Identifier
Created
Classification
Origin
07VIENTIANE163
2007-02-26 10:18:00
UNCLASSIFIED//FOR OFFICIAL USE ONLY
Embassy Vientiane
Cable title:  

VIENTIANE EAC MEETING - HUMAN CASE OF AVIAN INFLUENZA

Tags:  TBIO KFLU SOCI SCUL PREL AMED AMGT ASEC CASC EAGR 
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VZCZCXRO7444
PP RUEHCHI RUEHDT RUEHHM RUEHNH
DE RUEHVN #0163/01 0571018
ZNR UUUUU ZZH
P 261018Z FEB 07
FM AMEMBASSY VIENTIANE
TO RUEHC/SECSTATE WASHDC PRIORITY 0938
INFO RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 2100
RUEHBS/AMEMBASSY BRUSSELS 0311
RUEHBY/AMEMBASSY CANBERRA 0979
RUEHNE/AMEMBASSY NEW DELHI 0139
RUEHFR/AMEMBASSY PARIS 0222
RUEHRO/AMEMBASSY ROME 0105
RUEHKO/AMEMBASSY TOKYO 1140
RUEHCN/AMCONSUL CHENGDU 0196
RUEHCHI/AMCONSUL CHIANG MAI 0517
RUEHHK/AMCONSUL HONG KONG 7753
RUEHIN/AIT TAIPEI 0125
RUEAIIA/CIA WASHDC
RUEHPH/CDC ATLANTA GA
RHHMUNA/CDR USPACOM HONOLULU HI
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC
UNCLAS SECTION 01 OF 04 VIENTIANE 000163 

SIPDIS

SENSITIVE

SIPDIS

STATE FOR G, AVIAN INFLUENZA ACTION GROUP (AMBASSADOR LANGE,
PATTERSON),CA/OCS/ACS/EAP (VAUSE),EAP/EX, EAP/MLS, EAP/EP, INR,
OES/STC (PBATES),OES/IHA (SINGER AND COMELLA),MED, DS/IP/EAP, AND
H;

STATE PASS TO USAID FOR ANE AND GH (CARROLL, CLEMENTS, AND
JENNINGS)

STATE PASS TO USTR (DBISBEE)

STATE PASS TO HHS/OGHA (WSTEIGER, EELVANDER, AND ABHAT)

USDA PASS TO APHIS

DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (LSTERN)

BANGKOK FOR RMO, DCD, USAID (JMACARTHUR AND MBRADY)

ROME FOR FAO

PACOM ALSO FOR FPA HUSO

E.O. 12958: N/A
TAGS: TBIO KFLU SOCI SCUL PREL AMED AMGT ASEC CASC EAGR
EAID, ETRD, LA
SUBJECT: VIENTIANE EAC MEETING - HUMAN CASE OF AVIAN INFLUENZA

VIENTIANE 00000163 001.2 OF 004


UNCLAS SECTION 01 OF 04 VIENTIANE 000163

SIPDIS

SENSITIVE

SIPDIS

STATE FOR G, AVIAN INFLUENZA ACTION GROUP (AMBASSADOR LANGE,
PATTERSON),CA/OCS/ACS/EAP (VAUSE),EAP/EX, EAP/MLS, EAP/EP, INR,
OES/STC (PBATES),OES/IHA (SINGER AND COMELLA),MED, DS/IP/EAP, AND
H;

STATE PASS TO USAID FOR ANE AND GH (CARROLL, CLEMENTS, AND
JENNINGS)

STATE PASS TO USTR (DBISBEE)

STATE PASS TO HHS/OGHA (WSTEIGER, EELVANDER, AND ABHAT)

USDA PASS TO APHIS

DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (LSTERN)

BANGKOK FOR RMO, DCD, USAID (JMACARTHUR AND MBRADY)

