US embassy cable - 05HANOI626

UNCLAS SECTION 01 OF 02 HANOI 000626 
 
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 
AMEMBASSY ROME PASS TO FAO 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, TBIO, VM, AFLU 
SUBJECT: VIETNAM  - AVIAN FLU: SITUATION REPORT NO.2 
 
REF: Hanoi 316 
Case Count/Statistics 
--------------------- 
1.  In humans:  As of March 7th, the WHO officially reports 
21 cases of Avian Influenza, H5N1 (AI) in humans in Vietnam 
during the 2004-2005 outbreak, 13 of which have resulted in 
death.  The four cases reported in February include:  a) A 
21-year-old man from Thai Binh Province. He developed 
symptoms on 14 February and was admitted to hospital on 20 
February.  B) His 14-year-old sister, also from Thai Binh 
Province. She developed symptoms on 21 February and was 
hospitalized the following day. C) A 69-year-old man, also 
from Thai Binh Province. He developed symptoms on 19 
February, was admitted to hospital the same day, and died on 
23 February. D) A 35-year-old woman from Hanoi. She 
developed symptoms on 18 February and was hospitalized on 24 
February. 
2.  Although they don't appear in WHO's official case 
counts, the media is reporting on three cases in Vietnam (a 
nurse, and two non-symptomatic relatives of patients, all of 
who have tested positive for AI) that are receiving 
particular attention.  Initial indications are that these 
cases may not indicate a change in the virus or give cause 
for alarm.  They are probably consistent with other, 
previously reported cases and/or may be the result of 
increased surveillance.  Details on these recent cases 
follow in paras 5 and 6. 
3.  In Poultry:  Cases continue, however, MARD reported that 
of the 35 infected provinces/cities found to have bird flu 
incidences this year, in 18 of these provinces/cities, 
including Hanoi and HCMC, there were no new cases detected 
in the last 21 days (as of March 7).  On March 7, there was 
one case detected in Tra Vinh province--400 ducks were 
destroyed.  On March 6, there were 7 new cases in Bac Lieu, 
Ben Tre, and Dong Thap provinces--where 2,877 ducks were 
destroyed.  On a more positive note, Vietnam's Ministry of 
Agriculture and Rural Development (MARD)'s Veterinary 
Department said on March 7, that, "As of March 6, eighteen 
out of 35 bird flu-affected provinces and cities across Viet 
Nam had not reported any new cases for three weeks." 
The Nurse 
--------- 
4. A 26-year old male nurse in Thai Binh province, who 
treated AI patients, is hospitalized and has tested positive 
for AI.  While WHO still reports that this case is "under 
investigation" and cannot provide official guidance, we have 
received a more informal readout from the Medical Director 
of the local SOS International Clinic (a private, for-profit 
clinic).  The Medial Director, Dr. Bruce Miller, is well- 
connected with both WHO and MOH and indicated that his 
opinion was that of the WHO.  He believes that this is a 
likely case of human-to-human transmission, but not an 
indication of a change in the virus or a cause for alarm. 
The nurse likely has sustained close contact with the 
patient, just have we have seen in other family clusters, 
and vigilant use of PPE cannot be confirmed.  However, he 
reports that the nurse lived in a rural area and did have 
other opportunities for exposure to the virus, so human-to- 
human transmission will likely never be confirmed or ruled- 
out in this case.  He believes this case to be very similar 
to others in which human-to-human transmission was suspected 
or confirmed and does not believe this case indicates a 
change in the virus or its transmission. 
Non-Symptomatic but Positive for H5N1 
------------------------------------- 
5.  The BBC and other media outlets reported today on two 
patients (61 and 81 years old), also from Thai Binh 
province, who are non-symptomatic, but have tested positive 
for AI.  The WHO is not surprised at this development.  They 
report that the GVN is improving and expanding its contact 
surveillance, and it has long been suspected that cases with 
no or mild symptoms are going undetected.  WHO reported that 
it is not possible at this point to know whether the 
detection of these cases now is coincidental, a result of 
improved surveillance, or an indication of increased 
transmissibility in the AI virus. 
Hanoi AI Working Group 
---------------------- 
6.  Post's Working Group benefits from cooperation and 
participation the numerous relevant agencies at Post - 
including HHS, CDC, DOD, FAS, and AID.  Whenever needed, we 
are happy to serve as a resource for the Department's 
Working Group and provide input as "on the ground" experts 
whenever requested. 
MARINE