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Cablegate: Two First Human Cases of Influenza a/H5n1 in Vietnam In

VZCZCXRO4099
RR RUEHAST RUEHCN RUEHDH RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD RUEHSL
RUEHTRO
DE RUEHHI #0220/01 0571106
ZNR UUUUU ZZH
R 261103Z FEB 10
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 0975
INFO ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RHMCSUU/CDR USPACOM HONOLULU HI
RHMFISS/CJCS WASHINGTON DC
RUEAIIA/CIA WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHC/DEPT OF AGRICULTURE WASHINGTON DC
RUEHCN/AMCONSUL CHENGDU 0007
RUEHGZ/AMCONSUL GUANGZHOU 0008
RUEHHK/AMCONSUL HONG KONG 0049
RUEHHM/AMCONSUL HO CHI MINH CITY 0541
RUEHKO/AMEMBASSY TOKYO 0061
RUEHPH/CDC ATLANTA GA
RUEHSUN/USUN ROME IT
RUEHUL/AMEMBASSY SEOUL 0063
RUEKJCS/SECDEF WASHINGTON DC

UNCLAS SECTION 01 OF 02 HANOI 000220

SENSITIVE
SIPDIS
STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED,AND OES/IHB (DFANTOZZI, CPATTERSON, CSHAPIRO)
STATE PASS TO USAID GH (GSTEELE, DCARROLL, ACLEMENTS)
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN)
HHS/OSSI/DSI PASS TO FIC/NIH (RGLASS), OGHA (JMONAHAN, MABDOO, SCUMMINGS, DMILLER), ASPR (MPERDUE, RROBINSON)
CDC FOR COGH (SBLOUNT), CCID (SREDD) AND DIV-FLU (NCOX, AMOEN)
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS
BANGKOK FOR USAID (MACARTHUR/AATHWIN), APHIS (HHOWARD/RTANAKA) AND CDC (MSIMMERMAN)
BEIJING FOR HHS HEALTH ATTACHE (EYUAN) AND CDC (JMCFARLAND)
PHNOM PENH FOR CDC INFLUENZA COORDINATOR (PKITSUTANI)
ROME FOR FAO (JZINGESER)
VIENTIANE FOR CDC INFLUENZA COORDINATOR (ACORWIN)

E.O. 12958: N/A
TAGS: TBIO AMED EAGR PINR KFLU VM
SUBJECT: TWO FIRST HUMAN CASES OF INFLUENZA A/H5N1 IN VIETNAM IN
2010, SEVERAL ANIMAL OUTBREAKS NATIONWIDE

REF: 09 HANOI 1290

1. (U) Summary: Vietnam reported its first two Influenza A/H5N1
infections of 2010, one of them apparently fatal. Consistent with
seasonal trends, Vietnam also has experienced several outbreaks in
flocks of chickens and ducks throughout the country. End Summary.

First Human Infection of Influenza A/H5N1 in 2010

--------------------------------------------- ----

2. (U) Earlier this week, the local media reported the first 2010
human highly pathogenic avian influenza A/H5N1 infection, a three
year-old girl from south central Khanh Hoa province. Contacts at
the National Institute of Hygiene and Epidemiology told the Embassy
that onset of symptoms occurred on January 27 and that the girl was
taken to the district hospital outpatient clinic the following day
with a fever and cough. By February 3, the patient had fully
recovered. Lab samples taken January 28 came back negative for 2009
H1N1 and seasonal influenza, but positive for H5N1. It is not yet
clear why this child with mild disease was tested for influenza (as
influenza testing is not routine and this hospital is not in the
National Influenza Surveillance System), nor is the source of her
infection clear. This was Vietnam's 113th human infection since
2003, of which 57 have been fatal. This is the 13th case in a
child ages 0 to 5 in Vietnam. Notably, the patient is only the
second out of the past 12 human infections since late 2008 to
survive.

3. (SBU) To date, we have received somewhat inconsistent
information regarding animal outbreaks in the vicinity of the
victim's home. Initial reporting from the Regional Animal Health
Office Number 4 (RAHO 4) within the Ministry of Agriculture and
Rural Development (MARD), which covers six provinces along the
south central coast, including Khanh Hoa, stated that the Khanh Hoa
provincial Department of Animal Health (DAH) found abnormal deaths
in a flock of 770 unvaccinated chickens in the neighboring commune
and from a flock of 6,000 unvaccinated quail at a nearby farm.
The report noted that Khanh Hoa provincial DAH took 15 samples from
the two flocks with 10 positive results (note: it is unclear
whether the positive results came from samples from the chickens,
quail or both). Media reports also note the mysterious deaths of a
number of ostriches at a farm approximately 30 miles north of the
victim's village. According to NIHE, as part of the initial, local
investigation, it was reported that the family kept 15 healthy
chickens, but that the patient had no known animal exposure nor
contact with sick humans in the 7 day period prior to onset (Note:
NIHE has not yet performed an independent investigation). However,
in a call the Consulate General Ho Chi Minh City staff, a senior
Khanh Hoa DAH official stated that the victim's family had stopped
raising poultry prior to her infection, that the ostriches (with
which there is no known link to this patient or patient's family)
appeared to have died from other causes, and that the poultry in
the area had been vaccinated.

HANOI 00000220 002 OF 002


Second Human Infection and First Fatality

-----------------------------------------

4. (SBU) Earlier today, medical staff at the Pasteur Institute in
Ho Chi Minh City confirmed to ConGen Staff a second human infection
and first fatality in 2010 (114 cases and 58 deaths since 2003).
In this case, a 38 year old woman from An Thoi Trung commune, Cai
Be District, Tien Giang Province, south of Ho Chi Minch City, was
hospitalized at Sa Dec General Hospital, Dong Thap Province on
February 21 and diagnosed with pneumonia and septicemia. According
to the Ministry of Health, she had developed symptoms on February
13, but initially treated herself at home. On February 21, she was
admitted to Sa Dec hospital in Dong Thap province with chest pain,
difficulty breathing and exhaustion. Per MOH, the patient died on
February 23. A throat swab sample taken on February 22 and tested
on February 23, was positive for H5N1, as confirmed by the Pasteur
Institute in Ho Chi Minh City. The victim reportedly had
slaughtered ducks, which have not been tested. RAHO 6, which
covers Ho Chi Minh City and the surrounding provinces, stated that
it was coordinating with the Tien Giang provincial Department of
Animal Health to conduct an investigation. At the moment, animal
health officials have not confirmed any animal outbreaks in Tien
Giang.

Nationwide Animal Outbreaks

---------------------------

5. (U) Consistent with general seasonal trends, poultry outbreaks
have occurred in several provinces throughout the country,
including Nam Dinh (north coast), Soc Trang (Mekong Delta), Ca Mau
(far south), Ha Tinh (north central), Dien Bien (northwest
highlands), Kon Tum (central highlands), Quang Tri (north central)
and Nghe An (north central), in addition to the likely animal
outbreaks mentioned above in south central Khanh Hoa. Higher
outbreak numbers often are associated with increased poultry
production in the weeks leading up to the Vietnamese lunar New Year
(Tet). This year, outbreaks occurred primarily in small to medium
sized flocks of chickens and ducks, most of which apparently were
not vaccinated or had only received the first series of
vaccinations. In several instances, multiple farms in one
geographic area reported infections. As of February 26, the
provinces of Khanh Hoa, Ca Mau, Nghe An, Ha Tinh, Nam Dinh and Soc
Trang had official reported animal outbreaks within the past 21
days.

6. (U) This cable was coordinated with Consulate General Ho Chi
Minh City.
Michalak

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