AVIAN INFLUENZA - A LOOK AT FOUR PROVINCES IN VIETNAM'S

UNCLAS SECTION 01 OF 04 HO CHI MINH CITY 001269

SIPDIS

SENSITIVE

STATE PASS TO USTR (ELENA BRYAN)

E.O. 12958: N/A
TAGS: AMED AMGT CASC EAGR PINR SOCI PGOV TBIO VM AFLU
SUBJECT: AVIAN INFLUENZA - A LOOK AT FOUR PROVINCES IN VIETNAM'S
MEKONG DELTA

REF: HCMC 855


1. (SBU) Summary. USAID Regional Infectious Diseases Advisor
and EconOff visited Can Tho, Hau Giang, An Giang and Dong Thap
provinces of the Mekong Delta region in southern Vietnam to
assess provincial Avian Influenza (AI) preparedness activities.
While outbreaks of AI in poultry and humans in these provinces
still could be characterized as sporadic, authorities are
nevertheless concerned and are proceeding at a state of
heightened alertness. Two immediate worries are surveillance,
in particular the need for uniform case definition to identify
suspected AI cases, and a coherent public awareness campaign.
Local officials expressed interest in USG technical assistance
in both of these areas. The USG has committed USD 7.5 million
to support the GVN prepare for and respond to an AI pandemic.
End Summary.

Planning and Coordination
--------------


2. (SBU) During their November 28 - December 1 trip to the
Mekong Delta, HCMC EconOff and Bangkok-based USAID Regional
Infectious Diseases Advisor learned that provincial measures to
combat avian influenza include planning and coordination,
surveillance and outbreak response, poultry vaccination,
containment and awareness campaigns. Provincial People's
Committees have organized their own AI steering committees that
meet regularly, with representatives from the departments of
Health, Agriculture and Rural Development, Education, and Trade
and Investment, as well as the Marketing Management Board,
police and others. Coordination between animal and human health
authorities takes place via both official and unofficial
channels, but when actually tested the coordination network
shows some signs of inconsistency.

Surveillance and Outbreak Response
--------------


3. (SBU) Provincial officials reported that human and animal
health surveillance is carried out at the commune and district
levels and is then passed upward to the provincial leadership.
However, animal health surveillance is passive and primarily
relies on farmers themselves to report poultry deaths. In
instances of suspected cases of AI in poultry, the provinces'
Bureaus of Animal Health contact the regional office in Can Tho
as well as the provincial Department of Health (DoH). The DoH
is then responsible for investigating and monitoring the health
of the family or individuals exposed to the suspected birds. If
a hospital reports a suspected case of AI, it must contact the
DoH, which then notifies the local Animal Health Bureau.
Provinces compensate farmers for culled or lost poultry, but in
some places compensation levels are linked to previous
vaccination program compliance. The level of compensation
varies depending on the type and age of the bird, but the
previously reported level of 15,000 VND (approximately 1 USD)
per bird is still a valid benchmark (reftel). In addition to
compensation, many provinces also threaten fines for
non-compliance and promise rewards for farmers who report on
neighbors trying to hide dead chickens and ducks.


4. (SBU) Surveillance in the public health sector is primarily
conducted through district or provincial hospitals, with
suspected cases reported to provincial Departments of Health.
The DoH then notifies a province's AI Steering Committee, its
Health Prevention Center, the provincial Bureau of Animal
Health, and the Pasteur Institute in HCMC. All the provinces we
visited had conducted some AI training for medical staff at
least on the district level. When we asked district health care
workers what symptoms constitute a suspected AI case, the
TAGS:QMED, AMGT, CASC, EAGR, PINR, SOCI, PGOV, TBIO, VM
answers were generally the same: cough, fever, difficulty
breathing and exposure to poultry. There appeared to be some
disconnect between the pervasiveness of the symptoms and the
rarity of suspected cases; if hospital officials were strictly
adhering to the case criteria cited - i.e. cough, fever,
exposure to poultry, there should be more suspected cases.
Medical and health officials reported difficulty in defining
uniform case criteria that would be broad enough to ensure early
detection, but narrow enough to be manageable. Technical
assistance from the United States in this matter would be
appreciated, officials said.

Example of a suspected case
--------------


5. (SBU) In November 2005, in a suspected AI case in Dong Thap
Province, a patient checked into the provincial hospital with
fever, cough, and difficulty breathing. An X-ray showed two
spots on his lung. The patient informed the medical
professionals that four of his six chickens had just died. The
patient was isolated, and given Tamiflu and antibiotics.
Specimens were sent to the Pasteur Institute for testing, and
the Dong Thap Animal Health Bureau was notified. While these
measures seem to indicate that human health coordination and
surveillance functioned as intended, when we asked the DoH about
the results of tests on the poultry in the case, none of the
health officials at the meeting knew what had happened to the
poultry. As it turned out, the family members of the sick man
were so frightened by the incident that they killed their
remaining birds and incinerated all of the dead animals. The
Pasteur Institute's results came back negative for AI in less
than 48 hours, and the patient recovered.


