VZCZCXRO2792
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DE RUEHYE #0208/01 0411322
ZNR UUUUU ZZH
O 101322Z FEB 06
FM AMEMBASSY YEREVAN
TO RUEHC/SECSTATE WASHDC IMMEDIATE 2414
INFO RUEAUSA/DEPT OF HHS WASHDC PRIORITY
RUEHRC/DEPT OF AGRICULTURE WASHDC PRIORITY 0048
RUEKJCS/SECDEF WASHDC PRIORITY
RUEHPH/CDC ATLANTA GA PRIORITY 0034
RUCNCIS/CIS COLLECTIVE

UNCLAS SECTION 01 OF 04 YEREVAN 000208 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
DEPARTMENT FOR OES, EUR/PGI AND EUR/CARC - DSTAVROPOULOS 
PLEASE PASS TO USAID 
 
E.O. 12958: N/A 
TAGS: KFLU TBIO SENV ECON EARG PREL AM
SUBJECT: AVIAN FLU UPDATE AND ACTION REQUEST 
 
REF: A) YEREVAN 113 B) 05 YEREVAN 2053 
 
Sensitive but unclassified.  Please protect accordingly. 
 
-------------------------- 
SUMMARY AND ACTION REQUEST 
-------------------------- 
 
¶1. (SBU) An eleven-member Avian Influenza (AI) Interagency 
Team including representatives from USAID, USDA, HHS/CDC, DoD 
and State, traveled in Yerevan from January 24-26.  The team, 
or elements thereof, met with the Ministers of Agriculture, 
Health and Education, with representatives from international 
organizations and visited a local hospital and local 
laboratories.  Team members were pleased with the GOAM's 
openness and the fact that most government representatives 
appeared to recognize the serious nature of the AI threat. 
Subsequent to the Team's visit, teams from the World Health 
Organization (WHO) and World Bank visited Armenia to assess 
AI preparedness.  A USAID-funded expert is also currently in 
Armenia providing training on AI testing to local 
veterinarians.  Testing capacity in Armenia remains limited. 
On the human health side, the U.S. AI Team and WHO Team 
agreed that the local genetics lab had the capacity to test 
for AI in humans.  The WHO Team raised serious concerns, 
however, about bio-security at the lab.  While U.S. 
assistance would be helpful in all areas, the most urgent 
need is in the agricultural sector (see action request, para. 
11).  End Summary. 
 
-------------------------------------- 
USG AI INTERAGENCY TEAM VISITS ARMENIA 
-------------------------------------- 
 
¶2. (U) An eleven-member AI Interagency Team including 
representatives from USAID, USDA, HHS/CDC, DoD and State, 
traveled in Yerevan from January 24-26.  The team, or 
elements thereof, met with the Ministers of Agriculture, 
Health and Education, with representatives from international 
organizations including the WHO, World Bank, FAO, UNICEF and 
European Commission, and visited the Nork Infectious Disease 
Hospital, a local private genetics testing lab, the Central 
Veterinary Laboratory and local poultry markets.  While the 
team was originally scheduled to depart on the evening of 
January 25, their departure was delayed due to poor weather. 
The team members were pleased with the openness of the 
Government and the fact that most government representatives 
appeared to recognize the serious nature of the AI threat. 
 
--------------------------------------------- - 
AGRICULTURE: MOVING FORWARD WITH RAPID TESTING 
--------------------------------------------- - 
 
¶3. (SBU) The Minister of Agriculture was candid and direct 
with representatives from the AI Team.  He cited the report 
produced by USAID-funded avian flu expert Dr. Elizabeth 
Krushinskie following her November 2005 trip to Armenia (ref 
B) and said that he "expected" additional technical 
assistance from the U.S.  He welcomed the Team's offer of 
1,500 sets of personal protective equipment (PPE) and was 
very receptive to the idea of a regional conference to 
discuss AI preparedness.  According to the Minister, 
veterinarians at the Central Lab tested over 170 birds in the 
period from November-January, and have not identified any 
cases of AI.  Members of the AI Team later visited the 
Central Veterinary Lab where lab technicians confirmed that 
they had received over 170 birds for testing.  The lab's 
testing capacity is extremely limited, however, and consists 
primarily of non-functioning and outdated polymerase chain 
reaction (PCR) equipment and an ELIZA test which detects 
anti-bodies, but not the virus.  Due to the high and very 
rapid mortality caused by the H5N1 virus, the Team's experts 
felt that the ELIZA was not the best method for diagnosing AI 
because it is likely that birds would die before producing 
anti-bodies.  The Minister also detailed many of the other 
steps taken to combat AI in Armenia including disinfecting of 
vehicles at the borders, banning poultry imports from 
countries where AI has been identified, disinfecting through 
a three-level process at commercial poultry farms and banning 
hunting (refs).  (Note: Embassy personnel traveling to 
Georgia found decontamination efforts the border to be 
inconsistent and untreated vehicles were allowed to cross. 
We all have heard that the ban on hunting is not being 
properly enforced.  End note.)  The Minister was open to 
additional international assistance and acknowledged the 
 
YEREVAN 00000208  002 OF 004 
 
 
serious nature of the AI threat, saying "the risk is very 
high, but luckily there is no virus in Armenia." 
 
