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Cablegate: Avian Influenza Update - Vietnam's Second Ai Fatality Of

VZCZCXRO9266
RR RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #0177/01 0461016
ZNR UUUUU ZZH
R 151016Z FEB 08
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 7186
INFO RUEHHM/AMCONSUL HO CHI MINH 4304
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHUL/AMEMBASSY SEOUL 3239
RUEHKO/AMEMBASSY TOKYO 5817
RUEHHK/AMCONSUL HONG KONG 1351
RUEHGZ/AMCONSUL GUANGZHOU 0846
RUEHCN/AMCONSUL CHENGDU 0343
RUEHIN/AIT TAIPEI 1553
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 03 HANOI 000177

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/DMILLER/HICKEY)
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN)
HHS/OSSI/DSI PASS TO OGHA (WSTIEGER/LVALDEZ/CHICKEY) AND
FIC/NIH (RGLASS) AND DIV-FLU (COX/MOHEN)
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS
BANGKOK FOR RMO, CDC (MALISON), USAID (MACARTHUR/BRADY) BANGKOK FOR
APHIS (NCARDENAS), REO(JWALLER)
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 - VIETNAM'S SECOND AI FATALITY OF
2008

REF: A. HANOI 80 B. 07 HANOI 2116

HANOI 00000177 001.2 OF 003


1. (U) Summary: Government of Vietnam (GVN) officials confirmed the
second and third human Avian Influenza (AI) fatalities of 2008, both
from northern provinces close to Hanoi. A 40-year old male from Hai
Duong province died on February 13 after cooking and eating dead
chickens. A 27-year old male from Ninh Binh province died on
February 15 after slaughtering sick chickens. The Ministry of Health
(MOH) and the Department of Animal Health (DAH) within the Ministry
of Agriculture and Rural Development have sent response teams to the
victims' villages. However, once again the MOH failed to provide
timely notification to the World Health Organization (WHO). End
Summary.

50 Fatalities Since Onset of Avian Influenza
--------------------------------------------

2.(U) The GVN confirmed the second and third AI-related human
fatalities of 2008, a 40-year old man from Quang Bi hamlet, Pham
Chau Village, Gia Loc District, Hai Duong province, roughly 50
kilometers from Hanoi, and a 27-year old man from Ninh Binh
province, approximately 100 kilometers south of Hanoi. Vietnam now
has suffered eight deaths and 11 infections since the most recent
wave of AI outbraks began in May 2007 and 50 fatalities and 104
human infections since the initial outbreak of AI in 2003. Each of
the last eight reported human infections resulted in death.

Hai Duong Fatality
------------------

3. (U) A 40-year old man from Hai Duong province died at noon on Feb
13 at the National Institute for Infectious and Tropical Diseases
(NIITD) following four days of treatment, including mechanical
ventilation and hemoperfusion. According to press reports, the
patient arrived on February 9 already suffering from severe
pneumonia and internal organ failure. He had been ill for six days
prior to initial hospitalization at Hai Duong Provincial Hospital.
The Director General of the Vietnam Administration of Preventative
Medicine within the MOH, Nguyen Huy Nga, stated that the man had
cooked and consumed, along with his family, at least two dead
chickens. Authorities subsequently found numerous dead chickens
around the man's residence and DAH noted that nine of the man's 12
fighting cocks had died since late January.

4. (SBU) The National Institute of Hygiene and Epidemiology (NIHE)
was notified of the suspect case on February 9, responded promptly,
and reported confirmatory laboratory test results on February 10.
However, MOH only notified the WHO on February 14 -- a day after the
local press reported the case - although WHO International Health
Regulation guidelines stipulate reporting within 24 hours. The Hai
Duong Preventative Medicine Center sent an investigation and control
team to the man's village to conduct case detection and surveillance
and sterilize the environment (including wells) surrounding the
patient's residence with chloramine. The response team reportedly
was unable to provide osetmavir (Tamiflu) to family members and
neighbors due to the available medication already passing its

HANOI 00000177 002.2 OF 003


expiration date necessitating VAPM sending additional mediction from
its central stocks. To date, we have seen no reports of additional
human infections in this village. Both the DAH and the MOH have
since sent investigation and control teams to the area and MOH
invited a WHO epidemiologist to join.

Death in Ninh Binh
------------------

5. (SBU) VAPM confirmed today to USAID that a 27-year old man
infected by the H5N1 virus died yesterday. According to NIHE, the
Ninh Binh resident slaughtered sick chickens on January 31 and
became ill two days later. His fever worsened on February 7 and he
was admitted to Army Hospital Number 5 in Ninh Binh on February 11
and transferred to Bach Mai hospital in Hanoi on February 12. Bach
Mai received a positive H5N1 confirmation test on February 13. NIHE
collected an additional sample but has not yet reported results.
The MOH sent a response team today to the residence. Though MOH has
discussed this case with the local WHO office, it has not yet
provided official notification.

Recent Animal outbreaks
-----------------------

6. (U) In addition to the two recent human fatalities (and related
poultry deaths), Vietnam currently has ongoing animal outbreaks in
northern Thai Nguyen and central Quang Binh province, according to
DAH. Most recently, on February 11, DAH reported an outbreak in Tan
Lap ward of Thai Nguyen city where local authorities culled 700
ill-looking ducks. A January 29-30 outbreak in Hong Thuy province
in Quang Binh killed 100 ducks in three flocks totaling 5,300 birds.
Though 3,800 of the ducks had received vaccinations, not enough
time had elapsed to build up immunity. DAH and local authorities
culled the flocks and took other preventive actions. Also on
January 29, 1,200 chickens in a 4,165 bird flock died in Thai
Nguyen. The remaining birds subsequently were culled. The two to
four month old chickens had been vaccinated on December 21. Quang
Binh had suffered an additional animal outbreak on January 23, when
over 1,000 50-day old and unvaccinated ducks became infected in Hong
Thuy Commune, Le Thuy district.

Comment:
-------

7. (SBU) Unlike the two previous human fatalities (reftels), these
two patients resided in high-risk provinces in the Red River delta
close to Hanoi and in which the GVN has focused its AI response
campaign (including mandatory vaccinations of chickens and ducks).
Nevertheless, the facts of this case are quite familiar - and
involve the handling, preparation, and consumption of sick or
already dead poultry. Although the overall number and intensity of
animal outbreaks remains substantially lower than this time period
last year, human exposure through high risk behaviors, such as
handling and preparing sick or already dead poultry, appear common
in some areas.


HANOI 00000177 003.2 OF 003


8. (SBU) Comment cont'd: During the Lunar New Year, or Tet, which
stretched from February 5 to February 11, huge numbers of Vietnamese
return to their ancestral villages and the consumption of chicken is
an important holiday ritual. The holidays also leave medical
facilities and government agencies short staffed and sick persons
often are reluctant to seek care during the celebrations. This may
account for the late diagnosis of the disease and for what appears
to be another failure by the MOH to promptly notify the WHO of the
infection. Though we are pleased by the inclusion of a WHO
epidemiologist as part of the MOH response team, once again, we will
work with WHO to remind our Vietnamese interlocutors of the need for
prompt notification to ensure proper international response.

9. (SBU) Comment cont'd: Importantly and disturbingly, in several
recent cases, we have seen human infections in the absence of
detection of or reporting by authorities of pre-existing animal AI
outbreaks in the patient's village or commune. Only after human
victims were hospitalized did local authorities note ill or dead
poultry. In essence, human cases have been serving as sentinels of
avian infection, which is the opposite of how the sentinel
surveillance system should work. End comment.

MICHALAK

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