US embassy cable - 05TELAVIV6720

UNCLAS SECTION 01 OF 03 TEL AVIV 006720 
 
SIPDIS 
 
STATE FOR NEA/IPA, OES/PCI, OES/STC AND OES/IHA 
HHS FOR OGHA/STEIGER 
INTERIOR PASS FISH AND WILDLIFE 
USDA FOR APHIS 
 
E.O. 12958: N/A 
TAGS: TBIO, SENV, EAGR, EAID, PREL, IS, ENVIRONMENT, SCIENCE AND TECHNOLOGY 
SUBJECT: AVIAN INFLUENZA: NO CONFIRMED H5N1 IN ISRAEL; 
REGIONAL MEETING PLANNED FOR ISTANBUL; OPPORTUNITIES FOR 
EARLY WARNING TRACKING OF MIGRATORY BIRDS 
 
REFS: A) STATE 209622, B) TEL AVIV 05579, C) TEL AVIV 06170 
 
1.   (U) INTRO AND SUMMARY:  This message is Post's response 
to Ref A questions regarding the GOI's efforts to prepare 
for avian and pandemic influenza, and its capability to 
respond to an AI epidemic.  Questions are answered in the 
order provided in reftel.  To date, there have been no/no 
confirmed cases of H5N1 in Israel, in birds or humans.  Two 
American NGOs are sponsoring a regional preparedness meeting 
to be held in Istanbul in December.  Local experts are 
seeking funding for early warning monitoring of birds 
passing through Israel on their way to more vulnerable 
locations in Africa.  END INTRO AND SUMMARY. 
 
------------------------ 
ANSWERS TO QUESTIONS 
------------------------ 
 
2.   (U) Answers 
 
A)   PREPAREDNESS/COMMUNICATION 
 
-- ESTH Officer met with the Director of the Israel Center 
for Disease Control (ICDC) Dr. Manfred Green, Advisor to the 
Head of Public Services and National AI Preparedness 
Coordinator Shmuel Reznikovich, and their colleagues 
November 27 to discuss the GOI's national preparedness plan 
to deal with a possible outbreak of avian and pandemic 
influenza.  The Ministry of Health (MOH) distributed a 
detailed working paper (89 pages) on avian flu preparedness 
October 10 that describes health care system and other 
measures that will be taken if an outbreak of avian and 
pandemic influenza occurs.  The ICDC Director noted that the 
national preparedness plan closely follows WHO guidelines 
and recommendations on responding to and containing avian 
and pandemic influenza. 
 
-- The GOI has set up a national task force, with 
representatives from the MOH and Ministry of Agriculture 
(MOA) Veterinary Services.  The team guides the development 
of policy, recommends actions when needed, and provides 
training in the field to deal with a potential outbreak. 
 
-- The national preparedness plan is easily accessible to 
the general public and health care professionals through the 
MOH Internet website in Hebrew at www.health.gov.il.  The 
plan will be available on the MOH website in English in 
December. 
 
-- MOH will participate in a regional Middle East Consortium 
on Infectious Disease Surveillance (MECIDS) conference on 
influenza preparedness in Istanbul December 11 - 14.  The 
conference is sponsored by Search for Common Ground and the 
NTI Global Health and Security Initiative and will include 
public health and veterinary specialists from Egypt, Jordan, 
and Palestine.  The organizers expect observers from Iraq, 
and there may be participants from Turkey and Cyprus, as 
well as WHO and other international experts.  Health and 
veterinary services representatives from Turkey and Cyprus 
have also been invited to attend.  The goal of the 
conference is to coordinate regional efforts in disease 
surveillance and control measures and to find ways to assist 
each other in the event of a pandemic influenza outbreak. 
The organizers have welcomed participation from the U.S. 
Consulate in Istanbul, and Embassy has conveyed that 
invitation to the Consul General. 
 
-- The GOI will be forthcoming in reporting any AI cases, 
both to the WHO and to its own citizens.  In a recent case 
in which a man working in a nature preserve experienced flu- 
like symptoms, MOH moved quickly to test the man's blood in 
country and sent blood samples overseas for confirmation 
testing as well.  MOH was open with press and public about 
steps being taken in that case.  MOH officials have stated 
that they will notify WHO and the public immediately of any 
confirmed cases of H5N1.  So far there have not/not been any 
confirmed cases of H5N1 in birds or humans in Israel. 
 
