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Cablegate: Avian Influenza Update - Persistent Sporadic Animal

VZCZCXRO5231
RR RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #0973/01 1441055
ZNR UUUUU ZZH
R 241055Z MAY 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 5470
INFO RUEHHM/AMCONSUL HO CHI MINH 3106
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHBK/AMEMBASSY BANGKOK 5707
RUEHJA/AMEMBASSY JAKARTA 0673
RUEHUL/AMEMBASSY SEOUL 3133
RUEHKO/AMEMBASSY TOKYO 5698
RUEHVN/AMEMBASSY VIENTIANE 3954
RUEHHK/AMCONSUL HONG KONG 1169
RUEHGZ/AMCONSUL GUANGZHOU 0799
RUEHCN/AMCONSUL CHENGDU 0300
RUEHSUN/USUN ROME IT
RUEHIN/AIT TAIPEI 1493
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC//USDP/ISA/AP//
RHMFISS/CJCS WASHINGTON DC//J2/J3/J5//
RHEFDIA/DIA WASHINGTON DC//DHO-3//
RHMFIUU/CDR USPACOM HONOLULU HI//J00/J2/J3/J5//
RHEFAFM/DIRAFMIC FT DETRICK MD//MA-1A//

UNCLAS SECTION 01 OF 03 HANOI 000973

SIPDIS

SENSITIVE
SIPDIS

STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED
STATE PASS TO USAID FOR ANE AND GH
STATE PASS TO HHS/OGHA (STIEGER, VALDEZ, BELL, BHAT, HICKEY)
STATE PASS TO CDC (COX AND MOHEN)
USDA PASS TO APHIS
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN)
BANGKOK FOR RMO, CDC, USAID (MACARTHUR AND BRADY)
ROME FOR FAO

E.O. 12958: N/A
TAGS: TBIO KFLU AMED AMGT CASC EAGR PINR SOCI VM
SUBJECT: AVIAN INFLUENZA UPDATE - PERSISTENT SPORADIC ANIMAL
OUTBREAKS GIVE RISE TO HUMAN SUSPECT CASE


HANOI 00000973 001.2 OF 003


SENSITIVE BUT UNCLASSIFIED

REF: HANOI 725 and previous

1. (U) Summary: After a month-long period of no highly pathogenic
avian influenza (AI) outbreaks in animals, limited outbreaks in
poultry have been reported in five provinces, including Hanoi. One
suspected human case, a 30-year old man from Vinh Phuoc Province, is
recovering but still in critical condition at the Bach Mai hospital
in Hanoi. Initial test results for H5N1 AI, which are being
confirmed, are positive for the virus. GVN has indicated it will
send material into the World Health Organization (WHO) Collaborating
Network. The first round of the annual poultry vaccination campaign
continues. The Partnership for Avian and Human Influenza (PAHI)
established its Secretariat office and plans to host its first
meeting on May 29. End Summary.

Human Case
----------

2. (SBU) A 30-year old man from northern Vietnam's Vinh Phuc
province has been hospitalized with severe pneumonia and respiratory
failure consistent with AI. The man's relatives reported to the
media that he handled chicken carcasses before becoming ill. The
man is currently in critical condition at the Bach Mai hospital in
Hanoi. Initial test results for H5N1 AI by PCR are positive for the
virus. An investigation and confirmatory testing is underway and
required before labeling it as an official case. If confirmed, this
will be the first case in humans since November 2005.

3. (SBU) At a May 23 meeting between Ministry of Agriculture and
Rural Development (MARD) official and Agricultural Counselor on a
separate subject, MARD informally revealed that this human suspect
case from Me Linh District in Vinh Phuc Province was presented to
the National Steering Committee Weekly meeting on Tuesday May 15 by
Ministry of Health's (MOH) Administration of Preventive Medicine.
The positive laboratory result was presented to the Committee on
Tuesday May 22. Animal samples have been taken and results are
expected on Thursday May 24. There were no prior official reports
of AI animal outbreaks in the area where this case occurred since
2004. However, MARD unofficially reports that, upon further
investigation, they have uncovered unconfirmed reports of limited
chicken die-offs. This area produces far more chickens than ducks
and there is no reported history of duck exposure or duck illness.

4. (SBU) According to unofficial reports from the WHO and MOH
(including an interview with one of the leads on the investigative
team), the affected person is a 30-year old farmer and was exposed
to chickens May 5 or 6. He reportedly prepared chickens for a
wedding party of about 100 persons, some of which were sick when
killed and some of which may have been already dead before
preparation. Two other women helped with the preparation of the
birds but did not help kill the chickens. The women did not become
ill. The index case may have been symptomatic as early as May 7,
but by May 11 he was symptomatic and progressively worsened with
fever, cough, and shortness of breath by May 14. He presented to
the local commune level polyclinic on May 15 and was treated
overnight. On May 15 he was transferred to Hanoi because his

HANOI 00000973 002.2 OF 003


condition worsened. On May 18 he was admitted to the intensive care
unit (ICU) with decreased responsiveness, in respiratory failure,
was intubated and mechanically ventilated. Initial testing was by
PCR at MOH's National Institute of Hygiene and Epidemiology (NIHE)
and completed within 6 hours of admission to the ICU. The positive
result was available the next morning. The patient was started on
oseltamivir (Tamiflu).

