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Cablegate: Ai: South Korea Mulls Changes in H5n1 Surveillance System,

VZCZCXYZ0000
PP RUEHWEB

DE RUEHUL #1379/01 1920447
ZNR UUUUU ZZH
P 100447Z JUL 08
FM AMEMBASSY SEOUL
TO RUEHC/SECSTATE WASHDC PRIORITY 0811
INFO RUEHBJ/AMEMBASSY BEIJING 4509
RUEHBK/AMEMBASSY BANGKOK 7378
RUEHKO/AMEMBASSY TOKYO 4637
RUEHHI/AMEMBASSY HANOI 2183
RUEHJA/AMEMBASSY JAKARTA 2487
RUEHUM/AMEMBASSY ULAANBAATAR 1697
RUEHRO/AMEMBASSY ROME 0835
RUEHHK/AMCONSUL HONG KONG 3607
RUEHSH/AMCONSUL SHENYANG 3759
RUEHIN/AIT TAIPEI 2754
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHRC/DEPT OF AGRICULTURE WASHDC
RUEHGV/USMISSION GENEVA 1975

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

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