6. (SBU) Comment: This example illustrates some key points
about AI preparedness in southern Vietnam:

-- as in this specific case, when a patient checks into a
hospital, and matches all the case criteria, including exposure
to poultry, the surveillance system in place seems to work;
-- coordination between animal and human health officials
exists, but may be tenuous;
-- under current conditions, the Pasteur Institute is able to
react quickly;
-- hospital staff are adequately trained and equipped to deal
with a few AI cases; and
-- the general population is aware of the risks of AI to their
own health and is willing to cull their birds even before
ordered to do so, when an immediate danger is perceived.

The provinces visited would be challenged to handle an outbreak
of more than 10 to 30 patients before becoming overwhelmed. End
Comment.

Poultry Vaccination
--------------


7. (SBU) The poultry vaccination program is completed or is near
completion in all four of the Mekong Delta provinces visited.
Despite some difficulties with vaccine supplies, shortage of
staff, and farmer reluctance to participate, officials reported
their provinces have met or surpassed the GVN's target of an 80%
coverage rate of the poultry population. Authorities were
encouraged by reports that the number of farmers willing to
participate in the vaccination program had increased as fears
and concerns regarding the effects of the vaccine had
dissipated. Farmer compliance with poultry vaccination was
linked to government measures such as permission to bring
poultry to the market, compensation for culled birds, and other
government programs designed to help poultry farmers.
Containment
--------------


8. (SBU) There is a nationwide ban on the transportation of and
trade in poultry between provinces. Each province has
implemented various regulations and measures regarding the sale
of poultry within its own borders. Measures include
establishing official slaughterhouses and designating health
certification stamps for poultry. The purpose of these
regulations is to ensure that only healthy, vaccinated poultry
is sold at markets, but the process can be laborious and is
incomplete in places. The result is a shortage of official
poultry markets, which could drive future poultry sales
completely underground and make them even more difficult to
monitor. For example, in Can Tho City, bringing a bird to
market is a seven-step process that requires two certificates.
Hau Giang Province does not have an official slaughterhouse yet
and presently asks farmers to keep their birds until an official
site can be designated.

Public Awareness Campaign
--------------


9. (SBU) Raising public awareness about AI was of primary
importance to all of the government and medical officials we
met. Public health, animal health and medical officials have
printed and distributed hundreds of thousands of leaflets and
pamphlets. They have created radio messages, TV programs and
even megaphone announcements about AI. Authorities said the
Ministry of Health (MOH) and Ministry of Agriculture and Rural
Development (MARD) provide guidelines for public awareness
messages, but wording and format is left up to provincial
departments. The result is an awareness campaign that lacks
uniformity, has no cohesive message and does not take advantage
of opportunities for synergy. Provincial officials agreed that,
taking into account the proximity of poultry and people in the
countryside, it would be prudent to consider a comprehensive
approach that would address both animal and human health aspects
of AI and could be distributed through all government networks.


10. (SBU) Provincial Departments of Health and Animal Health
Bureaus have all provided some level of training for staff at
the provincial, district, and in some cases, commune levels. It
is the job of those trained to return to their offices and train
other staff members. When asked what a "typical Vietnamese
person" would do when feeling sick with flu-like or other
symptoms, the most common answer was "go see a pharmacist."
However, pharmacists have not yet been trained in AI prevention,
nor did we hear of any plans to include them in public awareness
campaigns.

Conclusion
--------------


11. (SBU) Comment: Several provinces in Vietnam's Mekong Delta
region have established a basic framework to build an effective
AI preparedness network. Medical and health officials have
benefited from the lessons learned during SARS and are adapting
them to AI. Animal health officials understand they are on the
frontline of preventing an AI epidemic, as well as minimizing
the economic damage AI has already caused to a nation heavily
reliant on agriculture. The poultry vaccination campaign and
mass culling have provided the MARD's provincial counterparts
with practical insight on how mobilize their forces in case of
emergency.


12. (SBU) However, these measures are only the beginning, as it
is clear each province would find it difficult to cope with more
than a handful of human AI cases. Strengthening surveillance
and public awareness is essential for strengthening Vietnam's
capability to help stem a possible pandemic. Provincial
authorities expressed interest in possible USG technical
assistance and cooperation in the development of a standardized
suspected AI case definition that could produce immediate
tangible results, as would the distribution to provinces of
professionally prepared public awareness materials. End comment.


13. (U) The USG has committed USD 7.5 million (USD 2.4 million
from USAID/USDA; USD 5.1 million from HHS) to help the GVN
prepare for and respond to an AI pandemic, including support for
GVN's nationwide poultry vaccination campaign, improving the
capacity of the public health care system in epidemiological
monitoring and surveillance, and raising farmers' awareness and
attitudes toward AI.
WINNICK