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