US embassy cable - 04HANOI2993

UNCLAS SECTION 01 OF 02 HANOI 002993 
 
SIPDIS 
 
CORRECTED COPY 
 
FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV 
BANGKOK FOR RMO, CDC (JTAPPERO), AID 
BEIJING FOR HHS (CSHAPIRO) 
STATE PASS HHS/OGHA ERIKA ELVANDER 
STATE PASS AMEMBASSY BANGKOK/JORDAN TAPPERO 
STATE PASS AMENBASSY BEIJING/ CRAIG SHAPIRO 
USDA FOR FAS/PASS TO APHIS 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, VM, AFLU 
SUBJECT:  AVIAN FLU, in Viet Nam, FALL 2004 (AI) 
 
REFS: A) HANOI 2973  B) HCMC 1258 
 
1. (U) Summary.  Poultry flocks in South East Asia, continue 
to be infected with highly pathogenic Avian Influenza A 
Subtype H5N1 (AI) with sporadic reports of human fatalities 
both in Vietnam and Thailand. As the weather cools and the 
humidity drops, the viability of the influenza virus 
improves, such that the virus may remain active in the 
environment for a longer period of time.  Therefore, there 
is still a threat for a severe outbreak of AI among poultry. 
In addition, as long as people are in contact with live 
poultry, some of which may have an unapparent AI infection, 
the chance of human cases of AI remains of concern. 
Avoidance of poultry markets, good hand-washing practices, 
kitchen sanitation and thorough cooking of poultry and eggs 
are common sense practices to follow. End Summary. 
 
2.  (U) In Vietnam, and likely most of Southeast Asia, 
highly pathogenic AI, subtype H5N1 is endemic and is 
circulating in the native and domesticated bird populations. 
In many of the domesticated poultry populations, 
particularly chickens, AI causes severe illness and death. 
It is highly transmissible in flocks through the respiratory 
tract via droplets or feces.  Ducks appear not to have overt 
symptoms, but are capable of shedding high virus loads 
through feces.  Highly pathogenic viruses can survive for 
long periods in the environment, especially when 
temperatures and humidity are lower. 
 
3. (U) The Ministry Of Agriculture and Rural Development 
continues to report destruction of poultry attributed to AI 
infection throughout Vietnam. The majority of the 
destruction is occurring in the southern provinces, although 
there are reports from provinces in the north and in the 
middle of the country. 
 
4. (SBU) Recently, there have been public disagreements 
between local media reports and GVN officials.  Several 
reports indicate fresh flare-ups of AI in southern Vietnam 
but the GVN refuted the reports.  This is unusual for a 
country that has a controlled press.  It indicates there is 
uncertainty as well as unanswered questions concerning the 
occurrence of AI infection. Reftel reports on the disease's 
effects on the poultry market. 
 
5.  (U) Since December 2003, Vietnam has reported 27 
confirmed human cases of AI.  Twenty have died. Twenty-three 
cases occurred between December 2003 and March 2004. All of 
the cases were under the age of 30, and approximately 
equally divided between males and females. 
 
6. (U) Seroprevalence studies of the general population for 
antibodies to subtype H5N1 have not been conducted in 
Vietnam. Therefore, it is not known how many individuals 
have been infected but whose condition did not become severe 
enough to be hospitalized, or, if hospitalized, were not 
recognized as AI. Such studies, while important, may not be 
feasible in Vietnam given limited laboratory capacity to 
handle large numbers of samples. 
 
7. (SBU) Evidence suggests very limited human-to-human 
transmission of AI. Public health professionals suspect 
transmission may be occurring only through close, sustained 
contact with an infected individual.  Two of five confirmed 
family clusters suggest that transmission occurred not from 
exposure to infected birds but, most likely, to an infected 
individual. However, studies of health care workers who 
cared for confirmed AI hospitalized cases suggest no 
infection of the health care workers occurred. Thus, 
statements recorded in the press, as `no evidence of human 
to human transmission' should be regarded as optimistic, not 
factual. 
 
8. (SBU) According to scientists from the Influenza Branch 
at the U.S. Centers for Disease Control and Prevention 
(CDC), samples received from the Ministry of Health through 
summer 2004 indicated that the AI viruses analyzed are 
similar to each other and have not yet reassorted or mutated 
to a more transmissible form for humans. However, this does 
not mean that ressortment at a future date will not happen, 
Therefore, it is very important for the international 
scientific community to have access to additional influenza 
viruses from Vietnam as they are isolated from humans and 
birds. 
 
9.  (SBU) Although the World Health Organization (WHO) 
reports that most suspected human cases of AI are reported 
to WHO, there appears to be some delay between suspicion of 
a diagnosis and confirmation and release of the 
confirmation.  WHO reports that diagnostic capacity of 
health care providers is limited to Hanoi and Ho Chi Minh 
City and there is no systematic laboratory confirmation of 
suspected cases at the National Institute for Hygiene and 
Epidemiology (NIHE) in Hanoi or the Pasteur Institute in Ho 
Chi Minh City.  This limited capacity and lack of 
standardized diagnostic and laboratory confirmation 
seriously discount the value of the available information to 
increasing the understanding of the breadth and depth of 
human AI infections in Vietnam. 
 
10. (U) The CDC continues to caution travelers to avoid 
visiting poultry farms and poultry markets, eat only well- 
cooked poultry and eggs, and to avoid touching surfaces that 
may have been contaminated by uncooked or live poultry. 
Good public health practice also advises regular hand 
washing with soap and water or alcohol-based hand washes. 
 
11. (U) In summary, as the weather cools and the humidity 
drops in the northern provinces of Vietnam, the viability of 
the AI virus improves, such that the virus may remain active 
in the environment for a longer period of time.  As a 
result, there is still a threat for a severe outbreak of AI 
among poultry.  In addition, as long as people are in close 
contact with live poultry, some of which may be inapparently 
infected with AI, the chance of human cases of AI remains of 
concern. 
 
MARINE