US embassy cable - 05HANOI467

UNCLAS SECTION 01 OF 03 HANOI 000467 
 
SIPDIS 
 
FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV; OES/STC (M.GOLDBERG); 
OES/IHA (D.SINGER AND N.COMELLA) 
BANGKOK FOR RMO, CDC 
STATE PASS HHS 
USDA FOR FAS/PASS TO APHIS 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, TBIO, VM, AFLU 
SUBJECT: VIETNAM  - AVIAN FLU: SITUATION REPORT 
 
REF: Hanoi 316 
 
Summary 
------- 
 
1.  The outbreak of Avian Influenza, subtype H5N1, in 
Vietnam resulted in approximately 1 million dead or 
destroyed ducks and chickens, and 13 cases in humans.  Human- 
to-human transmission has been confirmed in one very close 
family contact situation (i.e., from an infected individual 
to the primary caregiver in the family), but there currently 
have been no confirmed or suspected cases of second or third 
generation spread, or spread in casual contact situations. 
The Government of Vietnam (GVN) now seems to recognize that 
this will be a recurring problem if eradication and 
prevention measures are not taken seriously.  The GVN is 
working with the international community to develop both a 
short-term emergency response strategy, and a long-term 
prevention and eradication strategy.  Embassy Hanoi has 
assembled an Avian Influenza Working Group (AIWG) that 
coordinates with the Consulate General in Ho Chi Minh City. 
The AIWG is developing tripwires for use if the situation 
worsens and has made recommendations for preparedness and 
prevention within the Embassy community. 
 
Case Count/Statistics 
--------------------- 
 
2.  The Ministry of Agriculture and Rural Development (MARD) 
reports that this is the second of two outbreaks - the first 
began in December 2003 with peaks in December and around the 
Vietnamese Lunar New Year holiday and dwindled to a small 
number of sporadic cases in March and April 2004.  During 
the first outbreak, the Government of Vietnam destroyed more 
than 43 million birds (30 million chickens and 13 million 
ducks).   The second outbreak officially began in April 
2004, is following the same timing in terms of peaks in 
December and around the Lunar New Year, and seems to be 
infecting smaller numbers of poultry.  Both outbreaks have 
been centered in the Mekong and Red River Deltas where 
conditions are more conducive to the spread of the virus. 
 
3. In Fowl:  According to the Ministry of Agriculture and 
Rural Development, as of February 22, 2005, there have been 
approximately 750 reports of avian influenza in flocks in 35 
provinces (last year's outbreak occurred in 57 provinces). 
The Vietnamese Department of Animal Health reported that as 
of February 21, no new cases of avian influenza were 
recorded in 12 of these provinces during the first two weeks 
of February.  Since the start of this second outbreak, 1.2 
million poultry have been culled, substantially less than 
the same period last year. 
 
4. In Humans:  As of February 22, 2005, there have been 13 
reported cases of avian influenza in humans since December 
2004.  Of the 13 reported cases, 12 have resulted in death. 
Since the report of the first case in 2003, the fatality 
rate is approximately 75%, but this may be misleading. The 
World Health Organization (WHO) officials note that some of 
these fatalities may have been avoidable with earlier 
detection or more advanced medical care. It is unknown how 
many cases have gone undetected, undiagnosed, or unreported. 
 
5. While human-to-human transmission has been confirmed in 
one very close family contact situation (i.e., from an 
infected individual to the primary caregiver in the family), 
there currently have been no confirmed or suspected cases of 
second or third generation spread, or spread in casual 
contact situations. 
 
6.  Recently, the media has reported on two deaths from 
encephalitis in which the individuals had no respiratory 
symptoms, but later tested positive for the H5N1 virus. 
When asked about these cases, the Preventive Medicine 
Department of the Ministry of Health (MOH) reported that 
they did not know of this research and have no comment. 
 
GVN Response 
------------ 
 
7. To date, the GVN has been more transparent regarding its 
handling of the outbreak than in the past. The GVN has 
analyzed the problem, recognized its limitations, requested 
assistance, and considered both short-term and long-term 
solutions regarding outbreaks in animals.  Recently, the GVN 
seems to have recognized that this is a problem that will 
recur regularly if prevention and eradication measures are 
not thorough. 
 
8. A number of informational briefings have been held for 
the diplomatic and `donor' communities.  On February 3, 
2005, WHO and the Food and Agriculture Organization of the 
United Nations (FAO) briefed the diplomatic community and on 
February 21, 2005, MARD, MOH, WHO, and FAO briefed the donor 
community. 
 
9. MARD reported that since last year they have improved 
surveillance, reporting, laboratory capability, and the 
involvement of public organizations; but challenges remain 
in lack of trained staff, laboratory capacity, current 
poultry industry practices (mostly small family farms with 
varying flocks and herds raised together), and a lack of 
understanding of the disease.  An outline of the current GVN 
response strategy includes:  increasing public awareness, 
continuing emergency response, considering vaccination of 
poultry, prevention of circulation of the virus, developing 
an effective compensation system for farmers with affected 
flock, changing current poultry industry practices, and 
research into the disease.  MARD specifically requested 
international assistance in the form of experts to aid with 
diagnosis, vaccination, and research, and strengthening 
capabilities of laboratories, veterinary science, grassroots 
efforts, and training. 
 
10. At the February 21st meeting, FAO presented a proposal 
to donors to establish an AI Technical Support Unit (TSU) to 
lead the GVN response to the current emergency, and in the 
long-term complement the ongoing AI Emergency Recovery 
Project.  Full text of the proposal is available upon 
request. 
 
Ducks Role in AI Transmission Significant 
----------------------------------------- 
 
11. As noted above, MARD reports that AI outbreaks in 
chicken may be highly correlated with duck production and 
rice cultivation.  Ducks may multiply the challenge of AI 
because they can serve as carriers of the disease, spreading 
the virus to other fowl without showing symptoms or 
suffering fatality.  In addition, they are raised in 
conditions that are particularly unhygienic, and often in 
the waters of rice paddies in close contact with workers. 
 
Embassy Preparedness 
-------------------- 
 
12. Embassy Hanoi has established an Avian Influenza Working 
Group (AIWG), in cooperation with the Consulate General in 
Ho Chi Minh City, to track the situation, advise the front 
office, and monitor preparedness in the Embassy and 
Consulate General.  The AIWG is chaired by Consular Chief 
Jennifer Savage and includes representatives from RSO, PAS, 
HHS/CDC, CONS, DAO, MED, MGMT, HHS, FAS, AID, and CONGEN 
HCMC. 
 
13.  The AIWG is developing tripwires that will be used to 
guide consideration of recommended responses to developments 
and changes in the outbreak situation.  The Embassy and 
Consulate General have begun preventative cleaning measures 
and circulated the prevention recommendations from HHS/CDC 
and WHO among the official and private American communities. 
For preparedness purposes, stock of supplies are being 
reviewed and medevac options are being researched and 
confirmed. 
 
14.  A summary of the on-going Second Regional Meeting on 
Avian Influenza held by FAO/OIE in Ho Chi Minh City will be 
reported septel. 
MARINE