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06BANGKOK4530 AVIAN INFLUENZA RE-SURFACES IN THAILAND; ONE HUMAN DEATH AMID NUMEROUS POULTRY DIE-OFFS

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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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Written by thaicables

July 12, 2011 at 5:11 am

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