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Cablegate: Avian Influenza Re-Surfaces in Thailand; One Human Death

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FM AMEMBASSY BANGKOK
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UNCLAS SECTION 01 OF 08 BANGKOK 004530

SIPDIS

SENSITIVE
SIPDIS

DEPARTMENT FOR G/AIAG/JLANGE
DEPARTMENT FOR EAP/MLS
DEPARTMENT FOR OES/STC/MGOLDBERG AND PBATES
DEPARTMENT FOR OES/PCI/ASTEWART
DEPARTMENT FOR OES/IHA/DSINGER AND NCOMELLA
DEPARTMENT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL
DEPARTMENT PASS CDC FOR COGH SDOWELL AND NCID/IB AMOEN
DEPARTMENT PASS HHS/OGHA/WSTEIGER AND MSTLOUIS
DEPARTMENT OF AGRICULTURE FOR OSEC AND APHIS
DEPARTMENT OF AGRICULTURE FOR FAS/DLP/HWETZEL AND DEPARTMENT OF
AGRICULTURE FOR FAS/ICD/LAIDIG, PETTRIE
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN
PARIS FOR FAS/AG MINISTER COUNSELOR/OIE
ROME FOR FAO

E.O. 12958: N/A
TAGS: TBIO KFLU SOCI PGOV EAID EAGR KPAO XE

SUBJECT: AVIAN INFLUENZA RE-SURFACES IN THAILAND; ONE HUMAN DEATH
AMID NUMEROUS POULTRY DIE-OFFS

BANGKOK 00004530 001.2 OF 008


1. (U) Summary: Numerous die-offs of poultry have occurred in
Thailand over the past month, concentrated mostly in the central and
north-central provinces. Despite testing of samples taken from the
dead birds over the month-long period, government veterinary
laboratories failed to detect the virus until July 24 when they
isolated H5N1 virus from the carcass of a single fighting cock.
Today, July 26, all doubts about the cause of the poultry die-offs
vanished when the Minister of Public Health confirmed that the death
of a 17-year-old boy in a province with heavy poultry fatalities was
caused by H5N1 avian influenza. Although the Minister's quick
confirmation and open communication is commendable, serious
questions remain why the virus was not detected earlier in the
veterinary laboratories. End summary.

Poultry Die-Offs in July
----------------------------
2. (U) The Bangkok Post reported on July 4 that "more than 2000
poultry have died... within the Phichit Province" about 200 miles
north of Bangkok. The article said that local livestock officials
were running tests on the dead poultry, but that they suspected E.
Coli (a species of bacteria) to be the cause of the die-off.

3. (U) During the month of July, numerous other poultry die-offs
occurred in Phichit, Phitsanulok, Sukothai, and Uttaridit Provinces
in north-central Thailand as well as in other provinces in the
country. The Department of Livestock Development (DLD), under the
Ministry of Agriculture and Cooperatives, reported on July 16, that

BANGKOK 00004530 002.2 OF 008


large numbers of fowl had recently died in 430 tambons [sub
districts] in 50 provinces. Although a DLD official told the
Bangkok Post that "the department did not rule out the possibility
of a re-emergence of the [avian influenza] virus," laboratory tests
had yielded negative results.

4. (U) On July 22, Professor Prasert Thongcharoen, a microbiologist
at Bangkok's Siriraj Hospital, told The Nation newspaper in a
telephone interview after returning from Phitsanulok Province that
he had strong doubts about the accuracy of official reports of
avian-flu tests on dead birds by livestock authorities. "To be
fair, they might have checked the samples and simply could not
detect the virus," said Prasert. "Yet, once again, things are so
obvious."

Avian Influenza Detected in a Single Poultry Sample
--------------------------------------------- -------
5. (U) Finally, on the morning of July 24, using Reverse
Transcriptase-Polymerase Chain Reaction (RT-PCR) methodology, the
DLD's Lower Northern Regional Veterinary Research and Development
Center in Phitsanulok Province detected avian influenza H5 virus in
a sample taken from a household in Phichit Province's Bang Mun Nak
District where 31 fighting cocks and free-range chickens had died
over several days beginning July 16. The authorities took immediate
and stringent containment measures, including culling of the
remaining 295 chickens on the Phichit farm, putting a 10-km radius
quarantine and surveillance zone around the farm, and imposing a

BANGKOK 00004530 003.2 OF 008


total ban on the transport of poultry in the province to prevent
villagers from trying to smuggle out potentially infected birds. On
the same day, the DLD submitted a formal report to the World
Organization for Animal Health (OIE), notified the UN's Food and
Agriculture Organization (FAO), and the Minister of Agriculture and
Cooperatives called a news conference to inform the public.

Human Death Attributed to Avian Influenza
-----------------------------------------

6. (U) Since July 22, at least seven persons in Phichit Province
and two persons in nearby Uttaridit Province (where poultry have
succumbed in large numbers over the past three weeks) have been
admitted to the provincial hospitals with flu-like symptoms. All of
the patients had contact with sick or dead poultry or with wild
birds. Laboratory testing performed on samples taken from all of
the patients, including from the 17-year-old boy, tested negative
for avian influenza virus. Further testing of samples taken from
the dead teenager, however, confirmed the presence of H5N1 avian
influenza.

7. (U) The young man had buried between 10 and 20 chickens that had
died of unknown causes in his village on July 10. He became ill
July 15 and went to the district hospital with heavy coughing on
July 18. A rapid test carried out that day was negative for
influenza, and a chest x-ray was normal. He was sent home, but
returned to the hospital on July 20 with a high temperature. The

BANGKOK 00004530 004.2 OF 008


first diagnosis was dengue fever and he was admitted for treatment.
His conditions deteriorated, and he was sent to Phichit provincial
hospital on July 22 where he died on July 24.

