US embassy cable - 05HOCHIMINHCITY1269

UNCLAS SECTION 01 OF 04 HO CHI MINH CITY 001269 
 
SIPDIS 
 
SENSITIVE 
 
STATE PASS TO USTR (ELENA BRYAN) 
 
E.O. 12958: N/A 
TAGS: AMED, AMGT, CASC, EAGR, PINR, SOCI, PGOV, TBIO, VM, AFLU 
SUBJECT: AVIAN INFLUENZA - A LOOK AT FOUR PROVINCES IN VIETNAM'S 
MEKONG DELTA 
 
REF: HCMC 855 
 
1. (SBU) Summary.  USAID Regional Infectious Diseases Advisor 
and EconOff visited Can Tho, Hau Giang, An Giang and Dong Thap 
provinces of the Mekong Delta region in southern Vietnam to 
assess provincial Avian Influenza (AI) preparedness activities. 
While outbreaks of AI in poultry and humans in these provinces 
still could be characterized as sporadic, authorities are 
nevertheless concerned and are proceeding at a state of 
heightened alertness.  Two immediate worries are surveillance, 
in particular the need for uniform case definition to identify 
suspected AI cases, and a coherent public awareness campaign. 
Local officials expressed interest in USG technical assistance 
in both of these areas.  The USG has committed USD 7.5 million 
to support the GVN prepare for and respond to an AI pandemic. 
End Summary. 
 
Planning and Coordination 
------------------------- 
 
2.  (SBU) During their November 28 - December 1 trip to the 
Mekong Delta, HCMC EconOff and Bangkok-based USAID Regional 
Infectious Diseases Advisor learned that provincial measures to 
combat avian influenza include planning and coordination, 
surveillance and outbreak response, poultry vaccination, 
containment and awareness campaigns.  Provincial People's 
Committees have organized their own AI steering committees that 
meet regularly, with representatives from the departments of 
Health, Agriculture and Rural Development, Education, and Trade 
and Investment, as well as the Marketing Management Board, 
police and others.  Coordination between animal and human health 
authorities takes place via both official and unofficial 
channels, but when actually tested the coordination network 
shows some signs of inconsistency. 
 
Surveillance and Outbreak Response 
---------------------------------- 
 
3.  (SBU) Provincial officials reported that human and animal 
health surveillance is carried out at the commune and district 
levels and is then passed upward to the provincial leadership. 
However, animal health surveillance is passive and primarily 
relies on farmers themselves to report poultry deaths.  In 
instances of suspected cases of AI in poultry, the provinces' 
Bureaus of Animal Health contact the regional office in Can Tho 
as well as the provincial Department of Health (DoH).  The DoH 
is then responsible for investigating and monitoring the health 
of the family or individuals exposed to the suspected birds.  If 
a hospital reports a suspected case of AI, it must contact the 
DoH, which then notifies the local Animal Health Bureau. 
Provinces compensate farmers for culled or lost poultry, but in 
some places compensation levels are linked to previous 
vaccination program compliance.  The level of compensation 
varies depending on the type and age of the bird, but the 
previously reported level of 15,000 VND (approximately 1 USD) 
per bird is still a valid benchmark (reftel).  In addition to 
compensation, many provinces also threaten fines for 
non-compliance and promise rewards for farmers who report on 
neighbors trying to hide dead chickens and ducks. 
 
4. (SBU) Surveillance in the public health sector is primarily 
conducted through district or provincial hospitals, with 
suspected cases reported to provincial Departments of Health. 
The DoH then notifies a province's AI Steering Committee, its 
Health Prevention Center, the provincial Bureau of Animal 
Health, and the Pasteur Institute in HCMC.  All the provinces we 
visited had conducted some AI training for medical staff at 
least on the district level.  When we asked district health care 
workers what symptoms constitute a suspected AI case, the 
TAGS:QMED, AMGT, CASC, EAGR, PINR, SOCI, PGOV, TBIO, VM 
answers were generally the same: cough, fever, difficulty 
breathing and exposure to poultry.  There appeared to be some 
disconnect between the pervasiveness of the symptoms and the 
rarity of suspected cases; if hospital officials were strictly 
adhering to the case criteria cited - i.e. cough, fever, 
exposure to poultry, there should be more suspected cases. 
Medical and health officials reported difficulty in defining 
uniform case criteria that would be broad enough to ensure early 
detection, but narrow enough to be manageable.  Technical 
assistance from the United States in this matter would be 
appreciated, officials said. 
 
Example of a suspected case 
--------------------------- 
 
5. (SBU) In November 2005, in a suspected AI case in Dong Thap 
Province, a patient checked into the provincial hospital with 
fever, cough, and difficulty breathing. An X-ray showed two 
spots on his lung.  The patient informed the medical 
professionals that four of his six chickens had just died.  The 
patient was isolated, and given Tamiflu and antibiotics. 
Specimens were sent to the Pasteur Institute for testing, and 
the Dong Thap Animal Health Bureau was notified.  While these 
measures seem to indicate that human health coordination and 
surveillance functioned as intended, when we asked the DoH about 
the results of tests on the poultry in the case, none of the 
health officials at the meeting knew what had happened to the 
poultry.  As it turned out, the family members of the sick man 
were so frightened by the incident that they killed their 
remaining birds and incinerated all of the dead animals.  The 
Pasteur Institute's results came back negative for AI in less 
than 48 hours, and the patient recovered. 
 
