US embassy cable - 05SANSALVADOR3433

UNCLAS SECTION 01 OF 03 SAN SALVADOR 003433 
 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: TBIO, SENV, ECON, EAGR, EAID, PREL, ES, AVIAN FLU 
SUBJECT: INFORMATION ON AVIAN INFLUENZA 
 
REF: A. SECSTATE 209622 
     B. USAID RAPID ASSESSMENT FOR AVIAN AND PANDEMIC 
        INFLUENZA PREPAREDNESS 
 
1. Post, through USAID and the Regional Medical Officer 
(RMO), is coordinating with Salvadoran authorities to support 
local efforts to control avian influenza and assess their 
capability to respond to an influenza pandemic. Responses to 
Ref. A questions are included in paragraph 2; they are based 
on information provided by USAID in response to a similar 
tasking (Ref. B.) and also information gathered during a 
seminar on avian influenza hosted by the RMO on November 29 
that was attended by officials from the Ministry of Health 
(MOH) and Ministry of Agriculture (MAG). 
 
2. Begin survey response: 
 
A) Preparedness/Communication 
 
Does the government have a preparedness plan/strategy for 
preventing avian flu from becoming a pandemic and containing 
a pandemic once it occurs?  If the country has a strategy, 
how capable is it of implementing it?  Please provide a copy 
of the plan or the internet address for the plan. 
 
--The Government of El Salvador (GOES), with MOH and MAG 
taking the lead, has developed a preparedness strategy that 
includes general anti-avian flu measures.  It was developed 
with support from the World Health Organization (WHO).  Post 
will forward a copy to OES. The GOES will face significant 
resource and technical constraints in implementing its 
strategy to prevent or contain a pandemic. 
 
How truthful will the government be in reporting the scope of 
any disease outbreak among people?  Among animals?  What 
incentives could be offered that would likely result in more 
transparency? 
 
--The GOES will likely be forthcoming in reporting the scope 
of any disease outbreak among people and animals. However, it 
is likely that individual poultry farmers would hide cases 
should they occur. 
 
Where does preparing for an avian flu human pandemic rank 
among government priorities?  Who and what would most 
influence the country to give the issue a higher Priority? 
Who is the key "go-to" person, office or Department (i.e., 
Minister for Health, Prime Minister, etc.) for USG officials 
to engage on this issue? 
 
--This issue is not currently a national priority and is 
unlikely to become one until it poses a more immediate threat 
to public health.  The MOH and MAG are the most active within 
the GOES, but there this a national task force on avian 
influenza that also includes the National Emergency 
Committee, armed forces, Ministry of Governance (public 
security), Ministry of Education, Ministry of Public Works 
(transportation) Ministry of Foreign Relations, local 
governments, and the parastatal water company. A vaccine 
against H5N2 is used regularly by commercial poultry 
producers. MAG officials believe this vaccine is also 
effective against H5N1. El Salvador bans the import of raw 
and live poultry from outside Central America. 
 
Have national laws been reviewed to ensure that they are 
consistent with the international health regulations and do 
not pose barriers to avian influenza detection, reporting, 
containment, or response? 
 
--There has been no formal legal review in response to this 
issue, but Salvadoran laws are generally consistent with 
international health regulations. Legal review would likely 
occur only if a specific barrier to avian influenza 
detection, reporting, containment, or response were 
identified in practice. 
 
Is the host country already working with international 
organizations or other countries on the avian flu issue?  Are 
government leaders likely to ask for assistance from the 
United States or other countries?  Would government leaders 
be receptive to messages from U.S. leaders through a 
bilateral approach, at a multilateral forum such as the 
United Nations (WHO, FAO, etc.) or APEC, or through bilateral 
contacts by a third country?  What would the country want 
from the United States in return for its efforts? 
 
--El Salvador is already working with the World Health 
Organization (WHO) and Pan American Health Organization. 
USAID has developed an effective coordinating group for 
bilateral and multilateral donors that is active on this 
issue. Officials in the Ministries of Health and Agriculture 
are working with counterparts in other Central American 
governments to develop a coordinated approach to the issue. 
 
Does the country currently administer annual flu shots? If 
not, might it consider doing so?  What is the production 
capability (i.e. how many doses of the annual Trivalent flu 
vaccine can the country make) for human influenza vaccines in 
the country? Does the country produce influenza vaccine for 
poultry and if so how much? If the country is developing an 
H5N2 vaccine, where is it in production and testing? Are 
there any licensing issues? Is there a liability shield for 
foreign makers/donors of vaccines? If not, any prospects of 
one being enacted? 
 
--The GOES administers free annual flu shots to children 
under 5 and adults over 60. Funding constraints limit the 
extension of this program to others outside these high-risk 
groups. There is currently no human influenza vaccine 
production in El Salvador, nor is there influenza vaccine 
manufactured for poultry in El Salvador. Local pharmaceutical 
companies are not capable of developing or manufacturing an 
H5N1 vaccine in El Salvador. 
 
How well informed is the population about the avian flu 
threat and about measures they should take to mitigate the 
threat? What mechanisms are available for providing 
additional information to the population, particularly in 
rural areas and how effective are these measures? 
 
--Press reports on the spread of avian influenza in Asia and 
Europe have featured prominently in print, radio, and 
television news. The Ministers of Health and of Agriculture 
and representatives of the WHO have appeared in television 
interviews. 
 
B) Surveillance/detection 
 
How capable are the medical and agriculture sectors of 
detecting a new strain of influenza among people or animals 
respectively? How long might it take for cases to be properly 
diagnosed, given other endemic diseases? Can influenza 
viruses be subtyped in the country, if so by whom, and if not 
where are they sent? Does the country send samples to a 
WHO/EU/U.S. reference laboratory? 
 
--Local laboratories can identify the virus but cannot 
identify its genotype. To determine genotype, samples are 
sent to CDC in Atlanta, and results are usually available 
within 30 days. The CDC and U.S. Army have collaborated with 
technical assistance and processing/analysis of blood samples 
taken from avian stock at five sentinel sites. 
 
What are the critical gaps that need to be filled in order to 
enhance the country's disease detection and outbreak response 
capabilities? What is the country's greatest need in this 
area from the United States or international organizations? 
 
--El Salvador lacks resources, both technical and financial, 
needed to enhance the country's disease detection and 
outbreak response capabilities. Post will continue to serve 
as a source of information on the virus for the Salvadorans. 
CDC's continued cooperation on genotype testing is important 
as well. 
 
C) Response/Containment 
 
Does the country have a stockpile of medications, 
particularly of antivirals, and if so how much? If some has 
been ordered, how much and when is it expected? 
 
--El Salvador has limited stockpiles of most medicines, but 
does not have antiviral stockpiles. El Salvador hopes to 
begin acquiring antivirals to treat humans in 2007, but has 
not yet ordered any medicines. 
 
Does the country have a stockpile of pre-positioned personal 
protective gear? 
 
--El Salvador has limited stockpiles of personal protective 
gear. 
 
What is the rapid response capacity for animal and human 
outbreaks? Are guidelines in place for the culling and 
vaccination of birds, disinfection of facilities, and 
limitations on animal movement? 
 
--The national task force on Avian Influenza is developing 
guidelines for culling and vaccination of birds, disinfection 
of facilities, and limitations on animal movement. 
 
How willing and capable is the government of imposing 
quarantines and social distancing measures (closing schools, 
public gatherings, mass transit)? Would its military enforce 
quarantines? 
 
--If required, the government would attempt to impose 
quarantines, but resource constraints would limit their 
effectiveness in doing so. The military would support 
quarantines. 
 
End survey response. 
Barclay