections
(CPQMHI),also a BTRP facility. The MOH publically reported that
all samples were "negative" for Anthrax and all cases were "an
infected ulcer."



Comment

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7. (SBU) Recent reports to the DTRA from the Infections Disease
Hospital Directors and Regional Diagnostics Laboratory Directors
have revealed the use of the fully functional RDLs for response to
Especially Dangerous Pathogens in the regions of Samarqand and
Tashkent. During a recent site visit to the Samarqand Oblast Center
for Sanitary and Epidemiological Surveillance, the director
informed the DTRA Chief, Ms. Brie Tinsley, of the recent suspected
cases reported in and around Samarqand. He informed her that his
RDL was being used for the detection of these three cases in the
different regions, however he requested that this information not
be shared.




8. (SBU) DTRA has been requested by three RDLs, two in Tashkent
and one in Samarqand, to provide additional Anthrax kits used in
the Polymerase Chain Reaction (PCR) equipment installed and trained
by the USG for detection of EDPs.




9. (SBU) The BTRP Electronic Integrated Disease Surveillance
System (EIDSS) used for mass reporting via the internet, has been
installed at all RDLs established by the USG, however EIDSS has not
yet been accepted by the MOH or the Ministry of Agriculture and
Water Resources (MAWR) as their reporting system. Reporting of
infectious diseases is still considered very sensitive with
possible repercussions for the reporting activity. If there is an
EDP reported in an oblast, the Hakim (mayor) might be blamed for
the outbreak and said to have not been doing his job properly. As a
result of this pattern of controlling diagnostic information,
infectious diseases are often covered up by misdiagnosis, as was
the case in Tashkent. In reality, however, this USG-provided
capability is being used to identify and isolate potential
biological hazards, even if Uzbek authorities are reluctant to
publicly admit that such episodes occur.

NORLAND
NORLAND