----------------------------------- 
DOD OFFERS SUPPORT TO DEVELOP A LAB 
----------------------------------- 
 
¶4. (SBU) The Minister of Agriculture specifically requested 
assistance with training on both ELIZA and PCR equipment. 
Team member and DoD representative Dr. Samuel Yingst said DoD 
would consider assisting with the development of a testing 
laboratory in Armenia.  The Minister reacted positively to 
this suggestion and the Embassy is currently coordinating 
with DoD and the government to move this process forward. 
 
--------------------------------------------- --------- 
USAID-FUNDED EXPERT TRAINS LOCAL VETS ON RAPID TESTING 
--------------------------------------------- --------- 
 
¶5. (SBU) On January 28, avian flu expert Dr. Elizabeth 
Krushinskie arrived in Armenia to follow up on her November 
2005 visit (ref B) and to provide training to Central 
Veterinary Lab employees and others on the use of rapid assay 
AI detection kits and corresponding protocols.  Krushinskie 
brought some equipment including 20 testing kits, 40 sample 
shipment containers and PPEs with her for use in her training 
sessions.  Krushinskie conducted training seminars with local 
veterinarians in areas near the Armenian border with Turkey 
and with veterinarians and lab technicians in Yerevan.  While 
the sessions have been productive, additional training and 
supplies as well as continued political encouragement will 
likely be needed to develop a fully functioning active 
surveillance program.  The World Bank recently announced a 
USD 4 million loan program to assist the government with its 
efforts to combat AI and indicated a willingness to encourage 
the GOAM to use a portion of said funds, or funds redirected 
from other World Bank projects, to purchase additional 
testing kits. 
 
--------------------------------------------- -------- 
ADDITIONAL TRAINING, SUPPLIES FOR HEALTH CARE WORKERS 
--------------------------------------------- -------- 
 
¶6. (SBU) Representatives from the AI Team had a productive 
meeting with the Minister of Health.  The Minister noted that 
the National Assembly recently approved the Armenian National 
Response Plan.  He emphasized that the Ministry is 
coordinating closely with the Ministry of Agriculture, 
particularly as both Ministries sit on the GOAM's 
Inter-Ministerial AI Committee.  He welcomed the offer of 
PPEs and was supportive of the idea of a regional conference. 
 The Minister said that the Ministry of Health was still 
developing a case definition for AI, but had adopted the 
WHO's model for responding to any possible outbreak. 
According to the Minister, the priorities of the Ministry 
include maximizing the availability of information to the 
public, containing AI in animals and isolating and treating 
with TamiFlu any potential human AI cases.  In subsequent 
meetings, the First Deputy Minister of Health requested U.S. 
assistance in improving Armenia's human health laboratory 
testing capacity.  The Team also visited the Nork Infectious 
Disease Hospital.  The Nork Hospital has been identified as 
the country's referral hospital for suspected human H5N1 
cases and has 15 separate isolation rooms and three 
ventilators in its intensive care unit.  The team identified 
a need for additional training and supplies for health care 
workers at the hospital and in Armenia generally.  The 
laboratory facilities at the Nork Hospital are extremely poor 
and diagnostic testing for human cases would be done at the 
Center for Medical Genetics (the Center). 
 
------------------------------------------ 
EXPERTS DISAGREE ON HUMAN TESTING CAPACITY 
------------------------------------------ 
 
¶7. (SBU)  Although, the Team members who visited the Center 
for Medical Genetics (the Center) were impressed, and 
according to the Team's assessment, the Center had "good 
laboratory capacity to identify H5 in specimens by real-time 
PCR," members of the WHO-sponsored team, who were in Armenia 
from January 28 to February 5, were concerned that the Center 
did not meet the necessary bio-safety standards to test for 
AI.  According to the WHO team, the Center lacked the 
necessary equipment to protect the laboratory technicians, 
the ventilation hood as it was being used was inadequate to 
 
YEREVAN 00000208  003 OF 004 
 
 
prevent the virus from spreading throughout the lab and the 
ventilation system in general lacked sufficient safeguards to 
ensure that exhaust released outside the lab would be free of 
live virus.  The WHO Team was sufficiently concerned about 
the bio-safety standards at the Center that they told us they 
would likely advise the GOAM not to conduct diagnostic 
testing at the site.  The WHO Team members also noted that 
the Center for Medical Genetics and the Central Veterinary 
Lab are both located in highly populated areas and in both 
locations there is a single entrance for staff, the general 
public and potentially infected samples.  The WHO Team is 
drafting a final report from their visit which we hope to 
have early next week.  When we have the report, we will 
provide additional information about their assessment 
(septel). 
 
