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Cablegate: Public Health in Fujian Province: Dealing with Disease

VZCZCXRO2381
RR RUEHCN RUEHGH RUEHVC
DE RUEHGZ #0696/01 3560555
ZNR UUUUU ZZH
R 220555Z DEC 09
FM AMCONSUL GUANGZHOU
TO RUEHC/SECSTATE WASHDC 1198
INFO RUEHOO/CHINA POSTS COLLECTIVE 0390
RUEHBJ/AMEMBASSY BEIJING 0960
RUEHGH/AMCONSUL SHANGHAI 0315
RUEHCN/AMCONSUL CHENGDU 0316
RUEHSH/AMCONSUL SHENYANG 0325
RUEAUSA/DEPT OF HHS WASHINGTON DC 0056
RUEAIIA/CIA WASHDC 0363
RUEKJCS/DIA WASHDC 0359
RUEKJCS/SECDEF WASHDC 0030
RHHMUNA/HQ USPACOM HONOLULU HI

UNCLAS SECTION 01 OF 03 GUANGZHOU 000696

SENSITIVE
SIPDIS

STATE FOR EAP/CM, , S/GAC, OES/IHA, MED
STATE PASS TO ENVIRONMENTAL SCIENCE & TECHNOLOGY COLLECTIVE
STATE PASS TO USAID FOR ANE AND GH
HHS PASS TO OGHA, NIH/FIC, CDC/COGH
BANGKOK FOR RMO, CDC, USAID
BEIJING FOR HHS HEALTH ATTACHE AND RMO

E.O. 12958: N/A
TAGS: SOCI TBIO ELAB PGOV ECON CH
SUBJECT: Public Health in Fujian Province: Dealing with Disease

REF: Guangzhou 628

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This report is sensitive but unclassified. Please protect
accordingly.

1. (SBU) Summary. Drawing on lessons learned from the 2003 SARS
outbreak, public health officials in Fujian worked to establish a
comprehensive emergency response and alert system for communicable
diseases. The current H1N1 outbreak has highlighted the limitations
of the system and a need to improve the institutional capacity to
manage health emergencies. Influenza and hepatitis remain the most
common types of contagious disease in Fujian, but the spread of HIV
to new segments of the population (seniors and youth) is of concern
to public health officials. Two Fujian cities have abnormally high
cancer rates. Economic growth and improved living standards have
created heightened public expectations regarding health care. End
summary.

Developing an Emergency Response System
---------------------------------------

2. (U) Fujian province was hit badly by the outbreak of SARS in
2003. Caught largely unprepared, public health officials resolved
to establish a comprehensive emergency response and alert system.
According to Fujian Center for Disease Control (CDC) officials, a
total of 13 different contingency plans were adopted since 2003 to
guide the province's response to the spread of infectious diseases
within the general population. More than 260 disease monitoring
stations were established at hospitals and clinics province-wide.
This network monitors communities throughout the province on a
24-hour basis. Since 2007, an additional 1,000 monitoring points
were established in rural areas.

3. (U) According to public health officials, Fujian's public health
organizations and hospitals regularly conduct drills and exercises
so that public health officials and medical personnel are familiar
with the protocols for dealing with infectious diseases. The
province also provided funding to upper level medical institutions
and hospitals so that they could improve their capacity to respond
to pandemic and contagious diseases. Fujian also established an
infectious diseases information center within the Fujian CDC. To
minimize the possibility of disease transmission through its blood
supply, Fujian banned the commercial collection of blood products.
At present, all blood products in Fujian's blood banks are collected
from volunteers and inspected by local blood centers before being
transferred to local hospitals.

4. (SBU) During 2009, the spread of the H1N1 virus has tested
Fujian's emergency response and alert system. While the system
effectively provided early alerts and an organized, systematic
method of dealing with H1N1 cases--with certain hospitals in each
area of the province designated to treat H1N1 cases--the system has
had less success in preventing or slowing the spread of H1N1
infection.

Dealing with the H1N1 Virus
---------------------------

5. (SBU) Officials from Fujian's CDC equivalent say that Fujian
residents returning to Fujian from North America prior to August of
2009 were responsible for the first wave of H1N1 outbreaks. The
third H1N1 case diagnosed in China was found in Fujian. Officials
say 99% of the cases found in Fujian during the first 2 months
originated in the United States. After August, however, most of the
new H1N1 cases originated locally. To deal with the H1N1 outbreak,
Fujian designated 21 hospitals and established more than 10
laboratories to deal with the virus. Every district in Fujian has a
clinic that can test for H1N1. Currently, almost all of the H1N1
cases diagnosed in Fujian are attributed to local transmission.

6. (U) Because of the widespread nature of H1N1 infection,
hospitals and clinics now are not required to report H1N1 cases
unless they develop into severe cases or result in death. Mass
outbreaks have been reported in several Fujian schools during the
past several weeks. As a result, schools throughout Fujian take

GUANGZHOU 00000696 002.2 OF 003


temperature scans of students before they are allowed to attend
classes. Still, Fujian officials claim that the number of H1N1
cases in Fujian remains lower than the national average. They say
that in Fujian, an estimated 38% of flu patients are infected with
H1N1, while the remaining 62% are infected with the seasonal flu.
This compares to an estimated 80% H1N1 infection rate for flu
patients in Guangdong province.

