U.S. Government support to combat avian and pandemic influenza — South and Central Asia

South and Central Asia's first outbreak of the highly pathogenic avian influenza (HPAI ) H5N1 virus occurred in wild fowl and poultry in Kazakhstan in July 2005. Other outbreaks of HPAI H5N1 in poultry followed in early 2006 in Afghanistan, India and Pakistan.

Tens of thousands of birds have died or become infected, causing social and economic disruption with implications for the food supply as well as the incomes of business and individuals in the region. After initial precipitous drops, poultry consumption and poultry prices returned to previous levels. With assistance from the U.S. Department of Health and Human Services' Centers for Disease Control and Prevention (HHS/CDC), trained scientists in Almaty, Kazakhstan investigated and eventually ruled out a suspected human case of H5N1 in 2005. In February 2007, Afghanistan and Pakistan reported new outbreaks of HPAI H5N1 in poultry, and in the spring of 2007, reports of several outbreaks among poultry came from Bangladesh.

The United States combats HPAI H5N1 in South and Central Asian nations by working with governments and regional entities, and with international organizations such as the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE). Through the International Partnership on Avian and Pandemic Influenza, the United States works to elevate the issue on national agendas — and to coordinate efforts between affected nations in South and Central Asia and donors around the world.

To assist South and Central Asia in responding to avian influenza outbreaks and preparing for possible human pandemic influenza, the United States is supporting bilateral and regional programs.
As of June 2007, the United States had made country-specific contributions totaling $9.5 million to South and Central Asian nations and contributed $1.1 million in regional assistance programs.
The United States has provided funds for avian and pandemic influenza assistance in Afghanistan, Bangladesh, India, Kazakhstan, the Kyrgyz Republic, Nepal, Pakistan, Sri Lanka, Tajikistan, Turkmenistan and Uzbekistan.

The U.S. Agency for International Development (USAID), the U.S. Department of Agriculture (USDA), the U.S. Department of Health and Human Services (HHS) — including the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) — the U.S. Department of State (DOS) and the Broadcasting Board of Governors (BBG) contribute to the U.S. engagement in South and Central Asia. Their efforts have focused on strengthening preparedness and response planning, assisting with field investigations of suspected human H5N1 cases, building South and Central Asian capacity in human and animal health, strengthening laboratory diagnostics, providing training to experts, increasing public awareness and information, and enhancing disease surveillance and detection. The U.S. Department of Defense (DOD) also provides medical technical assistance and has purchased personal protective equipment (PPE) for combatant command use in military-to-military and international humanitarian assistance globally, and USAID has deployed nonpharmaceutical commodities, including PPE , for surveillance and emergency outbreak management throughout the region.

PREPAREDNESS AND COMMUNICATION
U.S. preparedness and communication assistance efforts to South and Central Asia include:
* Supporting preparedness and planning for avian and pandemic influenza response in Afghanistan, Bangladesh, India, Kazakhstan, the Kyrgyz Republic, Nepal, Pakistan, Sri Lanka, Tajikistan, Turkmenistan and Uzbekistan (USAID, HHS/CDC);
* Offering support for infectious disease research and outbreak control to India (HHS/CDC);
* Concluding a cooperative agreement with India to enhance influenza surveillance and capacity building, and working through the Global Avian Influenza Network for Surveillance (GAIN S) and other partners to strengthen surveillance in Afghanistan, Bangladesh, India, Kazakhstan, Nepal, Pakistan, Sri Lanka and Tajikistan (HHS/CDC, USAI D);
* Building, through WHO, regional capacity for avian influenza detection and control (HHS/CDC);
* Stationing HHS/CDC experts in Bangladesh and India to assist with outbreak response and offering advanced epidemiology training in Central Asia and India (HHS/CDC);
* Building awareness of avian influenza and prevention throughout the region through materials and other targeted communications activities (USAI D);
* Developing an avian influenza prevention and control training module and materials for officials in Bangladesh (USAID);
* Providing a workshop and training materials on avian influenza in India (HHS/CDC);
* Conducting avian influenza communications workshops and other communications activities in Bangladesh in collaboration with FAO , the United Nations Children's Fund (UNICEF), and the International Federation of Red Cross and Red Crescent Societies (USAID);
* Conducting avian influenza workshops for Afghani, Bangladeshi and Indian journalists (DOS and BBG with HHS/CDC, USDA, USAI D);
* Offering regional technical media workshops on pandemic influenza preparedness and human influenza infection and supporting risk communication training for public health officials from Bangladesh, Bhutan and Sri Lanka (HHS/CDC);
* Providing information through broadcasting and web pages in Dari, Hindi, Pashto and Urdu (BBG/USAID), Persian and Uzbek and other languages at www.voanews.com (BBG).

