Cablegate: Vietnam - Avian Flu Update #5

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

UNCLAS SECTION 01 OF 03 HANOI 000302

SIPDIS

SENSITIVE BUT UNCLASSIFIED

FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV
BANGKOK FOR RMO, CDC, AID (TDOLAN)
STATE PASS HHS
USDA FOR FAS/PASS TO APHIS

E.O. 12958: N/A
TAGS: AMED AMGT CASC EAGR TBIO VM AFLU
SUBJECT: VIETNAM - AVIAN FLU UPDATE #5

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CURRENT STATUS
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1. (U) The number of suspected cases of avian influenza in
humans in Vietnam continues to increase. 10 have now been
confirmed as H5N1 in the laboratory. (Yesterday, we
mistakenly reported a total of 12.) The number of affected
provinces has further increased to 52 out of a total of 64
provinces. According to the FAO here, approximately 8
million birds have been "culled", representing 3.2 percent
of the chickens in Vietnam. It is unclear if this figure
represents true culling, or just disposal of birds that have
died. WHO has appealed again for urgent donor assistance in
the form of protective suits and equipment to carry out
increased culling.

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WHO/FAO BRIEFING FOR AMBASSADORS
--------------------------------

2. (U) At the EU's invitation, the WHO and FAO gave a
briefing for Ambassadors on February 3. The briefing began
with a technical presentation by Dr. Peter Horby of the WHO,
who described the general characteristics of human and avian
influenza.

3. (U) Looking more specifically at Vietnam's outbreak, Dr.
Horby showed a chart of the affected provinces. The
outbreak appeared to be concentrated in the northern and
southern provinces, with only a few central provinces
reporting cases. (We may actually be seeing a lack of
reporting rather than a lack of cases in the central
provinces.) Horby pointed out a number of other anomalies
in this outbreak that are puzzling scientists. There are
many more cases among children. The disease appears to have
high rates of fatality in Vietnam. Finally, none of the
1000 Vietnamese doing the chicken culling has gotten sick
even though most are not wearing PPE.

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WHAT TO DO?
-----------

4. (U) WHO recommendations: Dr. Horby then focused on
next steps in Vietnam. WHO said that it would concentrate
efforts on: containing the outbreak in animals (through
surveillance, culling, quarantine, and restricted movement
of poultry); protecting people (through education, PPE for
cullers, infection control in hospitals, and early
diagnosis); improving early detection of human cases
(through improving laboratory capacities and capabilities);
characterizing the structure of the virus (to help examine
possibilities for human-to-human spread and the development
of vaccine); and development of a vaccine.

5. (U) WHO recommendations to individuals: As for current
advice to individuals in Vietnam, Horby's advice was the
same that has been available through WHO, CDC, and MED -
avoid high-risk areas, practice good hygiene, etc. Horby
did reiterate that for now WHO recommends no travel
restrictions. He reiterated that Tamiflu is useful in early
treatment, and has usefulness as prophylaxis. A vaccine
particular to the H5N1 strain of avian influenza is likely 6-
8 months from development of even a limited supply.

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WHO Urges More Activism by GVN
------------------------------

6. (U) WHO/FAO activities: WHO and FAO have been
encouraging the GVN to take a more aggressive approach to
control infection in birds (through more aggressive culling)
and to detect human cases (through improved surveillance).
WHO Vietnam Director Pascale Brudon told the Ambassadors,
"We should all continue to push the Government of Vietnam to
act because more needs to be done." Vietnam has now
established a GVN working group, and WHO has encouraged
Deputy Prime Minister Pham Gia Khiem to chair it himself.

7. (U) WHO and FAO are developing training programs for
cullers and educational materials for provincial level
veterinary officials and farmers. FAO Vietnam
representative Anton Rychener informed the Ambassadors that
FAO had just provided a grant of $400,000 for training
support in Vietnam. WHO has been working to increase the
capacity and capabilities of laboratories in Vietnam.
Finally, at the GVN request, additional WHO clinicians will
arrive shortly to assist with case management. Both WHO and
FAO continued the appeal for additional PPE.

