AVIAN INFLUENZA PREPAREDNESS IN CENTRAL VIETNAM

UNCLAS SECTION 01 OF 03 HO CHI MINH CITY 001128 SIPDIS SENSITIVE SIPDIS STATE FOR G, CA/OCS/ACS/EAP, EAP/EX, EAP/MLS, EAP/EP, INR, OES/ST STATE PASS TO USAID FOR ANE AND GH (DCARROLL, SCLEMENTS AND PCHAP STATE PASS TO USTR (DBISBEE) STATE PASS TO HHS/OGHA (WSTIEGER, EELVANDER AND ABHAT) USDA PASS TO APHIS DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (LSTERN) BANGKOK FOR RMO, CDC, USAID (MFRIEDMAN, JMACARTHUR AND MBRADY) ROME FOR FAO E.O. 12958: N/A TAGS: TBIO KFLU AMED AMGT CASC EAGR PINR SOCI VM SUBJECT: AVIAN INFLUENZA PREPAREDNESS IN CENTRAL VIETNAM REF: 05 HCMC 0891 B) HCMC 0810 C) HANOI 2361 AND PREVIOUS HO CHI MIN 00001128 001.2 OF 003 ¶1. (SBU) Summary: Econoff visited Danang, Quang Nam, and Thua Thien Hue provinces in Central Vietnam to assess provincial Avian Influenza (AI) preparedness activities. Animal Health and Preventive Health authorities are generally satisfied with current AI prevention programs in their provinces, citing the lack of an AI outbreak in poultry or humans since 2004 as proof of success. Animal Health officials cite inadequate resources, the lack of an AI vaccine for geese, and the diffused, backyard nature of the poultry industry as the primary challenges to AI prevention in poultry. Per GVN priorities, health authorities in Central Vietnam are focusing on poultry vaccination, disease detection, and public outreach but lack the resources to handle widespread cases of AI in humans. End Summary. ANIMAL HEALTH AND POULTRY VACCINATIONS -------------- ¶2. (SBU) EconOff met in September with Mr. Tran Van Quan, Director of the Regional Center for Animal Health in Danang City. Covering nine provinces in the Central Highlands and Central Coastal provinces in Vietnam, the center is responsible for the surveillance and vaccination of 18.3 million birds. Unable to test for the presence of Avian Influenza in diseased birds, the center's fifteen doctors send blood samples to Hanoi or Ho Chi Minh City and usually receive test results within 24 hours. Quan reported that by the end of September 2006, 90 percent of the region's poultry would be vaccinated against H5N1 with Chinese-made vaccines, provided by the GVN. Post-vaccination surveillance (Ref B) included the testing of 9,000 specimens from the region's nine provinces, all of which showed no signs of carrying the virus. While AI was detected in poultry in eight of the region's nine provinces in 2004, the region has had no new reported cases of AI in poultry in 2005 or 2006, leading Quan to declare victory in the fight against AI in poultry in Central Vietnam. ¶3. (SBU) Mr. Pham Ngoc Anh, Director of Animal Health for Quang Nam Province, agreed with Director Quan's assessment that animal health authorities were successful in combating AI in poultry but cited several remaining challenges. Anh reported that 80 percent of the province's three million poultry have been vaccinated at least once in 2006. Anh said that given the backyard nature of the province's poultry industry, most birds probably receive only one shot per year, thereby raising the risk of infection in at-risk flocks. Anh also claimed that during a suspected poultry outbreak in 2005, animal health authorities in HCMC were back-logged with blood specimens to test for AI and were unable to alert provincial authorities as to whether or not the virus was present in diseased poultry. The tests eventually came back negative for AI, but not before animal health authorities had culled 327,000 birds. USDA and USAID are currently providing funding and training for the upgrade of veterinary labs in Danang and southern Vietnam. When completed, the upgraded labs will have the capability to independently confirm the presence of H5N1 in poultry. ¶4. (SBU) Directors Quan and Anh, as well as Thua Thien Hue Vice Director of Agriculture and Rural Development Hoang Huu He, confirmed that the results of post-vaccination poultry testing showed variations in the presence of viral antibodies across provincial districts and among bird species. Animal health authorities in all three provinces confirmed, on average, the presence of viral antibodies in 70 percent of animals, the HO CHI MIN 00001128 002.2 OF 003 minimum acceptable level set by the GVN. (Comment: Animal health authorities in Ho Chi Minh City and the Mekong Delta reported wide ranges in the presence of viral antibodies in vaccinated poultry, fluctuating from 0 to 96 per cent in some areas and almost always below 70 per cent in ducks. It is unusual that animal health authorities in all three provinces were adamant that poultry flocks in their provinces exactly met the GVN minimum standard. End Comment.) Quan reported that the twice-yearly vaccination of poultry was not adequate and suggested all poultry be vaccinated every four months to adequately maintain viral resistance levels, especially in ducks, the primary vector for AI. All three directors reiterated the need for the GVN to deliver a vaccination campaign for geese, thus far unavailable to poultry farmers in Vietnam. (Note: While animal health authorities in Hanoi reported to USDA officials that vaccines are being used on geese, provincial animal health authorities reported to EconOff that geese remain an unvaccinated, at-risk