Cablegate: Nilfamari District Outbreak Case Study

VZCZCXRO4151
RR RUEHCI
DE RUEHKA #1035/01 1750317
ZNR UUUUU ZZH
R 240317Z JUN 07
FM AMEMBASSY DHAKA
TO RUEHC/SECSTATE WASHDC 4387
INFO RUEHNE/AMEMBASSY NEW DELHI 9991
RUEHKT/AMEMBASSY KATHMANDU 9149
RUEHIL/AMEMBASSY ISLAMABAD 1709
RUEHLM/AMEMBASSY COLOMBO 7982
RUEHGO/AMEMBASSY RANGOON 2551
RUEHCI/AMCONSUL KOLKATA 0805
RUEHPH/CDC ATLANTA
RUEKJCS/SECDEF WASHINGTON DC//ISA/NESA
RUEKDIA/JOINT STAFF WASHINGTON DC//J2/J5
RHHMUNA/CDR USPACOM HONOLULU HI//J2/J4/J5

UNCLAS SECTION 01 OF 02 DHAKA 001035

SIPDIS

SENSITIVE
SIPDIS

DEPARTMENT PLEASE PASS TO AIAG/HOLLIS SUMMERS, AIAG/TONY NEWTON AND
AIAG/NICHOLAS STUDZINSKI
DELHI PLEASE PASS TO FAS/OLIVER FLAKE

E.O. 12958: N/A
TAGS: TBIO KFLU PREL PGOV BG
SUBJECT: NILFAMARI DISTRICT OUTBREAK CASE STUDY

REF: (A) DHAKA 976, (B) DHAKA 776, (C) DHAKA 743, (D) DHAKA 730 AND

PREVIOUS

1. (SBU) SUMMARY. The Nilfamari district first confirmed an
outbreak of H5 in mid-April, 2007. United Nations Food and
Agriculture Organization representatives studied the GOB response in
that district and identified both positive and negative features,
ranging from local villagers self-identifying a suspected outbreak
and activating veterinary alert apparatus on the plus side, to
improper culling techniques and a continuing lack of coordination
with human health efforts on the negative side. Many of the FAO
observations draw attention to epidemiological questions that seem
to remain unanswered, and in some cases, unasked. END SUMMARY.

2. (SBU) BACKGROUND ON NILFAMARI. Nilfamari is located in the far
northwest corner of Bangladesh; it borders on the Bangladesh
districts of Panchagarh to the west, Dinajpur and Rangpur to the
south and Lalmonirhat to the east, and the Indian state of West
Bengal to the north. When Nilfamari first confirmed the presence of
H5 in mid-May it did not border on an infected district; however
Dinajpur and Rangpur have both subsequently reported H5 outbreaks.
United Nations Food and Agriculture Regional Coordinator Dr.
Mohinder Oberoi and National Consultant Dr. Abul Kalam visited
Nilfamari June 4 Q 7 to make firsthand observations about the GOB
response in this district.

3. (SBU) POSITIVE INDICATORS FROM NILFAMARI. The case study
reported that the local veterinary officials responded quickly after
local Non-Government Organizations reported the suspected disease
based on villagers recognizing signs and symptoms. The villagers
report knowing about avian influenza and its potential human health
risks from TV, radio, and UNICEF posters. The villagers informed
local NGO workers about sick chickens, die-offs, and symptoms such
as swollen heads, bluish wattles and combs, and reddening of shanks;
the NGO workers then forwarded the information to local veterinary
officers. Media also report that local administrators acted quickly
and ingeniously to quell panic in surrounding areas by utilizing the
loudspeaker systems of local mosques to make announcements about
bird flu.

4. (SBU) AND THE NEGATIVES. Generally, strict adherence to
critical procedures, such as disinfection and quarantine, remains
problematic and inconsistent. Specific problems identified in the
case study include disposal of culled birds by door-to-door
collection, putting the carcasses in bags and piling them in a van
for transport to burial sites. These burial sites are unmarked, and
in one case a corner of a school playground was used and in another
a farmerQs field where crops have subsequently been planted. The
human response also was not coordinated with the veterinary effort;
despite several people in one village developing flu-like symptoms
and recovering, there has been no human health monitoring. With
respect to the Field Disease Investigation Laboratories at Gaibandha
and Joyphurhat, discussion between the FAO officers and laboratory
workers revealed serious questions about technical capacity, and the
observation that serious underreporting may be occurring. The
underreporting stems from lab workers being allowed to use only one
test strip per sample, and declaring the sample negative based on
the results of that one flu detect test even if true clinical and
post-mortem signs are present.

5. COMMENT. The ability of villagers to correctly identify the
threat posed by signs and symptoms, and to effectively utilize
various NGO avenues to convey that information to activate the
district veterinary apparatusQ response, should be commended. The
NGOs involved should be encouraged to continue reporting unusual
mortalities, and the education campaign through TV, radio and print
media has had a clear, positive effect. A coordinated, rigorous
response still seems to be lacking, laboratory capacity remains low,
and effective epidemiological investigation, if occurring, has not
produced demonstrable results. Also, since the GOB response seems
to follow reported and suspected outbreaks without engaging in
testing populations apart from those in proximity with or having
obvious connection vectors to outbreak areas, the questions is
whether the GOB can ever really get ahead of the outbreak. The full
text of the case study and other information is available on post's
avian influenza webpage at:
http://10.208.1.12/dhkavianinfluenza.htm.

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