VIETNAM - AVIAN INFLUENZA SITUATION REPORT

1. (U) Summary: Local media reported three new cases of
avian influenza (AI) in northern Vietnam this week. Although
the World Health Organization (WHO) has not received
official notification from the Ministry of Health (MoH) of
these cases yet, WHO believes that reporting of human cases
has improved. WHO country director Dr. Hans Troedsson
warned that the risk of an influenza pandemic breaking out
in northern Vietnam is greater than anywhere else in the
world. Though Vietnam does not have a National Pandemic
Influenza Preparedness Plan, MoH has not yet responded to
WHO's offer of technical and monetary assistance to develop
such a plan. The United Nation's Development Program (UNDP)
is working with FAO and WHO to assist the Government of
Vietnam (GVN) in coordinating donor activities and funding,
using a recently released consolidated strategy. End
Summary.

Case Statistics


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2. (U) In recent days, the Vietnamese press has reported
that MoH identified three new cases of AI: a 52-year-old man
from northern Vinh Phuc Province, a 58-year-old man from
central Thanh Hoa Province and a 46-year-old man from Hung
Yen Province (a death). The individual from Vinh Phuc
Province is reported to have eaten chicken that may have
died from avian influenza. MoH has not reported these cases
to WHO. (Note: There have been no recent reports to the
Ministry of Agriculture and Rural Development (MARD) of
outbreaks in poultry from any of these areas. This suggests
that reporting of animal outbreaks from the provinces to the
central government is not as complete as it should be. End
Note.)



3. (U) Dr. Troedsson noted that MoH reporting of confirmed
and suspected human cases to WHO has improved greatly in
recent months. WHO and the MoH have agreed to establish two
reporting systems: an official report of laboratory
confirmed cases which are shared with member states; and,
informal reports of suspected cases which require further
investigation of contact with infected poultry and
laboratory confirmation and are shared only with the WHO.

Briefing of the Diplomatic Community


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4. (U) On May 18, Directors of UNDP, WHO and FAO in Vietnam
jointly briefed the Hanoi diplomatic community on the status
of AI activities in Vietnam.



5. (U) WHO's Dr. Troedsson warned diplomats that the risk of
a pandemic breaking out is greater in northern Vietnam than
anywhere else in the world. WHO bases this conclusion on
the findings of recent WHO-sponsored meetings and
consultations on AI in Southeast Asia in which experts found
decreased virulence of H5N1, broader demographic spread of
victims, and increased numbers and duration of clusters in
northern Vietnam. The AI virus appears to be less virulent,
as the case fatality rate (CFR) dropped from 100 percent in
the first outbreak in 2004 to 35 percent in the most recent
outbreak in 2005. The CFR fell to 18 percent in the North
during the second sub-wave but did not change at all in the
South during the same period. Additionally, some recent
cases have been milder or even asymptomatic. Note: Although
the virus seems to be killing fewer people, a less virulent
virus may infect more people. End Note. The WHO also noted
the virus appears to have infected a wider range of age
groups. In 2004, the average age affected was approximately
17 years while in 2005, the average age affected was
approximately 31 years. Finally, there are more and larger
clusters of infected victims this year than in previous
years. The time between the first infection in the cluster
and the last is longer, which may reflect prolonged contact
with contaminated conditions or human-to-human
transmissions. Recent clusters have included more than
family members, such as health care workers and community
residents.



6. (U) Anton Rychner, Country Representative for FAO said
that MARD has not officially reported an outbreak of AI
since April 2 and confirmed that FAO has not received
outbreak reports among poultry stocks in the areas where the
recently reported human cases occurred. The H5N1 virus
continues to circulate in the Mekong Delta, where 25 percent
of 10,000 samples taken from waterfowl tested positive for
H5N1. Over the past few months MARD has sought to improve
its responsiveness to H5N1 by: developing and implementing
plans to rehabilitate the poultry sector by limiting
production to bigger industrial farms and rezoning
industrial farms; banning the raising of free-range
waterfowl; reducing the number of places where poultry are
slaughtered; strengthening AI prevention and control
enforcement; enhancing veterinary services at all levels to
improve detection and prevent infection; and, developing a
compensation strategy. FAO noted that the GVN needs the
support of the international community to enact the above
policies, improve active and passive surveillance in the
field, create a system to harmonize activities at the
central and provincial levels, and implement countrywide
control measures in the field.

Lack of AI National Preparedness Plan


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7. (U) Although the GVN reports that it is working on a
national pandemic influenza preparedness plan, it is not
clear how much progress the GVN has actually made. The MoH
has not yet responded to WHO's offer of technical and
monetary assistance to develop this plan. In addition to
MoH and MARD, development of an effective plan will require
participation of many other ministries. For example,
closing schools and banning public meetings would require
action by the Ministries of Education and Public Security,
and it is unclear whether MoH and MARD have solicited input
from other ministries. FAO and WHO feel that this issue
requires attention at the highest level (Prime Minister) in
order to develop an effective plan that engages all
Ministries. Additionally, capacity remains especially weak
at the local level where skills, funding and political
reinforcement are lacking.



8. (U) MARD is conducting poultry vaccination trials in the
provinces of Nam Dinh and Kien Giang with the goal of more
widespread vaccination in target areas by October, 2005. In
preparation for implementation of a broader vaccination
program in Vietnam, FAO is consulting with MARD to develop a
national vaccination strategy. However, the FAO
representative cautioned that vaccination is only one part
of a prevention and control strategy, emphasizing that the
GVN also needs to implement bio-security measures.



9. (U) The UNDP will work with FAO and WHO to coordinate
donor activities and funding to address the AI threat in
Vietnam under the framework of a WHO plan released in
February 2005 and updated in April. The plan outlines those
activities that need funding and seeks to coordinate the
donor response. According to WHO, the plan focuses
primarily on the needs of MARD but lacks substantial input
from the MoH. WHO identified ten key areas donors where
donors also need to provide support to the GVN: improve
human technical capacity (epidemiologists, lab technicians
and clinicians); improve lab capacity (bio safety and the
ability to analyze samples); improve communication and
coordination between MoH, MARD and the international
community; improve surveillance of animal and human health;
develop vaccines for animals and humans; develop a national
pandemic influenza response plan; conduct further research
on routes of transmission of the virus; advocate public
education to the at-risk populations; improve local
preparedness and response to an outbreak; and improve care,
treatment and case management of identified cases.



10. (SBU) The GVN may be overly optimistic in its goal to
control AI by 2006-2007 and eradicate it by 2010. While
much has been done, there is a consensus within the
international community in Hanoi that the GVN approach is
not effectively organized and Vietnam does not have the
capacity yet to contain a serious outbreak or monitor fast
breaking developments. FAO is concerned that the GVN has
agreed to compensate poultry farmers only 50 percent of the
price of culled poultry as they believe that at least 75
percent would be needed to be effective in convincing
farmers to cull their infected stock. Note: The GVN
compensated poultry farmers for only 15 percent last year.
End Note.



11. (U) The FAO representative noted that a mid-term
Consultative Group (CG) meeting of donor countries,
international organizations and the GVN on June 2, would
present an opportunity to discuss AI and the need for a
country pandemic influenza plan. It will also give GVN
leaders and the international donor community the
opportunity to discuss apparent financial needs of Vietnam
to control AI.
BOARDMAN