VZCZCXRO9925
RR RUEHCHI RUEHDT RUEHHM
DE RUEHJA #7614/01 1660924
ZNR UUUUU ZZH
R 150924Z JUN 06
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC 5904
RUEHPH/CDC ATLANTA GA
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHZS/ASSOCIATION OF SOUTHEAST ASIAN NATIONS
RUEHRC/USDA FAS WASHDC
RHEHNSC/NSC WASHDC
RHMFIUU/BUMED WASHINGTON DC
RHEFDIA/DIA WASHINGTON DC
RUEKJCS/SECDEF WASHDC
RHHMUNA/CDR USPACOM HONOLULU HI
RUEKJCS/CJCS WASHDC
RUEHBY/AMEMBASSY CANBERRA 9615
RUEHFR/AMEMBASSY PARIS 0895
RUEHRO/AMEMBASSY ROME 1885
RUEHIN/AIT TAIPEI 1812
RUEHHK/AMCONSUL HONG KONG 2146
RUEHBJ/AMEMBASSY BEIJING 3476
RUEHHM/AMCONSUL HO CHI MINH CITY 0080
RUEHGZ/AMCONSUL GUANGZHOU 0238

UNCLAS SECTION 01 OF 03 JAKARTA 007614 
 
SIPDIS 
 
SIPDIS 
SENSITIVE 
 
DEPT FOR EAP/IET, A/MED AND S/ES-O 
DEPT FOR OES/FO, OES/EID, OES/PCI, OES/STC AND 
OES/IHA 
DEPT PASS TO USDA/FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG 
DEPT ALSO PASS TO USDA/FAS/FAA/DYOUNG AND USDA/APHIS 
DEPT ALSO PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL 
DEPT ALSO PASS TO HHS/BILL STEIGER AND AMAR BHAT 
PARIS FOR FAS/AG MINISTER COUNSELOR 
CANBERRA FOR APHIS/DHANNAPEL 
ROME FOR FAO 
NSC FOR JMELINE 
BANGKOK FOR RMO, CDC, USAID/RDM/A 
USPACOM ALSO PASS TO J07 
 
E.O. 12958: N/A 
TAGS: TBIO AMED CASC EAGR AMGT PGOV KFLU ID
SUBJECT: East Java: Suspected AI Death Exposes Local 
Underreporting 
 
JAKARTA 00007614  001.2 OF 003 
 
 
¶1. (SBU) Summary: A 10 month old child in 
Tulungagung, East Java is suspected to have died 
June 4 of Avian Influenza. The inexperienced local 
hospital doctor did not recognize the AI symptoms 
and released the child's body for burial prior to 
taking any blood samples.  Regency health officials 
are treating the death as though caused by AI.  A 
Surabaya newspaper reported June 8 that local animal 
husbandry officials were not disclosing the full 
extent of the AI outbreak in the Tulungagung poultry 
population, motivated by fears of "public panic" if 
the full extent of the outbreak were made public. 
End Summary. 
 
Possible AI Death in East Java 
------------------------------ 
 
¶2. (SBU) Jawa Pos reported June 6 that Aditya Bima 
Saputra (10 months old) of Sukowiyono village, 
Tulungagung Regency, East Java died June 4 at Dr 
Iskak Hospital in Tulungagung of suspected Avian 
Influenza (AI). The child was reportedly sick for 
three days with AI symptoms before dieing.  The 
article also stated that approximately 100 chickens 
recently died not far from the child's house and a 
goat that lived next to his house collapsed and died 
instantly the previous day. 
 
¶3. (SBU) ConGen Surabaya staff followed up with 
local hospital officials that treated the child and 
Tulungagung Regency human health and animal 
husbandry officials.  Tri Widyo Agus Basuki, Public 
Affairs Director of Dr. Iskak Hospital in 
Tulungagung stated that the child died and the 
child's body was removed from the hospital for 
burial before any medical tests were done. 
According to Basuki, hospital staff on duty at the 
time the child was admitted did not consider testing 
for AI.  Apparently, Aditya was admitted on a Sunday 
and the medical lab was closed.  The inexperienced 
duty doctor decided to wait until the lab opened 
Monday morning at 8:00 am to draw blood samples. 
Aditya died at 5:00 am Monday morning and, as is 
local custom, his parents took him home for burial 
half an hour later.  It was not until a neighbor 
noticed the victim's older brother Rizal Prasdana 
Efendi (7 years old) was ill with similar symptoms 
that anyone thought to test for AI.  By then, it was 
too late because Aditya was already buried. 
 
