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Cablegate: Avian Flu in Southern Vietnam

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 HO CHI MINH CITY 000855

SIPDIS


SENSITIVE

STATE FOR FOR CA/OCS/ACS/EAP; EAP/EX; EAP/BCLTV;
STATE FOR OES/STC (M.GOLDBERG); OES/IHA (D.SINGER AND N.COMELLA)
BANGKOK FOR RMO, CDC, USAID/RDM/A (MFRIEDMAN)
STATE PASS HHS
USDA FOR FAS/PASS TO APHIS
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN
USAID FOR ANE AND GH (DCAROLL, SCLEMENTS AND PCHAPLIN)
DEPT PASS TO AID
AMEMBASSY ROME PASS TO USMISSION FAO

E.O. 12958: N/A
TAGS: EAGR ECON AMED TBIO CASC PGOV SENV SOCI VM AFLU
SUBJECT: AVIAN FLU IN SOUTHERN VIETNAM

1. (SBU) Summary: Experts in southern Vietnam have begun to
prepare for the possibility of an avian influenza (AI) outbreak
during the cool season of December-February by focusing on poultry
biosafety and vaccinations. ConGen contacts report that the
Ministry of Agriculture and Rural`QQ$Qpment has ordered 20
million doses of poultry vaccine from China and the Netherlands
and began inoculating chickens and ducks with these doses in
August. In addition, the Department of Health of Ho Chi Minh City
(DoH HCMC) is addressing human health concerns by attempting to
increase its supply of Tamiflu. Currently, the DoH HCMC has a
disaster plan that is limited to administering anti-viral drugs to
a maximum of 1,000 persons infected with AI, which is generally
assumed to be insufficient by international standards. Challenges
for local authorities include the implementation of the poultry
vaccination program and enforcement of biosafety measures in the
selling and production of poultry, particularly in outlying areas.
Vietnam's ability to implement the poultry vaccination campaign
will serve as a good barometer of its ability to handle this
potential health and economic crisis. End Summary.

ADDRESSING THE VIRUS AT ITS SOURCE: TREATMENT OF POULTRY
--------------------------------------------- -----------

2. (SBU) ConGen contacts report that Vietnam has addressed the
problem of avian influenza in poultry by culling and is now
undertaking a nationwide vaccination program. More than 42
million birds, or approximately 17 percent of Vietnam's poultry
population, have been culled. Authorities have also extended a
ban on duck hatcheries at least until early 2006. Several poultry
vaccines have also been tested. Based on the results of the
vaccine tests, Department of Animal Health (DAH) Vice Director
Pham Chung reported to EconOff that the Ministry of Agriculture
and Rural Development (MARD) will begin the nationwide vaccination
program in southern Tien Giang and northern Nam Dinh provinces.
The inoculation effort will focus on waterfowl, with a range in
size from large hatcheries to backyard poultry ranchers.

3. (SBU) According to the Southern Representative Office of the
Department of Animal Health (DAH), MARD has conducted a survey of
poultry from 20 provinces across southern Vietnam, with sample
sizes ranging from 1,000-2,000 birds each. Preliminary results
indicate that approximately 60% of birds show AI antibodies,
suggesting that at some point these birds had been exposed to the
virus.

4. (SBU) The DAH explained that the MARD AI vaccination program in
southern Vietnam began in August. In July, the GVN ordered nearly
20 million vaccination doses from China, and another 2 million
from a Dutch company, Intervet. DAH claimed that the vaccines
will be free of charge, although Deputy General Manager Nguyen Huu
Tin of Intervet reported that Intervet's vaccine would be sold to
the larger foreign owned hatcheries (such as CP, Cargill, and
Japfa). The vaccination campaign -- which involves a course of
two injections -- will focus on domestic ducks and three types of
poultry: parent stock, layers and broilers. Parent stock and
layers have longer life expectancy, so they are of primary
importance. The vaccination of ducks is significant because they
can carry the virus without displaying symptoms and therefore shed
the virus for a longer period of time.