8. (U) In answering questions about the spread of the
disease from province-to-province, both Rychener and Brudon
stated that, while the GVN has ordered the suspension of all
movement of poultry, the fact remains that enforcement is
not taking place effectively, and poultry is being
transported from city to city and province to province.

9. (U) WHO addressed the question of human-to-human
transmission by stressing that we will probably never be
able to confirm the method of transmission in the well-
publicized Vietnamese cases in Thai Binh. Human-to-human
transmission remains one of a number of possibilities.
Brudon said that WHO expects to see limited human-to-human
transmission within families for sure, but that this does
not necessarily mean there will be a community spread or
pandemic.

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FAO COMMENTS
------------

10. (SBU) In response to questions, FOA's Rychener was
clearly pessimistic. He stated that the avian flu outbreak
here "has brutally uncovered the inefficiency of the
Agriculture Extension Service in Vietnam," which he said
lacks motivation, funding, and transportation. Personnel in
the Extension Service are not willing or empowered to take
personal initiative or make decisions. The poor state of
affairs at the Ag Service, he observed, makes it difficult
for the GVN to deal with the current threat quickly or
effectively.

11. (U) WHO tempered the FAO comments. While agreeing that
the problem will not go away soon and that "today there is a
vacuum in what needs to be done", Brudon stated that the
Government of Vietnam is moving forward in developing a
strategy, but added that it needs to do so more quickly.

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DONOR COORDINATION
------------------

12. (U) The Japanese Embassy representative raised the
question of coordination among donors. WHO acknowledged the
need for greater coordination of donations and promised to
work with the World Bank to develop an effective way to
coordinate donor assistance. Brudon did encourage those
donating equipment to work directly with the GVN, and to
simply keep WHO informed.

--------------------------------------------- --
SEPARATE MEETING WITH HCMC DEPARTMENT OF HEALTH
--------------------------------------------- --

13. (U) IN HO CHI MINH CITY, THREE REPRESENTATIVES OF THE
CONSULAR CORPS (FRENCH, CHINESE, AND U.S.) RECEIVED A
BRIEFING FROM DR. NGUYEN THE DUNG, DIRECTOR OF THE HCMC
DEPARTMENT OF HEALTH. DR. DUNG STRESSED THAT THERE WAS
STILL NO CONFIRMED CASE OF HUMAN-TO-HUMAN TRANSMISSION.
HCMC MEDICAL PERSONNEL CONTINUED TO MONITOR VETERINARIANS,
FARM WORKERS, AND FAMILY MEMBERS WHO ARE INVOLVED IN CULLING
POULTRY. THEY ARE ALSO MONITORING THE FAMILIES OF ALL THE
SUSPECTED AVIAN FLU PATIENTS. THE INSTITUTE OF TROPICAL
MEDICINE, CHO RAY HOSPITAL, AND PEDIATRIC HOSPITALS #1 AND
#2 HAVE BEEN DESIGNATED AS RECEIVING HOSPITALS FOR SUSPECTED
AVIAN FLU PATIENTS.
14. (U) Dr. Dung said it was the city's policy to cull/kill
all poultry, whether sick or healthy. But as a matter of
practicality, HCMC authorities have focused on large chicken
farms first, so Dr. Dung emphasized that the percentages and
numbers we see about how many chickens have been culled
refers only to the percentage of those on large chicken
farms. He acknowledged that the city could not control
small family holdings or pet birds. Pet bird sales have
been prohibited by the city, but police authority varies
from district to district, so there is no consistent
enforcement of the ban, nor of culling small family chicken
holdings. He passed out a Vietnamese public information
flyer which states: "Don't eat them. Don't raise them.
Don't transport them."

15. (U) As for provincial coordination, Dr. Dung said there
was a meeting with the Ministry of Health scheduled for
tomorrow, where it was expected all provinces and cities
would be instructed to coordinate their actions. He
acknowledged there were different attitudes among the
provinces, but they had to wait for a directive from the
central government before initiating cooperation. Even HCMC
was not coordinating its culling and public health
information with its neighboring provinces. (Post Note:
HCMC and the three surrounding provinces of Binh Duong, Dong
Nai, and Ba Ria-Vung Tau are host to many American and
foreign-invested factories, and the work populations of
these provinces travel back and forth daily.)
BURGHARDT

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