---------------------------------------- 
PROGRESS ON EDUCATION AND COMMUNICATIONS 
---------------------------------------- 
 
¶8. (SBU) Representatives from the AI Team met with the 
Minister of Education and discussed public outreach efforts 
with a number of international organizations and USAID 
implementing partners.  The Minister of Education has not 
been well integrated into the AI prevention effort and the AI 
Team heard conflicting accounts of whether or not the 
Ministry of Education sits on the Inter-Ministerial AI 
Committee.  The Minister, however, was clearly interested in 
engaging on the AI issue.  UNICEF has capitalized on the 
momentum built by the Team's visit.  UNICEF designed a 
leaflet aimed at teaching children (and adults) who own 
chickens about protecting flocks, responding to bird die-offs 
and basic hygiene.  UNICEF has printed 50,000 of these 
leaflets and given them to the Inter-Ministerial AI Committee 
for distribution.  UNICEF plans to print an additional 
250,000 copies of the leaflet by February 20.  UNICEF has 
also designed and is printing 1,000 copies of a poster for 
use in public schools and developed a series of in-class 
exercises about AI for teachers to use with students.  Public 
schools in Armenia are closed because of the cold weather, 
but UNICEF expects to have these materials in place when 
classes resume on February 15.  These educational materials 
were approved by the Ministry of Health which has requested 
that other donors use these materials in their public health 
outreach.  All of UNICEF's activities have been carried out 
in conjunction with the National Institute of Education, an 
affiliate of the Ministry of Education. 
 
--------------------------------------------- ------ 
CLOSE COORDINATION WITH THE INTERNATIONAL COMMUNITY 
--------------------------------------------- ------ 
 
¶9. (SBU) We continue to coordinate closely with other 
international donors and the GOAM on the AI issue.  Over the 
past week, representatives from the Embassy and USAID have 
met with visiting teams from the WHO and World Bank.  We are 
in almost daily contact with local representatives from these 
and other donor organizations.  We are also in the midst of 
Krushinskie's two-week training mission which is being very 
well received.  The Ambassador regularly raises avian flu in 
his meetings with government representatives and the USG AI 
Team's visit was widely (and positively) covered in the press 
(ref A). 
 
------- 
COMMENT 
------- 
 
¶10. (SBU) The U.S. AI Team's visit marked the start of a 
flurry of activity on the AI issue, including visits by 
assessment teams from the World Bank and WHO and a two-week 
training program by USAID-funded AI expert Krushinskie. 
While the GOAM has been extremely open and cooperative with 
all of these teams, they are clearly hoping for more concrete 
assistance in the near future.  The AI Team's generous 
donation of 1,500 sets of PPE and Krushinskie's training 
sessions are the type of direct support the GOAM needs.  The 
differing opinions of some of the visiting experts also 
complicate the situation.  The U.S. AI Team and the WHO Team 
agreed that the Center for Medical Genetics laboratory had 
the capacity to test human samples for H5 using real-time 
PCR.  The WHO Team, however, was sufficiently concerned about 
the bio-safety standards at the Center that they told us they 
would likely advise the GOAM not to conduct diagnostic 
testing there.  Further assessment is needed concerning human 
 
YEREVAN 00000208  004 OF 004 
 
 
testing capacity and appropriate support for the Center for 
Medical Genetics. 
 
-------------- 
ACTION REQUEST 
-------------- 
 
¶11. (SBU) The WHO and UNICEF have taken active leadership 
roles in the areas of health and communications respectively. 
 The U.S. should support these efforts, both financially and 
through on-the-ground coordination.  Per the AI Team's health 
related recommendations, the U.S. should also consider 
technical assistance for human surveillance, acquiring 
additional PPEs, infection control education, health care 
worker education, and clinical management training.  We would 
also welcome support in line with the AI Team's 
recommendations concerning communications.  U.S. assistance 
is particularly critical, however, in the agricultural 
sector.  DoD's longer-term proposal to improve Armenia's 
testing laboratories is welcome and responds to a serious 
shortfall in diagnostic capacity, but immediate support is 
also required.  Therefore, we request funding for a long-term 
(one year minimum) agricultural expert to develop and 
implement a comprehensive agricultural active surveillance 
system, a six-month supply of rapid assay testing kits and 
laboratory supplies, shipping supplies so that suspect cases 
can be sent to an overseas reference laboratory and PPEs, 
plastic bags, disinfectant and other equipment sufficient to 
support wide-spread culling and disposal if necessary. 
EVANS