US embassy cable - 05HANOI1218

UNCLAS SECTION 01 OF 03 HANOI 001218 
 
SIPDIS 
 
STATE FOR FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV; 
STATE FOR OES/STC (M.GOLDBERG); OES/IHA (D.SINGER AND 
N.COMELLA) 
BANGKOK FOR RMO, CDC, USAID/RDM/A (MFRIEDMAN) 
STATE PASS HHS 
USDA FOR FAS/PASS TO APHIS 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN 
USAID FOR ANE AND GH (DCAROLL, SCLEMENTS AND PCHAPLIN) 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, TBIO, VM, AFLU 
SUBJECT: VIETNAM  - AVIAN INFLUENZA SITUATION REPORT 
 
REF: Hanoi 1034 and previous 
 
1.  (U) Summary:  Local media reported three new cases of 
avian influenza (AI) in northern Vietnam this week. Although 
the World Health Organization (WHO) has not received 
official notification from the Ministry of Health (MoH) of 
these cases yet, WHO believes that reporting of human cases 
has improved.  WHO country director Dr. Hans Troedsson 
warned that the risk of an influenza pandemic breaking out 
in northern Vietnam is greater than anywhere else in the 
world. Though Vietnam does not have a National Pandemic 
Influenza Preparedness Plan, MoH has not yet responded to 
WHO's offer of technical and monetary assistance to develop 
such a plan.  The United Nation's Development Program (UNDP) 
is working with FAO and WHO to assist the Government of 
Vietnam (GVN) in coordinating donor activities and funding, 
using a recently released consolidated strategy. End 
Summary. 
 
Case Statistics 
--------------- 
 
2.  (U) In recent days, the Vietnamese press has reported 
that MoH identified three new cases of AI: a 52-year-old man 
from northern Vinh Phuc Province, a 58-year-old man from 
central Thanh Hoa Province and a 46-year-old man from Hung 
Yen Province (a death). The individual from Vinh Phuc 
Province is reported to have eaten chicken that may have 
died from avian influenza. MoH has not reported these cases 
to WHO.  (Note: There have been no recent reports to the 
Ministry of Agriculture and Rural Development (MARD) of 
outbreaks in poultry from any of these areas. This suggests 
that reporting of animal outbreaks from the provinces to the 
central government is not as complete as it should be. End 
Note.) 
 
3. (U) Dr. Troedsson noted that MoH reporting of confirmed 
and suspected human cases to WHO has improved greatly in 
recent months. WHO and the MoH have agreed to establish two 
reporting systems: an official report of laboratory 
confirmed cases which are shared with member states; and, 
informal reports of suspected cases which require further 
investigation of contact with infected poultry and 
laboratory confirmation and are shared only with the WHO. 
 
Briefing of the Diplomatic Community 
------------------------------------ 
4. (U) On May 18, Directors of UNDP, WHO and FAO in Vietnam 
jointly briefed the Hanoi diplomatic community on the status 
of AI activities in Vietnam. 
 
5. (U) WHO's Dr. Troedsson warned diplomats that the risk of 
a pandemic breaking out is greater in northern Vietnam than 
anywhere else in the world.  WHO bases this conclusion on 
the findings of recent WHO-sponsored meetings and 
consultations on AI in Southeast Asia in which experts found 
decreased virulence of H5N1, broader demographic spread of 
victims, and increased numbers and duration of clusters in 
northern Vietnam.  The AI virus appears to be less virulent, 
as the case fatality rate (CFR) dropped from 100 percent in 
the first outbreak in 2004 to 35 percent in the most recent 
outbreak in 2005.  The CFR fell to 18 percent in the North 
during the second sub-wave but did not change at all in the 
South during the same period.  Additionally, some recent 
cases have been milder or even asymptomatic.  Note: Although 
the virus seems to be killing fewer people, a less virulent 
virus may infect more people.  End Note.  The WHO also noted 
the virus appears to have infected a wider range of age 
groups.  In 2004, the average age affected was approximately 
17 years while in 2005, the average age affected was 
approximately 31 years. Finally,  there are more and larger 
clusters of infected victims this year than in previous 
years. The time between the first infection in the cluster 
and the last is longer, which may reflect prolonged contact 
with contaminated conditions or human-to-human 
transmissions. Recent clusters have included more than 
family members, such as health care workers and community 
residents. 
 
