Cablegate: Vietnam - Avian Flu Update #1

This record is a partial extract of the original cable. The full text of the original cable is not available.





E.O. 12958: N/A


1. (U) There are currently 48 human cases including 18
deaths under investigation in Vietnam's avian influenza
outbreak. The work of the WHO/CDC team was delayed due to
the Tet (Lunar New Year) holidays, but preliminary
exploration of the extent of the outbreak has begun, and
support for their efforts is expected to increase as the
holidays come to a close. The team's major concerns at this
point are to control the outbreak in poultry and identify
and implement measures to protect the public. To accomplish
this, the team aims to determine the extent of H5 infection
in humans, identify the mechanisms of transmission, explore
any evidence of human-to-human spread, and improve
laboratory capacity to identify H5N1 influenza virus. End


2. (U) A six-person team of experts from the Centers for
Disease Control and Prevention (CDC) arrived in Vietnam on
January 19th at the invitation of the GVN to support World
Health Organization (WHO) activities related to the avian
influenza outbreak in Vietnam. As of the morning of January
26th, there are 48 human cases and 18 deaths under
investigation. Of these, laboratory tests have confirmed
the presence of the H5N1 virus in 7 cases (6 deaths and 1
presently hospitalized in HCM city). The two most recent
cases are in children in HCMC. Due to limited epidemiologic
surveillance, it seems likely that there are more cases in
country that have not yet been identified.


3. (U) The Tet holidays delayed many of the efforts of the
WHO/CDC team over the past week. Only a skeleton staff in
the GVN laboratory was made available to the team during the
past week. Tet holidays and related closure of government
facilities have also delayed the completion of confirmatory
diagnostic laboratory testing in Hong Kong. The WHO/CDC team
requested two visits to affected poultry farms. The CDC
scientists traveled to one affected poultry farm in a
province just outside of Hanoi on Jan 25. This farm had seen
the loss of more than 90% of its ducks and chickens in the
preceding 10 days. Tests conducted by these scientists have
confirmed avian influenza as the cause of this outbreak. The
visit to the second farm was cancelled at the last minute
with no explanation. Tet ends on January 26, and WHO/CDC
anticipate much greater cooperation and support to begin in
the next few days.

4. (U) The closure of the Customs office over Tet also
resulted in delays in access to a supply of Personal
Protective Equipment (PPE) a warehouse in the port in Hai
Phong. This PPE had originally been ordered in preparation
for the possible return of SARS, but is now needed by those
culling infected poultry. WHO/CDC anticipates the clearance
of that shipment later this week, and further shipments will
arrive and be cleared over the next couple of weeks.


5. (U) A number of significant concerns at this time
revolve around the culling of poultry. First, is large-
scale culling even being performed? Figures released last
week by the GVN group poultry deaths due to culling and to
avian influenza in one category. It is therefore unclear
how many birds have actually been culled. The figures
indicate that of the approximately 254 million domestic
poultry in Vietnam, about 2 million have died. Given the
mortality rates among poultry and the spread of the disease,
it is likely that the majority of those 2 million deaths
were due to disease and not culling. There are indications
that culling efforts are more aggressive in southern
Vietnam, but these efforts do not appear to be sufficient in
proportion to the outbreak. Secondly, are those performing
the culling using adequate protection? The Ministry of
Agriculture indicates that there are at least six thousand
workers involved in the culling and disposal of deceased
poultry. It is safe to say that the majority of these
workers have not been provided adequate protective equipment
to reduce the risk of infection. The existence of numerous
small, non-commercial farms in rural areas poses a further
challenge to culling efforts. The USDA US Animal and Plant
Health Inspection Service (US APHIS) is providing technical
consultation to advise on proper culling procedures. A USDA
expert may be asked to join the team in coming days.

6. (U) Incentives to cull are also inadequate. While the
market rate for a healthy chicken is 40,000 VND (USD 2.58),
farmers are being compensated only 5,000 VND (USD 0.33) for
deceased birds, and 15,000 VND (USD 0.97) for living birds
surrendered for culling. Given the low level of
compensation, there is incentive for many farmers to sell
off living chickens and/or wait to see if some of their
birds survive the infection. The UN's Food and Agriculture
Organization will contribute $400,000 USD in financial
assistance, some of which will be used to provide increased
incentives for farmers to surrender poultry for culling.

7. (U) Human-to-human transmission remains a major concern.
While human-to-human transmission is not confirmed in any of
the 48 cases currently under investigation, CDC and WHO
experts believe such transmission between close contacts
(e.g. family members) is likely to happen in the future if
it has not already. Of concern is whether transmission of
the avian influenza virus may become possible through casual
contact. According to WHO/CDC, this worst-case scenario is
what epidemiologists call "sustained community
transmission", meaning that the disease is spread
extensively through casual contact. The result would most
likely be an global influenza epidemic (pandemic).

8. (U) Finally, laboratory services to confirm cases
currently under investigation are limited in Vietnam. The
National Institute for Hygiene and Epidemiology (NIHE) and
the National Center for Veterinary Diagnostics (NCVD) are
inadequately prepared to perform the number and types of
complex testing required in both livestock and humans in
order to appropriately study and advise on containment of
this outbreak. The WHO/CDC team is trying to improve this


9. (U) As the outbreak continues to spread in Vietnam and
across Eastern and Southeastern Asia, regional cooperation
becomes essential. Officials in Vietnam hope that the
January 28, ministerial level meeting of ASEAN + 3
countries, plus the US and EU, in Bangkok will bolster
cooperation. We understand that efforts are underway in
Thailand to arrange a technical expert-level meeting to
follow the ministerial level talks.

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