VZCZCXRO2372
RR RUEHCN RUEHGH
DE RUEHGH #0035/01 0280821
ZNR UUUUU ZZH
R 280821Z JAN 08
FM AMCONSUL SHANGHAI
TO RUEHC/SECSTATE WASHDC 6640
INFO RUEHBJ/AMEMBASSY BEIJING 1667
RUEHSH/AMCONSUL SHENYANG 1080
RUEHGZ/AMCONSUL GUANGZHOU 1050
RUEHCN/AMCONSUL CHENGDU 1079
RUEHHK/AMCONSUL HONG KONG 1208
RUEHIN/AIT TAIPEI 0890
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHGH/AMCONSUL SHANGHAI 7171

UNCLAS SECTION 01 OF 03 SHANGHAI 000035 
 
SIPDIS 
 
SIPDIS 
 
STATE FOR EAP/CM 
HHS FOR ELVANDER/BHAT 
NSC FOR WILDER, TONG 
 
E.O. 12958: N/A 
TAGS: TBIO PGOV ECON CH
SUBJECT: AVIAN INFLUENZA PREVENTION IN JIANGSU PROVINCE 
 
REF: 2005 SHANGHAI 3660 
 
(U) This cable is sensitive but unclassified and for official 
use only.  Not for distribution outside of USG channels or via 
the internet. 
 
¶1.  (SBU) Summary:  Two confirmed cases of Avian Influenza (AI) 
in Jiangsu Province have focused attention on Jiangsu's ongoing 
efforts against AI.  In meetings with Conoff, Jiangsu health 
officials confirmed reports that a father and son both 
contracted AI in December.  Jiangsu CDC does not have any 
evidence that this is a case of human-to-human infection nor 
were they able to confirm the source of the infection.  They did 
provide details about their efforts to contain the disease and 
informational campaign to alert the public.  They assured Conoff 
that Jiangsu is prepared to take prompt action on any future 
outbreaks and is also maintaining a high state of vigilance to 
prevent any future outbreaks. End summary. 
 
¶2.  (SBU) On January 16-17 Conoff and Environment, Population, 
and Health (EPH) Assistant met in Nanjing with officials from 
Jiangsu Center of Disease Control (CDC), Jiangsu Health 
Department, and the Jiangsu Agriculture and Forestry Department 
to discuss their roles in Jiangsu's Avian Influenza (AI) 
prevention and emergency pandemic plans. 
 
Death in Nanjing or the Beggars Chicken Mystery 
--------------------------------------------- -- 
 
¶3.  (SBU) Jiangsu CDC officials were eager to discuss recent 
reports of the infection of a son and father of AI in Nanjing, 
Jiangsu Province's capital.  Jiangsu CDC Director Wang Hua, a 
nationally recognized expert on AI who serves on the board that 
determines national AI policy, acknowledged the high level of 
interest in the two recent Nanjing city confirmed cases of AI. 
He said that Jiangsu CDC was proud of their response to this 
recent health related emergency situation and provided a 
detailed account of the case.  Accompanying Wang to the meeting 
were four members of the CDC Emergency Response team that 
oversaw all aspects of this case.  Vice Chief of Serious 
Infections Doctor Bao Chongjun headed this team. 
 
¶4. (SBU) According to Wang on December 1, Jiangsu Health 
officials were notified that a 24 year old man was hospitalized 
for AI.  The Jiangsu CDC immediately implemented the provincial 
emergency response plan.  Working around the clock for the 
entire month of December, the emergency response team carried 
out an extensive outreach program and implemented an exhaustive 
investigation. 
 
¶5.  (SBU) On December 3, the team blanketed the province with AI 
informational brochures.  A public service message ran 24 hours 
each day on all television screens next to public elevators. 
Altogether 556,000 informational tracts were distributed within 
three days of notification. 
 
¶6.  (SBU) The young man died on December 2 and Nanjing CDC 
officials supervised the disposal of the body on December 4. 
Officials ensured that the body was disinfected, particularly 
around the ears and nose.  They cremated the remains then 
disinfected the burn area.  They also went to the deceased's 
residence to destroy the young man's clothing and isolate the 
area. 
 
