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06BANGKOK2856 SPECIAL REPRESENTATIVE IN BANGKOK – THAILAND’S CONTAINMENT OF AVIAN INFLUENZA

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“64025”,”5/15/2006 9:52″,”06BANGKOK2856″,

“Embassy Bangkok”,”UNCLASSIFIED”,””,

“This record is a partial extract of the original cable.

The full text of the original cable is not available.

 

“,”UNCLAS SECTION 01 OF 08 BANGKOK 002856

 

SIPDIS

 

DEPARTMENT FOR G/AIAG/JLANGE AND RFENDRICK

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

USDA FOR OSEC AND APHIS

USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG

USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM

DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN

PARIS FOR FAS/AG MINISTER COUNSELOR/OIE

ROME FOR FAO

KATHMANDU FOR REO KOCH

 

E.O. 12958: N/A

TAGS: TBIO, KFLU, SOCI, PGOV, EAID, EAGR,

KPAO, XE, Avian Influenza

SUBJECT: SPECIAL REPRESENTATIVE IN BANGKOK – THAILAND\’S CONTAINMENT

OF AVIAN INFLUENZA

 

1. Summary: Thailand experienced 22 cases of human H5N1 avian

influenza in 2004 and 2005, 14 of which were fatal. It has also

reported more than 1000 separate outbreaks of avian influenza in

poultry, most of them occurring in 2004. Since November 2005,

however, Thailand has not detected a single human or animal H5N1

infection. During his visit to Bangkok on May 2, Special

Representative on Avian and Pandemic Influenza Lange heard Thai

officials credit high-level political commitment and a highly

integrated village network of health and surveillance volunteer

workers for the success of their efforts at containing avian

influenza. The Thai officials were quick to point out, however,

that they remain \”vulnerable\” and that their goal cannot be to

eradicate the virus, but to contain it. End summary.

 

High-Level Political Commitment

——————————-

2. In separate meetings with Thai Ministry of Agriculture and

Cooperatives Department of Livestock Development (DLD) Deputy

Director General Dr. Chaweewan Leowijuk and with Ministry of Public

Health (MOPH) Vice-Minister Dr. Wachara Phanchet, Ambassador Lange

inquired what they attribute to the absence of reported avian

influenza outbreaks in Thailand over the past several months. The

Vice-Minister and Deputy Director General both placed \”high-level

political commitment\” at the top of the list. After the first

outbreaks occurred in early 2004, they said, Prime Minister Thaksin

put the fight against avian influenza at the top of the political

agenda. He created a horizontally integrated National Committee on

Avian Influenza Response with representatives from 14 ministries

chaired by the Deputy Prime Minister that continues to meet once a

week to plan, prepare, and promulgate strategies and courses of

action to contain avian influenza in the country. The Committee has

compiled a \”Strategic Plan for Avian Influenza Control,\” as well as

a \”Strategic Plan for Pandemic Preparedness,\” they said.

 

From National Committee to Village Health Volunteers

——————————————— ——-

3. The MOPH Vice-Minister and LDL Deputy Director General also

emphasized that \”vertical integration\” from the national center to

the provinces, district, and community level is also essential to

successfully carry out the Committee\’s strategies and activities on

the ground in the countryside. More than 1000 MOPH Surveillance and

Rapid Response Teams have been trained in the past year and operate

at the district level. They make daily reports of their

surveillance findings. Separate DLD teams would be the first on the

scene to implement culling and other control measures if an outbreak

is detected.

 

4. In addition, Vice-Minister Wachara said that between 800,000 and

900,000 \”village health volunteers\” perform daily visits to local

households throughout Thailand. They not only look for sick or dead

birds and severe respiratory illness in humans, but distribute news

and information on avian influenza and other health issues. MOPH

Vice-Minister Wachara said that the system of village health workers

in Thailand has developed over a 30-year history, long before the

threat of avian influenza emerged. They have been involved over the

years in campaigns, he said, to correct cleft palates, to battle

dengue fever, and to fight HIV/AIDS, and will continue to be useful

even if the H5N1 virus one day disappears. He said the key to the

success of Thailand\’s village health volunteer program is that

volunteers are recruited from their own locality and not sent in

from the outside. He said it might be difficult for other countries

to duplicate such a system, and certainly not within a short

timeframe. He added that the village health volunteers gain

prestige and receive recognition (March 20 is Village Health Worker

Day in Thailand), but receive no remuneration for their services.

 

Culling, Sampling, and Testing

——————————

5. In response to Ambassador Lange\’s questions about poultry

culling as an avian influenza control measure and about sampling of

birds as possible carriers of the virus, Deputy Director General

Chaweewan said that during the first round of outbreaks in poultry

in early 2004, which she described as \”very devastating,\” the DLD

culled all birds within a 5-kilometer radius of an affected farm or

household. During the next two rounds of poultry outbreaks

(September-October 2004 and September-November 2005) the DLD cull

only those birds in an infected flock. In addition, the DLD

disinfects affected areas, collects samples for testing from birds

within a one-kilometer radius and restricts the movement of birds

within a 10-kilometer radius of an affected farm or household. She

said that current policy is to compensate farmers 75 percent of the

market price per culled bird – sufficient, she said, to secure

farmers\’ cooperation in reporting outbreaks.

