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Cablegate: Avian Influenza Update - More Poultry Outbreaks

VZCZCXRO2315
RR RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #1026/01 1520829
ZNR UUUUU ZZH
R 010829Z JUN 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 5529
INFO RUEHHM/AMCONSUL HO CHI MINH 3150
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHBK/AMEMBASSY BANGKOK 5759
RUEHJA/AMEMBASSY JAKARTA 0676
RUEHUL/AMEMBASSY SEOUL 3166
RUEHKO/AMEMBASSY TOKYO 5731
RUEHVN/AMEMBASSY VIENTIANE 3987
RUEHHK/AMCONSUL HONG KONG 1203
RUEHGZ/AMCONSUL GUANGZHOU 0802
RUEHCN/AMCONSUL CHENGDU 0303
RUEHSUN/USUN ROME IT
RUEHIN/AIT TAIPEI 1496
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 04 HANOI 001026

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, HICKEY)
CDC (COX AND MOHEN)
USDA PASS TO APHIS
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN)
BANGKOK FOR RMO, CDC, USAID (MACARTHUR AND BRADY)
VIENTIANE FOR CDC (CORWIN)
ROME FOR FAO

E.O. 12958: N/A
TAGS: TBIO KFLU AMED AMGT CASC EAGR PINR SOCI VM
SUBJECT: AVIAN INFLUENZA UPDATE - MORE POULTRY OUTBREAKS


HANOI 00001026 001.2 OF 004


SENSITIVE BUT UNCLASSIFIED

REF: HANOI 973 and previous

1. (U) Summary: Vietnam is experiencing a new wave of H5N1 AI
outbreaks in poultry. In May 2007, poultry outbreaks have been
reported in 12 provinces and municipalities throughout the country.
The Government of Vietnam's (GVN) public health response to the
reported first human case since November 2005 was swift and
appropriate, but only after the case-patient arrived at the Bach Mai
Hospital's Intensive Care Unit. Several days lapsed between the
case-patient's initial contact with sick and dead poultry and this
response, indicating that there remain gaps at the village- and
district-levels. The 30-year old man from Vinh Phuoc Province is
recovering and has been taken off a ventilator. The Partnership for
Avian and Human Influenza (PAHI) held its first meeting on May 29.
USAID Vietnam hosted a USG implementing partners meeting on May 30
to provide programmatic updates, share ideas on recent outbreaks and
provide informal updates on USG-funded activities. End Summary.

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

2. (SBU) Per reftel, a 30 year-old man from northern Vietnam's Vinh
Phuc Province has been confirmed as the first human case of highly
pathologic AI since November 2005. This case-patient from Thach Da
Commune, Me Linh District, Vinh Phuc Province slaughtered chickens
for a wedding party of 100 people on May 5. Response teams reported
that the chickens had been purchased in neighboring northern Ha Tay
Province and that some were reported to have been ill or dead at
time of the slaughtering. On May 10, the case-patient developed an
illness with fever, cough, and difficulty in breathing; milder
symptoms may have arisen 2-3 days earlier. In the period May 11-14,
the case-patient became progressively more ill, and on May 14 he was
admitted overnight at the district clinic. On May 15, he was
transferred to Bach Mai Hospital, Hanoi, where he was hospitalized
on a general medical ward with a diagnosis of pneumonia.

3. (SBU) The patient's condition deteriorated further over the next
several days and on May 18 he was transferred to the Bach Mai
Intensive Care Unit for mechanical ventilation. On May 19, the
National Institutes of Hygiene and Epidemiology (NIHE) was notified
of a case of severe viral pneumonia and, following protocol, a team
was dispatched to collect clinical specimens and exposure
information. Results of polymerase chain reaction (PCR) testing
available later that day were positive for H5N1 infection; results
were confirmed with repeat PCR and preliminary sequencing was
performed and reported to higher authorities on May 20. At that
point, information became available on exposure to sick chickens at
time of slaughtering.

4. (SBU) On May 21-22, a team comprised of epidemiology, laboratory,
and sanitarian staff from the Ministry of Health's (MOH) Preventive
Medicine Department at central and local level levels and NIHE, a
clinician from Hospital Infectious and Tropical Diseases, Hanoi, and
District Animal Health staff investigated circumstances at the site
of probable exposure, Me Linh District, Vinh Phuc Province, and took
appropriate prevention and control actions. Investigations and

HANOI 00001026 002.2 OF 004


control measures were also carried out at the health facilities
where the patient had received treatment. Approximately 40 health
care workers and 70 family members and other close contacts were
administered prophylactic 7-day courses of oseltamivir (Tamiflu).
Epidemiologic investigations revealed only one contact with
symptoms, a 16-year old niece with a mild upper respiratory illness
who was H5N1 test negative and recovered without consequence.
Intensive area surveillance over the next week identified no further
persons with suspect symptoms, and no AI outbreaks in Me Linh
District or Ha Tay Province. By May 30, the patient's condition was
reported to be much improved and recovering without need for
ventilator assistance.