8. (U) At 11:30 a.m. on July 26, the Ministry of Public Health
(MOPH) confirmed via press release that a sputum specimen from the
17-year-old boy had tested positive for H5N1 virus. The
announcement included a clinical history of the boy's illness, but
specified neither the laboratory nor the testing method. MOPH
officials in Bangkok told Bangkok-based CDC personnel that these
tests were performed in provincial or regional laboratories, and
have not yet been confirmed by Thai National Institute of Health
(NIH). The Bangkok CDC personnel have not yet received any requests
for assistance with confirmatory testing. Until Thai the NIH
confirms the laboratory results, they must be considered
preliminary.

9. (U) In the same press release, MOPH also announced that 20
specimens from human cases have been tested for H5N1; in addition to
the one positive, half have tested negative for H5N1 but positive
for another common respiratory pathogen, and the rest are pending or
inconclusive. The release also stated that more than 2000 specimens
from poultry have been tested, with H5N1 found only in the sample
taken in Bang-Moon-Nak District (near to the Tubklor District where
the single human laboratory-positive case resided). Shortly after
the press release, Minister of Public Health Phinij Jarusombat
briefed the media at a press conference in Bangkok.

BANGKOK 00004530 005.2 OF 008

Serious Questions for the Agriculture Ministry
--------------------------------------------- -
10. While the Minister of Public Health's quick confirmation and
open communication is commendable, serious questions remain why the
virus was not detected earlier among the 2000 poultry specimens
tested by the Agriculture Ministry's veterinary laboratories.
Earlier detection and public knowledge of H5N1 as the cause of the
poultry die-offs would have put health authorities, as well as the
general population, on higher guard, possibly preventing the death
of the 17-year-old.

11. (SBU) On July 24, Senator Nirun Phitakwatchara publicly called
on the Minister of Agriculture to resign for his mismanagement of
bird flu monitoring. The Senator had earlier accused the ministry
of covering up the re-emergence of bird flu for fear the country's
poultry exports would be hit. He recalled that the ministry had
tried to cover up bird flu outbreaks when the virus first came to
Thailand in late 2003 and early 2004.

12. (SBU) Officials at the World Health Organization (WHO) office
in Thailand said they were aware of allegations of cover up, but saw
no reason to doubt the integrity of the responsible Thai authorities
at this stage. Privately, however, an FAO official told Embassy
Regional Environmental Officer that he was concerned about the
possibility of politicians trying to hide the cause of the poultry
outbreaks in the hopes the die-offs would subside quickly and

BANGKOK 00004530 006.2 OF 008


without human illness.

13. (SBU) Comment: The Ministry of Agriculture and Cooperatives
likely did try to hide the presence of avian influenza in poultry in
Thailand in late 2003. However, since January 2004, Thailand has
worked hard to become a model of exemplary and timely reporting of
avian influenza to the OIE, FAO, and WHO. It works closely with
CDC, the U.S. Embassy, and other international entities, and has
been subject to close international scrutiny. That said, USAID has
been hearing "rumors" for some time about ongoing outbreaks in
private commercial farms. And there are strong and obvious economic
incentives to Thailand's politically powerful commercial poultry
industry to maintain an "avian influenza-free" Thailand that can
begin re-exporting raw chicken meat.

14. (U) Comment Continued: Assuming there has been no intentional
cover-up, there still remains the question of why the H5N1 virus is
not being detected in veterinary laboratory testing of poultry we
now believe to have been infected with the virus. It is possible
that the problem is technical in nature. During the visit to
Thailand last May of Special Representative for Avian and Pandemic
Influenza Ambassador John Lange, the Deputy Director-General of the
Department of Livestock Development (DLD) said that the DLD
routinely pools samples when conducting surveillance. There is a
long history of pooling specimens as a cost effective way of
performing screening with expensive reagents. Moreover, RT-PCR
methodology is extremely sensitive, capable of detecting and

BANGKOK 00004530 007.2 OF 008


amplifying viral DNA in the tiniest amounts. Pooling of large
numbers of samples, however, could theoretically dilute the virus
and at some point decrease the sensitivity of the test. FAO
currently recommends pooling specimens in batches of 5-10, and
mathematical models support that recommendation. Post was unable
today to confirm whether the DLD complies with FAO's 5-10 specimens
per batch recommendation. Post also points out that improper
collection, storage, and transport of samples can negatively impact
laboratory testing.

15. (U) Comment Continued: Thailand has a well-deserved reputation
for good public awareness and education campaigns, good
community-based surveillance, rapid outbreak investigation and
control, and prompt laboratory confirmation related to avian
influenza. The USG and other international donors and organizations
have been instrumental in assisting Thailand achieve these
competencies. The re-surfacing of avian influenza in Thailand,
then, shows that the virus can only be controlled, and not totally
eliminated. Moreover, the re-surfacing of the virus in Thailand,
along with the negative laboratory tests on specimens from poultry
die-offs, the misdiagnosis of the first human case of avian
influenza in Thailand in over six months, and the reported continued
human contact with sick and dead poultry in affected areas
demonstrates the continuing need for basic public awareness,
education and hygiene messages, better animal husbandry practices,
improved disease surveillance among birds and humans, practical
training of animal and human health providers, and improved capacity

BANGKOK 00004530 008.2 OF 008


of technicians in specimen collection and laboratory procedures.
Arvizu

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