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### Viewing cable 05ANKARA6481, TURKEY: AVIAN INFLUENZA AND PREPAREDNESS RAPID

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Reference ID | Created | Released | Classification | Origin
--- | --- | --- | --- | ---
05ANKARA6481 | 2005-10-27 16:08 | 2011-08-24 01:00 | UNCLASSIFIED//FOR OFFICIAL USE ONLY | Embassy Ankara

`

    This record is a partial extract of the original cable. The full text of the original cable is not available.

` `

    UNCLAS SECTION 01 OF 03 ANKARA 006481

    SIPDIS

    STATE FOR EUR/RUS, OES/STC, EB/TPP/ATP, EB/TPP/BTA
    STATE ALSO PASS USAID FOR BLANCHET AND CARROLL
    HHS FOR WSTEIGER/PBUDASHEWITZ
    FAS FOR ITP/MACKE/THOMAS, CMP/DLP/WETZEL
    FAS PASS FSIS AND APHIS
    VIENNA PASS APHIS
    BRUSSELS PASS APHIS/FERNANDEZ
    GENEVA PASS HEALTH ATTACHE

    SENSITIVE

    E.O. 12958:N/A
    TAGS: ETRD EAGR KPAO TBIO AMED
    SUBJECT:  TURKEY: AVIAN INFLUENZA AND PREPAREDNESS RAPID
    ASSESSMENT

    Ref:  (A) ANKARA 6430 AND PREVIOUS SIT-REPS
          (B) ANKARA OCTOBER 19 E&E INITIAL RESPONSE ON AI

    Sensitive but unclassified.  Not for Internet Distribution.

    ¶1.  (SBU) Summary.  Turkey experienced one confirmed
    outbreak of the H5N1 strain of Avian Influenza in Balikesir
    in northwestern Turkey in early October without reports of
    human illness or deaths.  The Ministry of Health has taken a
    leadership role in contingency planning for a potential
    pandemic, but inter-agency coordination may be a weak area.
    Turkey could use technical assistance and training in
    laboratory testing capacity and kits and surveillance as the
    first line of defense.  According to the Health Ministry,
    the GOT would welcome cooperation from USID or the CDC.  End
    summary.

    Planning and Preparedness:
    --------------------------

    ¶2.  (SBU) Turkey is located on a major bird fly-way between
    Africa, Russia and the Black Sea.  The Turkish Ministry of
    Agriculture and Rural Affairs (MARA) has the lead for
    surveillance and containment of potential avian influenza
    cases, and has received good marks for its containment,
    culling, and quarantine procedures implemented in the one
    outbreak so far discovered in the Balikesir area, located
    near the Sea of Marmara in northwestern Turkey .  The
    Ministry of Health (MOH) coordinated with MARA on
    prophylaxis, surveillance, and treatment of workers.  The
    two agencies are working closely with private industry to
    implement regular controls and tracking for industry
    workers.   MARA has only one reference lab near Izmir and
    does not have capability to test for H5N1.

    ¶3.  (SBU) In a meeting on October 20, MOH official Yildirim
    Bayazit described a newly drafted national plan for a
    potential pandemic.  It was developed under close
    supervision with the WHO.  According to Beyazit, the plan
    provides for the following key elements:

    -Creation of a 70-member multi-agency (Health, Agriculture,
    Universities, Military, Pharmaceuticals, etc.) task force.
    In the event of a crisis, he said MOH would take the lead
    with the National Crisis Center which is under the Prime
    Ministry (per normal disaster assistance procedures).
    -Action plan for providing information to the public.
    -Action plan for provision and coordination of health
    services, including surveillance, protection, isolation,
    precautions, triage, anti-viral measures, and extraordinary
    measures, such as increasing hospital bed capacity and/or
    identifying special hospitals for isolation or care (and
    closing public institutions, etc.)

    ¶4.  (SBU) Comment: While the task force exists in draft on
    paper, it is not clear whether it has been approved more
    broadly within the Turkish government, let alone tested.
    Key spokespeople are not yet clearly designated.  MOH
    appears engaged, but admits that there are deficiencies and
    need for drills to hone the national plan.  MOH said it
    would welcome technical support, testing kits, training,
    and/or information sharing on surveillance and laboratory
    testing capacity.  The Turkey Emergency Management Agency
    has not been involved in the drafting of the MOH plan,
    indicating it may be more of a MOH, rather than, national
    plan.  (TEMA, under the Prime Ministry, would normally lead
    crisis management in Turkey.)  End Comment.