¶4. (SBU) Rizal was admitted to the local hospital on 
June 7 with a high fever and respiratory infection 
symptoms.  Basuki informed ConGen staff that Rizal 
was in much better condition than his brother at the 
time of admission but is being isolated and was 
tested for AI.  Basuki confimed on June 12 that 
Rizal's AI tests were negative, relieving the 
suspicion of an AI cluster in Tulungagung. 
 
JAKARTA 00007614  002.2 OF 003 
 
 
 
¶5. (SBU) Affandi, head of Technical Operation Unit 
of Basic Health Office in Tulungagung, confirmed 
that local government is treating Aditya's death 
like an AI case and conducted a large disinfectant 
spraying campaign in the patient's neighborhood and 
some of bird shops in Tulungagung. His office has 
distributed Tamiflu tablets to 28 local medical 
clinics in Tulungagung and doctors were briefed on 
AI symptoms and when to use the drug.  Affandi 
admitted it is standard procedure to draw blood on 
any patient with a high fever as soon as they are 
admitted and that the hospital did not properly 
follow procedure. 
 
Animal Health Official Spills the Beans 
--------------------------------------- 
 
¶6. (SBU) In a June 7 interview with ConGen staff, 
Danduk Sudarham, head of Tulungagung Animal 
Husbandry Department, disputed the facts presented 
in the Jawa Pos article claiming that only 43 
chickens in the regency had perished from AI in the 
regency in the past month.  He stated that the 
deaths now were nothing compared to the 600,000 
poultry that died from AI in the regency from 
October 2003 to February 2004.  He seemed defensive 
and concerned that ConGen was taking an interest in 
the case.  On June 8, Surya newspaper published a 
story that the Tulungagung Animal Husbandry 
Department was withholding information that 
thousands of birds had recently died from AI in the 
regency.  Surya claims to have read confidential 
information from a file on Sudarham's desk when he 
left the room during an interview, revealing a much 
more serious AI problem in the Tulungagung poultry 
population that had been publicly reported.  The 
story also claims that when confronted with the 
stolen information, Sudarham admitted to 
underreporting the problem and pleaded with the 
journalists to not publish the data for fear of a 
public panic. 
 
¶7. (SBU) The following day both Surya and Jawa Pos 
newspapers reported hundreds of AI related poultry 
deaths in Tulungagung regency and Surya published a 
photograph of a pit filled with several hundred dead 
birds being cremated.  The story published remarks 
by Sudarham downplaying the situation stating that 
the incidents were isolated and not indicative of a 
more widespread problem.  After repeated efforts, 
ConGen was able to make contact again with Sudarham 
on June 13.  He claimed that the information 
uncovered by the reporters was from 2005 and that 
what he had told us was accurate.  Sundarham was at 
a loss to explain the photograph of the dead birds 
or his previous statement to ConGen staff that there 
were no reported AI poultry deaths in Tulungagung in 
 
JAKARTA 00007614  003.2 OF 003 
 
 
¶2005. 
 
Health Expert Calls For Transparency 
------------------------------------ 
 
¶8. (SBU) East Java AI expert, Dr. C.W. Nidom, PhD, 
publicly called for government officials to be more 
transparent in reporting the AI situation in 
Indonesia to the public in a June 12 interview 
published in the Jakarta Post.  Nidom is a leading 
researcher on AI at the Tropical Disease Center of 
Airlangga University, Surabaya's largest public 
university, and a longstanding and vocal critic of 
local, provincial and the national governments' 
attempts to "cover-up" or downplay the severity of 
the AI problem in Indonesia.  Nidom is working on 
research at the University of Tokyo, based on 
samples taken from Indonesian swine, he claims shows 
the H5N1 virus in East Java has mutated to become 
transmittable to humans. 
 
Comment 
------- 
 
¶9. (SBU) In light of the economic and social damage 
facing the North Sumatra village caused by the Medan 
cluster, local animal husbandry officials may be 
sorely tempted to not report or underreport AI 
outbreaks in their districts. The motivation to "not 
cause a public panic" is strong because the public 
is likely to panic if facing a serious AI outbreak. 
By the time Aditya was taken to the hospital, he was 
too weak to have blood taken.  However, had local 
health officials and doctors been aware of the 
extent of the AI outbreak in Tulungagung's poultry 
population, they would have certainly tested Aditya 
for AI prior to releasing his body to the parents. 
 
AMSELEM