VZCZCXRO8031
PP RUEHDBU
DE RUEHKB #0444/01 0811319
ZNY CCCCC ZZH
P 221319Z MAR 06
FM AMEMBASSY BAKU
TO RUEHC/SECSTATE WASHDC PRIORITY 9923
INFO RUCNCIS/CIS COLLECTIVE PRIORITY
RUEHAK/AMEMBASSY ANKARA PRIORITY 1554
RUEHRO/AMEMBASSY ROME PRIORITY 0202
RUEHLO/AMEMBASSY LONDON PRIORITY 0291
RHEHNSC/NSC WASHDC PRIORITY
RHMFISS/CDR USEUCOM VAIHINGEN GE PRIORITY
RUEHGV/USMISSION GENEVA SZ PRIORITY 0156

C O N F I D E N T I A L SECTION 01 OF 03 BAKU 000444 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR EUR/CARC AND EUR/PGI, ALSO OES AND MED 
DEPT PLEASE PASS USAID FOR GLOBAL HEALTH MURRAY TROSTLE 
ANKARA FOR AGRICULTURAL COUNSELOR 
ROME FOR FAO REPRESENTATIVE 
GENEVA FOR HEALTH ATTACHE 
TBILISI FOR USAID; ALSO PASS A/S FRIED 
HOMELAND SECURITY COUNCIL FOR RAJIV VENKAYYA AND KEN STALEY 
 
E.O. 12958: DECL: 03/22/2016 
TAGS: KFLU EAID PGOV EAGR TBIO CASC AJ
SUBJECT: WHO CONFIRMS 5 AVIAN INFLUENZA CASES IN AZERBAIJAN 
 
REF: BAKU 402 AND PREVIOUS 
 
Classified By: DCM JASON P. HYLAND; REASONS 1.4 (B,D) 
 
¶1. (SBU)  SUMMARY: On March 21, the World Health Organization 
(WHO) announced that UK reference laboratory tests showed 
that five deaths (reftel) in Azerbaijan were caused by H5N1 
avian influenza.  Testing confirmed two additional H5N1 
infections; one patient recovered and has been discharged 
from hospital, while a second girl remained hospitalized in 
critical condition.  Two additional patients from the Salyan 
and Neftchala regions were also hospitalized with suspected 
bilateral pneumonia; testing is underway.  According to WHO, 
a total of 19 cases of suspect illness, including the five 
deaths, are under investigation.  A five-person WHO team on 
the ground has implemented an aggressive human surveillance 
program and is working to improve the GOAJ's still weak 
public education campaign.  FAO has identified two of the 
three experts it plans to field to Azerbaijan, a critical 
step to mitigate the GOAJ's unacceptable veterinary response. 
 USAID has now begun a project with the State Veterinary 
Committee, and has deployed a veterinary expert who is 
recording a series of public service announcements on avian 
influenza.  Embassy AI working group reviewed post's AI 
tripwires March 17; Post plans to release a warden notice 
following WHO's March 21 announcement.  END SUMMARY. 
 
¶2.  (SBU) On March 21, the WHO issued a statement indicating 
that reference laboratory testing in the UK showed that H5N1 
avian influenza caused five recent deaths in Azerbaijan (full 
text at www.who.int).  Four of the five deaths (17-year-old 
female, 20-year-old female, 16-year-old male, and 17-year-old 
female) were in Azerbaijan's Salyan region, while the fifth 
(21-year-old female) was in Terter region.  All of the Salyan 
cases are reportedly from the same family unit, extended 
family, or persons in close contact with the same family.  In 
addition, the WHO statement indicates two additional 
confirmed H5N1 cases from Salyan region: a 10-year-old boy 
who has recovered and a 15-year-old girl currently 
hospitalized in critical condition.  In addition, two other 
patients, one from Salyan and one from adjacent Neftchala 
region, are now hospitalized with symptoms of bilateral 
pneumonia; testing on these cases is underway.  The WHO 
statement indicates that the source of the infections is 
under investigation.  Not surprisingly, there are multiple 
stories depending on which source is consulted.  The Minister 
of Agriculture claimed to DCM March 15 that no large poultry 
die-offs were reported in Salyan region.  He indicated that 
the family in question had been involved in illegal hunting 
and harvested down from migratory birds as a family business. 
 He surmised that this was the source of infection.  However, 
a visiting FAO expert told Econoff March 16 that his visit to 
Salyan had yielded reports of backyard poultry die-offs 
throughout the area. 
 