ROME FOR FAO

PACOM ALSO FOR FPA HUSO

E.O. 12958: N/A
TAGS: TBIO KFLU SOCI SCUL PREL AMED AMGT ASEC CASC EAGR
EAID, ETRD, LA
SUBJECT: VIENTIANE EAC MEETING - HUMAN CASE OF AVIAN INFLUENZA

VIENTIANE 00000163 001.2 OF 004



1. (U) SUMMARY: Embassy Vientiane EAC met February 26 to discuss a
WHO report of first-ever case of probable human infection of avian
influenza (AI) in Laos. Samples from the patient have been sent for
H5N1 confirmation, which is still pending. The Lao press is already
highlighting this first "suspected" case. The EAC reviewed current
AI tripwires and decided to draft a warden message.


2. (SBU) For Embassy Vientiane, the EAC saw three key differences
with other human cases which have occurred in Southeast Asia: a)
this case occurred in a district within Vientiane Municipality in
close proximity to areas where Embassy officers live; b) this very
small Embassy community has five new-born infants and one more baby
expected this year; and c) the Embassy is heavily dependent on the
Lao-Thai Friendship Bridge for land transportation to nearby medical
facilities in neighboring Thailand, and the potential that Thailand
will close this bridge in response to a larger outbreak may be
higher than previously assessed. END SUMMARY.


3. The Embassy EAC met February 26 to discuss avian influenza (AI)

developments. The Ambassador had been notified during the weekend
by Dr. Dong Il Ahn, WHO Representative in Laos, that the first human
case of AI had been detected in Vientiane. The English-language
Vientiane Times newspaper of Monday, February 26, carried the news -
"First human case of bird flu suspected" - on its front page, and
other local newspapers also highlighted the case.

The Case
--------------

4. (SBU) Embassy Vientiane's Infectious Disease Coordinator Dr.
Andrew Corwin briefed the EAC on the details of this case. A
15-year-old girl on February 15 was brought by her family to
Vientiane's Sethathirat Hospital for treatment. She had been
exhibiting symptoms including difficulty breathing beginning on
February 10. The family claimed she had had not contact with sick
or dead chickens in the previous 14 days even though the family
lived next door to a household where chickens had died February 1 of
suspected H5N1 infection. Although the hospital is located within 5
kilometers of the AI "red zone" involved and despite extensive
training about AI, the staff failed to check that the family lived
in the "red zone" and did not diagnose possible AI. The patient was
released.


5. (SBU) On February 17, the family took the girl across the border
to a private clinic in Thailand's neighboring Nong Khai Province -
where an AI outbreak in poultry has also been underway. She was
exhibiting pneumonia-like symptoms of congestion and difficulty
breathing. The private clinic doctor (thankfully) immediately
initiated Tamiflu treatment. She was treated at the private clinic
for three days and then referred to the Nong Khai Provincial

VIENTIANE 00000163 002.2 OF 004


Hospital on February 20. Two procedures have been done to help
drain fluid from the girl's chest cavity. She is currently in ICU
responding to treatment with very slight improvement. A leading
epidemiology specialist from Bangkok is at the Nong Khai Provincial
Hospital to help monitor treatment.


6. (SBU) Thai/Lao cooperation at this point appears to be excellent.
A team from Nong Khai has visited Vientiane to inspect the
neighborhood of the outbreak. There are ten households with 37
people involved. Of the 37, 20 were identified as close contacts of
the girl and are being monitored daily for symptoms including rise
in temperature.


7. (SBU) Testing in Vientiane on a sample taken from the girl has
been inconclusive. Samples have been sent from Nong Khai to Bangkok
for further testing, and we expect they will also be sent to NIID
(Japan). Dr. Corwin, the Embassy's Infectious Disease Coordinator,
was invited by Lao health officials to join them when they visited
the Nong Khai Provincial Hospital. He was able to view the patient
on a monitor screen. Dr. Corwin's expectation, based among other
criteria on the speed of the pleurism involved, is that this case
will likely be confirmed as AI.