Other Contagious Diseases and Diseases of Concern
--------------------------------------------- ----

7. (U) According to Fujian public health officials, influenza and
hepatitis are the two most common types of contagious disease in
Fujian and the biggest burdens on the public health care system.
Fujian CDC officials say 28 different types of infectious diseases
have been found in Fujian. The diseases, grouped into three
categories, are as follows: A) plague and cholera; B) hepatitis,
dysentery, typhoid, HIV, gonorrhea, syphilis, poliomyelitis,
measles, pertussis, diphtheria, epidemic cerebrospinal meningitis,
scarlet fever, hemorrhagic fever, rabies, leptospirosis,
brucellosis, anthrax, typhus, encephalitis, leishmaniasis, malaria,
and dengue; C) tuberculosis, schistosomiasis, filariasis,
echninococcus, influenza, leprosy, mumps, rubella, neonatal tetanus,
acute hemorrhagic conjunctivitis, and other types of diarrhea.
Officials note that the following infectious diseases have been
eliminated (with year eradicated in Fujian noted in parenthesis):
plague (1953), schistosomiasis (1987), malaria (1992), polio (1995),
and filariasis (2008).

8. (U) Corresponding to the province's economic growth and
prosperity, officials have discerned a noticeable trend away from
diseases of "poverty" to diseases of "affluence." They note that
Fujian is currently witnessing significantly higher rates of heart
disease, high blood pressure, diabetes, and near-sightedness.
Demographic factors influencing the types of diseases found in
Fujian also include the province's aging population and steady trend
towards urbanization.

HIV/AIDS in Fujian
------------------

9. (U) According to the Fujian Health Department, the number of
identified HIV/AIDS cases in Fujian increased from 1952 cases in
2008 to 2409 cases in 2009. In addition, 176 Fujian residents
living in other provinces in China have been identified as HIV
carriers. Broken down by sex, there are 1.9 HIV/AIDS cases
involving males for every case involving a female. The Health
Department's statistics indicate that as of October 31, 2009 there
have been 477 deaths attributed to AIDS in Fujian. Most of the
province's HIV/AIDS cases come from Fuzhou, Quanzhou, and Xiamen,
with Fuzhou having the largest number of known HIV/AIDS cases. In
releasing the 2009 report on HIV/AIDS, public health officials
expressed special concern over the growth in infection rates among
youth and senior citizens. In 2009, 20% of the newly reported cases
involved persons over 50 in age; 5% of the new cases involved
adolescents under age 20. According to data gathered by the Health
Department, 67.3% of those newly infected acquired the virus through
heterosexual contacts, while 7.8% were attributed to homosexual
contacts. Sharing needles among drug users accounted for 6.1% of the
new infections.

10. (U) To help stem the spread of HIV among drug users, Fujian has
established 15 special clinics that provide methadone-type
medications. These clinics served an estimated 5,800 patients with
drug addictions in 2009. HIV/AIDS education campaigns have been
extended to Fujian's rural areas. In 2008, 3.8 million brochures
and posters were produced and distributed to local residents.
Health authorities have implemented national plans relating to
providing HIV/AIDS medications to qualified individuals. In 2008,
308 patients received free medications. In addition, authorities
have established a central HIV laboratory that is linked with eleven
satellite laboratories throughout the province. In addition, 197
HIV monitoring posts have been established through the province to
provide information to the Fujian CDC. Two cities in
Fujian--Changle and Jinjiang--have been identified as national

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experimental comprehensive assistance zones for dealing with
HIV/AIDS cases. Social welfare assistance programs in these cities,
manned by social workers and counselors, help HIV/AIDS patients find
jobs and return to normal schedules.

Fujian Cities with Elevated Cancer Rates
----------------------------------------

11. (U) Fujian Public Health Department officials say that, in
general, the average incidence rate of cancer in Fujian is roughly
comparable to the rest of the world. Liver cancer, gastric cancer,
lung cancer, and cancers of the esophagus and colon are the most
common varieties found in Fujian. However, higher than normal rates
of gastric cancer have been found in Fuzhou's Changle township;
abnormally high rates of liver cancer have been uncovered in
Xiamen's Tong'an District. According to researchers, the gastric
cancer in Changle (death rate of 93 per 100,000 people) may be
connected with contamination from sources including helicobacter
pylori, fungi, nitrites and the uneven distribution of minerals.
Researchers believe that some of these contaminants come from
preserved foods, including fish juice, which are traditionally
consumed by Changle area residents. Researchers have said Tong'an's
abnormally high cancer rates may stem from industrial water
pollution problems or from aflatoxin found in peanuts consumed in
the Tong'an area.

Economic Progress Brings Heightened Expectations
--------------------------------------------- ---

12. (SBU) Fujian public health officials note that the province's
rapid rate of economic development and improvement in standard of
living over the past several decades have created heightened public
expectations regarding medical standards and health care. In
addition to pressure for wider access and better health insurance
coverage (see reftel), the heightened expectations also extend to
effectively monitoring and treating communicable diseases. In this
regard, Fujian officials acknowledged a particular need to
strengthen their ability to manage public health emergencies and
contingency response plans. Officials say that in addition to
taking steps to strengthen institutional capacity--especially as it
relates to extending medical care to rural areas, more must be done
to improve the level of health-related education provided to the
public. They noted that H1N1-related public health education
programs directed at children highlighting the need to wash hands
represented a small step in the right direction. One official noted
that when it comes to educational outreach, it has generally been
more effective to teach children and then let the children teach
their parents.

13. (SBU) Comment: At the start of the H1N1 outbreak, Fujian
officials used the outbreak as a reason for keeping consulate
officers out of Fujian universities, explaining that public
gatherings at the schools were restricted. More recently, even as
mass outbreaks were reported in some Fujian schools, this
restrictive policy was eased and consulate officers were allowed to
speak to sizeable groups of students at several universities.
Public health officials, it seems, are now less "panicked" about the
spread of H1N1 and less inclined to view foreigners as the agents of
infection. End comment.

GOLDBECK

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