6. (U) Anton Rychner, Country Representative for FAO said 
that MARD has not officially reported an outbreak of AI 
since April 2 and confirmed that FAO has not received 
outbreak reports among poultry stocks in the areas where the 
recently reported human cases occurred. The H5N1 virus 
continues to circulate in the Mekong Delta, where 25 percent 
of 10,000 samples taken from waterfowl tested positive for 
H5N1. Over the past few months MARD has sought to improve 
its responsiveness to H5N1 by: developing and implementing 
plans to rehabilitate the poultry sector by limiting 
production to bigger industrial farms and rezoning 
industrial farms; banning the raising of free-range 
waterfowl; reducing the number of places where poultry are 
slaughtered; strengthening AI prevention and control 
enforcement; enhancing veterinary services at all levels to 
improve detection and prevent infection; and, developing a 
compensation strategy.  FAO noted that the GVN needs the 
support of the international community to enact the above 
policies, improve active and passive surveillance in the 
field, create a system to harmonize activities at the 
central and provincial levels, and implement countrywide 
control measures in the field. 
 
Lack of AI National Preparedness Plan 
------------------------------------- 
 
7. (U) Although the GVN reports that it is working on a 
national pandemic influenza preparedness plan, it is not 
clear how much progress the GVN has actually made.  The MoH 
has not yet responded to WHO's offer of technical and 
monetary assistance to develop this plan.  In addition to 
MoH and MARD, development of an effective plan will require 
participation of many other ministries.  For example, 
closing schools and banning public meetings would require 
action by the Ministries of Education and Public Security, 
and it is unclear whether MoH and MARD have solicited input 
from other ministries.  FAO and WHO feel that this issue 
requires attention at the highest level (Prime Minister) in 
order to develop an effective plan that engages all 
Ministries. Additionally, capacity remains especially weak 
at the local level where skills, funding and political 
reinforcement are lacking. 
 
8. (U) MARD is conducting poultry vaccination trials in the 
provinces of Nam Dinh and Kien Giang with the goal of more 
widespread vaccination in target areas by October, 2005. In 
preparation for implementation of a broader vaccination 
program in Vietnam, FAO is consulting with MARD to develop a 
national vaccination strategy.  However, the FAO 
representative cautioned that vaccination is only one part 
of a prevention and control strategy, emphasizing that the 
GVN also needs to implement bio-security measures. 
 
9. (U) The UNDP will work with FAO and WHO to coordinate 
donor activities and funding to address the AI threat in 
Vietnam under the framework of a WHO plan released in 
February 2005 and updated in April.  The plan outlines those 
activities that need funding and seeks to coordinate the 
donor response.  According to WHO, the plan focuses 
primarily on the needs of MARD but lacks substantial input 
from the MoH.  WHO identified ten key areas donors where 
donors also need to provide support to the GVN: improve 
human technical capacity  (epidemiologists, lab technicians 
and clinicians); improve lab capacity (bio safety and the 
ability to analyze samples); improve communication and 
coordination between MoH, MARD and the international 
community; improve surveillance of animal and human health; 
develop vaccines for animals and humans; develop a national 
pandemic influenza response plan; conduct further research 
on routes of transmission of the virus; advocate public 
education to the at-risk populations; improve local 
preparedness and response to an outbreak; and improve care, 
treatment and case management of identified cases. 
 
10. (SBU) The GVN may be overly optimistic in its goal to 
control AI by 2006-2007 and eradicate it by 2010.  While 
much has been done, there is a consensus within the 
international community in Hanoi that the GVN approach is 
not effectively organized and Vietnam does not have the 
capacity yet to contain a serious outbreak or monitor fast 
breaking developments.  FAO is concerned that the GVN has 
agreed to compensate poultry farmers only 50 percent of the 
price of culled poultry as they believe that at least 75 
percent would be needed to be effective in convincing 
farmers to cull their infected stock.  Note: The GVN 
compensated poultry farmers for only 15 percent last year. 
End Note. 
 
11. (U) The FAO representative noted that a mid-term 
Consultative Group (CG) meeting of donor countries, 
international organizations and the GVN on June 2, would 
present an opportunity to discuss AI and the need for a 
country pandemic influenza plan.  It will also give GVN 
leaders and the international donor community the 
opportunity to discuss apparent financial needs of Vietnam 
to control AI. 
BOARDMAN