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Cablegate: H5n1 Avian Flu Response

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

REF: State 23762

1. Following are post's responses to questions posed in

I. Yes, there is active animal surveillance in Vietnam.

A. Ministry of Agriculture Contact:
Dr. Bui Quang Anh
Director General
Department of Animal Health (MARD/DAH)
Ministry of Agriculture and Rural Development (MARD)
No. 15 Ngo 78, Giai Phong Street
Phuong Mai, Dong Da
Hanoi, Vietnam
Office Tel: (84-4) 868-5460 / 869-5691
Fax: (84-4) 869-1311

B. Where are Samples Tested?

Hanoi - Main Site

MARD / DAH - National Center for Veterinary Diagnosis
Dr. Phuong Song Lien, Director
(co-located with MARD/DAH in Phuong Mai, Dong Da)
Tel: (84-4) 868-5202
Fax: (84-4) 868-6813

C. Is Lab capacity sufficient?
Two CDC lab specialists are working with Dr. Lien and feel
that lab staff are competent and are working towards
securing needed supplies and equipment.

D. Are results being communicated?
Lab results are shared daily with national officials and the
provincial officials where the samples originated and CDC
advisors are documenting results as needed for the WHO team.

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II. Culling has been ordered, but it is unclear if
sufficient culling is being done to control the outbreak.

III. Legal Measures to Control Movement

Under Vietnam's Ordinance on Animal Health (15-Feb-1993) the
MARD/DAH is granted special authority to address animal
disease outbreaks. In Chapter II, Article 12, MARD/DAH is
given authority to control the movement of animals and
animal products within and between regions.

On 8-Jan-2004, MARD/DAH issued Guideline #29, using the
authority granted under the Ordinance on Animal Health, to
start addressing the avian influenza outbreak. In this
Guideline (official instructions to all involved parties),
MARD/DAH describes the disease and the general ways the
disease might spread and ordered central and provincial
veterinarians to start monitoring the poultry sector. It
also bans the movement of poultry into or out of infected
areas, and described measures that poultry farmers should
take when they suspect there might be a problem (report the
problem to local officials, isolate any infected chickens,
culling and destruction methods, including burning or
burying all dead chickens). Finally, the Guideline suggests
additional steps provincial vet officials should take to
prevent poultry to human transmission of the disease,
including measures to protect their own health while
inspecting farms.

Additional measures were outlined in MARD/DAH Guideline #104
issued on 31-Jan-2004. All movement of poultry was
suspended (within regions of Vietnam, as well as trade
to/from Vietnam and other countries), poultry culling was
ordered within a 3 km radius around any infected flock, and
all poultry processing (including egg movement and sales)
was prohibited.

IV. Vaccine - Vaccine has been discussed at length but is
not currently being used.

V. Animal Demographics

Roughly, 60-70 percent of Vietnam's population (80 million)
is associated with rural agricultural activities. The
majority of Vietnamese farmers raise chickens, ducks, and
pigs. Smallholder livestock operations are found all over
the country, but larger more-commercial operations are
concentrated in the provinces near Hanoi and Ho Chi Minh
City. Smallholder farmers generally raise livestock (dairy
cows, pigs and poultry) in close proximity to their own

Estimated Livestock Population - 2003
Cattle 4,394,000
Water Buffalo 2,835,000
Pigs 25,461,000
Chicken 185,000,000
Ducks 69,000,000
Source: General Statistic Office and MARD

Vietnam's chicken sector includes small-farmer (back-yard)
raised chicken and `industrial' (larger commercial-sized)
chicken operations. The industrial chicken flocks account
for around 35% of the total chicken population. Foreign-
invested companies including Japfa Comfeed (Indonesia), CP
Vietnam (Thailand) and Cargill (USA) supply more than 80% of
the baby industrial chicks.

Poultry is grown all over the country, but there are
concentrations in the Red River Delta (RRD, in northern
Vietnam) with about 26 percent of the total poultry
population, the Mekong River Delta, stretching south from
HCMC (with 21 percent of the poultry population), and then
in various provinces in the northeast and southeast coastal
areas. Hay Tay province in the RRD and Dong Nai province in
the southeast have the biggest poultry stocks with more than
8 million in each province.

There are about 2,260 (small, but still commercial-oriented)
poultry farms operating in Vietnam with an average of 1,000-
1,400 chickens per farm. For example, there are about 797
poultry farms in Ha Tay (RRD), 281 farms in Dong Nai and 208
farms in Binh Duong (southeast region). Many of the larger
poultry farms are operating under various financial and
processing arrangements with foreign invested companies
including CP-Vietnam (Thailand) and Japfa Comfeed

V. Surveillance for influenza-like illness in humans.

Active surveillance is in place and routinely conducted at
hospitals in urban settings including Hanoi and HCMC
(described in more depth below). There is concern that in
more rural or remote provinces surveillance may not be done
as routinely or effectively as is observed in more urban
settings. The extensive, ongoing local media coverage about
the problem will likely aid surveillance greatly in rural
areas where medical or public health staffing may be more

A. Have health care providers been alerted?

Due to extensive media attention nation-wide, hospitals and
physicians are very aware of the AI problem. Many patients
customarily seek initial care at large hospitals in cities
or provinces. In Hanoi and HCMC the WHO investigative teams
have worked closely with staff at these locations, checking
new admissions daily for patients with symptoms or
conditions suggestive of influenza. Specimens are routinely
collected following admission by hospital staff and sent for
laboratory testing. Charts are reviewed and more extensive
patient histories, including poultry exposure, are taken by
WHO teams within a day or two of admission.

