US embassy cable - 04HANOI334

H5N1 AVIAN FLU RESPONSE

Identifier: 04HANOI334
Wikileaks: View 04HANOI334 at Wikileaks.org
Origin: Embassy Hanoi
Created: 2004-02-08 23:31:00
Classification: UNCLASSIFIED
Tags: TBIO ECON EAID KHIV AMED VM AFLU
Redacted: This cable was not redacted by Wikileaks.
This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 04 HANOI 000334 
 
SIPDIS 
 
STATE FOR OES/IHA SARA ALLINDER MESTRE 
STATE PASS HHS OFFICE OF GLOBAL AFFAIRS E ELVANDER 
 
E.O. 12958: N/A 
TAGS: TBIO, ECON, EAID, KHIV, AMED, VM, AFLU 
SUBJECT: H5N1 AVIAN FLU RESPONSE 
 
REF: State 23762 
 
1.   Following are post's responses to questions posed in 
Reftel. 
 
I. Yes, there is active animal surveillance in Vietnam. 
 
A.   Ministry of Agriculture Contact: 
Dr. Bui Quang Anh 
Director General 
Department of Animal Health (MARD/DAH) 
Ministry of Agriculture and Rural Development (MARD) 
No. 15 Ngo 78, Giai Phong Street 
Phuong Mai, Dong Da 
Hanoi, Vietnam 
Office Tel:  (84-4) 868-5460 / 869-5691 
Fax: (84-4) 869-1311 
 
B. Where are Samples Tested? 
 
Hanoi - Main Site 
 
MARD / DAH - National Center for Veterinary Diagnosis 
Dr. Phuong Song Lien, Director 
(co-located with MARD/DAH in Phuong Mai, Dong Da) 
Tel: (84-4) 868-5202 
Fax: (84-4) 868-6813 
 
C.   Is Lab capacity sufficient? 
Two CDC lab specialists are working with Dr. Lien and feel 
that lab staff are competent and are working towards 
securing needed supplies and equipment. 
 
D.   Are results being communicated? 
Lab results are shared daily with national officials and the 
provincial officials where the samples originated and CDC 
advisors are documenting results as needed for the WHO team. 
 
II.  Culling has been ordered, but it is unclear if 
sufficient culling is being done to control the outbreak. 
 
III. Legal Measures to Control Movement 
 
Under Vietnam's Ordinance on Animal Health (15-Feb-1993) the 
MARD/DAH is granted special authority to address animal 
disease outbreaks.  In Chapter II, Article 12, MARD/DAH is 
given authority to control the movement of animals and 
animal products within and between regions. 
 
    On 8-Jan-2004, MARD/DAH issued Guideline #29, using the 
authority granted under the Ordinance on Animal Health, to 
start addressing the avian influenza outbreak.  In this 
Guideline (official instructions to all involved parties), 
MARD/DAH describes the disease and the general ways the 
disease might spread and ordered central and provincial 
veterinarians to start monitoring the poultry sector.  It 
also bans the movement of poultry into or out of infected 
areas, and described measures that poultry farmers should 
take when they suspect there might be a problem (report the 
problem to local officials, isolate any infected chickens, 
culling and destruction methods, including burning or 
burying all dead chickens).  Finally, the Guideline suggests 
additional steps provincial vet officials should take to 
prevent poultry to human transmission of the disease, 
including measures to protect their own health while 
inspecting farms. 
 
    Additional measures were outlined in MARD/DAH Guideline #104 
issued on 31-Jan-2004.  All movement of poultry was 
suspended (within regions of Vietnam, as well as trade 
to/from Vietnam and other countries), poultry culling was 
ordered within a 3 km radius around any infected flock, and 
all poultry processing (including egg movement and sales) 
was prohibited. 
 
    IV.  Vaccine - Vaccine has been discussed at length but is 
not currently being used. 
 
V. Animal Demographics 
 
Roughly, 60-70 percent of Vietnam's population (80 million) 
is associated with rural agricultural activities.  The 
majority of Vietnamese farmers raise chickens, ducks, and 
pigs.  Smallholder livestock operations are found all over 
the country, but larger more-commercial operations are 
concentrated in the provinces near Hanoi and Ho Chi Minh 
City.  Smallholder farmers generally raise livestock (dairy 
cows, pigs and poultry) in close proximity to their own 
homes. 
 