¶7.  (SBU) In addition to the informational campaign, a team of 
investigators gathered information about the young man's 
activities for the last month of his life.  A total of 62 people 
were identified as having close contact with him during this 
time.  Of this number, ten were quarantined.  On December 4, 
those quarantined were given vaccines sent down from Beijing to 
prevent them from contracting AI.  This group included his 
mother (herself a medical doctor), father, girlfriend, and the 
seven doctors who had treated him since he had first sought 
medical care on November 24.  Because the father's health 
condition was under such intense scrutiny, when he developed a 
fever and was diagnosed with AI, he was immediately sent to the 
Infectious Disease Hospital in Nanjing for treatment where he 
was treated with oseltamivir, commonly known by the brand name 
Tamiflu.  The father recovered.  However, thirteen days after 
his fever returned to normal levels, the AI pathogen was still 
found in his feces. 
 
¶8.  (SBU) Wang said he wanted to dispel several myths about the 
cause of the young man's death.  He said that the young man 
 
SHANGHAI 00000035  002 OF 003 
 
 
initially became ill with salmonella in August and his reaction 
was so severe that he lost 5 kilograms.  Later he was bitten by 
a dog and underwent the rabies shot treatment regimen.  At the 
time of his death, he had received four out of five shots.  The 
dog that bit him is still under observation and it was verified 
that he is not a carrier for rabies or any other infectious 
disease bacteria. 
 
¶9.  (SBU) It was a well know fact that the young man especially 
liked to eat chicken and the freezer in his home was well 
stocked.  In late November the family shared a celebratory 
Beggars Chicken meal at a Nanjing temple restaurant but no one 
else became ill.  (NOTE: Beggars chicken is cooked inside a 
shell of clay.) Wang said that to date, no contaminated chicken 
has been identified. 
 
¶10.  (SBU) While Wang insisted repeatedly that there was no 
evidence of human-to-human transmission, however it was his 
opinion that the father's close contact with the son was a 
factor.  He said perhaps the father came into contact with the 
same objects.  To date, Jiangsu CDC still has not discovered the 
source of the contamination.  Wang speculates that only a small 
population has the "special receptors" to contract AI.  He 
believes that the young man's weak immune system, his genetic 
makeup and his exposure to the virus were the factors in his 
contracting and dying from the disease. 
 
Ongoing AI Prevention Steps 
--------------------------- 
 
¶11.  (SBU) Wang explained that since the SARS scare in 2003, 
Jiangsu provincial health offices have invested substantial 
efforts and resources on infectious disease prevention and the 
refinement of their emergency pandemic protocols.  In the past 
four years, Jiangsu CDC has spent more than 165 million RMB to 
build four dedicated infectious disease laboratories, raise AI 
awareness through education programs and implement monitoring 
and reporting programs throughout the province.  The Jiangsu CDC 
staff of 415 oversees health care issues for a population of 
75,000,000 people. 
 
¶12.  (SBU) According to Wang, Jiangsu adheres to the "Humans 
Infected with Avian Influenza Emergency Response Protocol Plan". 
 This National plan has been revised 3 times and a fourth 
revision is expected in 2008.  (Comment: National level 
provincial and municipal AI plans are virtually identical. 
However, implementation varies depending on budget and local 
conditions. End Comment) The two-pronged plan addresses routine 
and emergency issues.  Part one includes all routine 
surveillance of agriculture, livestock, migratory birds and 
humans.  Part two focuses on potential emergency pandemic 
situation plans. 
 
