US embassy cable - 05PRETORIA4387

UNCLAS SECTION 01 OF 05 PRETORIA 004387 
 
SIPDIS 
 
STATE PLEASE PASS TO PEACE CORPS FOR STEVE WEINBERG, 
OMS AND HENRY MCKOY, 
USDA FOR AF REGION  RANDY HAGER/FAA/FAS@USDA.GOV 
HHS FOR OGHA: WSTEIGER, SNIGHTENGALE 
HHS/CDC FOR SBLOUNT 
AID FOR HSUKIN (AFR/SD), DCARROLL (GH/HIDN) AND 
MHARVEY (AFR/SD), JTURK (EGAT), JTHOMAS (EGAT/AG/ARPG), 
STHOMPSON (EGAT/AG), RSTRICKLAND (AFR/DP) 
GLOBAL HEALTH AND AFRICA BUREAU FOR KHILL, LPEARSON 
 
E.O. 12958: N/A 
TAGS: AMGT, AMED, TBIO, KSCA, SENV, EAGR, PREL, SF 
SUBJECT:  POST PREPARATIONS FOR AVIAN INFLUENZA 
 
REF:  STATE 195603 
 
1.While there are no reports of animal or human 
infections with the H5N1 strain of avian influenza, 
there is considerable concern about avian influenza in 
the South African press and in the mission community. 
Because South Africa experienced an avian outbreak of 
f 
influenza (H5N2) in 2004, which led to widespread 
poultry and ostrich culling, there is a public 
expectation that avian influenza will reoccur.  News of 
human deaths due to H5N1 has led to special concerns. 
 
2.In response, Mission South Africa has initiated 
preparations for animal and human outbreak of avian 
influenza.  Under Chargis direction, post has 
established a large inter-agency task force (including 
USDA, APHIS, HHS/CDC, HHS/OGHA, USAID, DHS, Med., 
Admin, Consular Affairs, Pol., all Consulates, PAS, 
Peace Corps and others).  The Avian Flu Task Force 
(AFTF) meets every two weeks and shares its output with 
U.S. Embassies Mbabane and Maseru.  Comment: 
reportedly, Swaziland and Lesotho will rely heavily on 
RSA because all their imported food passes through 
South Africa.  End Comment. The AFTF has undertaken six 
tasks: 
 
-To advise Embassy leadership on any questions 
which arise related to avian and pandemic influenza. 
 
-To form linkages with relevant elements of the 
the 
South African Government, local offices of concerned 
international organizations and other interested 
government missions, to be fully informed about 
surveillance findings and local preparations for an 
avian flu outbreak. 
 
-To prepare an analysis of agricultural concerns 
and interventions based on information from USDA and 
local agricultural agencies. 
 
-To compile information of use to the official and 
unofficial American Communities, including FSNs, to 
help ensure a reasoned and coordinated response to the 
avian flu threat - ensuring that all information made 
available to any agency represented at post is made 
available to all. 
 
-To develop informative materials and guidelines 
that would assist individuals concerned about avian flu 
(based on guidance from CA, CDC, WHO and other approved 
sources). 
 
-To develop an outbreak management plan for the 
South Africa Mission. 
 
3.To date, the AFTF has prepared a draft South 
Africa-specific information document drawn from CA, CDC 
 CDC 
and WHO guidance for the official and unofficial 
American Communities in South Africa (Department 
clearance awaited; text provided in para 5).  It has 
established a site for AI information on the Embassy 
internet website and a dedicated e-mail address for 
queries and answers, managed by the task force.  It has 
started development of outbreak communications and 
management plans, building on the warden network and 
earlier Embassy emergency plans.  And communications 
have been initiated with international organizations 
offices in South Africa, other concerned missions (U.K, 
Canada), and with SAG agricultural and health 
officials.  A separate communication from the Charg 
has gone to the Director General for Health to provide 
information from the first IPAPI meeting (reftel) and 
to offer assistance.  On the agricultural side, 
according to news reports, the Onderstepoort Veterinary 
Institute is analyzing Eurasian migratory bird fecal 
material from Durban harbor.  Officials have informed 
Mission personnel that no H5N1 has yet been found 
through this surveillance.  Ministry of Agriculture and 
Land Affairs also has just issued recommended 
biosecurity measures for the poultry and ostrich 
industries.  In addition, the AFTF has assisted 
individual agencies to complete information requests 
from their agency headquarters so that all information 
from South Africa reflects the best collective 
information available. 
 
