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Cablegate: Shaky Response to New Avian Influenza Fatality

VZCZCXRO1022
RR RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #2116/01 3621140
ZNR UUUUU ZZH
R 281140Z DEC 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 6935
INFO RUEHHM/AMCONSUL HO CHI MINH 4108
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHUL/AMEMBASSY SEOUL 3221
RUEHKO/AMEMBASSY TOKYO 5793
RUEHHK/AMCONSUL HONG KONG 1318
RUEHGZ/AMCONSUL GUANGZHOU 0841
RUEHCN/AMCONSUL CHENGDU 0338
RUEHIN/AIT TAIPEI 1547
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC//USDP/ISA/AP//
RHMFISS/CJCS WASHINGTON DC//J2/J3/J5//
RHEFDIA/DIA WASHINGTON DC//DHO-3//
RHMFIUU/CDR USPACOM HONOLULU HI//J00/J2/J3/J5//
RHEFAFM/DIRAFMIC FT DETRICK MD//MA-1A//
RUEHSUN/USUN ROME IT

UNCLAS SECTION 01 OF 03 HANOI 002116

SIPDIS

SENSITIVE
SIPDIS

STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED
STATE PASS TO USAID FOR ANE AND GH
HHS/OSSI/DSI PASS TO OGHA (WSTIEGER/LVALDEZ/DMILLER/CHICKEY) AND
FIC/NIH (RGLASS)
CDC FOR OGHA (SBLOUT/KMCCALL) AND DIV-FLU (NCOX/AMOHEN)
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN)
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS
BANGKOK FOR RMO, CDC (MALISON), USAID (CBOWES/JMACARTHUR/MBRADY),
APHIS (NCARDENAS), REO(JWALLER)
BEIJING FOR HHS HEALTH ATTACHE (BROSS)
PHNOM PENH FOR CDC INFLUENZA COORDINATOR(WBRADY)
ROME FOR FAO
VIENTIANE FOR CDC INFLUENZA COORDINATOR (ACORWIN)

E.O. 12958: N/A
TAGS: TBIO AMED AMGT CASC EAGR PINR KFLU VM
SUBJECT: SHAKY RESPONSE TO NEW AVIAN INFLUENZA FATALITY

REF: A. HANOI 1793 B. HANOI 1147

HANOI 00002116 001.2 OF 003


1. (SBU) Summary. Vietnamese officials confirmed the death of a
four year old boy from Avian Influenza (AI). However, the
Government of Vietnam (GVN) response showed three significant
communication failures; between animal and human health experts,
between local and central officials, and between clinicians at the
National Pediatric Hospital and epidemiologists at the National
Institute for Hygiene and Epidemiology (NIHE). Department of Animal
Health (DAH) officials confirmed a poultry outbreak in southern Tra
Vinh province, but discounted press reports of improper
vaccinations. Finally, several officials stated that the local
press incorrectly reported the presence of H7N3 in Vietnam. In
reality, GVN officials merely noted the presence of this strain
elsewhere and noted that Vietnam had to prepare a possible response
should it spread. End Summary.

Human Fatality in Son La
------------------------

2. (SBU) Vietnam's Ministry of Health (MOH) confirmed and has
reported to WHO a fatal case of H5N1 AI in a four year old boy from
Moc Chau District in northwestern Son La Province which borders on
Laos. Information provided to the WHO and reported in the press
indicates that the child became ill on December 7, was admitted to
the district hospital on December 11, and transferred to the
National Pediatric Hospital on December 14, where he died on
December 16. National Institutes of Hygiene and Epidemiology (NIHE)
tests of diagnostic specimens, received on December 21, confirmed
H5N1 infection on December 22. The child, an ethnic minority living
in a mountainous area, reportedly had recent exposure to sick
poultry in the household and had ingested meat of a chicken that had
died. Testing of the victim's close contacts has not indicated any
additional human infection and the MOH provided tamiflu to those
residing nearby. Vietnamese authorities culled all poultry in the
village. This was Vietnam's first human fatality since August 2007
and the fifth fatality and eighth human infection for the year. No
AI outbreaks had been detected in Son La since June 2007 (ref B).