population. End Note.) ¶5. (SBU) Animal health authorities in Hue, Danang, and Quang Nam all cited inadequate resources as their greatest concern in fighting AI. Quan reported that the primary problem in the Danang animal health region is the presence of illegal hatcheries and the lack of well-trained health inspectors to monitor the GVN's ban on the raising of poultry in major urban areas. Animal health authorities are present on-site at slaughterhouses, but the department lacks enough officials to survey urban markets more than once a week. (Comment: The lack of trained inspectors and surveillance personnel, even in major urban areas such as Danang, is an indication that provincial-level authorities still lack effective surveillance networks throughout rural districts, thereby increasing the risk of poultry outbreaks and unreported infections. End Comment.) PREPARING FOR LIMITED CASES OF AI IN HUMANS -------------- ¶6. (SBU) The GVN has mandated that every provincial commune have at least one doctor working on AI prevention and surveillance, but of Danang, Quang Nam and Thua Thien Hue, only Thua Thien Hue has so far been able to comply; it reportedly has stationed one doctor in each of the province's 156 communes. Thua Thien Hue, along with Danang and Quang Nam, still lacks resources to handle widespread AI infection in humans. The province has designated three hospitals to handle AI cases: Hue City Hospital, Phong Dien Hospital, and the 1,200-bed General Hospital of Hue City, each of which is equipped with isolation rooms, respirators, and limited supplies of Tamiflu. Hue City, a traditional education center in Vietnam, has also designated the 300-bed University Hospital for the exclusive use of AI patients in a pandemic situation. Mr. Nguyen Dung, Director of the Health Service of Thua Thien Hue, admitted that while the province can handle several hundred cases, only ten to fifteen patients can be isolated and placed on a respirator at any given time. The province is currently dependent on the Pasteur Institutes in Nha Trang and Ho Chi Minh City for the testing of suspected AI cases, though a new center for research on respiratory diseases is scheduled to open in late 2007. ¶7. (SBU) Health officials in Danang and Quang Nam also report being able to cope with only a few cases of AI in humans. Mr. Ton That Thanh, Director of Preventive Health in Danang, and Dr. Tran Van Hoan, Vice Director of Preventive Health in Quang Nam, HO CHI MIN 00001128 003.2 OF 003 admitted there are only two or three isolation rooms in each of the designated AI hospitals, General Hospital of Danang and the General Hospital of Quang Nam. Hoan reported the GVN provided Quang Nam with 3,000 doses of Tamilfu in 2005, but the province has yet to receive any new medication from the central government in 2006. Health officials in both provinces rely on the Pasteur Institute in Nha Trang and the National Institute for Health in Hanoi for confirmation of H5N1 in samples taken from suspected AI patients, a process that can take up to ten days. PUBLIC AWARENESS TO THE THREAT A PRIORITY -------------- ¶8. (SBU) Quang Nam is one of three provinces in Vietnam designated for an expanded public outreach program on AI awareness. Along with Ha Tay Province in northern Vietnam and Ben Tre Province in the Mekong Delta, Quang Nam has instituted a two-pronged approach to AI prevention: increase public awareness and provide assistance to poultry farmers to heighten sanitation levels. The public awareness program, begun in early 2006, targets all media sources, including television, newspapers, leaflets, and GVN-sponsored community groups such as the Women's Union and Youth Union. In addition, teams of human and animal health workers travel around the province providing chemicals to clean chicken coops and materials and guidance for the construction of fenced-in, isolated poultry-raising areas. Hoan of Quang Nam Preventive Health stressed the need to increase AI awareness among individual households on the commune level and reiterated the commonly-held opinion that changing the methods by which individual households keep backyard flocks is a difficult but crucial requirement in the GVN's fight against AI. COMMENT -------------- ¶9. (SBU) Health officials in Thua Thien Hue, Quang Nam, and Danang were all unanimous in their belief that the GVN's national AI prevention program has been successful in preventing further outbreaks of AI in poultry and humans. That said, several gaps exist. On the animal health side, provincial authorities lack the resources to adequately monitor and confirm poultry outbreaks at the commune level. While hospitals have taken steps to prepare for cases of AI in humans, provincial health authorities have the resources to properly treat only a handful of patients. The provinces of Central Vietnam, following GVN national guidelines, have prioritized poultry vaccination, disease surveillance and public outreach. Resource constraints at the national and provincial levels have made the large-scale mobilization of public health resources for the possibility of widespread cases of AI in humans impractical. Consequently, even relatively well-prepared provinces and cities lack the resources to handle widespread cases of AI in humans. End Comment. WINNICK