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Cablegate: Avian Influenza Update - More Human Cases and First Deaths

VZCZCXRO2917
RR RUEHCHI RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #1147/01 1730932
ZNR UUUUU ZZH
R 220932Z JUN 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 5703
INFO RUEHHM/AMCONSUL HO CHI MINH 3281
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHUL/AMEMBASSY SEOUL 3172
RUEHKO/AMEMBASSY TOKYO 5739
RUEHHK/AMCONSUL HONG KONG 1219
RUEHGZ/AMCONSUL GUANGZHOU 0810
RUEHCN/AMCONSUL CHENGDU 0309
RUEHIN/AIT TAIPEI 1502
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEAUSA/DEPT OF HHS 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//
RUEHSUN/USUN ROME IT

UNCLAS SECTION 01 OF 05 HANOI 001147

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 FOR OGHA (BLOUT/MCCALL) AND DIV-FLU (COX/MOHEN)
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN)
HHS PASS TO FIC/NIH (GLASS)
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS
BANGKOK FOR RMO, CDC (MALISON), USAID (MACARTHUR/BRADY)
BEIJING FOR HHS HEALTH ATTACHE (ROSS)
PHNOM PENH FOR CDC INFLUENZA COORDINATOR(BRADY)
ROME FOR FAO
VIENTIANE FOR CDC INFLUENZA COORDINATOR (CORWIN)


E.O. 12958: N/A
TAGS: TBIO AMED AMGT CASC EAGR PINR KFLU VM
SUBJECT: AVIAN INFLUENZA UPDATE - MORE HUMAN CASES AND FIRST DEATHS
SINCE 2005

HANOI 00001147 001.2 OF 005


SENSITIVE BUT UNCLASSIFIED

REF: A. HANOI 973; B. HANOI 1026; AND C. HANOI 1050

1. (U) Summary. The Government of Vietnam (GVN) now reports a total
of five confirmed human cases of highly pathologic H5N1 avian
influenza A (AI) since May 1, including two deaths, the first since
November 2005. There have been no associated cases among contacts
and no common sources of infection. Since May 1, there have been
over 100 animal AI outbreaks in 18 of Vietnam's 64 provinces and
municipalities. Animal Health authorities report that the first
shot of two in the first of two rounds of poultry vaccinations is
complete in 43 provinces.

2. (SBU) The GVN has shipped the samples from the first two human
cases to a World Health Organization (WHO) influenza collaborating
center; shipping was delayed by procedural and logistical
complications. End Summary.

Summary of Human Cases
----------------------

3. (U) Between 24 May and June 16, the Ministry of Health (MOH)
reported five new cases of H5N1 infection including two deaths,
bringing the national total to 98 cases and 44 deaths. These first
reported cases since November 2005 include four men and one woman,
all young adults (aged 19 to 30 years) living in rural areas of
northern Vietnam. Two patients have died. Of the remaining three
patients, two have recovered and been discharged from the hospital;
one is hospitalized and in good condition.

4. (SBU) Each of the five cases was an isolated occurrence and we
have seen no evidence of epidemiological links that would suggest a
common source or person-to-person transmission. The source of
infection is presumed to be the slaughter or preparation of sick
poultry in three cases (chickens in two instances; duck in one);
exposure to ducks and fighting cocks in the family in one case; and
unknown in one case.

5. (SBU) MOH reports that all five cases resulted in investigations
and further preventive measures were taken. A course of oseltamivir
(Tamiflu) was given to individuals in close contact with the
infected patient, supplemental information and educational materials
were provided to local communities and environmental decontamination
was organized.

6. (SBU) Although the MOH reports that the human and animal public
health investigations and responses for control and containment have
been prompt and thorough, two different sources in the Ministry of
Agricultural and Rural Development (MARD) reported that they were
not made aware of the cases by MOH in sufficient time to coordinate
and direct local officials on the animal health side. (Comment:
Post believes that provincial action could have occurred on the
animal side as directed by local People's Committees and that MARD
may have been out of the loop. We cannot confirm veterinary
investigation or action. End Comment.)


HANOI 00001147 002.2 OF 005


7. (U) All but one of the five patients required intensive care and
mechanical ventilation for respiratory failure. The overall
survival rate for Vietnam patients remains high at 55 percent (54 of
98). There is no evidence to suggest a change in the clinical
picture or response to therapy compared with previously treated
patients in Vietnam.

