SHAKY RESPONSE TO NEW AVIAN INFLUENZA FATALITY

UNCLAS SECTION 01 OF 03 HANOI 002116 SIPDIS SENSITIVE SIPDIS STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED STATE PASS TO USAID FOR ANE AND GH HHS/OSSI/DSI PASS TO OGHA (WSTIEGER/LVALDEZ/DMILLER/CHICKEY) AND FIC/NIH (RGLASS) CDC FOR OGHA (SBLOUT/KMCCALL) AND DIV-FLU (NCOX/AMOHEN) DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN) USDA PASS TO APHIS, FAS (OSTA AND OCRA),FSIS BANGKOK FOR RMO, CDC (MALISON),USAID (CBOWES/JMACARTHUR/MBRADY), APHIS (NCARDENAS),REO(JWALLER) BEIJING FOR HHS HEALTH ATTACHE (BROSS) PHNOM PENH FOR CDC INFLUENZA COORDINATOR(WBRADY) ROME FOR FAO VIENTIANE FOR CDC INFLUENZA COORDINATOR (ACORWIN) E.O. 12958: N/A TAGS: TBIO AMED AMGT CASC EAGR PINR KFLU VM SUBJECT: SHAKY RESPONSE TO NEW AVIAN INFLUENZA FATALITY REF: A. HANOI 1793 B. HANOI 1147 HANOI 00002116 001.2 OF 003 ¶1. (SBU) Summary. Vietnamese officials confirmed the death of a four year old boy from Avian Influenza (AI). However, the Government of Vietnam (GVN) response showed three significant communication failures; between animal and human health experts, between local and central officials, and between clinicians at the National Pediatric Hospital and epidemiologists at the National Institute for Hygiene and Epidemiology (NIHE). Department of Animal Health (DAH) officials confirmed a poultry outbreak in southern Tra Vinh province, but discounted press reports of improper vaccinations. Finally, several officials stated that the local press incorrectly reported the presence of H7N3 in Vietnam. In reality, GVN officials merely noted the presence of this strain elsewhere and noted that Vietnam had to prepare a possible response should it spread. End Summary. Human Fatality in Son La -------------- ¶2. (SBU) Vietnam's Ministry of Health (MOH) confirmed and has reported to WHO a fatal case of H5N1 AI in a four year old boy from Moc Chau District in northwestern Son La Province which borders on Laos. Information provided to the WHO and reported in the press indicates that the child became ill on December 7, was admitted to the district hospital on December 11, and transferred to the National Pediatric Hospital on December 14, where he died on December 16. National Institutes of Hygiene and Epidemiology (NIHE) tests of diagnostic specimens, received on December 21, confirmed H5N1 infection on December 22. The child, an ethnic minority living in a mountainous area, reportedly had recent exposure to sick poultry in the household and had ingested meat of a chicken that had died. Testing of the victim's close contacts has not indicated any additional human infection and the MOH provided tamiflu to those residing nearby. Vietnamese authorities culled all poultry in the village. This was Vietnam's first human fatality since August 2007 and the fifth fatality and eighth human infection for the year. No AI outbreaks had been detected in Son La since June 2007 (ref B). Communications Breakdown -------------- ¶3. (SBU) Unlike previous instances, the Vietnamese response to this case highlighted possible gaps in Vietnamese communication and internal cooperation. While local health care providers apparently suspected possible AI infection when the child was admitted to the district hospital on December 11, they provided no information to NIHE or other MOH offices, though they apparently did inform local animal health officials. Additionally, DAH, within the Ministry of Agriculture and Rural Development (MARD),told the U.S. Agricultural Attache's office that after DAH was informed of the child's illness on December 10 (Note: this appears to have occured a day before the child was admitted to the local hospital),it sent a team to the commune to take samples from poultry, which came back negative. However, according to Dr. Tran Thanh Duong, Chief of Communicable Diseases in the Vietnam Administration of Preventive Medicine at MOH, DAH apparently did not forward AI concerns to human health responders at MOH. Finally, the National Pediatric Hospital HANOI 00002116 002.2 OF 003 suspected H5N1 infection and took samples from the child upon arrival on December 14, yet did not follow established protocol and notify NIHE (the WHO-designated National Influenza Center) immediately when it suspected H5N1 so that NIHE could perform an independent investigation and testing. NIHE did not obtain specimens for official confirmation until December 20, four days after the patient died. At this point, we are not yet sure whether the National Pediatric Hospital sent to NIHE samples taken on December 14 or post-mortem. We also cannot explain why Dr. Nguyen Tran Hien, Director of NIHE, told ESTHOff that the boy was infected on December 17 and died on December 26. Poultry Outbreaks in Tra Vinh -------------- ¶4. (SBU) DAH officially reported four separate poultry outbreaks in Tra Vinh province in southern Vietnam, which previously saw an animal outbreak in October (ref A). In two instances, deaths were reported in small flocks of unvaccinated ducks. In two other cases, AI struck vaccinated ducks. However, both flocks had been vaccinated in mid-December with deaths occuring just a few days later, not enough time for the vaccinations to take effect. DAH stated that press reports that a DAH official blamed ineffective or improper vaccines were incorrect. DAH did not confirm media reports of other localized animal outbreaks in northen Cao Bang Province and southern Tien Giang province on the Mekong Delta. No H7N3 in Vietnam -------------- ¶5. (SBU) Van Dang Ky, Head of Epidemiology at the Department of Animal Health of the Ministry of Agriculture and Rural Development, and To Long Thanh, Deputy Director of the National Center of Veterinary Diagnostics, refuted recent media reports regarding possible outbreaks of H7N3 avian influenza. Local media had stated that the GVN was developing a response to the H7N3 strain after it had been detected locally. Ky and Thanh stated that the media reports were wrong and that no GVN entity had tested for the H7N3 strain. According to Thanh, during a recent meeting of the National Steering Committee for Avian Influenza Prevention and Control, he simply stated that Vietnam should develop a long-term plan to research and produce vaccines for a variety of AI viruses, including H7N3. Though China already had produced H7N3 vaccine, Vietnam had no plans to import. Finally, while meeting ESTHOff, NIHE doctors stated that they had not seen any evidence to date of H7N3 in Vietnam and had not heard of any cases in poultry or humans in the region. Comment -------------- ¶6. (SBU) As winter approaches, we expect a cyclical upswing in AI poultry outbreaks and possible human infection. While the GVN response generally remains good, the lapses in the response to the case in Son La are disturbing. The GVN needs to ensure that animal health and human health officials communicate with each other promptly and fully. Additionally, health care clinicians need to follow established protocols and report concerns and forward samples HANOI 00002116 003.2 OF 003 to NIHE. Though it appears as though human infection was limited to the one fatality, breakdowns such as this will slow GVN and international responses to possible human outbreaks. MICHALAK