US embassy cable - 04HANOI302

UNCLAS SECTION 01 OF 03 HANOI 000302 
 
SIPDIS 
 
SENSITIVE BUT UNCLASSIFIED 
 
FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV 
BANGKOK FOR RMO, CDC, AID (TDOLAN) 
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 #5 
 
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CURRENT STATUS 
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1.  (U) The number of suspected cases of avian influenza in 
humans in Vietnam continues to increase.  10 have now been 
confirmed as H5N1 in the laboratory.  (Yesterday, we 
mistakenly reported a total of 12.)  The number of affected 
provinces has further increased to 52 out of a total of 64 
provinces.  According to the FAO here, approximately 8 
million birds have been "culled", representing 3.2 percent 
of the chickens in Vietnam.  It is unclear if this figure 
represents true culling, or just disposal of birds that have 
died.  WHO has appealed again for urgent donor assistance in 
the form of protective suits and equipment to carry out 
increased culling. 
 
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WHO/FAO BRIEFING FOR AMBASSADORS 
-------------------------------- 
 
2.  (U) At the EU's invitation, the WHO and FAO gave a 
briefing for Ambassadors on February 3.  The briefing began 
with a technical presentation by Dr. Peter Horby of the WHO, 
who described the general characteristics of human and avian 
influenza. 
 
3.  (U) Looking more specifically at Vietnam's outbreak, Dr. 
Horby showed a chart of the affected provinces.  The 
outbreak appeared to be concentrated in the northern and 
southern provinces, with only a few central provinces 
reporting cases.  (We may actually be seeing a lack of 
reporting rather than a lack of cases in the central 
provinces.)  Horby pointed out a number of other anomalies 
in this outbreak that are puzzling scientists.  There are 
many more cases among children.  The disease appears to have 
high rates of fatality in Vietnam.  Finally, none of the 
1000 Vietnamese doing the chicken culling has gotten sick 
even though most are not wearing PPE. 
 
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WHAT TO DO? 
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4.  (U)  WHO recommendations:  Dr. Horby then focused on 
next steps in Vietnam.  WHO said that it would concentrate 
efforts on:  containing the outbreak in animals (through 
surveillance, culling, quarantine, and restricted movement 
of poultry); protecting people (through education, PPE for 
cullers, infection control in hospitals, and early 
diagnosis); improving early detection of human cases 
(through improving laboratory capacities and capabilities); 
characterizing the structure of the virus (to help examine 
possibilities for human-to-human spread and the development 
of vaccine); and development of a vaccine. 
 
5.  (U) WHO recommendations to individuals:  As for current 
advice to individuals in Vietnam, Horby's advice was the 
same that has been available through WHO, CDC, and MED - 
avoid high-risk areas, practice good hygiene, etc.  Horby 
did reiterate that for now WHO recommends no travel 
restrictions.  He reiterated that Tamiflu is useful in early 
treatment, and has usefulness as prophylaxis.  A vaccine 
particular to the H5N1 strain of avian influenza is likely 6- 
8 months from development of even a limited supply. 
 
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WHO Urges More Activism by GVN 
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6.  (U) WHO/FAO activities:  WHO and FAO have been 
encouraging the GVN to take a more aggressive approach to 
control infection in birds (through more aggressive culling) 
and to detect human cases (through improved surveillance). 
WHO Vietnam Director Pascale Brudon told the Ambassadors, 
"We should all continue to push the Government of Vietnam to 
act because more needs to be done."  Vietnam has now 
established a GVN working group, and WHO has encouraged 
Deputy Prime Minister Pham Gia Khiem to chair it himself. 
 
7.  (U) WHO and FAO are developing training programs for 
cullers and educational materials for provincial level 
veterinary officials and farmers.  FAO Vietnam 
representative Anton Rychener informed the Ambassadors that 
FAO had just provided a grant of $400,000 for training 
support in Vietnam.  WHO has been working to increase the 
capacity and capabilities of laboratories in Vietnam. 
Finally, at the GVN request, additional WHO clinicians will 
arrive shortly to assist with case management.  Both WHO and 
FAO continued the appeal for additional PPE. 
 
8.  (U) In answering questions about the spread of the 
disease from province-to-province, both Rychener and Brudon 
stated that, while the GVN has ordered the suspension of all 
movement of poultry, the fact remains that enforcement is 
not taking place effectively, and poultry is being 
transported from city to city and province to province. 
 