New and Updated Details of the Five Human Cases
--------------------------------------------- --

8. (SBU) The first human case, a 30-year old man (alias PMP) who was
thought to have been infected while slaughtering chickens for a
wedding on May 5 (reftel B), recovered from respiratory failure and
was discharged from the hospital after 16 days. It was reported
that he received 10 days of oseltamivir and that the virus had been
confirmed in his saliva, gastric contents, and excrement.
Approximately 40 health care workers and 70 family members and other
close contacts were administered prophylactic 7-day courses of
oseltamivir. Epidemiologic investigations revealed only one contact
with symptoms, a 16-year old niece with a mild upper respiratory
illness who tested negative for H5N1 and recovered without
consequence. Intensive area surveillance over the next week
identified no further persons with suspect symptoms, and no
outbreaks in poultry.

9. (SBU) The second case, a 19 year old man, had occupational
exposure to chickens at a slaughter house on the outskirts of Hanoi
(reftel C). He was working in Dong Anh District from May 13 to 18,
returned home to Thai Nguyen Province May 19, complained of fever
and abdominal pain May 20 to 23, and was hospitalized May 24. He
quickly developed respiratory failure and acute respiratory distress
syndrome (ARDS) and was transferred to a referral hospital in Hanoi
on May 26. Test results confirmed the presence of the H5N1
influenza A virus. A joint human and animal investigation was
unrevealing and all of the patient's coworkers were closely
monitored. The patient is still hospitalized but breathing on his
own and his condition is slowly improving.

10. (SBU) The third case, a 29-year old male (alias LNL and possibly
female in a conflicting report) who is a staff member of the Local
Youth's Union in Som Son Town, Thanh Hoa Province (about 150 km
south of Hanoi) reportedly became ill on May 28 or 29. One press
report stated that he had eaten a sick duck. MARD official reported
to FAS staff that he had slaughtered chickens on May 25. He began
to exhibit influenza-like symptoms on May 28 or 29 and was
hospitalized on May 31 and treated with oseltamivir. He was
discharged June 6. Positive results for H5N1 were available June 8.


11. (SBU) The fourth case is a 20-year old male from Ba Vi District,
Ha Tay Province, less than 100 km west of Hanoi. Press reports
indicate that ducks and fighting cocks were maintained by his
family. He became symptomatic on June 2, hospitalized on June 8 and
transferred to a referral hospital in Hanoi on June 10. He died the
same day. Results from specimens tested positive for H5N1. This is
the first human bird flu death in Vietnam since November 2005.
Details of the case investigation are unknown at this time.

HANOI 00001147 003.2 OF 005

12. (SBU) The fifth case, a 28-year old female farmer from the Thanh
Liem District of Northern Vietnam's Ha Nam Province (about 40 km
south of Hanoi) exhibited fever and chest pain on June 4. She was
admitted to the provincial hospital on June 6 and transferred to a
referral hospital in Hanoi on June 8. Doctors diagnosed her with
pneumonia. On June 12, test results confirmed the presence of H5N1.
She died June 21, the second death since May 1, bringing the total
to 44 since the end of 2003. The patient's exposure history is
currently under investigation, including the collection of clinical
specimens from 20 close contacts.

13. (SBU) Test results for two patients previously described as
under investigation (reftel C) tested negative for H5N1. Several
other reports of patients with influenza-like symptoms progressing
to severe pneumonia, including at least three deaths, have been
reported by MOH and media sources but have tested negative for H5N1.
(Note: These reports are to be expected given the increased testing
as a consequence of heightened awareness and the baseline occurrence
of severe pneumonia from other causes. End Note)

Sample Sharing
--------------

14. (SBU) The MOH gave approval for WHO-Vietnam to obtain
confirmation of diagnosis for the first two cases. The WHO has sent
a letter requesting approval for the remaining three. The specimens
for the first two cases have been sent to the CDC in Atlanta, one of
the four WHO influenza collaborating centers.

15. (SBU) The actual shipment of samples to Atlanta was delayed due
to technical and bureaucratic obstacles. The specific issues
included a) new personnel in more than one organization who were
unfamiliar with the process of shipping the samples, b) one of the
downloadable customs approval forms was illegible and not suitable
for signature, c) the introduction of "new" requirements based on
H5N1 being categorized as a select agent, d) non-functioning FAX
numbers, and e) obstacles to amending and correcting forms already
approved by USDA for importation.