 

6. Deputy Director Chaweewan said the DLD performs \”X-ray

surveillance operations\” in February and July, in which surveillance

teams perform close inspections of poultry-raising farms and

households. During this past February the DLD collected 60,000

samples for testing in addition to more than 200 samples collected

in wet markets during Chinese New Year – all of them, she said,

tested negative for H5N1. In response to a question, Dr. Chaweewan

said the samples collected are swabs for PCR testing (which detects

viral nucleic acid, indicating the actual presence of the virus).

The DLD has not yet implemented sampling of blood specimens for

serological antibody-testing (testing for previous exposure to the

virus).

 

7. (Note: Antibody-testing would provide a picture of the general

prevalence of the H5N1 virus in various species of poultry and other

birds. However, it is much more expensive to perform and requires a

biosafety level 3 laboratory to conduct the micro-neutralization

test. In addition, when the DLD performs antigen-testing, tests are

performed on pooled material from batches of swabs. Although

separate testing on each individual sample would provide better

scientific data, it would be time- and cost-prohibitive. Post

wishes to point out that DLD is not performing scientific research,

however, but instead is screening samples as part of public health

surveillance. End note.)

 

Improved Infrastructure

———————–

8. Vice-Minister Wachara told Ambassador Lange that Thailand has

significantly improved its own human health infrastructure and

capacity since the emergence of avian influenza. At the beginning

of 2004, Thailand had only one laboratory capable of testing samples

for H5N1 virus; now the Thai National Institute of Health has 14

regional medical science centers, all of which are being trained in

H5 diagnosis. The Ministry has worked to better prepare hospitals

in infection control. Even the smallest district hospital now has at

least one isolation room, he asserted. He also said that risk

communication, public awareness and education about avian influenza

have been a priority.

 

9. The MOPH Vice-Minister acknowledged shortfalls in pandemic

preparedness. Thailand has stockpiled 1.5 million capsules of

Tamiflu, enough for 150,000 treatment courses. Vice-Minister

Wachara said this would be enough only to contain a single

human-to-human outbreak and only if it was detected early enough.

He said Thailand would like to begin local production of Tamiflu,

but may not have the capacity or resources to do so. He added that

MOPH procured API (active pharmaceutical ingredient) from India and

is testing it now to see if they can buy in bulk and then package in

Thailand. Likewise, Thailand wants to develop a human H5N1 vaccine,

but realizes that it would not be able to do so on its own. He said

he is proposing to other countries in the region the idea of

regional collaboration on producing Tamiflu for a regional

stockpile, as well as regional collaboration on human vaccine

development.

 

Regional Activities

——————-

10. Both Vice-Minister Wachara and Deputy Director General

Chaweewan described activities they are undertaking to combat avian

influenza from a regional perspective. Thailand\’s Northeast

Veterinary Research and Diagnostic Centre and National Institute of

Animal Health have accepted and performed tests on poultry samples

from Laos and Burma. Deputy Director Chaweewan said the DLD sent

veterinary laboratory experts to Vietnam in 2004 and on several

occasions to Cambodia carry out training and help establish lab

procedures for avian influenza testing. The DLD also recently

donated laboratory reagents and supplies and sent an animal

virologist to Burma for a 2-week TDY to conduct laboratory

training.

 

11. Vice-Minister Wachara listed several training activities the

MOPH has conducted, many of them in conjunction with the U.S. CDC

and WHO, at which invitees from other countries in the region

participated, including training in H5N1-related epidemiology at the

Field Epidemiology Training Center, laboratory diagnostics,

surveillance and control measures, and risk communication. He

expressed special appreciation of the Thailand MOPH-U.S. CDC

Collaboration (TUC), and particularly for TUC\’s International

Emerging Infectious Disease Program, in developing Thailand\’s

capacity to contain avian influenza and become a regional center of

H5N1 expertise. He noted that Thailand has a self-interest in

building the health capacity of its neighbors. \”As long as avian

influenza is present in countries around us,\” he said, \”we feel

vulnerable.\”

 

12. Comment: Thailand has made great progress in developing

procedures and strategies to deal with the threat of avian

influenza. Not all of Thailand\’s methods, however, can be adapted

to other countries. Nor is there any guarantee, for all of

Thailand\’s preparedness, that it can avoid future H5N1 poultry

outbreaks or human infections. But there are lessons that can be

learned from Thailand\’s experience. At the end of his meeting with

Ambassador Lange, Deputy Director General Chaweewan summed it up

best by declaring, \”We cannot control avian influenza, but we can

contain it.\”

BOYCE

Written by thaicables

July 11, 2011 at 8:15 am

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