VZCZCXRO4151
RR RUEHCI
DE RUEHKA #1035/01 1750317
ZNR UUUUU ZZH
R 240317Z JUN 07
FM AMEMBASSY DHAKA
TO RUEHC/SECSTATE WASHDC 4387
INFO RUEHNE/AMEMBASSY NEW DELHI 9991
RUEHKT/AMEMBASSY KATHMANDU 9149
RUEHIL/AMEMBASSY ISLAMABAD 1709
RUEHLM/AMEMBASSY COLOMBO 7982
RUEHGO/AMEMBASSY RANGOON 2551
RUEHCI/AMCONSUL KOLKATA 0805
RUEHPH/CDC ATLANTA
RUEKJCS/SECDEF WASHINGTON DC//ISA/NESA
RUEKDIA/JOINT STAFF WASHINGTON DC//J2/J5
RHHMUNA/CDR USPACOM HONOLULU HI//J2/J4/J5

UNCLAS SECTION 01 OF 02 DHAKA 001035 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
DEPARTMENT PLEASE PASS TO AIAG/HOLLIS SUMMERS, AIAG/TONY NEWTON AND 
AIAG/NICHOLAS STUDZINSKI 
DELHI PLEASE PASS TO FAS/OLIVER FLAKE 
 
E.O. 12958: N/A 
TAGS: TBIO KFLU PREL PGOV BG
SUBJECT:  NILFAMARI DISTRICT OUTBREAK CASE STUDY 
 
REF: (A) DHAKA 976, (B) DHAKA 776, (C) DHAKA 743, (D) DHAKA 730 AND 
 
PREVIOUS 
 
¶1.  (SBU) SUMMARY. The Nilfamari district first confirmed an 
outbreak of H5 in mid-April, 2007.  United Nations Food and 
Agriculture Organization representatives studied the GOB response in 
that district and identified both positive and negative features, 
ranging from local villagers self-identifying a suspected outbreak 
and activating veterinary alert apparatus on the plus side, to 
improper culling techniques and a continuing lack of coordination 
with human health efforts on the negative side. Many of the FAO 
observations draw attention to epidemiological questions that seem 
to remain unanswered, and in some cases, unasked.  END SUMMARY. 
 
¶2.  (SBU) BACKGROUND ON NILFAMARI.  Nilfamari is located in the far 
northwest corner of Bangladesh; it borders on the Bangladesh 
districts of Panchagarh to the west, Dinajpur and Rangpur to the 
south and Lalmonirhat to the east, and the Indian state of West 
Bengal to the north.  When Nilfamari first confirmed the presence of 
H5 in mid-May it did not border on an infected district; however 
Dinajpur and Rangpur have both subsequently reported H5 outbreaks. 
United Nations Food and Agriculture Regional Coordinator Dr. 
Mohinder Oberoi and National Consultant Dr. Abul Kalam visited 
Nilfamari June 4 Q 7 to make firsthand observations about the GOB 
response in this district. 
 
¶3.  (SBU) POSITIVE INDICATORS FROM NILFAMARI.  The case study 
reported that the local veterinary officials responded quickly after 
local Non-Government Organizations reported the suspected disease 
based on villagers recognizing signs and symptoms.  The villagers 
report knowing about avian influenza and its potential human health 
risks from TV, radio, and UNICEF posters.  The villagers informed 
local NGO workers about sick chickens, die-offs, and symptoms such 
as swollen heads, bluish wattles and combs, and reddening of shanks; 
the NGO workers then forwarded the information to local veterinary 
officers.  Media also report that local administrators acted quickly 
and ingeniously to quell panic in surrounding areas by utilizing the 
loudspeaker systems of local mosques to make announcements about 
bird flu. 
 
¶4.  (SBU) AND THE NEGATIVES.  Generally, strict adherence to 
critical procedures, such as disinfection and quarantine, remains 
problematic and inconsistent.  Specific problems identified in the 
case study include disposal of culled birds by door-to-door 
collection, putting the carcasses in bags and piling them in a van 
for transport to burial sites.  These burial sites are unmarked, and 
in one case a corner of a school playground was used and in another 
a farmerQs field where crops have subsequently been planted.  The 
human response also was not coordinated with the veterinary effort; 
despite several people in one village developing flu-like symptoms 
and recovering, there has been no human health monitoring.  With 
respect to the Field Disease Investigation Laboratories at Gaibandha 
and Joyphurhat, discussion between the FAO officers and laboratory 
workers revealed serious questions about technical capacity, and the 
observation that serious underreporting may be occurring.  The 
underreporting stems from lab workers being allowed to use only one 
test strip per sample, and declaring the sample negative based on 
the results of that one flu detect test even if true clinical and 
post-mortem signs are present. 
 
¶5.  COMMENT.  The ability of villagers to correctly identify the 
threat posed by signs and symptoms, and to effectively utilize 
various NGO avenues to convey that information to activate the 
district veterinary apparatusQ response, should be commended.  The 
NGOs involved should be encouraged to continue reporting unusual 
mortalities, and the education campaign through TV, radio and print 
media has had a clear, positive effect.  A coordinated, rigorous 
response still seems to be lacking, laboratory capacity remains low, 
and effective epidemiological investigation, if occurring, has not 
produced demonstrable results.  Also, since the GOB response seems 
to follow reported and suspected outbreaks without engaging in 
testing populations apart from those in proximity with or having 
obvious connection vectors to outbreak areas, the questions is 
whether the GOB can ever really get ahead of the outbreak.  The full 
text of the case study and other information is available on post's 
avian influenza webpage at: 
http://10.208.1.12/dhkavianinfluenza.htm. 
 
 
DHAKA 00001035  002 OF 002 
 
 
PASI