16. (SBU) When issues were recognized, various staff, on both sides
of the ocean, dropped what they were doing to solve the problems and
worked after hours, in one case driving back in to work due to the
time difference. The actual procedure for WHO counting and
reporting a human case in Vietnam is not clear at this time. HHS/OS
and CDC Hanoi are encouraging WHO-Vietnam and the National Institute
of Epidemiology and Hygiene (NIHE) to examine these events in closer
detail with CDC-Vietnam in order to a) improve the process and b)
uncover what may be potentially systemic issues applicable to other
countries.

Continued Animal Outbreaks
--------------------------

17. (U) Vietnam continues to experience AI poultry outbreaks in all
regions -- southern, central and northern -- of the country. The
north has been particularly hard hit in this latest wave of

HANOI 00001147 004.2 OF 005


outbreaks. Since the beginning of the fifth wave of poultry
outbreaks in early May, 16 provinces and 2 municipalities have been
affected; 13 of these are located in the northern region, including
all provinces contiguous with the city of Hanoi. More than 100
outbreaks have occurred in approximately 70 communes in 40
districts; these have involved mostly waterfowl (ducks and geese)
and to a much lesser degree, chickens.

18. (U) Media reports state that since the beginning of the fifth
wave, nearly 200,000 poultry have died or been culled, 96 per cent
of them ducks. Flocks of unvaccinated ducklings have been the most
affected. Although the outbreaks have been easily contained because
of early detection, culling, quarantine, environmental
decontamination and ring vaccination, the potential for large scale
outbreaks increases as these flocks mature and are released for
free-grazing in the coming months.

19. (U) Poultry reared for consumption has been affected, as it is
the presumed source of infection for all five recent human cases.
Various markets have been sampled. A MARD Central Veterinary
Diagnostic Center official reported to FAS staff that 62 of 1109
(5.6 percent) poultry sampled have tested positive for H5N1 virus.
These samples were taken from birds in seven northern provinces and
cities, namely Bac Giang, Ha Nam, Hanoi, Ha Tay, Hai Duong, Thai
Binh and Vinh Phuc, and an province bordering China, Lang Son. The
percentage positive in Lang Son was 12 percent. Sampling in two
Hanoi retail markets yielded a positive fraction of 6 percent and in
one Hanoi wholesale market, 14 percent. These statistics differ
from those in the media.

20. (SBU) (Comment: These numbers seem high as an indicator of
infection in healthy animals, i.e. detection by PCR, compared to
studies in Thailand. More information is needed on species
involved, sampling methodology, type of test, and whether waterfowl
were vaccinated or unvaccinated before conclusions can be drawn from
this report. End Comment.)

Media Reports
-------------

21. (U) Numerous media reports have covered the stepped up response
of the GVN, including explicit directives from the Prime Minister
(PM). A media report quoted the PM as saying he expected "directed
officials to take responsibility for bird flu" and that "penalties
will be imposed on leading officials if a new outbreak occurs in
their area." At the national steering committee meeting in
mid-June, MARD proposed that an additional 200 million doses of
animal vaccine should be imported; and there are continued concerns
about vaccine efficacy. National media also reported that Vietnam
reserves the right to quarantine incoming passengers from bird
flu-hit countries. Ton Son Nhat International Airport in HCMC would
screen incoming passengers by body temperature, a scenario they
played out to combat SARS in previous years.

USAID and CDC Activities
------------------------


HANOI 00001147 005.2 OF 005


22. (U) NGOs and international organizations that receive USAID and
CDC funds met on June 14th to discuss the methodology coordination
of USAID-funded "Knowledge, Attitude and Practice" surveys carried
out in Vietnam. These surveys have been used to gauge the awareness
of households and backyard farmers about AI prevention and control.
Participant organizations discussed methods to improve their data
collection process, the feasibility of including several standard
questions in future KAP surveys and target groups, which had
previously been overlooked.

23. (U) The MOH's Vietnam Administration for Preventive Medicine
(VAPM) hosted a launching ceremony on June 14 for HHS/CDC's 5-year
cooperative agreement designed to build capacity around the
framework of President's three pillars. The first-year FY2006
funding is 1.15 million USD; second year funding was cut from the
projected figure of 1.3 million USD to the actual FY2007 of 525,000
USD. Ambassador Marine remarked that the new initiative
complemented other USG supported projects (i.e., USAID, USDA,
HHS/OS, and CDC). Vice Minister of Health Trinh Quan Huan said,
"Prevention of an avian influenza pandemic by enhancing different
levels of surveillance, rapid detection, and our response to
outbreaks is critical in Vietnam." Press coverage was heavy and the
reporting on this USG support was coupled with reports of the need
for increased Vietnamese efforts to combat the current high level
threat.

ALOISI

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