9.  (U) WHO addressed the question of human-to-human 
transmission by stressing that we will probably never be 
able to confirm the method of transmission in the well- 
publicized Vietnamese cases in Thai Binh.  Human-to-human 
transmission remains one of a number of possibilities. 
Brudon said that WHO expects to see limited human-to-human 
transmission within families for sure, but that this does 
not necessarily mean there will be a community spread or 
pandemic. 
 
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FAO COMMENTS 
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10.  (SBU) In response to questions, FOA's Rychener was 
clearly pessimistic.  He stated that the avian flu outbreak 
here "has brutally uncovered the inefficiency of the 
Agriculture Extension Service in Vietnam," which he said 
lacks motivation, funding, and transportation.  Personnel in 
the Extension Service are not willing or empowered to take 
personal initiative or make decisions.  The poor state of 
affairs at the Ag Service, he observed, makes it difficult 
for the GVN to deal with the current threat quickly or 
effectively. 
 
11.  (U) WHO tempered the FAO comments.  While agreeing that 
the problem will not go away soon and that "today there is a 
vacuum in what needs to be done", Brudon stated that the 
Government of Vietnam is moving forward in developing a 
strategy, but added that it needs to do so more quickly. 
 
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DONOR COORDINATION 
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12.  (U) The Japanese Embassy representative raised the 
question of coordination among donors.  WHO acknowledged the 
need for greater coordination of donations and promised to 
work with the World Bank to develop an effective way to 
coordinate donor assistance.  Brudon did encourage those 
donating equipment to work directly with the GVN, and to 
simply keep WHO informed. 
 
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SEPARATE MEETING WITH HCMC DEPARTMENT OF HEALTH 
--------------------------------------------- -- 
 
13.  (U)  IN HO CHI MINH CITY, THREE REPRESENTATIVES OF THE 
CONSULAR CORPS (FRENCH, CHINESE, AND U.S.) RECEIVED A 
BRIEFING FROM DR. NGUYEN THE DUNG, DIRECTOR OF THE HCMC 
DEPARTMENT OF HEALTH.  DR. DUNG STRESSED THAT THERE WAS 
STILL NO CONFIRMED CASE OF HUMAN-TO-HUMAN TRANSMISSION. 
HCMC MEDICAL PERSONNEL CONTINUED TO MONITOR VETERINARIANS, 
FARM WORKERS, AND FAMILY MEMBERS WHO ARE INVOLVED IN CULLING 
POULTRY.  THEY ARE ALSO MONITORING THE FAMILIES OF ALL THE 
SUSPECTED AVIAN FLU PATIENTS.  THE INSTITUTE OF TROPICAL 
MEDICINE, CHO RAY HOSPITAL, AND PEDIATRIC HOSPITALS #1 AND 
#2 HAVE BEEN DESIGNATED AS RECEIVING HOSPITALS FOR SUSPECTED 
AVIAN FLU PATIENTS. 
14.  (U) Dr. Dung said it was the city's policy to cull/kill 
all poultry, whether sick or healthy.  But as a matter of 
practicality, HCMC authorities have focused on large chicken 
farms first, so Dr. Dung emphasized that the percentages and 
numbers we see about how many chickens have been culled 
refers only to the percentage of those on large chicken 
farms.  He acknowledged that the city could not control 
small family holdings or pet birds.  Pet bird sales have 
been prohibited by the city, but police authority varies 
from district to district, so there is no consistent 
enforcement of the ban, nor of culling small family chicken 
holdings.  He passed out a Vietnamese public information 
flyer which states: "Don't eat them.  Don't raise them. 
Don't transport them." 
 
15.  (U) As for provincial coordination, Dr. Dung said there 
was a meeting with the Ministry of Health scheduled for 
tomorrow, where it was expected all provinces and cities 
would be instructed to coordinate their actions.  He 
acknowledged there were different attitudes among the 
provinces, but they had to wait for a directive from the 
central government before initiating cooperation.  Even HCMC 
was not coordinating its culling and public health 
information with its neighboring provinces.  (Post Note: 
HCMC and the three surrounding provinces of Binh Duong, Dong 
Nai, and Ba Ria-Vung Tau are host to many American and 
foreign-invested factories, and the work populations of 
these provinces travel back and forth daily.) 
BURGHARDT