4.Post plans to complete its key tasks within two 
weeks, prior to the expected arrival of avian influenza 
in the migratory bird population.  Additional guidance 
and information from Department and other USG agencies 
will be appreciated.  Post also would appreciate 
information from other posts about their preparations. 
5.Begin Text: 
DRAFT INFORMATION FOR THE AMERICAN COMMUNITY (INCLUDING 
FSNs). There has been much public concern about the 
risk of a global outbreak of the H5N1 strain of avian 
influenza (flu) because it might cause widespread human 
n 
illness and death.  While a limited number of humans 
have become infected in the South East Asia region, no 
cases of human avian flu have occurred in South Africa. 
 
This document is designed to answer common questions 
related to avian flu.  Websites below will provide 
further information.  If you have other questions or 
concerns related to the possibility of Avian Flu in 
South Africa, please send them to: 
pretoriafluinquiries@state.gov.   Responses will be 
posted at the U.S. Embassy website: 
http://pretoria.usembassy.gov/, following coordination 
with the Medical Unit, the Centers for Disease Control 
and Prevention (CDC), the U.S. Department of 
Agriculture (USDA) and other informed agencies. 
 
Background 
 
The H5N1 strain of avian influenza is a severe viral 
disease affecting domestic poultry, and wild birds. 
Humans who have close contact with infected birds, for 
example by working in a poultry industry where the 
virus is present, can contract the disease.  Since 
December 2003 approximately 117 confirmed human cases 
of H5N1 influenza have been reported to the World 
Health Organization (WHO).  About 60 of these persons 
have died.  Sustained human to human transmission of 
avian influenza has not been detected.  Were the virus 
to mutate, however, and improve its transmissibility 
between humans, health authorities at CDC and WHO are 
concerned that a world-wide epidemic might result.  The 
likelihood of such a mutation is debated among 
scientists. 
 
The H5N1 strain of avian influenza appears to have 
originated in East Asia.  Some wild birds are resistant 
to the disease but are able to transmit it.  Since 
originally detected, avian influenza has spread across 
Central Asia to Turkey, Romania and parts of Europe. 
Bird migration patterns suggest a possible future 
spread into Africa. 
 
Symptoms and Medical Treatment of Avian Influenza 
 
The initial symptoms of avian influenza are similar to 
those of standard human influenza and include cough, 
fever and a feeling of illness. 
 
Researchers are developing a vaccine to prevent avian 
influenza in humans.  To date no effective vaccine is 
available.  The standard yearly human influenza 
vaccination is not protective against avian influenza 
but the continued use of this vaccine is encouraged. 
No information is available about avian flu risk in 
immune-compromised individuals. 
 
The CDC has suggested that an anti-viral medication, 
oseltamivir (brand name, Tamiflu) may prevent or reduce 
the severity of the disease.  The medication, however, 
has not been adequately tested to confirm its 
effectiveness when used to treat human H5N1 virus 
infection.  Based on this limited data, the Department 
of State has decided to pre-position some Tamiflu at 
its Embassies and Consulates worldwide.  It is yet to 
be determined specifically who within the Embassy 
community might have access to this drug or other 
interventions via Embassy facilities.   Tamiflu may not 
be readily available overseas and the State Department 
encourages American citizens traveling or living 
abroad, Foreign Service Nationals and others who are 
interested in obtaining this medication to consult with 
their physicians.  There is no provision for the U.S. 
Government to provide American citizens traveling or 
living abroad with medications, including in the event 
of an epidemic. 
 
Theoretical Modes of Transmission 
 
It is important to reiterate that routine human-to- 
human transmission has not yet been detected.  If a 
human-to-human epidemic were to occur, the disease 
likely would be spread by large respiratory droplets 
(produced primarily by coughs and sneezes). 
Theoretically, healthy persons would be able to acquire 
the disease by touching a surface contaminated by 
droplets from an infected person and subsequently 
touching a susceptible area on their bodies such as the 
mouth, nose or eyes.  Healthy persons in close contact 
with an infected person also could possibly inhale the 
droplets directly. 
 
Commercial Air Travel 
 
The State Department, CDC and WHO have not issued any 
travel alerts or warnings for avian influenza-affected 
areas.  However, the CDC advises travelers to countries 
with documented H5N1 outbreaks to avoid poultry farms, 
contact with animals in live food markets, and any 
surfaces that appear to be contaminated with feces or 
fluids from poultry or other animals.  In addition, the 
State Department has asked its Embassies and Consulates 
to consider public health preparedness measures that 
take into consideration the fact that travel into or 
out of a country with an avian influenza outbreak may 
not be possible, safe or medically advisable. 
 
Appropriate Measures to Protect Against Infection 
 
Regardless of whether Avian Flu ever appears in South 
Africa, individuals and families should implement good 
hygiene and public health practices to help protect 
against animal-borne infectious diseases.  These 
include: 
 
- Frequent thorough hand washing especially before 
eating, before cooking, before feeding infants and 
before going to bed.  Waterless alcohol-based hand gels 
may be used when soap is not available and hands are 
not visibly soiled. 
 
