AVIAN INFLUENZA UPDATE - WAVE DYING OUT BUT SAMPLE SHARING

UNCLAS SECTION 01 OF 04 HANOI 001265 SIPDIS SENSITIVE SIPDIS STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED STATE PASS TO USAID FOR ANE AND GH STATE PASS TO HHS/OGHA (STIEGER/VALDEZ/BELL/HICKEY) CDC FOR OGHA (BLOUT/MCCALL) AND DIV-FLU (COX/MOHEN) DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN) HHS PASS TO FIC/NIH (GLASS) USDA PASS TO APHIS, FAS (OSTA AND OCRA),FSIS BANGKOK FOR RMO, CDC (MALISON),USAID (MACARTHUR/BRADY) BEIJING FOR HHS HEALTH ATTACHE (ROSS) PHNOM PENH FOR CDC INFLUENZA COORDINATOR(BRADY) ROME FOR FAO VIENTIANE FOR CDC INFLUENZA COORDINATOR (CORWIN) E.O. 12958: N/A TAGS: TBIO AMED AMGT CASC EAGR PINR KFLU VM SUBJECT: AVIAN INFLUENZA UPDATE - WAVE DYING OUT BUT SAMPLE SHARING CONTINUES HANOI 00001265 001.2 OF 004 SENSITIVE BUT UNCLASSIFIED REF: A. Hanoi 1147 B. Hanoi 890 ¶1. (U) Summary. The Government of Vietnam (GVN) reports no human cases infected with the H5N1 strain of highly pathologic avian influenza A (HPAI) beyond the total of five confirmed cases since May 1. There have been no cases among contacts and no common sources of infection. Outbreaks of AI in poultry have substantially dropped off since Post's previous reports. The GVN continues its fully cooperative stance on sample sharing. End Summary. Update of Five Human Cases -------------- ¶2. (U) A total of five human cases infected with H5N1 HPAI have been reported by Ministry of Health (MOH) in 2007 (reftel A). Four were males; all were young adults aged 19-29 years. Cases resided in separate provinces all in the northern region of Vietnam. The dates of onset of illness spanned May 10 to June 3, coincident with the ascending wave of H5N1 HPAI outbreaks in ducks and chickens in the region. There were no links between cases or known single source exposures. Handling of infected poultry identified by epidemiologic investigations is the most likely mode of infection. Two cases were fatal; three recovered and have been discharged from hospital. Four of the five patients required mechanical ventilation and extended critical care for respiratory failure. Human and Animal Sample Sharing -------------- ¶3. (SBU) From the onset of the first human case in May, the MOH has worked with WHO in an open and transparent fashion to promptly report human cases, providing laboratory test results. Infection with H5N1 virus was established in each case by RT-PCR at the MOH's National Institutes of Hygiene and Epidemiology (NIHE) and confirmed 
in specimens from the first two cases by a WHO Influenza Collaborating Center (i.e., CDC, Atlanta). Sample sharing and its importance were reported in the local media (reftel B). The Director of NIHE, Dr. Hien reportedly said that the test results from CDC were the same as the results NIHE had found when carrying out the tests here in Vietnam, adding that NIHE would continue to work jointly with the CDC to decode the H5N1 virus gene and keep track of its transformation. ¶4. (SBU) H5N1 virus from the two cases confirmed to date is of genomic clade 2.3, first identified in a human in Vietnam in October 2005, and endemic since 2005 in southern China and elsewhere in Indochina. Transfer of specimens from the remaining three cases is currently in process. Materials transfer issues, mostly external to GVN, are under intensive review and some have been resolved. Some of these have been described earlier (reftel A). ¶5. (SBU) Apart from HPAI, NIHE, which is a WHO-designated National Influenza Center, routinely shares seasonal influenza isolates with the WHO Collaborating Center, CDC, Atlanta. NIHE is currently arranging a July transfer of 50 seasonal influenza virus isolates HANOI 00001265 002.2 OF 004 comprising subtypes A/H3 and B. ¶6. (SBU) According to USAID's Regional Development Mission in Bangkok, Vietnam poultry isolates are being shared among with international reference laboratories, including those obtained in the recent two waves of AI outbreaks in poultry that have occurred since December 2006. Futue reporting will validate this information and dtail the history and status of animal sample shaing. Animal Outbreaks Dropped Off Markedly -------------- ¶7. (U) Animaloutbreaks due to H5N1 AI have dropped off markedly Since May 1, there have been over 100 animal AIoutbreaks in 18 of Vietnam's 64 provinces and muicipalities. The week of June 19 was the peak o activity with 29 outbreaks recorded, whereas the wek of July 3 had nine outbreaks and the week of uly 10 had only one. (Note: See the epidemiologial curve on page 7 of the Food and Agricultural rganization (FAO) situational update for Vietnam a http://www.fao.org.vn/new1.pdf. End Note) Accoring to a Ministry of Agriculture and Rural Develpment (MARD) official, as of July 10, all but eight provinces have reached the 21-day mark to be declared AI free. ¶8. (U) On July 5, the Head of the National AI Prevention and Control Committee issued instruction No. 25 BNN/CD pertaining to the continuous enhancement of AI prevention and control activities sent to all provincial People's Committees, ministries and departments under the National AI Prevention and Control Committee. The emergency telegram laid out specific details for re-enforcing prevention and control efforts. Media Reports -------------- ¶9. (U) According to VietNamNet Bridge report on July 11, agricultural authorities verified a poultry outbreak in Dien Bien Province. From July 5 to 10, the Provincial Animal Health Department found six farming families in three communes of Thanh Yen, Thanh Hung and ThanhXuong in Dien Bien District, where around 500 ofa total 2,400 ducks died. All of the ducks were 