US embassy cable - 05ZAGREB1868

UNCLAS SECTION 01 OF 02 ZAGREB 001868 
 
SIPDIS 
 
SIPDIS 
 
DEPT PLEASE PASS TO DS/DSS, DS/IP, M/MED/JCTRIPLETT 
FAS/CMP/DLP WETZEL AND MAGGINNIS 
FAS/ITP/EAMED POMEROY AND FLEMING 
CA/OCS/ACS RICK DOWELL 
USAID FOR E&E/ECA/B/ANNE CONVERY 
 
E.O. 12958: N/A 
TAGS: TBIO, SENV, ECON, EAGR, PREL, HR 
SUBJECT: CROATIA:  AVIAN INFLUENZA UPDATE: NOVEMBER 
23 AND RESONSE TO INFORMATION REQUEST 
 
REF: A) STATE 209622 B) ZAGREB 1836 AND PREVIOUS 
 
SUMMARY:  As of November 23, no additional cases of 
H5N1 have been confirmed in Croatia.  In response to 
ref A, Post is providing responses to questions 
concerning the GOC's efforts to control avian 
influenza (AI) and capability to respond to an 
influenza pandemic in its weekly update report.  END 
SUMMARY 
 
A) Preparedness and Communications 
 
The GOC has a strategy for preventing and containing 
pandemic influenza, which is outlined in their 
national preparedness plan.  This plan was prepared 
using WHO and EU guidelines and is available online 
at http://www.vlada.hr/Download/2005/10/26/2.pdf 
Post believes the GOC is capable of implementing the 
plan.  Post will forward an English translation of 
the plan when it becomes available.  Dr. Gjenero- 
Margan, Director of Epidemiology and Infectious 
Disease at the Croatian Institute for Public Health, 
said that national laws would not pose barriers to 
detection, containment or response measures. 
 
To date, the GOC has been very transparent in 
reporting cases of avian influenza (AI) in animals 
and Post expects that transparency would continue in 
the event of an outbreak in people.  Croatia is a 
small country with a good telecommunications 
infrastructure and a free and vocal press.  Post 
feels these factors also contribute to continued 
transparency related to AI. 
 
Avian influenza is a priority for the GOC.  Top 
leaders including the Prime Minister and the 
Ministers for Health and Agriculture have spoken 
publicly about the need to be vigilant against the 
threat of AI.  The Ministry of Agriculture currently 
has the lead on AI in Croatia and Agricultural 
Minister Petar Cobankovic is an appropriate high- 
level political interlocutor.  Currently, the 
technical lead is Assistant Minister Mate Brstilo, 
Veterinary Directorate, Ministry of Agriculture. 
 
The GOC is working with international organizations 
such as FAO, OIE, WHO and EU (specifically the 
Dutch) on AI.  The GOC informally asked for and is 
receiving technical assistance from the Netherlands. 
Post believes the GOC would be receptive to US 
assistance offers through either a bilateral or 
multilateral approach. 
 
Gjenero-Margan said that Croatia purchases 
approximately 550,000 trivalent flu shots per year 
from foreign vaccine producers.  Flu shots are 
elective and are recommended to high-risk patients 
(such as the elderly).  In the case of an adverse 
reaction to a mandatory vaccine, cases are referred 
to the Ministry of Health for investigation and 
compensation.  Gjenero-Margan was unsure of the 
protocol for adverse reactions to voluntary vaccines 
such as the flu shot.  Nor did she know whether 
Croatia provides liability shields to foreign 
vaccine producers. 
 
The public appears to be well-informed about AI, 
although media interest in AI has waned since the 
initial discovery of H5N1.  For the most part, 
headlines and photos are sensationalistic, but 
reporting is largely factual.  GOC officials 
including the PM and Ministers of Health and 
Agriculture have also spoken publicly about the risk 
of AI. The Ministry of Agriculture has published AI 
pamphlets for the agricultural sector and uses a 
network of field offices and veterinarians to 
disseminate information on animal diseases to rural 
areas.  The City of Zagreb published an AI pamphlet 
for the general public, but it is unclear whether 
 
ZAGREB 00001868  002 OF 002 
 
 
this pamphlet reached a broader audience outside of 
the capital. 
 
B) SUREVEILLANCE AND DETECTION 
The GOC feels it has demonstrated its ability to 
quickly detect a new strain of influenza among 
animals.  The PM was quoted in the press touting the 
speed with which the GOC identified H5N1 in 
migratory birds and responded, thereby preventing 
the virus from spreading to domestic poultry. 
Croatia does not have any endemic infectious 
diseases that consume a majority of its resources. 
Currently, the Veterinary Directorate uses old but 
accurate technology to subtype viruses found in 
samples.  If the H5 subtype is identified, the 
samples are then sent to the EC reference lab for 
further testing.  Croatia is a member of WHO's 
FluNet.  Croatia's National Influenza Center 
collects an average of 1200 samples and forwards 
approximately four to five representative isolates 
to WHO reference labs a season. 
 
The GOC is expecting a new real time reverse 
transcription-polymerase chain reaction (RT-PCR) 
machine in the next few weeks.  The RT-PCR machine 
will help them more rapidly test the thousands of 
samples from the field.  The GOC is also interested 
in obtaining a DNA purifier machine to identify 
virus subtypes. 
 
C) RESPONSE AND CONTAINMENT 
 
In response to the three initial instances of H5N1, 
the GOC's response was very rapid and the guidelines 
for culling and increasing biosafety measures were 
quickly implemented.  Post will report on antiviral 
and personal protective equipment supplies in 
septel. 
 
Gjenero-Margan said that while quarantine and social 
distancing are options for response, they are not 
considered very effective measures.  She considers 
the use of anything but voluntary isolation highly 
unlikely in the event of a pandemic and stated that 
who would carry out these measures has not been 
decided. 
 
 
DELAWIE