VZCZCXRO8525
PP RUEHCHI RUEHDT RUEHHM
DE RUEHJA #0492/01 2351050
ZNR UUUUU ZZH
P 231050Z AUG 06
FM AMEMBASSY JAKARTA
TO RUEHC/SECSTATE WASHDC PRIORITY 9023
RUEHPH/CDC ATLANTA GA PRIORITY
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY
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 9874
RUEHFR/AMEMBASSY PARIS 0938
RUEHRO/AMEMBASSY ROME 1920
RUEHIN/AIT TAIPEI 1850
RUEHHK/AMCONSUL HONG KONG 2183
RUEHBJ/AMEMBASSY BEIJING 3618
RUEHHM/AMCONSUL HO CHI MINH CITY 0120
RUEHGZ/AMCONSUL GUANGZHOU 0269

UNCLAS SECTION 01 OF 03 JAKARTA 010492 
 
SIPDIS 
 
SIPDIS 
SENSITIVE 
 
DEPT FOR EAP/MLS, EAP/IET, A/MED AND S/ES-O 
DEPT FOR G/AIAG/JLANGE AND RFENDRICK 
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/WSTEIGER/ABHAT/MSTLOUIS AND HHS/NIH 
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 ID KFLU
SUBJECT: INDONESIA - NEW AVIAN INFLUENZA CASES IN WEST GARUT 
 
REF: A) Jakarta 10140 and previous 
 
JAKARTA 00010492  001.2 OF 003 
 
 
¶1. (SBU) Summary. Indonesian press has featured a series of 
alarming articles over the weekend of August 18-20 concerning up 
to ten possible human cases of avian influenza (AI) occurring in 
the Cikelet village of the Garut district of West Java.  NAMRU-2 
and the Ministry of Health (MOH) tested the ten suspected cases 
and confirmed that three of these cases (two fatal) are positive 
for Avian Influenza.  The remaining seven cases tested negative, 
with three being positive for Human A or H1N1 (ordinary flu) 
only.  The positive cases are from different hamlets and suggest 
point-source (poultry) not human-to-human transmission.  As of 
August 23, data from NAMRU-2 and the Ministry of Health show 62 
human AI cases with 48 fatalities. End Summary. 
 
Remote Village and Purchased Chickens 
------------------------------------- 
 
¶2. (U) Cikelet village, with its population of 5,000-6,000 
people, is located in a remote area of the Garut district, in 
West Java.  The village is really a collective of twenty-five 
hamlets, each with a population of between 200-400 people.  The 
hamlets are separated by one to three kilometers of rocky and 
steep paths.  Travelers enter the village by traveling 
approximately nine hours from Jakarta on progressively more 
difficult roads.  The final two hours of the journey consists of 
steep, winding, rocky paths, probably best traveled on horseback. 
Cikelet village sits in a basin surrounded by steep mountains, 
where slash and burn agriculture supports a subsistence economy. 
Large extended families live in the villages and commonly keep 
chickens and ducks underneath their homes, which are raised above 
ground. 
 
3.(U) According to local residents, in preparation for a late 
June religious holiday, villagers purchased birds from a market 
located outside of Cikelet village.  Residents integrated the 
purchased poultry into existing flocks.  Within days, poultry 
began to die off.  Residents noticed increased poultry deaths 
through July and the first seven to ten days of August, spreading 
from one hamlet to the next. 
 
Onset of Human Cases 
-------------------- 
 
¶4. (SBU) International attention focused on Garut when a 17 year- 
old man was hospitalized with pneumonia in Dr. Slamet Hospital in 
Garut on August 9.  The man first showed symptoms on July 25, 
after handling sick chickens.  Local health authorities sent 
samples to the MOH laboratory in Jakarta, which shared them with 
NAMRU-2.  Both laboratories promptly confirmed the samples as 
positive for avian influenza.  The patient's parents requested 
that he be released from the hospital and he is now recovering at 
home.  The patient's 20 year-old cousin died weeks before with AI 
symptoms but was buried before tests could be taken. 
 
¶5. (U) Indonesian press then ran alarming stories over the August 
18-20 weekend describing up to ten suspected new cases of Avian 
Influenza among the hamlets.  NAMRU-2 and MOH tested these cases 
and confirmed two additional (both fatal) as positive for H5N1. 
 
JAKARTA 00010492  002.2 OF 003 
 
 
NAMRU-2 reports the remaining cases as testing negative; three 
were positive for human A or H1N1 (ordinary flu).  Details on the 
two additional positive cases are as follows: 
 
--A 9 year-old female from Jojok hamlet who became sick on August 
3 after handling sick birds.  She was admitted to the Dr. Slamet 
Hospital and died on August 14. 
 
--A 35 year-old female from Pasir Gambir hamlet who became sick 
on August 8, was admitted to Dr. Slamet Hospital and died on 
August 17.  Her nine year-old daughter had died the week before 
but was buried before samples could be taken. 
 
¶6. (U) Although the cases are in the greater Garut area, they are 
from different hamlets and evidence appears to suggest point- 
source (poultry) transmission. 
 
¶7.  (SBU) Immediately upon learning of the human cases in Garut, 
USAID-trained animal health teams began investigating avian 
influenza in poultry, sending their first report to the Local 
Disease Control Center on August 11.  In accordance with the Food 
and Agriculture Organization (FAO) guidelines, the Ministry of 
Agriculture's animal health response has included culling with 
immediate compensation, vaccination, and disinfection.  Animal 
health teams are reporting approximately 2,000 poultry culled as 
of August 22.  Additional support teams are scheduled to arrive 
on August 24.  While response efforts are underway, the 
surveillance team is investigating the boundaries of the outbreak 
and the role of the local market in the outbreak.  The FAO, with 
USAID support, is assisting the Ministry of Agriculture in the 
investigation and working to increase efforts to contain the 
outbreak. 
 
Human AI Case Profile 
--------------------- 
 
¶8. (SBU) NAMRU-2 has confirmed four new cases including the three 
Garut cases and an unrelated case from Bekasi since last reftel. 
NAMRU-2 data indicates the following AI-related case profile as 
of August 23: 
 
-- Number of laboratory confirmed (positive PCR and/or serology) 
human AI cases: 62, of which 48 have been fatal (case fatality 
rate of 77 percent). 
 
-- Number of probable AI cases 4, with 2 deaths (fatality rate of 
50 percent). 
 
-- Number of cases awaiting sequencing at the U.S. CDC: 2. 
 
-- Number of possible untested AI cases under investigation (last 
30 days): approximately 22. 
 
Note: NAMRU-2 data corresponds with Ministry of Health data but 
may vary at times with AI case figures presented on the official 
World Health Organization (WHO) website, which usually lags NAMRU- 
2 data by one week.  The WHO website, last updated on August 17, 
notes 58 human AI cases in Indonesia with 45 deaths.  WHO figures 
can be accessed at www.who.int/csr/disease/avian_influenza. 
 
JAKARTA 00010492  003.2 OF 003 
 
 
 
PASCOE