Communications Breakdown
------------------------

3. (SBU) Unlike previous instances, the Vietnamese response to this
case highlighted possible gaps in Vietnamese communication and
internal cooperation. While local health care providers apparently
suspected possible AI infection when the child was admitted to the
district hospital on December 11, they provided no information to
NIHE or other MOH offices, though they apparently did inform local
animal health officials. Additionally, DAH, within the Ministry of
Agriculture and Rural Development (MARD), told the U.S. Agricultural
Attache's office that after DAH was informed of the child's illness
on December 10 (Note: this appears to have occured a day before the
child was admitted to the local hospital), it sent a team to the
commune to take samples from poultry, which came back negative.
However, according to Dr. Tran Thanh Duong, Chief of Communicable
Diseases in the Vietnam Administration of Preventive Medicine at
MOH, DAH apparently did not forward AI concerns to human health
responders at MOH. Finally, the National Pediatric Hospital

HANOI 00002116 002.2 OF 003


suspected H5N1 infection and took samples from the child upon
arrival on December 14, yet did not follow established protocol and
notify NIHE (the WHO-designated National Influenza Center)
immediately when it suspected H5N1 so that NIHE could perform an
independent investigation and testing. NIHE did not obtain
specimens for official confirmation until December 20, four days
after the patient died. At this point, we are not yet sure whether
the National Pediatric Hospital sent to NIHE samples taken on
December 14 or post-mortem. We also cannot explain why Dr. Nguyen
Tran Hien, Director of NIHE, told ESTHOff that the boy was infected
on December 17 and died on December 26.

Poultry Outbreaks in Tra Vinh
-----------------------------

4. (SBU) DAH officially reported four separate poultry outbreaks in
Tra Vinh province in southern Vietnam, which previously saw an
animal outbreak in October (ref A). In two instances, deaths were
reported in small flocks of unvaccinated ducks. In two other cases,
AI struck vaccinated ducks. However, both flocks had been
vaccinated in mid-December with deaths occuring just a few days
later, not enough time for the vaccinations to take effect. DAH
stated that press reports that a DAH official blamed ineffective or
improper vaccines were incorrect. DAH did not confirm media reports
of other localized animal outbreaks in northen Cao Bang Province and
southern Tien Giang province on the Mekong Delta.

No H7N3 in Vietnam
------------------

5. (SBU) Van Dang Ky, Head of Epidemiology at the Department of
Animal Health of the Ministry of Agriculture and Rural Development,
and To Long Thanh, Deputy Director of the National Center of
Veterinary Diagnostics, refuted recent media reports regarding
possible outbreaks of H7N3 avian influenza. Local media had stated
that the GVN was developing a response to the H7N3 strain after it
had been detected locally. Ky and Thanh stated that the media
reports were wrong and that no GVN entity had tested for the H7N3
strain. According to Thanh, during a recent meeting of the National
Steering Committee for Avian Influenza Prevention and Control, he
simply stated that Vietnam should develop a long-term plan to
research and produce vaccines for a variety of AI viruses, including
H7N3. Though China already had produced H7N3 vaccine, Vietnam had
no plans to import. Finally, while meeting ESTHOff, NIHE doctors
stated that they had not seen any evidence to date of H7N3 in
Vietnam and had not heard of any cases in poultry or humans in the
region.

Comment
-------

6. (SBU) As winter approaches, we expect a cyclical upswing in AI
poultry outbreaks and possible human infection. While the GVN
response generally remains good, the lapses in the response to the
case in Son La are disturbing. The GVN needs to ensure that animal
health and human health officials communicate with each other
promptly and fully. Additionally, health care clinicians need to
follow established protocols and report concerns and forward samples

HANOI 00002116 003.2 OF 003


to NIHE. Though it appears as though human infection was limited to
the one fatality, breakdowns such as this will slow GVN and
international responses to possible human outbreaks.

MICHALAK

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