6. (SBU) Comment:  This example illustrates some key points 
about AI preparedness in southern Vietnam: 
 
-- as in this specific case, when a patient checks into a 
hospital, and matches all the case criteria, including exposure 
to poultry, the surveillance system in place seems to work; 
-- coordination between animal and human health officials 
exists, but may be tenuous; 
-- under current conditions, the Pasteur Institute is able to 
react quickly; 
-- hospital staff are adequately trained and equipped to deal 
with a few AI cases; and 
-- the general population is aware of the risks of AI to their 
own health and is willing to cull their birds even before 
ordered to do so, when an immediate danger is perceived. 
 
The provinces visited would be challenged to handle an outbreak 
of more than 10 to 30 patients before becoming overwhelmed.  End 
Comment. 
 
Poultry Vaccination 
------------------- 
 
7. (SBU) The poultry vaccination program is completed or is near 
completion in all four of the Mekong Delta provinces visited. 
Despite some difficulties with vaccine supplies, shortage of 
staff, and farmer reluctance to participate, officials reported 
their provinces have met or surpassed the GVN's target of an 80% 
coverage rate of the poultry population.  Authorities were 
encouraged by reports that the number of farmers willing to 
participate in the vaccination program had increased as fears 
and concerns regarding the effects of the vaccine had 
dissipated.  Farmer compliance with poultry vaccination was 
linked to government measures such as permission to bring 
poultry to the market, compensation for culled birds, and other 
government programs designed to help poultry farmers. 
Containment 
----------- 
 
8.  (SBU) There is a nationwide ban on the transportation of and 
trade in poultry between provinces.  Each province has 
implemented various regulations and measures regarding the sale 
of poultry within its own borders.  Measures include 
establishing official slaughterhouses and designating health 
certification stamps for poultry.  The purpose of these 
regulations is to ensure that only healthy, vaccinated poultry 
is sold at markets, but the process can be laborious and is 
incomplete in places.  The result is a shortage of official 
poultry markets, which could drive future poultry sales 
completely underground and make them even more difficult to 
monitor.  For example, in Can Tho City, bringing a bird to 
market is a seven-step process that requires two certificates. 
Hau Giang Province does not have an official slaughterhouse yet 
and presently asks farmers to keep their birds until an official 
site can be designated. 
 
Public Awareness Campaign 
------------------------- 
 
9.  (SBU) Raising public awareness about AI was of primary 
importance to all of the government and medical officials we 
met.  Public health, animal health and medical officials have 
printed and distributed hundreds of thousands of leaflets and 
pamphlets.  They have created radio messages, TV programs and 
even megaphone announcements about AI.  Authorities said the 
Ministry of Health (MOH) and Ministry of Agriculture and Rural 
Development (MARD) provide guidelines for public awareness 
messages, but wording and format is left up to provincial 
departments.  The result is an awareness campaign that lacks 
uniformity, has no cohesive message and does not take advantage 
of opportunities for synergy.  Provincial officials agreed that, 
taking into account the proximity of poultry and people in the 
countryside, it would be prudent to consider a comprehensive 
approach that would address both animal and human health aspects 
of AI and could be distributed through all government networks. 
 
10.  (SBU) Provincial Departments of Health and Animal Health 
Bureaus have all provided some level of training for staff at 
the provincial, district, and in some cases, commune levels.  It 
is the job of those trained to return to their offices and train 
other staff members.  When asked what a "typical Vietnamese 
person" would do when feeling sick with flu-like or other 
symptoms, the most common answer was "go see a pharmacist." 
However, pharmacists have not yet been trained in AI prevention, 
nor did we hear of any plans to include them in public awareness 
campaigns. 
 
Conclusion 
---------- 
 
11.  (SBU) Comment:  Several provinces in Vietnam's Mekong Delta 
region have established a basic framework to build an effective 
AI preparedness network.  Medical and health officials have 
benefited from the lessons learned during SARS and are adapting 
them to AI.  Animal health officials understand they are on the 
frontline of preventing an AI epidemic, as well as minimizing 
the economic damage AI has already caused to a nation heavily 
reliant on agriculture.  The poultry vaccination campaign and 
mass culling have provided the MARD's provincial counterparts 
with practical insight on how mobilize their forces in case of 
emergency. 
 
12. (SBU) However, these measures are only the beginning, as it 
is clear each province would find it difficult to cope with more 
than a handful of human AI cases.  Strengthening surveillance 
and public awareness is essential for strengthening Vietnam's 
capability to help stem a possible pandemic.  Provincial 
authorities expressed interest in possible USG technical 
assistance and cooperation in the development of a standardized 
suspected AI case definition that could produce immediate 
tangible results, as would the distribution to provinces of 
professionally prepared public awareness materials. End comment. 
 
13. (U) The USG has committed USD 7.5 million (USD 2.4 million 
from USAID/USDA; USD 5.1 million from HHS) to help the GVN 
prepare for and respond to an AI pandemic, including support for 
GVN's nationwide poultry vaccination campaign, improving the 
capacity of the public health care system in epidemiological 
monitoring and surveillance, and raising farmers' awareness and 
attitudes toward AI. 
WINNICK