US embassy cable - 05HANOI502

UNCLAS SECTION 01 OF 06 HANOI 000502 
 
SIPDIS 
 
DEPT FOR EAP/BCLTV (DUNLAP), CA/OCS/ACS/EAP, OES/STC 
(GOLDBERG), OES/IHA (SINGER, COMELLA) 
DEPT DOD FOR OSD/ISA/AP FOR LEW STERN 
DEPT PASS HHS FOR OGHA/STEIGER, BHAT, ELVANDER; 
CDC/NCID/COX 
USDA FOR FAS/PASS TO APHIS 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, TBIO, VM, AFLU 
SUBJECT: Second FAO/OIE Regional Meeting on Avian Influenza 
Control in Asia, Ho Chi Minh City, Vietnam: 23-25 February 
2005 
 
Summary 
------- 
 
1. The Second FAO/OIE Regional Meeting on Avian Influenza 
Control in Asia was attended by 168 individuals including 
Chief Veterinary Officers of 28 countries and a delegation 
from Vietnam's Ministry of Agriculture and Rural 
Development, headed by Minister Cao Duc Phat. Leaders of 
the UN Food and Agriculture Organization, the World 
Organization for Animal Health and, the World Health 
Organization emphasized that, although Avian Influenza A, 
subtype H5N1 (AI), is an animal disease causing great 
economic and social impact on affected countries, the 
disease could lead to a new global human health crisis in 
the form of an influenza pandemic. Conference attendees 
agreed that one year after the beginning of the crisis, AI 
is endemic in many countries of Asia, circulating among 
poultry, ducks and wildlife in the region, and continues to 
pose a serious threat to human health and animals. 
Nevertheless, progress has been made in the understanding 
of the virus, its early detection and response to the 
disease and the role of vaccines in disease prevention. 
Over the past year experts have determined that 
transmission of the virus occurs primarily as a result of 
animal production methods and animal marketing behaviors in 
the region. Economic analyses on the impact of AI in the 
region suggested that these types of outbreaks are harder 
on the poor who rely on growing poultry as a means to make 
additional income as well as a necessary source of dietary 
protein. Conference recommendations to control virus spread 
and disease stressed the need to improve international 
coordination, national and regional veterinary services, 
diagnostic laboratory capacity, disease surveillance and 
epidemiology studies, and more transparent data sharing and 
called on developed and developing countries to contribute 
to these efforts. The conference presentations and the 
reports will be posted on the FAO website at 
http//:www.fao.org. 
 
 
Opening Remarks 
--------------- 
 
2. The Second FAO/OIE Regional Meeting on Avian Influenza 
Control in Asia was attended by 168 individuals including 
Chief Veterinary Officers of 28 countries and a delegation 
from Vietnam's Ministry of Agriculture and Rural 
Development (MARD), headed by Minister Cao Duc Phat. The 3- 
day conference was jointly organized by the UN Food and 
Agriculture Organization (FAO) and the World Organization 
for Animal Health (OIE), in collaboration with the World 
Health Organization (WHO). The regional leaders of each of 
theses organizations and Minister Phat addressed the 
conference. All underscored the immediate challenges and 
necessity to lessen the impact of the virus in countries 
where it is endemic and to prevent its spread into 
unaffected countries. While H5N1 infection has caused 
considerable economic and social disruption for some 
economies, the potential social and economic effects of a 
human influenza pandemic would be devastating. Dr. Shigeru 
Omi, World Health Organization Regional Director for the 
Western Pacific urged all governments to work on a pandemic 
preparedness plan now; explaining that the last influenza 
epidemic was 40 years ago, that this resilient, versatile 
and highly pathogenic virus is firmly entrenched in Asia 
(infecting species, such as cats and tigers that were 
previously not thought to be susceptible to Influenza A 
viruses), and that the public implications of domestic 
ducks carrying and excreting large quantities of the virus 
without signs of illness were enormous. He stressed that 
the longer the virus circulated in animals, the greater the 
risk of human cases, and the higher the risk of a pandemic 
virus emerging through genetic changes in the virus. 
 
3. Both Dr. T. Fujita, OIE Representative, Asia and the 
Pacific Region, and Dr. Samuel Jutzi, Director Animal 
Production and Health Division, FAO, Rome, emphasized the 
need for international collaboration and partnerships to 
strengthen veterinary services in the region for more 
effective early detection and response systems, biosecurity 
and, ultimately, disease control. Both organizations are 
working together to strategically control trans-boundary 
animal diseases, globally and regionally under the FAO/OIE 
Global Framework for the Progressive Control of 
Transboundary Animal Diseases. 
 