B. Are hospital infection control practices in place?

Yes. Standard, accepted procedures are in place for the
isolation of suspect cases in large hospitals. It is not
clear that such procedures are fully employed at smaller
facilities in the countryside.

C. Are samples taken from suspect human cases? Contact with
birds tracked?

Specimens are regularly taken at the time of admission and
sent to the National Institute of Hygiene and Epidemiology
laboratory. Histories are taken by WHO teams using a
standardized form that is focused on poultry exposure and
related activities; the information is later transferred to
a master database.

D. Estimated number of human cases:

Suspect cases are usually listed initially as "possible"
(based on initial positive rapid test for influenza A
without type specific test results) or "pending" (based on
suspicious clinical symptoms) and as more information and
test results become available are moved into the confirmed
category or eliminated altogether. Currently, there are 13
confirmed cases; approximately 60 possible or pending cases;
several per day might be dropped from the AI-related suspect

E. Laboratory surveillance done?
Laboratory surveillance has not been conducted to date, but
it has been discussed for selected cities with capable
hospital facilities and in conjunction with large poultry

F. Laboratory capacity sufficient?

CDC laboratory experts have been working with laboratory
staff in Hanoi and in HCMC to provide training in proper
procedures and techniques, and to assure that required
equipment is in place and operational. CDC staff in-country
believe that these goals have been achieved and that the
local staffs nationals are competent and capable of meeting
laboratory demands. The labs are, however, in need of
certain supplies and equipment that has been inventoried and
listed in detail. Initial arrangements have been made to
locate and procure these goods to be shipped in the near

F. Results communicated to national offices/ministries?

CDC staff members have worked hand-in-hand with laboratories
for the past 3-4 weeks and believe that adequate systems are
in place to report specimen results to those with a need to
know. Although there may have been some delays in
announcing official numbers of confirmed cases publicly,
there are no indications that results or reports have been
unduly delayed intentionally.

I. Communications policies and practices from government
officials, public and international community? Lead agency?

The WHO, with support from the FAO, has taken a strong lead
in Vietnam in organizing a response to the AI outbreak and
in maintaining relations with the government on management
and reporting of the outbreak. They have met regularly and
openly with GVN officials, foreign embassies in Hanoi and
consulates in HCMC, and with both local and international
media representatives. Articles are regularly featured on
the front page of the Viet Nam News, the leading English
language newspaper. WHO officials have been interviewed and
are seen regularly on local television, as well as CNN. The
WHO Working Group is in the process of developing an
informational video to be widely distributed, a brief
informational pamphlet for the general public, and a
newsletter targeting veterinarians and commune leaders.
Reports of increasing government interest and involvement
are noted daily.

VIII. (NO #8)

IX. Experts needed?

CDC has played a major role in providing epidemiology and
laboratory expertise to the WHO Working Group. Several of
the advisors are still in country and are intimately
involved with the ongoing response to the outbreak. Both
the Ministries of Health and Ministries of Agriculture have
been approached and asked about additional experts and have
indicated their thanks but that additional experts are not
currently required. The WHO office in Hanoi has coordinated
personnel requirements and replacements and appears to have
adequate staffing at this time. A negative response was
given to a similar query on staffing in a WHO recent
meeting. They have, however, made numerous requests for
donations of funds, not equipment, in open meetings in the
past two weeks.

GVN Response: The GVN was slow at the beginning to realize
the serious nature of the outbreak and the potential
transmission to humans. There are also some weaknesses in
follow through at the local level. On the other hand, the
GVN did notify the OIE in early January that they had Avian
Influenza and was the first country to do so. Ministries
have worked well together and have cooperated well with
international organizations and advisors from various
countries. They have acted on the advice received.

Assistance Requests: The GVN requested lab specialists, and
CDC has supplied two for two weeks to understand the
techniques required to test for the H5 virus. The GVN also
requested PPE, and OFDA/USAID this week provided 300 sets to
the GVN. In addition OFDA/USAID provided $250,000 as a
regional donation to WHO regional office in Manila to
address Avian influenza throughout Southeast Asia. The top
priorities continue to be protective clothing (PPE) and the
eventual restocking of Vietnam's poultry farms. In a
briefing for Ambassadors in Hanoi on February 5, a GVN
spokesperson highlighted the need for diagnostic equipment
for the Department of Animal Health, experts to train
Vietnamese veterinarians, PPE, and medication for human
cases. As for future needs, he mentioned help to restore
the poultry flocks, and particularly noted that the GVN will
seek international cooperation to improve the agricultural
sector and change current practices into more sustainable
ones. About ten days ago, Resident WHO Representative
Pascale Brudon circulated a letter to donors listing over 20
items. (Post will fax the list to DOS/EAP/BCLTV.)

Warden Messages: Yes, both the Embassy in Hanoi and ConGen
in HCMC are issuing warden messages. End response.

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