EAC Meeting
--------------

8. (SBU) The EAC was pleased with the level of trust being placed in
Dr. Corwin by both the Lao and Thai medical communities. The EAC
decided to draft a warden message in coordination with Bangkok RMO
McCoy and Embassy Bangkok. The text of message allows for
alternative language to be used if the test results are confirmed.
The EAC also decided to seek blanket country clearance and blanket
orders for travel to Thailand to ensure Dr. Corwin can cross the
border immediately as needed. (In this case, the DCM informed the
Embassy Bangkok Duty Officer of Dr. Corwin's travel across the
border.)


9. (SBU) Dr. Corwin will ask the Lao health authorities to issue
weekly updates to all hospital emergency rooms and out-patient
department listing all village and districts where AI outbreaks may
be occurring. The Embassy will issue an Admin Notice with latest AI
information for our staff, repeat protective gear training for
Embassy staff, and review shelter-in-place procedures for newer
Embassy officers and their families. The Embassy will maintain
close contact with the Vientiane International School. When RMO
McCoy next visits Vientiane, she will be asked to provide an AI
overview for the full Embassy staff. PDS will prepare press
guidance about this case.


10. (SBU) The EAC noted that, while this appears to be the first

VIENTIANE 00000163 003.2 OF 004


known human AI case in Laos, other deaths or current illnesses may
be linked to AI. The weakness of the Lao surveillance system, the
prevalence of other diseases among poultry (such as Newcastle
Disease and duck plague),the fear that reporting AI poultry deaths
will cause a person to be identified by neighbors as the one who
caused the culling of all poultry in the area, the lack of adequate
compensation for culled poultry by the Lao Government, and the
custom of many Lao families to cremate their dead without formal
death reports all combine to make AI reporting - among poultry or
among humans - difficult here.


11. (SBU) The EAC reviewed AI tripwires and found them still to be
appropriate in general. However, the EAC did note several factors
here that make this situation different from those faced elsewhere
in the region. The current AI outbreak is happening within
Vientiane Municipality, less than ten kilometers from the Embassy
and less than five kilometers from Embassy homes. And among the
Embassy staff of seventeen officers there have been five new-born
children during the past six months. Another baby is expected this
year. The effectiveness of Tamiful on infants or on pregnant women
is unclear.


12. (SBU) In addition, the EAC noted Dr. Corwin's additional
information that the Nong Khai Provincial Hospital had considered
releasing the patient because her Lao family was not covered by Thai
health insurance and did not have enough money for the expensive ICU
treatment required. The Nong Khai Governor intervened to prevent
the release and ensure continued treatment in this case. However,
this highlights the fact that ICU treatment is extremely expensive.
The EAC expressed concern that the potential cost of treatment for
Lao people flocking across the border to Thailand if human cases
were to increase here might lead the Thai authorities to close the
cross-Mekong Friendship Bridge earlier than might otherwise be the
case - at a point of popular fear of a major outbreak rather than
the actual occurrence of such an outbreak. The EAC agreed to watch
AI developments very closely.

Comment
--------------

13. (SBU) Clearly the 15-year-old girl's life was saved by the quick
decision to start Tamiflu treatment by the doctor at the private
clinic in Nong Khai. Despite extensive training and development of
clear case criteria, the staff at Sethathirat Hospital did not make
the AI link as it should have. Part of this was caused by the
family's misstatement about exposure to dead chickens, but in real
life situations, families will not always be willing to tell the
truth about AI exposure. Even though the private clinic in Nong
Khai referred the patient to the Provincial Hospital as a possible
AI case, apparently the Provincial Hospital staff did not use

VIENTIANE 00000163 004.2 OF 004


protective gear when first treating her, so more training apparently
needs to be done with hospital staffs on both sides of the border.


14. (SBU) The EAC was troubled by the three special factors
mentioned above. This outbreak is close to home. The Embassy staff
has very vulnerable members. And our land transportation and access
to professional-level hospitals on the Thai side of the border is
easily cut by a Thai decision to close the Friendship Bridge. The
EAC expects its attention to the AI issue to remain high for the
indefinite future.

HASLACH