Bird Watching 
------------- 
 
¶13.  (SBU) On January 17th, Jiangsu Agriculture and Forestry 
Department, Senior Engineer Section Chief Shen Quanming outlined 
his department's AI emergency protocol.  To monitor the 
migrating bird population, 82 surveillance spots are maintained 
along two identified main bird routes.  Appointees from 
designated villages, towns and cities must submit monthly 
samples from dead birds.  They are also tasked to report all 
suspicious bird deaths.  In this event, they collect the dead 
bird's tissue samples and send it to the Jiangsu CDC 
laboratories for testing.  If the sample is confirmed as AI 
infected, the specimen must be forwarded to national 
laboratories in Beijing within 2 hours.  Beijing laboratories 
must reconfirm the findings before the results are released to 
the Chinese public and other international health agencies. 
 
¶14.  (SBU) An area of 5 kilometers in circumference surrounding 
the area where the AI infected bird died is isolated.  If it is 
the site of a poultry farm, all birds must be destroyed.  People 
living in this area are quarantined for 21 days.  This method 
has been used effectively in the past, according to Shen. 
 
¶15.  (SBU) Shen stressed that it is essential that all poultry 
farmers are proactive and vaccinate livestock.  The Central 
Government provides vaccines free of charge and it is mandatory 
that all farmers vaccinate their poultry flocks.  The effect of 
the drug on the antibodies in the chicken is monitored by the 
Jiangsu Animal CDC.  If the antibody level is low, the dose is 
 
SHANGHAI 00000035  003 OF 003 
 
 
increased.  Farmers are told that in the event that they must 
destroy their animals due to AI, the Chinese Government makes up 
the loss and compensates them for all their losses.  This income 
guarantee assures farmer cooperation. 
 
¶16.  (SBU) Altogether Jiangsu has 186 animal monitoring points. 
Included in this number are 82 spots where Agriculture and 
Forestry employees monitor birds.  The animal monitoring points 
include airports, water stops for migrating birds and pig farms. 
 The responsible persons must report every month what they have 
observed.  Other monitoring spots include wet markets that are 
licensed to sell live chickens.  Observers there must report 
weekly.  In addition to the regularly scheduled monitoring, 
there is a random monitoring program that is conducted in May 
and October. 
 
¶17.  (SBU) CDC Director Wang pointed out that Jiangsu's key 
monitoring point is located in the Gaoyou Lake District.  This 
district is one of the largest poultry producing centers in 
China.  This area also requires extra scrutiny because it 
borders Anhui Province where there have been several confirmed 
AI cases. 
 
People Watching 
--------------- 
 
¶18.  (SBU) Routine surveillance of the human population is also 
an important part of the program.  Health care providers are 
trained to take an extra look at all pneumonia and influenza 
patients' symptoms.  If an unexplainable death occurs, samples 
must be collected and tested in CDC laboratories.  Wang said 
Jiangsu Province recently launched a pilot program to monitor 
student absenteeism that is modeled on successful U.S., European 
and Japanese programs.  Designated schools are required to 
report absentee statistics that reach specific benchmarks.  The 
"hygiene" teacher must report to the community doctor when 15 
per cent of the students fail to go to school.  If more than 20 
per cent of the students are absent, this information must be 
reported directly to the Jiangsu CDC.  Pilot cities 
participating in this program include Nanjing, Xuzhou, Yangzhou, 
Zhenjian, Wuxi, and Yancheng.  Future programs that monitor 
designated shop sales of toilet paper and flu/fever medicines 
are being considered. 
 
Comment: Regional Coordination? 
------------------------------- 
 
¶19.  (SBU)  Jiangsu Province appears to have taken on board some 
of the lessons of the SARS outbreak.  Jiangsu CDC officials were 
eager to demonstrate their openness to discussing AI and also 
provided detailed information on the late 2007 cases and the 
government's response.  One area where there is less information 
is coordination among provinces.  There was no mention of 
coordinating with neighboring provinces or Shanghai health 
authorities.  It appeared that the Jiangsu CDC official take 
their cues directly from Beijing.  Better regional coordination 
will be needed if a widespread outbreak occurs.  Anhui Province, 
which is much poorer and less efficient than Jiangsu Province, 
has had AI outbreaks in the past and shares some of the same 
migratory paths as Jiangsu. 
JARRETT