25days-old and had not been vaccinated. Testing dmonstrated H5N1 virus. The local Bird Flu Contrl Board culled all fowl flocks in the two communs of Thanh Xuong and Thanh Hung on July 10. The bard asked the Dien Bien Provincial People's Commitee to announce a bird flu epidemic in Dien Bien District. ¶10. (U) According to VietNamNet Bridge report on July 11, the MARD Vice Minister requested southern provinces to close "egg hatching areas" that fail to meet the standard to be on alert, adding that a recent new outbreak in Ca Mau Province could herald new activity in the southern Mekong Delta. The Provincial Animal Health Department said possible AI outbreak in the South would be a consequence of loose control over hatching, raising watery poultry and additional vaccination. Ca Mau was asked to shut-down non-registered egg-hatching premises and kill water fowl that are not vaccinated HANOI 00001265 003.2 OF 004 properly. USAID, CDC, HHS/OS, and NIH Activities -------------- ¶11. (U) The national influenza sentinel surveillance network, supported by a CDC cooperative agreement with NIHE/MOH, is expanding from 12 to 15 sites. CDC Influenza Coordinator completed site evaluations to all but the three newly enlisted sites (i.e., Danang, Tien Giang and Dong Nai Provinces). All 12 established sites are fully operational and in high compliance with protocol procedures. ¶12. (U) The CDC cooperative agreement "Surveillance and Response to Avian and Pandemic Influenza" with Vietnam Administration for Preventive Medicine (VAPM)/MOH was activated by transfer of funds June 2007. The first report of progress indicates a high level of activity. ¶13. (U) The CDC cooperative agreement "Community Mobilization for Enhanced Surveillance and Prevention of Avian Influenza in Vietnam (Development of a Model)" with CARE reported in June that project-trained animal and human health workers and village volunteers at sentinel commune sites, Hai Phong Province were successful in early detection and reporting of suspected HPAI in poultry flocks, and in taking appropriate control and prevention actions. ¶14. (U) USAID-sponsored plays encourage farmers to take action against AI. Mobile road shows are helping rural communities in 28 provinces across Vietnam understand the dangers of Avian Influenza and learn ways to detect and prevent the disease. Implemented by the Academy for Educational Development (AED),the mobile road shows include 20-minute plays on avian influenza, which are a combination of family drama and comedy with essential information about the disease woven into the plot. Seventy-eight shows are being held from June to July, in provinces selected by the Department of Animal Health. ¶15. (U) To mark the official start of its program in Can Tho, USAID grantee Abt Associates held a workshop for local authorities, animal and human health worker in Can Tho province. Within the workshop, participants discussed ways to increase surveillance and reporting of suspected AI cases; adopt safer poultry-handling practices and impact behavior change in farmers, poultry workers and marketers, health personnel, and the general public. ¶16. (U) To increasing AI private sector awareness, USAID-sponsored an AI workshop on June 28, bringing together private sector animal pharmaceutical and feed companies with local authorities, to create a strategy for increased engagement of the private sector in AI awareness-raising. Some 40 participants came to Hanoi at the invitation of USAID-funded NGO Australian Foundation for the Peoples of Asia and the Pacific. ¶17. (U) USAID sponsored the visit of a logistics technical assistance team to establish an accountability and management system HANOI 00001265 004.2 OF 004 for AI commodities for USAID partner agencies. The team developed release protocols and standard operating procedures, reviewed in-country distribution plans, identified potential logistics challenges in the storage and distribution of commodities, trained appropriate personnel in the proper receipt, storage, transportation of the personal protective equipment and other commodities and developed replenishment protocols schedules. ¶18. (SBU) After some challenging negotiations between MOH and WHO-Vietnam with the assistance of U.S. Embassy Health Attache, MOH sent a letter confirming receipt and acceptance of selection of IVAC, Vietnam as the recipient of an over 2 million USD WHO award to develop a human AI vaccine. This effort is largely funded by HHS/OS. ¶19. (U) On August 6-11, the National Institute of Health is planning two AI-related activities. The first is a workshop, "Avian Influenza Virus Bioinformatics and Genomics Training Workshop," to be held (see http://www.bioinfohelpdesk.org/AIV_Hanoi2007/ ). The objective is to promote surveillance and rapid response to outbreaks of avian influenza by advancing knowledge of the molecular genetics of avian influenza viruses. The second is an international conference co-hosted by NIHE, "NIH Multinatinal Influenza Seasonal Mortality Study Asia Regional Meeting," (see http://origem.info/misms/ program.php). Objectives include: i) review epidemiology of influenza in Asia through presentations of mortality models, transmission dynamics research, genomic mutation patterns, and vaccination impact studies; ii) demonstrate utility of secondary source data to study the epidemiology of influenza; iii) establish collaborations for binational and multinational studies; iv) communicate findings to policy makers; and v) analyze data during a workshop on methodologies for influenza studies, including possible expansion into discussion of primary data collection and genomics. MARINE