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Viewing cable 08JAKARTA1584, AVIAN INFLUENZA - POST-MORTEM ON ALLEGED AI OUTBREAK IN

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Reference ID Created Released Classification Origin
08JAKARTA1584 2008-08-21 02:11 2011-08-24 01:00 UNCLASSIFIED Embassy Jakarta
VZCZCXRO5225
PP RUEHCHI RUEHCN RUEHDT RUEHHM
DE RUEHJA #1584/01 2340211
ZNR UUUUU ZZH
P 210211Z AUG 08
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC PRIORITY 9850
RUEHPH/CDC ATLANTA GA
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEAWJB/DOJ WASHDC
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RUEHGV/USMISSION GENEVA 7815
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