¶3. (SBU) For the past two weeks, the World Health 
Organization has had a team of five international experts in 
Azerbaijan.  Reports indicate that they are working well with 
the Azerbaijani Ministry of Health.  Emboffs met on March 16 
with two representatives of the WHO's international mission 
to Azerbaijan.  These representatives reported excellent 
cooperation from Ministry of Health colleagues.  Other areas 
they highlighted: 
 
-- In the Dayikend settlement of the Salyan Region, WHO has 
implemented an active, aggressive human surveillance program. 
 To date, 4,200 people have been interviewed in door-to-door 
searches.  The active surveillance will continue until 14 
days after the final suspect case is resolved.  The WHO's 
chief epidemiologist is working with local doctors, who 
actually head the surveillance teams, to ensure a rigorous 
process; 
 
-- The WHO team planned to travel to the Terter region, where 
the fifth H5 death was confirmed, to assess the local 
response and determine what next steps are necessary; 
 
 
BAKU 00000444  002 OF 003 
 
 
-- As the Ministry of Agriculture's veterinary response had 
posed significant challenges for their own work, the WHO 
representatives said they would push FAO to dispatch 
immediately to Azerbaijan at least two experts for a two 
month term.  (NOTE: FAO regional representative told Econoff 
March 22 that FAO planned to send three experts to 
Azerbaijan.  A veterinary epidemiologist (already identified) 
would serve for six months, a communications specialist 
(already identified) would work for six weeks in cooperation 
with UNICEF, and a laboratory technician (to be identified) 
would serve four weeks in the GOAJ's veterinary lab.  END 
NOTE.); 
 
-- One of the five members, a communications specialist, was 
working directly with the MOH on a media strategy.  The WHO 
team noted that public communication was sorely lacking and 
only fueled rumors and confusion.  The goal was a daily 
"bulletin" system to control rumors and to have a central 
repository for information. 
 
-- The WHO continued to work with on the sampling issue, 
particularly with the supplies (i.e. packaging boxes) needed 
to ship samples to international labs.  Based on Post's 
experience facilitating sample shipment, Emboffs stressed how 
critical a large supply of sample containers was for rapid 
testing of suspect cases. 
 
¶4. (C)  The WHO representatives reported a disturbing finding 
that in Salyan, where multiple cases of H5N1 avian influenza, 
including four deaths, were identified, Azerbaijani 
veterinary officials were still telling people that there is 
no avian influenza in birds.  According to interviews done by 
WHO with local residents, many were told by veterinary 
authorities that absent AI in birds, the only way that the 
virus could have been contracted in humans would be through 
human-to-human transmission.  The WHO representatives also 
expressed a great deal of frustration with the Ministry of 
Agriculture, specifically with the Veterinary Service. 
(COMMENT: While there has been no definitive laboratory 
finding on whether poultry or wild birds in Salyan have AI, 
most of the anecdotal evidence Post has heard would make it 
likely that fowl in Salyan are infected with avian influenza. 
 END COMMENT.) 
 
¶5. (SBU) Although the WHO response is improving, the sole 
impetus for public outreach on avian influenza continues to 
be the international community.  However, these efforts are 
beginning to take hold.  Combined UNICEF/MOH PSAs are now 
running on television, with airings of these AI PSAs often 
followed by a tantalizing GOAJ message promising free 
treatment for tuberculosis cases.  Whether simply happy 
coincidence or ingenious design (we suspect the former), the 
combination of messages may encourage the public not only to 
protect itself properly, but also to come forward and seek 
treatment immediately should a suspicious illness present 
itself.  At the same time, post continues to follow our 
initial television and print campaign with more work to 
increase public awareness.  Most recently, USAID and its 
implementing partner Pragma are filming a number of short 
clips using a visiting U.S. veterinary specialist on how 
farmers should properly handle poultry.  Post plans to 
disseminate these clips widely.  Finally, the Ministry of 
Education has already distributed to schools around the 
country UNICEF-prepared information on avian influenza. 
 
¶6. (SBU) Post's AI working group met March 17 to review our 
AI action plan and tripwires.  The working group determined 
at that time that no further actions were required, but that 
Post would continue to monitor the situation carefully.  Post 
had issued a warden notice and embassy-wide management notice 
on March 14, following the first confirmation of H5 in 
humans, which cautioned the American community on the human 
cases and steps required to avoid contracting AI.  Following 
WHO's March 21 press release, Post will issue a follow-up 
warden message to the American community March 22. 
 
¶7. (SBU) COMMENT: We are greatly encouraged by the presence 
 
BAKU 00000444  003 OF 003 
 
 
of the WHO team; it includes people with both the technical 
knowledge, experience, and acumen to make positive changes. 
While FAO's response has been very slow, we are also 
encouraged by the commitment to send long-term experts to 
Azerbaijan.  As the number of cases continues to grow, Post 
strongly supports the deployment of more international 
experts to a front line of the international community's 
fight against avian influenza in a country whose government 
response has been poor, and medium- and long-term needs for 
capacity building are extensive.  Given the ongoing weakness 
of the GOAJ's veterinary response, and the challenge this 
inaction poses for human health efforts, experts in 
veterinary services are particularly useful.  With people 
continuing to fall ill, however, there is also great need for 
clinicians that can augment the WHO presence, in Baku as well 
as in the regions, to ensure patients receive proper 
treatment quickly.  Finally, in the midst of battling new 
cases of AI in humans and fowl, there is still a need for 
forensic epidemiologists to investigate regions, such as 
Massali and Ganja, where large birds die-offs, and rumors of 
human illness, have never been fully investigated.  As the 
WHO and FAO slowly come around, the reality in Azerbaijan 
remains that much more money, supplies, and expertise are 
needed.  Post appreciates Department's ongoing efforts to 
lobby FAO, WHO, EU (which has been surprisingly disengaged, 
apart from contributing to a World Bank facility), and others 
for the support Azerbaijan needs to meet this crisis.  END 
COMMENT. 
HARNISH