5. (SBU) The issue of which vaccine to use has been a source of
some contention and confusion. Beyond the two sources of vaccine
for Vietnam noted above, the U.S. company Merial also produces a
poultry vaccine, but MARD has declined to use this drug although
the reasons are unclear. Intervet has also raised questions about
the quality of its Chinese competitor's vaccine and reported that
Intervet has been unable to find any data about the Chinese
vaccine's effectiveness. The cost of the Chinese vaccine is
200VND (0.0125 USD)/dose, while the Intervet vaccine costs 780VND
(0.0494 USD)/dose.

PROTECTING AND TREATING HUMANS
------------------------------

6. (SBU) In addition to fighting the virus at its source,
authorities in southern Vietnam are working to better protect and
treat humans. The Pasteur Institute in HCMC has been designated
by the Ministry of Health as the institution responsible for the
surveillance and control of infectious diseases in southern
Vietnam, including AI. According to the Pasteur Institute, during
the first 6 months of 2005, ten people were diagnosed with AI in
the south and all ten died (with the last death occurring in
February). (Note: During the last few weeks, there have been 3
more deaths from AI in the South. End Note.) Districts are
required to report any flu-like cases to their respective
provinces, which in turn submit these standardized reports by fax
to the Pasteur Institute. Currently, these reports are submitted
weekly, but during times of epidemic the reports are submitted
daily. In order to step up surveillance, the Pasteur Institute
recommends more AI surveillance points at the district level. The
World Health Organization (WHO) established four such centers, the
Centre for Tropical Diseases (Ho Chi Minh City), Pediatric
Hospital No. 1 (Ho Chi Minh City), General Hospital in Khanh Hoa
Province and General Hospital in Dak Lak Province.

7. (SBU) HCMC has developed an interagency task force and
procedures to address small- to medium-sized outbreaks of AI in
humans. The task force, organized by the HCMC People's Committee,
is headed by a Vice Chairman and includes representatives from the
fields of public health, agriculture, the market management board,
animal health, and the police. The task force meets twice a month
to evaluate, suggest and implement policies aimed at combating
avian flu. Vice Director Dr. Le Truong Giang of the HCMC DoH
acknowledged that while HCMC has a strong grasp on the conditions
in the central districts, outlying districts are harder to
control. Currently, DoH HCMC has three contingency plans based on
the size of an outbreak of AI in humans, one for 10-30 patients, a
second for 100-300 patients, and a third for 500-1,000 patients.
HCMC is currently ill-equipped to effectively cope with an
outbreak larger than 30 patients for several reasons: the
inability to isolate patients, a lack respirators, and the scarce
quantity of Tamiflu doses to treat AI sufferers. HCMC has 10,000
doses of Tamiflu, enough for 1,000 people taking two doses a day
for five days. Dr. Giang is hopeful that HCMC will have
additional Tamiflu, in a powdered form, by October. DoH HCMC is
interested in increasing the level of preparedness at local
levels, but lacks experience and resources.

8. (SBU) Comment: The nationwide poultry vaccination program
marks a first step in a proactive versus a reactive approach to
combating avian influenza. Vietnam's ability to implement this
program will serve as a good barometer of its ability to handle
this potential health and economic crisis. Key areas of concern
include the need to increase stores of Tamiflu vaccine in case of
human epidemic; educate the public and convey policy decisions,
particularly in outlying areas; control the production and sale of
poultry; and enforce compliance with culling directives. The
current compensation of 15,000 VND (just under USD 1) per culled
bird is approximately 50% of the bird's market value and takes
three to five months to reach farmers, creating a disincentive for
farmers to comply with government orders. Public health safety is
further hampered in southern Vietnam by the inability of HCMC DoH
to handle outbreaks of more than a handful of patients, and by the
lack of resources to expand surveillance in high-risk areas such
as the Mekong Delta. End Comment.

WINNICK

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