5. (SBU) On May 21, the GVN dispatched a joint MOH/MARD
investigative team to the originating province. Molecular DNA
sequencing was just completed and confirms the presence of H5N1
virus. Information from the dispatched team preliminarily report
that there are no associated cases among close human contacts,
although a media report pointed to a young nephew or niece of the
index case who accompanied him to the clinic was being investigated
for a respiratory illness but tested negative for the presence of
H5N1 AI virus. About 90 close contacts have been started on
oseltamivir (Tamiflu) for prevention; no wedding guests are being
treated. The patient's condition is slightly improved today.

Animal Outbreaks
----------------

6. (SBU) Vietnam met the definition for an AI outbreak free period
based on a 21-day stretch, with no reported outbreaks from March 30
to May 5, 2007. The MARD reported a limited outbreak in northern
Vietnam's Nghe An Province on May 6 of an outbreak that was
determined to have begun on May 1. This was followed by a series of
confirmed outbreaks (ten total) in Nghe An, Quang Ninh, Son La and
Nam Dinh Provinces in the north and Can Tho and Dong Thap Provinces
in the south, all of which involved unvaccinated and recently
hatched ducklings (including Muscovy ducks). Although one of the
outbreaks involved three household farms where 1,298 out of 3,800
ducks died, most die-offs involved one isolated household farm and
less than several hundred ducks. All of the outbreaks were quickly
brought under control. Response measures included culling,
vaccinating surrounding flocks, disinfecting poultry pens,
restricting of the movement of poultry beyond outbreak areas and
animal quarantine.

7. (U) Local media continue to report details of most outbreaks,
providing information on the size of flocks, the location,
interventions, and in one case, the name of the farmer. More
recently, media reports have more thoroughly covered the supplier
aspect of the duck industry, including the private sector, quoting
agricultural officials saying that some localities in the northern
and central regions have not yet fully complied with the MARD's
strict regulations on egg hatching and waterfowl breeding.

8. (SBU) MARD's Department of Animal Health (DAH) Deputy Director
and Chief Veterinary Epidemiologist Hoang Van Nam told Agricultural
Counselor that the National AI Steering Committee met on May 22 to
discuss the recently occurring outbreaks. Nam blamed the recent
outbreaks on the poor management of provincial vaccination programs,
pledging to send more senior officials to address the program's
problems directly. A Hanoi-based FAO expert acknowledged that
"compliance is a huge issue." He added that the GVN's veterinary
field staff are "fed up" with the massive workload and that farmers

HANOI 00000973 003.2 OF 003


are less willing to cooperate, despite occasional and sporadic
outbreaks. Our source also speculated that the lack of human cases
gave health authorities a false sense of security.

Vaccinations
------------

9. (U) Sixty of Vietnam's 64 provinces are conducting the first
round of vaccinations for 2007. The first round consists of two
shots, separated in time. As of May 22, MARD reports that 116.6
million poultry have been vaccinated including 73.3 million
chickens, 40.1 million ducks and 3.2 million Muscovy ducks.
Currently, 34 provinces have completed first round shots. Nine
provinces are preparing for second round shots. FAO-Vietnam
estimates the first round of vaccination will cost about USD 6
million for the vaccine. Three provinces have fully completed the
entire two-shot vaccination round. In addition, large livestock
companies administered more than 5.6 million doses of TROVAC Aih5,
an AI poultry pox vector vaccine.

Partnership for Avian and Human Influenza
--------------------

10. (U) The Partnership for Avian and Human Influenza (a body formed
last year composed of GVN and donor organizations) has established a
Secretariat Office within the International Cooperation Department

SIPDIS
of MARD. Dr. David Payne is the resident international advisor
(email: david.pahi.htqt@mard.gov.vn) with a newly recruited
Secretariat Manager, Ms. Dao Thu Trang (email:

SIPDIS
trang.pahi.htqt@mard.gov.vn). A plenary meeting will be held on May
29. The draft agenda includes a: a) briefing on national situation
and response; b) update on management and coordination activities of
PAHI; c) update on ODA-funded AHI activities; and d) opportunity for
additional members to sign the PAHI's Partnership Framework,
originally chartered on November 1, 2006.

11. (SBU) Comment: Although there has been a recent increase in the
frequency of animal outbreaks, the previously reported downward
trend in the number and scope of poultry outbreaks since 2004 still
holds true. The fact that recent outbreaks are restricted mostly to
unvaccinated duck hatchlings is reassuring. However, the threat of
complacency continues to be a challenge for the GVN and
international partners to maintain momentum. With regards to the
reported human case, initial contacts within the MOH, WHO and MARD
reveal that the GVN's system is responding in a systematic and
adequate manner. The event calls attention to the need to build
capacity on both the animal and human side.

MARINE

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