-- The GOI is continuing to give avian and pandemic flu 
preparedness high priority.  The "go-to" person for USG 
officials to engage on this issue is MOH Director General 
Professor Avi Yisraeli at the Ministry of Health. 
 
-- Avian and pandemic influenza has been added to Israel's 
list of reportable diseases. 
 
-- GOI health officials have been in regular contact with 
the WHO, and are following WHO planning and response 
guidelines.  The MOH is also in contact with the Ministry of 
Agriculture regarding surveillance and monitoring of poultry 
and wild birds for evidence of the disease.  Health 
officials are also in contact with their counterparts in the 
Palestinian Authority and Egypt to coordinate disease 
surveillance efforts, as well as with colleagues at the U.S. 
CDC, and national public health services in Canada and the 
UK.  GOI veterinary officials are working closely with their 
Palestinian and Jordanian counterparts. 
 
-- Israeli hospitals and HMOs currently administer annual 
flu shots.  Israel does produce influenza vaccines, but does 
not produce Tamiflu.  It might be able to contribute to 
Tamiflu production under a WHO-declared emergency.  Vaccines 
for poultry are imported from the Netherlands.  Health 
officials were not aware of local research towards a H5N1 
vaccine, but Israel does have related research capabilities. 
 
-- Because AI features prominently in the local and 
international press and government ministries have been 
proactive in informing the Israeli public, the general 
population is aware of the issue.  However, health officials 
expressed concern that the public may disregard or downplay 
the threat of AI because of the previous public health 
scares (Swine flu and SARS) that did not become pandemics. 
There is also some risk that less informed third-country 
nationals (TCNs), some of whom work at Israeli poultry 
farms, might not be fully aware of the threat. 
 
B)   SURVEILLANCE/DETECTION 
 
-- The MOA Veterinary Service has its own laboratories to 
test samples from farms, markets, and migratory birds.  The 
MOA laboratories also serve as regional testing facilities 
for suspected cases from Gaza and the West Bank, as well as 
from Jordan.  Protective gear and doses of Tamiflu have been 
made-ready for poultry workers who may come into contact 
with chickens infected with the disease.   The GOI has long- 
standing relationships with the USDA and APHIS. 
 
-- MOA recently conducted an emergency action drill to train 
poultry workers and Veterinary Service specialists.  A U.S. 
veterinary health specialist attended that exercise. 
 
-- A critical international gap that Israel could help 
address is the need for expanded monitoring and surveillance 
to screen migratory birds for the H5N1 virus as part of an 
early warning system. Because Israel is a major fly-over 
region for migratory birds between Russia and Europe and 
Africa, a more aggressive screening effort here could 
identify risks for more vulnerable areas in Africa.  Two 
sets of local experts have submitted related proposals to 
GOI ministries, but it is unclear at this point whether they 
will be funded. 
 
C)   RESPONSE/CONTAINMENT 
 
-- Israel has already purchased NIS 44 million (just under 
USD 10 million) worth of Tamiflu.  MOH has requested 
additional funding of 150 million NIS to purchase additional 
Tamiflu.  MOH officials anticipate that the additional 
supplies will be available by March.  MOA officials have 
many years of experience controlling and containing diseases 
that may affect poultry and livestock. 
 
-- An additional 10 million NIS has been allocated for the 
purchase of protective gear.  The gear will be stockpiled in 
MOH warehouses.  A plan detailing logistics of distribution 
is in place. 
-- Based on the national preparedness plan, surveillance and 
monitoring of suspected cases of avian flu, emergency action 
drills and planning in the agricultural sector, and efforts 
made to stockpile vaccines and protective gear, the GOI 
rapid response capacity appears to be good.  The MOA 
Veterinary Service already closely monitors poultry 
producers and has stated that they would quickly cull 
infected poultry stocks and/or birds.  Although specific 
amounts have not been decided, the GOI plans to compensate 
poultry producers if it should be necessary to cull their 
stock.  In the case of an outbreak of avian flu, the MOA 
would handle the situation by using guidelines that it has 
in place for handling other diseases that affect poultry and 
birds; quarantining of poultry in the affected areas would 
be put into effect and the sale of poultry products would be 
restricted. 
 
-- Post believes that the GOI is willing to impose 
quarantine and social distancing measures.  Law enforcement 
and military personnel would enforce any quarantine, based 
on the severity of the outbreak of the disease. 
 
JONES