4. Minister Cao Duc Phat noted that Vietnam had 
experienced an unprecedented number of human deaths due to 
H5N1 infection.  He described the measures Vietnam and MARD 
have taken since late 2003 when the H5N1 outbreaks were 
first acknowledged including the culling or death of 43.8 
million poultry or 16.8% of the total poultry population in 
2003/2004 and more than 1.5 million more as a result of the 
2004/2005 outbreaks.  Other activities include full and 
timely disclosure of outbreak situations, improving control 
of poultry movement and transportation and slaughtering 
practices, improving biosecurity, mobilizing government 
authorities at all levels and public organizations to 
participate in disease prevention and control, and 
monitoring disease in duck populations and restricting 
breeding and others. However, Vietnam still faces many 
challenges including the persistence of backyard and small- 
scale production facilities, limited veterinary skills in 
the country as a whole, and limited laboratory and 
diagnostic capabilities.  He acknowledged assistance from 
international donors and multinational organizations and 
pledged Vietnam's willingness to share experiences and 
participate in activities of the international community to 
prevent and control AI. 
 
Epidemiology of Avian Influenza A, Subtype H5N1 
--------------------------------------------- -- 
 
5. Dr. Roger Morris, Massey University EpiCenter, New 
Zealand, outlined the current epidemiology of Avian 
Influenza H5N1 in Asia.  H5N1 viruses were first isolated 
in geese and domestic ducks in 1996 and have been 
circulating extensively in the region since then. There are 
no records of the virus in wild birds until 2002.  The 
spread throughout the region since the first identification 
of H5N1 in diseased geese in 1996 may be due to a number of 
factors such as cross infection at live poultry markets, 
movement of infected birds, inadvertent transport of the 
virus on equipment and infection of migratory birds by 
domestic ducks and geese. Migratory birds are not thought 
to be the main source of viral transmission.  Dr. Morris 
notes that the epidemic is best understood as a "reservoir- 
spillover-aberrant host relationship" -- that is, domestic 
ducks, geese and quails are the reservoir, which infected 
wild waterfowl and then domestic poultry, spilling over to 
a number of mammalian species, including man as an aberrant 
host becoming diseased but not involved in transmission 
(yet).  Dr. Ian Brown OIE/FAO Reference Laboratory for AI, 
VLA-Weybridge UK, provided further evidence noting that 
since first recognized, the H5N1 virus has mutated numerous 
times; these changes are reflected in changes in the 
pathology of the disease in the host and spreading to other 
unlikely hosts. 
 
6. Recent analyses from Thailand showed significant 
correlation between free grazing duck distribution and the 
distribution of outbreaks of AI in domestic poultry. 
Analyses of Vietnam's poultry outbreaks appear to show 
similar patterns, clustering primarily in the Red River 
Valley, near Hanoi in the north of Vietnam and in the 
Mekong River Delta region in the south of Vietnam where the 
density of both poultry, water fowl and humans are high. 
Dr. Nguyen Tien Dung, Chief, Virology Department, National 
Institute for Veterinary Research (NIVR), identified 
through sero-surveillance studies risk factors contributing 
to both the first (2003/2004) and second (2005/2005) AI 
outbreaks in Vietnam. Risk factors include: high chicken 
and duck density, bird movement (marketing, offal disposal, 
and disposal of infected birds), poultry management 
practices (backyard flocks, raising/housing of multiple 
bird species in a single location, and little or no 
biosecurity), surveillance (incomplete) and detection 
(delayed and/or disease misdiagnosis), and inadequate 
compensation and public awareness. 
 
7. In humans, both Drs. Oshitani and Horby from WHO 
confirmed that currently there is no efficient human-to- 
human transmission of H5N1 AI.  However, human cases 
correlate geographically with outbreaks in poultry. 
Recommendations to reduce the risk of human infections were 
to identify the at-risk populations through better 
surveillance and well-conducted epidemiologic studies, 
eliminate the source of human infection and establish 
appropriate interventions at the animal and human interface 
through greater public awareness, use of personal 
protective equipment for health care workers and farmers, 
the use of antivirals, and the development and use of 
influenza vaccines. At the time of the conference, 44 AI 
cases and 32 deaths from AI had been confirmed in humans in 
Vietnam. [Note: On February 20, 2005, Vietnam announced the 
33rd confirmed human death. End note].  Dr. Horby contended 
that the number of known cases was most likely an 
underestimate of the infected population. [Note: On 
February 19, 2005, Nature published a report, based on a 
study from Japan, alleging that the sensitivity of the 
diagnostic tests used by Vietnam's laboratories was too low 
to identify all cases. Scientists from Vietnam noted that 
the laboratories would begin using the more sensitive 
diagnostic test and training the technicians better. This 
information was not reported at the conference. End Note] 
 
Intervention and Control Strategies 
----------------------------------- 
 
8. Prevention and control of H5N1 AI infection requires a 
multi-tiered, multi-faceted strategic approach, which is 
culturally, socially, and economically sensitive, and 
reasonably priced and low-tech enough to be applied 
effectively over a wide range of farm situations.  Experts 
stressed key strategies to be implemented including 
improving veterinary services, laboratory diagnostic 
capacity, surveillance and detection, animal husbandry 
management including application of enhanced biosecurity 
methods, strategic use of vaccines, possible restructuring 
of the poultry industry and greater emphasis on public 
awareness and farmer training on AI management and control. 
Depending upon the country situation and outbreak status, 
implementation of all or some of these activities may be 
necessary. 
 