SURVEILLANCE AND DETECTION
To assist South and Central Asia in building capacity for surveillance and detection, the United States is:
* Providing real-time polymerase chain reaction (RT-PCR) testing equipment and technical assistance to Afghanistan's Ministry of Agriculture (DOD/U.S. Naval Medical Research Unit 3 in Cairo);
* Conducting avian influenza laboratory diagnostics workshops in Sri Lanka (USDA);
* Supporting the development of a national Disease Early Warning System in Afghanistan covering influenza and other severe acute respiratory illness and fourteen other reportable diseases (HHS/CDC);
* Providing funding to FAO for tabletop simulations on regional pandemic preparedness in Central Asia (USAID);
* Supporting regional coordination, technical exchange and strategy development for avian and pandemic influenza through WHO and FAO (USAID);
* Providing training in rapid response and laboratory testing in India, Kazakhstan, the Kyrgyz Republic, Tajikistan and Uzbekistan (USAID, HHS/CDC);
* Providing state-of-the-art diagnostic chemicals to the Ministry of Health and Family Welfare of India for detection of HPAI H5N1 (HHS/CDC);
* Assisting India to strengthen and develop laboratory capacity, including the use of RT -PCR techniques, at five regional centers (HHS/CDC);
* Developing and enhancing surveillance for seasonal and avian influenza in India through establishment of a network (HHS/CDC);
* Conducting workshops on surveillance, use of genetic databases and laboratory training (HHS/CDC);
* Conducting training in Kazakhstan on influenza surveillance systems for regional officials (HHS/CDC);
* Providing laboratory equipment for quick diagnosis of avian influenza to Pakistan, Tajikistan and Uzbekistan (USAID);
* Conducting training in avian influenza epidemiology, diagnostics and live bird markets for veterinary experts from Afghanistan, Bangladesh, India, Nepal and Pakistan (USDA);
* Providing regional training on influenza epidemiology, disease surveillance, and laboratory diagnostics for public health experts from Afghanistan, Bangladesh, India, Kazakhstan, the Krygyz Republic, Nepal, Pakistan, Sri Lanka, Tajikistan, Turkmenistan and Uzbekistan (HHS/CDC);
* Responding to requests from Bangladesh and Sri Lanka to hold USDA's National Veterinary Services Laboratories (NVSL) laboratory diagnostics training in those countries, based on requests from participants in 2006 NVSL laboratory training courses in Ames, Iowa (USDA); and
* Training 35 epidemiologists and laboratory scientists in Pakistan in surveillance and outbreak detection and response for influenza, avian influenza and other diseases (HHS/CDC).

RESPONSE AND CONTAINMENT
To help South and Central Asian nations respond to and contain avian and pandemic influenza outbreaks, the United States is taking the following actions:
* Strengthening human response capacity for avian and pandemic influenza in Afghanistan, India, Kazakhstan, Tajikistan and Uzbekistan (USAID);
* Sending 33,900 PPE kits and nine lab kits to six countries (Afghanistan, Bangladesh, India, Nepal, Sri Lanka and Pakistan) for detecting and responding to avian influenza outbreaks, and supporting training in use of PPE's and other equipment in Afghanistan, Bangladesh, Nepal and Pakistan (USAID);
* Providing training funds to establish mobile rapid response teams (RRT s) in India and Kazakhstan that can be deployed regionally (HHS/CDC);
* Educating trainers in Afghanistan, Bangladesh and Pakistan on proper use of PPE and lab kits (USAID);
* Supporting training of Indian trainers for RRT s and pandemic influenza preparedness, including training of outbreak investigation professionals in 30 states (HHS/CDC);
* Supporting regional training in rapid response for public health workers from Bangladesh, India, Maldives, Nepal, Pakistan and Sri Lanka, and country-level RRT training in Afghanistan (USAID);
* Providing technical assistance to India for avian influenza containment (HHS/CDC);
* Providing technical experts to assist Bangladesh with its 2007 poultry outbreaks, and providing technical and financial support to the FAO Crisis Management Center (CMC) for rapid response and capacity building in the region; and
* Deploying technical experts to Bangladesh, India and Nepal to strengthen response capacity and coordination with national and local-level officials (USDA, USAID).
The U.S. Government's official website on avian and pandemic influenza is www.pandemicflu.gov .