    Surveillance and Diagnosis:
    ---------------------------

    ¶5.  (SBU) MARA has first level responsibility for
    surveillance for AI outbreaks in animals.  While MARA has
    told the Embassy that it has implemented active
    surveillance; it is difficult to assess the quality of the
    surveillance.  (Are no new outbreaks discovered based on no
    new AI cases, or does it reflect inadequate surveillance?)
    The GOT has been quick to investigate and then dismiss false
    outbreaks elsewhere in the country (Ref A).  MOH also told
    Embassy that it is actively carrying out surveillance; it
    has two virology labs (Ankara National Influenza Center and
    Istanbul Medical School Viral Institute).  Both MARA and MOH
    have extensive regional networks, but their level of inter-
    agency coordination may be weak and/or untested.  Both
    agencies could use more laboratory and testing capacity, as
    well as testing kits.  There is no capacity to test for H5N1
    in Turkey.

    Communications:
    ---------------

    ¶6.  (SBU) Both MARA and MOH have identified communications
    and public awareness as a critical area.  Both have told
    Embassy that they are actively engaged in communicating with
    the public, farmers, and poultry workers on education,
    surveillance, and precautions.  The general public is very
    concerned about the threat of avian influenza and has a
    lingering distrust of the government.  Poultry consumption
    is sharply down and the industry is asking for government
    assistance.  Communications is a key aspect of MOH
    contingency planning.  In the event of a pandemic, MOH would
    distribute posters, brochures, and other materials.  MOH
    aims to establish a regular internet-based AI bulletin as of
    November 7.

    Response
    --------

    ¶7. (SBU) The GOT responded quickly to the Balikesir
    outbreak, establishing a 3 km quarantine zone and culling
    about 6000 birds (Refs).  Farmers were compensated for their
    birds and the GOT has announced increased funding for
    contingency compensation reserves.  In the event of multiple
    AI outbreaks the adequacy of the funds might be tested and
    the capacity of the MARA and MOH to respond and coordinate
    may be challenged.  The GOT has not employed wide animal
    vaccination as a containment measure, relying instead on
    surveillance.  The MOH has generated a national pandemic
    plan, but in the event of a public health crisis would
    likely not have adequate surge capacity.  The MOH aims to
    identify potential high risk groups and stockpile adequate
    masks, antivirals, and other medicines, including special
    protective equipment for health workers.  There are plans to
    work with the Red Crescent to increase hospital bed capacity
    and mobile units.  The GOT currently has 5,000 boxes of
    Tamiflu and has written a letter of intent to Roche to seek
    to acquire one million treatments.  WHO has announced
    support to Turkey, but the nature of this support has not
    been determined.

    Other Partners
    --------------

    ¶8.  (SBU) The GOT at first did not seek any foreign
    assistance after the AI outbreak.  Soon after, however, the
    GOT accepted an EU expert team to visit the outbreak site.
    The generally good marks given to the GOT for its
    containment are at least partly due to earlier cooperation
    with the EU on training and testing.  Part of the credit of
    the discovery of the outbreak was good awareness in the
    poultry industry.  The GOT has sought to work with private
    companies to improve surveillance capacity.  In many parts
    of the country, there are many smaller, less-organized
    family farms, where birds are kept outside, sometimes under
    limited control.   It is not clear whether the GOT has
    actively reached out to other NGO's or civil society, other
    than universities.  An MOH official attended the recent
    International AI and Pandemic Partnership meeting in
    Washington D.C.  MOH applied to the World Bank to receive
    funding for posters and brochures on AI under the WB's
    Health Transformation Project in Turkey.  MOH official
    Bayazit said the Ministry would be particularly interested
    in help from the USG and/or CDC for technical assistance to
    increase lab capacity, to procure more test kits, and to
    exchange and gain training, information, and experience.
    MCELDOWNEY

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