Vaccines 
-------- 
 
9. A number of presentations addressed the pros and cons 
of vaccine use as a tool to help control H5N1 AI. Clearly, 
depending upon the phase of an outbreak or infection, a 
mixed control approach is generally recommended.  Depending 
upon the country, vaccination intervention may be 
considered.  In general, vaccination against H5N1 AI, 
protects birds against developing the clinical signs of the 
disease and death, helps to reduce viral shedding if the 
bird is infected, prevents bird to bird, and, hopefully, 
bird to human contact transmission.  As a food safety 
issue, vaccination prevents H5N1 AI in poultry meat. 
However, the widespread use of vaccinations is 
controversial from a number of perspectives including the 
overall cost particularly to small backyard farmers, 
limited effectiveness in ducks, the inability to 
discriminate between infected birds or vaccinated birds (a 
concern of importing countries) and the development of a 
sense of complacency among farmers and the public that the 
problem will go away without making the necessary 
infrastructure and biosecurity changes. 
 
Food Safety 
----------- 
 
10. Of concern to both poultry producers and consumers is 
the issue of food safety.  Dr. David Swayne, Southeast 
Poultry Research Laboratory, USDA/ARS, presented a number 
of studies examining the ability to infect meat by giving 
birds AI infected feed and viral load in the body of H5N1 
AI infected birds.  He approached food safety from the 
perspective of worker safety issues and consumer 
protection.  Workers or individuals who slaughter poultry 
or fowl (chicken, ducks, geese, quail) infected with Avian 
Influenza H5N1 maybe at risk from exposure through 
inhalation or mucosal membrane contact with virus particles 
which may be in the bird's respiratory and digestive 
tracts, in the blood, meat or bones, or as contaminants on 
feathers.  This possibility necessitates the use of 
appropriate personal protective equipment when slaughtering 
poultry and fowl. 
 
11. Consumers not involved in slaughtering should be made 
aware that the blood, meat or bones of H5N1 infected 
poultry and fowl may contain the virus. Cooking to 70 
degrees C will kill H5N1 virus.  Additionally, H5N1 AI 
virus may contaminate eggs, particularly if laid shortly 
before death.  Pasteurization and cooking thoroughly will 
inactivate the virus. In summary, infected birds, (sick, 
dying or potentially infected) should not be processed for 
consumption.  Proper vaccination can prevent H5N1 virus 
from invading poultry meat. 
 
 
Economic Impact 
--------------- 
 
12.  Evaluation of the economic impact of the H5N1 AI 
outbreak is complex.  All economies of Southeast Asia with 
H5N1 AI outbreaks experienced GDP reductions, not only from 
loss of poultry stocks and human illnesses, but also from 
the costs necessary to respond to the outbreaks.  Experts 
noted that the impact of the outbreaks varies along the 
market chain, e.g., industrial production system versus 
backyard scavenging system.  Socioeconomic surveys of 
countries in Southeast Asia document that the resulting 
effects of H5N1 AI outbreaks take the heaviest toll on the 
poorest families.  Loss of birds, restriction of bird 
movements and sale, lowered prices, loss of substantial 
proportion of annual income coupled by the lack of 
compensation, all impact the livelihood of subsistence 
farmers.  Additionally, concomitant increases in the price 
of other sources of protein, put those at the bottom of the 
economic ladder at greater risk of nutritional 
deficiencies.  Medium- to large-scale producers also 
experience financial loss primarily due to lack of adequate 
compensation, and in Vietnam, the need to obtain loans to 
finance culling, disposal, restocking, and perhaps, changes 
in animal husbandry practices.  However, these producers 
may be able to shift production to other types of 
commodities, such as pigs or rice. 
 
Conference Conclusions 
---------------------- 
 
13.  Conference delegates concluded that to reduce the risk 
of a global human pandemic of H5N1 AI, a concerted effort 
to control the spread, and if possible, eliminate the virus 
from the region is necessary.  Such goals will require 
concerted efforts and collaboration on the part of 
international organizations, governments and others. 
Representatives of FAO and OIE project that more than 100 
million USD is needed in direct financial support as well 
as in-kind assistance to make the improvements recommended 
by the body.  They noted that less than 18 million USD was 
donated in the past year towards mitigating this problem. 
While these donations have contributed to improvements in 
the veterinary systems of countries in the region, it falls 
short of the true need.  Final conference recommendations 
will be posted on the FAO website at http//: www.fao.org. 
MARINE