5. (SBU) Comment. The GVN's public health response to this human
case was swift and appropriate, but only after the case-patient
arrived at the Bach Mai Hospital's Intensive Care Unit. Several
days lapsed between the case-patient's initial contact with dead
poultry and this response, indicating that there remain gaps at the
village- and district-level. This case illustrates the need for
continuing USG's activities at the grassroots level and particularly
with farmers and village animal and human health workers. USG
implementing partners reveal that awareness levels are not equal in
all provinces and districts, with many areas still having quite low
levels of awareness (e.g., how one contracts HPAI). End Comment.

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

6. (SBU) Vietnam is experiencing a new wave of H5N1 AI outbreaks in
poultry. In May 2007, poultry outbreaks have been reported in 12
provinces and municipalities, including Nghe An, Nam Dinh, Son La,
Hai Phong, Quang Ninh, Bac Giang, Ninh Binh, Bac Ninh, Vinh Phuc and
Ha Nam in the north, and Dong Thap and Can Tho in the south. The
most recent poultry outbreaks have occurred in northern Nam Dinh and
Ninh Binh Provinces and southern Dong Thap Province. The outbreaks
in Vietnam have mostly affected unvaccinated, immature duck flocks,
but smaller numbers of older birds have also been affected. As
previously reported, 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) The Minister of Agriculture and Rural Development (MARD) Cao
Duc Phat stated at a session of the National Steering Committee for
Bird Flu Control and Prevention on May 29 that all waterfowl must
either be immediately vaccinated or culled. Media reports indicate
that since early May over 49,000 poultry have been found either dead
or have been culled by animal health workers.

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

8. (U) The GVN hosted a plenary meeting of the Partnership for Avian
and Human Influenza (PAHI) and formally established its Secretariat
office on May 29. Beyond the original nine signatory partners,
which includes the U.S. Mission, three additional non-governmental
organizations (NGO) joined the PAHI. The GVN's national plan calls
for USD 250 million in assistance. The GVN has pledged to

HANOI 00001026 003.2 OF 004


contribute 50 percent of this amount. The international donors have
delivered about USD 70 million, leaving a gap of about USD 55
million. The USG remains the second largest donor to PAHI, second
only to Japan.

9. (SBU) During the original negotiation and clearance of the PAHI
framework document, Japan pushed for decreasing the perception of
the binding nature of the framework by suggesting that the document
be changed from a memorandum of understanding to a simple agreement.
Although this point was conceded, Japan did not sign at the meeting
in November 2006. At the May 29 plenary, Japan left prior to the
signing portion of the agenda, but pledged to sign sometime in the
future.

10. (U) The PAHI Secretariat serves to: a) facilitate and coordinate
donor commitments and funding; b) serve as a platform for
information exchange and policy development; and c) harmonize
monitoring and evaluation efforts. The Secretariat announced plans
to add two other technical working groups, one each on animal and
human health activities to compliment the existing communications
workgroup, which predates PAHI.

11. (SBU) The announcement of the technical workgroups was welcomed
by the USG AI in-country team, who has been advocating since
November 2006 for the addition of technical workgroup function to
better harmonize efforts across donors programs. There was open
support that PAHI examine ongoing USG planning efforts on monitoring
and evaluation.

12. (SBU) United Nations Resident Coordinator John Hendra concluded
the meeting by summarizing two important points: a) the need to draw
out the total funds spent and pledged to date, by the implementing
start date of the national plan as well as to justify with current
figures on the gap; and b) to need to further discuss and address
the GVN's organization structure as illustrated in the national plan
versus the current operating approach.

13. (SBU) Comment: Post believes the PAHI has to-date succeeded to
deliver its objectives. The PAHI has leveraged the USG's investment
in building capacity for highly pathological AI in Vietnam through
the promotion of openness, transparency and accountability. End
Comment.

USG Implementing Partners Meeting
---------------------------------

14. (SBU) USAID Vietnam hosted a USG implementing partners meeting
on May 30 to provide programmatic updates, share ideas on recent
outbreaks and provide informal updates on USG-funded activities.
Thirteen representatives of USAID, State, CDC, FAO, Abt Associates,
AED, AVSF, CRS, and Kenan Institute attended. Topics discussed
include the status of 2007 supplemental funding for AI, the current
grassroots level demand and use of rapid testing kits, farmers'
compensation for culled poultry, the barriers to conducting a
comprehensive poultry vaccination campaign, sharing methodologies
and results of various KAP surveys, gaps in local knowledge levels
and the use of mass media and television, a pilot supply chain
management activity, development of public-private partnership

HANOI 00001026 004.2 OF 004


activities, discussions between the MOH and CARE to expand their
model village-based surveillance activity and the MOH's response to
the human case-patient.

MARINE

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