- Obtain the standard yearly human influenza 
vaccination.  This will not prevent avian influenza but 
will greatly reduce the number of persons seeking 
medical evaluation for cough and fever. 
 
- Avoid poultry farms and contact with animals in live 
food markets and any environment where birds are kept 
under unsanitary conditions. 
 
- Eat only well-cooked poultry and poultry products. 
 
Public Health Preparedness Measures 
 
The U.S. Embassy in South Africa is preparing outbreak 
communication plans to have available in the event of 
an outbreak of human H5N1 virus in South Africa. 
Individuals should check regularly for current avian 
flu information on the Embassy internet page 
(http://pretoria.usembassy.gov/). 
 
If there were a human outbreak of H5N1 virus infection, 
public health prevention measures would seek to limit 
the exposure of healthy persons to virus particles. 
Recommended measures during an epidemic may include the 
following: 
 
- Close schools and minimize other community 
gatherings, 
- Exclude individuals who are sick or fevered from 
workplaces, 
 
- Consider tele-commuting or other techniques to limit 
the number of workers in workplaces, 
 
- Remain in your home (home quarantine) with pre- 
stocked food and water.  The duration of any quarantine 
would be specified at the time of its announcement. 
 
There have been no cases of H5N1 detected in South 
Africa.  The South African Government is conducting 
surveillance and is developing an outbreak response 
plan.  Embassy, USDA, CDC and USAID officers are in 
contact with South African officials in the public 
health, disease surveillance and agricultural sectors 
to share information and to learn about any H5N1 
threats to humans or animals in South Africa. 
 
Agricultural Concerns 
 
An outbreak of avian influenza of the H5N2 strain (a 
different strain) occurred among ostriches on a few 
farms of the Eastern Cape of South Africa during 
November-December 2004. These farms were quarantined 
and all poultry and ostriches were culled.  Strict 
quarantine measures were imposed and the disease was 
contained and eliminated.  No transmission to humans 
was identified.  South Africa is currently free of 
avian influenza. The importation of poultry and poultry 
products from affected countries is banned. 
 
There is a strong possibility that the H5N1 virus will 
be transmitted by migratory birds moving from Europe to 
eastern and southern Africa.  Wading birds pose the 
greatest risk, but these are mainly confined to coastal 
areas in South Africa. To this end, wild bird fecal 
samples are being collected and monitored as part of an 
early warning system in South Africa. Local garden 
birds should be of little concern.  They do not move 
great distances and are unlikely to be exposed to the 
virus.  If a dead bird is found, use a spade to 
dispose. 
 
There is no danger of acquiring avian influenza from 
normally and properly cooked food. Like all viruses, 
the heat of normal cooking destroys the H5N1 virus. 
 
What Else the U.S. is Doing 
 
On May 11, 2005, President Bush signed an emergency 
appropriations bill which contained $25 million to 
prevent and control the spread of avian influenza.  On 
September 14, 2005, President Bush announced the 
International Partnership on Avian and Pandemic 
Influenza.  This Partnership will bring together key 
nations and international organizations including 
UNICEF and WHO to improve global readiness.  At the 
first Partnership meeting 80 countries and 8 
international organizations were represented and the 
groundwork was laid for increasing cooperation. 
 
Additional Information 
 
Additional updated information regarding avian 
influenza is available from the following sources: 
 
U.S. Embassy in South Africa 
Pretoria, South Africa 
http://pretoria.usembassy.gov/ 
To post questions: PretoriaFB@state.gov. 
 
Department of State 
Washington, DC 
Tel: (888) 407-4747, or if calling from overseas, (202) 
501-4444 
http://travel.state.gov 
For travelers medical information: 
http://travel.state.gov/travel/tips/health/he alth_1185. 
html 
 
Centers for Disease Control (CDC) 
Atlanta, GA 
Tel:  (888) 246-2675 
http://www.cdc.gov/flu/avian/index.htm 
http://www.cdc.gov/flu/avian/gen-info/facts.h tm 
http://www.cdc.gov/flu/avian/outbreaks/asia.h tm 
For information on influenza antiviral drugs: 
http://www.cdc.gov/flu/professionals/treatmen t/ 
For Travelers: 
http://www.cdc.gov/travel/seasia.htm 
 
Department of Agriculture 
Washington, D.C. 
http://www.usda.gov/2005/10/0461.xml 
 
World Health Organization (WHO) Liaison Office 
Washington, DC 
Tel:  (202) 331-9081 
http://www.who.int/csr/disease/avian_influenz a/en/ 
 
The Government of South Africa 
Pretoria, RSA 
http://www.info.gov.za/speeches/2005/05101715 451005.htm 
 
End Text 
 
HARTLEY