Estimated Livestock Population - 2003 
Cattle                        4,394,000 
Water Buffalo                 2,835,000 
Pigs                         25,461,000 
Chicken                     185,000,000 
Ducks                        69,000,000 
Source: General Statistic Office and MARD 
 
Vietnam's chicken sector includes small-farmer (back-yard) 
raised chicken and `industrial'  (larger commercial-sized) 
chicken operations.  The industrial chicken flocks account 
for around 35% of the total chicken population.  Foreign- 
invested companies including Japfa Comfeed (Indonesia), CP 
Vietnam (Thailand) and Cargill (USA) supply more than 80% of 
the baby industrial chicks. 
 
Poultry is grown all over the country, but there are 
concentrations in the Red River Delta (RRD, in northern 
Vietnam) with about 26 percent of the total poultry 
population, the Mekong River Delta, stretching south from 
HCMC (with 21 percent of the poultry population), and then 
in various provinces in the northeast and southeast coastal 
areas.  Hay Tay province in the RRD and Dong Nai province in 
the southeast have the biggest poultry stocks with more than 
8 million in each province. 
 
There are about 2,260 (small, but still commercial-oriented) 
poultry farms operating in Vietnam with an average of 1,000- 
1,400 chickens per farm. For example, there are about 797 
poultry farms in Ha Tay (RRD), 281 farms in Dong Nai and 208 
farms in Binh Duong (southeast region).  Many of the larger 
poultry farms are operating under various financial and 
processing arrangements with foreign invested companies 
including CP-Vietnam (Thailand) and Japfa Comfeed 
(Indonesia). 
 
V. Surveillance for influenza-like illness in humans. 
 
Active surveillance is in place and routinely conducted at 
hospitals in urban settings including Hanoi and HCMC 
(described in more depth below).  There is concern that in 
more rural or remote provinces surveillance may not be done 
as routinely or effectively as is observed in more urban 
settings.  The extensive, ongoing local media coverage about 
the problem will likely aid surveillance greatly in rural 
areas where medical or public health staffing may be more 
limited. 
 
A. Have health care providers been alerted? 
 
Due to extensive media attention nation-wide, hospitals and 
physicians are very aware of the AI problem.  Many patients 
customarily seek initial care at large hospitals in cities 
or provinces.  In Hanoi and HCMC the WHO investigative teams 
have worked closely with staff at these locations, checking 
new admissions daily for patients with symptoms or 
conditions suggestive of influenza.  Specimens are routinely 
collected following admission by hospital staff and sent for 
laboratory testing.   Charts are reviewed and more extensive 
patient histories, including poultry exposure, are taken by 
WHO teams within a day or two of admission. 
 
B. Are hospital infection control practices in place? 
 
Yes.  Standard, accepted procedures are in place for the 
isolation of suspect cases in large hospitals.  It is not 
clear that such procedures are fully employed at smaller 
facilities in the countryside. 
 
C. Are samples taken from suspect human cases?  Contact with 
birds tracked? 
 
Specimens are regularly taken at the time of admission and 
sent to the National Institute of Hygiene and Epidemiology 
laboratory.  Histories are taken by WHO teams using a 
standardized form that is focused on poultry exposure and 
related activities; the information is later transferred to 
a master database. 
 
D. Estimated number of human cases: 
 
Suspect cases are usually listed initially as "possible" 
(based on initial positive rapid test for influenza A 
without type specific test results) or "pending" (based on 
suspicious clinical symptoms) and as more information and 
test results become available are moved into the confirmed 
category or eliminated altogether.  Currently, there are 13 
confirmed cases; approximately 60 possible or pending cases; 
several per day might be dropped from the AI-related suspect 
list. 
 
E. Laboratory surveillance done? 
Laboratory surveillance has not been conducted to date, but 
it has been discussed for selected cities with capable 
hospital facilities and in conjunction with large poultry 
populations. 
 
