US embassy cable - 04HANOI178

UNCLAS SECTION 01 OF 02 HANOI 000178 
 
SIPDIS 
 
SENSITIVE 
 
FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV 
BANGKOK FOR RMO, CDC 
STATE PASS HHS 
USDA FOR FAS/PASS TO APHIS 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, TBIO, VM, AFLU 
SUBJECT:  VIETNAM  - AVIAN FLU UPDATE #1 
 
 
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SUMMARY 
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1.  (U) There are currently 48 human cases including 18 
deaths under investigation in Vietnam's avian influenza 
outbreak.  The work of the WHO/CDC team was delayed due to 
the Tet (Lunar New Year) holidays, but preliminary 
exploration of the extent of the outbreak has begun, and 
support for their efforts is expected to increase as the 
holidays come to a close. The team's major concerns at this 
point are to control the outbreak in poultry and identify 
and implement measures to protect the public.  To accomplish 
this, the team aims to determine the extent of H5 infection 
in humans, identify the mechanisms of transmission, explore 
any evidence of human-to-human spread, and improve 
laboratory capacity to identify H5N1 influenza virus.  End 
summary. 
 
 
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CURRENT STATUS 
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2.  (U) A six-person team of experts from the Centers for 
Disease Control and Prevention (CDC) arrived in Vietnam on 
January 19th at the invitation of the GVN to support World 
Health Organization (WHO) activities related to the avian 
influenza outbreak in Vietnam.  As of the morning of January 
26th, there are 48 human cases and 18 deaths under 
investigation.  Of these, laboratory tests have confirmed 
the presence of the H5N1 virus in 7 cases (6 deaths and 1 
presently hospitalized in HCM city). The two most recent 
cases are in children in HCMC. Due to limited epidemiologic 
surveillance, it seems likely that there are more cases in 
country that have not yet been identified. 
 
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WHO/CDC ACTIVITIES 
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3.  (U) The Tet holidays delayed many of the efforts of the 
WHO/CDC team over the past week.  Only a skeleton staff in 
the GVN laboratory was made available to the team during the 
past week. Tet holidays and related closure of government 
facilities have also delayed the completion of confirmatory 
diagnostic laboratory testing in Hong Kong. The WHO/CDC team 
requested two visits to affected poultry farms. The CDC 
scientists traveled to one affected poultry farm in a 
province just outside of Hanoi on Jan 25. This farm had seen 
the loss of more than 90% of its ducks and chickens in the 
preceding 10 days. Tests conducted by these scientists have 
confirmed avian influenza as the cause of this outbreak. The 
visit to the second farm was cancelled at the last minute 
with no explanation. Tet ends on January 26, and WHO/CDC 
anticipate much greater cooperation and support to begin in 
the next few days. 
 
4.  (U) The closure of the Customs office over Tet also 
resulted in delays in access to a supply of Personal 
Protective Equipment (PPE) a warehouse in the port in Hai 
Phong. This PPE had originally been ordered in preparation 
for the possible return of SARS, but is now needed by those 
culling infected poultry.  WHO/CDC anticipates the clearance 
of that shipment later this week, and further shipments will 
arrive and be cleared over the next couple of weeks. 
 
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CURRENT CONCERNS 
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5.  (U) A number of significant concerns at this time 
revolve around the culling of poultry.  First, is large- 
scale culling even being performed?  Figures released last 
week by the GVN group poultry deaths due to culling and to 
avian influenza in one category.  It is therefore unclear 
how many birds have actually been culled.  The figures 
indicate that of the approximately 254 million domestic 
poultry in Vietnam, about 2 million have died.  Given the 
mortality rates among poultry and the spread of the disease, 
it is likely that the majority of those 2 million deaths 
were due to disease and not culling.  There are indications 
that culling efforts are more aggressive in southern 
Vietnam, but these efforts do not appear to be sufficient in 
proportion to the outbreak.  Secondly, are those performing 
the culling using adequate protection?  The Ministry of 
Agriculture indicates that there are at least six thousand 
workers involved in the culling and disposal of deceased 
poultry. It is safe to say that the majority of these 
workers have not been provided adequate protective equipment 
to reduce the risk of infection.  The existence of numerous 
small, non-commercial farms in rural areas poses a further 
challenge to culling efforts. The USDA US Animal and Plant 
Health Inspection Service (US APHIS) is providing technical 
consultation to advise on proper culling procedures.  A USDA 
expert may be asked to join the team in coming days. 
 
6.  (U) Incentives to cull are also inadequate.  While the 
market rate for a healthy chicken is 40,000 VND (USD 2.58), 
farmers are being compensated only 5,000 VND (USD 0.33) for 
deceased birds, and 15,000 VND (USD 0.97) for living birds 
surrendered for culling.  Given the low level of 
compensation, there is incentive for many farmers to sell 
off living chickens and/or wait to see if some of their 
birds survive the infection. The UN's Food and Agriculture 
Organization will contribute $400,000 USD in financial 
assistance, some of which will be used to provide increased 
incentives for farmers to surrender poultry for culling. 
 
7.  (U) Human-to-human transmission remains a major concern. 
While human-to-human transmission is not confirmed in any of 
the 48 cases currently under investigation, CDC and WHO 
experts believe such transmission between close contacts 
(e.g. family members) is likely to happen in the future if 
it has not already.  Of concern is whether transmission of 
the avian influenza virus may become possible through casual 
contact.  According to WHO/CDC, this worst-case scenario is 
what epidemiologists call "sustained community 
transmission", meaning that the disease is spread 
extensively through casual contact.  The result would most 
likely be an global influenza epidemic (pandemic). 
 
8.  (U) Finally, laboratory services to confirm cases 
currently under investigation are limited in Vietnam. The 
National Institute for Hygiene and Epidemiology (NIHE) and 
the National Center for Veterinary Diagnostics (NCVD) are 
inadequately prepared to perform the number and types of 
complex testing required in both livestock and humans in 
order to appropriately study and advise on containment of 
this outbreak. The WHO/CDC team is trying to improve this 
situation. 
 
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REGIONAL COOPERATION 
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9.  (U) As the outbreak continues to spread in Vietnam and 
across Eastern and Southeastern Asia, regional cooperation 
becomes essential.  Officials in Vietnam hope that the 
January 28, ministerial level meeting of ASEAN + 3 
countries, plus the US and EU, in Bangkok will bolster 
cooperation.  We understand that efforts are underway in 
Thailand to arrange a technical expert-level meeting to 
follow the ministerial level talks. 
BURGHARDT