F. Laboratory capacity sufficient? 
 
CDC laboratory experts have been working with laboratory 
staff in Hanoi and in HCMC to provide training in proper 
procedures and techniques, and to assure that required 
equipment is in place and operational.  CDC staff in-country 
believe that these goals have been achieved and that the 
local staffs nationals are competent and capable of meeting 
laboratory demands.  The labs are, however, in need of 
certain supplies and equipment that has been inventoried and 
listed in detail.  Initial arrangements have been made to 
locate and procure these goods to be shipped in the near 
future. 
 
F. Results communicated to national offices/ministries? 
 
CDC staff members have worked hand-in-hand with laboratories 
for the past 3-4 weeks and believe that adequate systems are 
in place to report specimen results to those with a need to 
know.  Although there may have been some delays in 
announcing official numbers of confirmed cases publicly, 
there are no indications that results or reports have been 
unduly delayed intentionally. 
 
I.   Communications policies and practices from government 
officials, public and international community?  Lead agency? 
 
The WHO, with support from the FAO, has taken a strong lead 
in Vietnam in organizing a response to the AI outbreak and 
in maintaining relations with the government on management 
and reporting of the outbreak.  They have met regularly and 
openly with GVN officials, foreign embassies in Hanoi and 
consulates in HCMC, and with both local and international 
media representatives.  Articles are regularly featured on 
the front page of the Viet Nam News, the leading English 
language newspaper.  WHO officials have been interviewed and 
are seen regularly on local television, as well as CNN.  The 
WHO Working Group is in the process of developing an 
informational video to be widely distributed, a brief 
informational pamphlet for the general public, and a 
newsletter targeting veterinarians and commune leaders. 
Reports of increasing government interest and involvement 
are noted daily. 
 
VIII. (NO #8) 
 
IX.  Experts needed? 
 
CDC has played a major role in providing epidemiology and 
laboratory expertise to the WHO Working Group.  Several of 
the advisors are still in country and are intimately 
involved with the ongoing response to the outbreak.  Both 
the Ministries of Health and Ministries of Agriculture have 
been approached and asked about additional experts and have 
indicated their thanks but that additional experts are not 
currently required.  The WHO office in Hanoi has coordinated 
personnel requirements and replacements and appears to have 
adequate staffing at this time.  A negative response was 
given to a similar query on staffing in a WHO recent 
meeting.  They have, however, made numerous requests for 
donations of funds, not equipment, in open meetings in the 
past two weeks. 
 
GVN Response: The GVN was slow at the beginning to realize 
the serious nature of the outbreak and the potential 
transmission to humans.  There are also some weaknesses in 
follow through at the local level.  On the other hand, the 
GVN did notify the OIE in early January that they had Avian 
Influenza and was the first country to do so.  Ministries 
have worked well together and have cooperated well with 
international organizations and advisors from various 
countries.  They have acted on the advice received. 
 
Assistance Requests:  The GVN requested lab specialists, and 
CDC has supplied two for two weeks to understand the 
techniques required to test for the H5 virus.  The GVN also 
requested PPE, and OFDA/USAID this week provided 300 sets to 
the GVN.  In addition OFDA/USAID provided $250,000 as a 
regional donation to WHO regional office in Manila to 
address Avian influenza throughout Southeast Asia.  The top 
priorities continue to be protective clothing (PPE) and the 
eventual restocking of Vietnam's poultry farms.  In a 
briefing for Ambassadors in Hanoi on February 5, a GVN 
spokesperson highlighted the need for diagnostic equipment 
for the Department of Animal Health, experts to train 
Vietnamese veterinarians, PPE, and medication for human 
cases.  As for future needs, he mentioned help to restore 
the poultry flocks, and particularly noted that the GVN will 
seek international cooperation to improve the agricultural 
sector and change current practices into more sustainable 
ones.  About ten days ago, Resident WHO Representative 
Pascale Brudon circulated a letter to donors listing over 20 
items.  (Post will fax the list to DOS/EAP/BCLTV.) 
 
Warden Messages:  Yes, both the Embassy in Hanoi and ConGen 
in HCMC are issuing warden messages.  End response. 
BURGHARDT 

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