CHOLERA REAPPEARS IN NORTHERN VIETNAM

UNCLAS SECTION 01 OF 02 HANOI 000383 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/CHICKEY),FIC/NIH (GLASS),FDA (MPLAISER) CDC/COGH FOR SBLOUT/KMCCALL/RARTHUR, PASS TO NCZVED/DFBMD/EDEB (RTAUXE/EMINTZ) AND GDD, IEIP, DEOC USDA PASS TO APHIS, FAS (OSTA AND OCRA),FSIS BANGKOK FOR RMO, CDC (MMALISON/SMALONEY/AHENDERSON),USAID/RDM/A (CBOWES/JMACARTHUR),APHIS (NCARDENAS),REO (JWALLER) BEIJING FOR HHS HEALTH ATTACHE (BROSS) ROME FOR FAO E.O. 12958: N/A TAGS: TBIO AMED AMGT CASC EAGR PINR VM SUBJECT: CHOLERA REAPPEARS IN NORTHERN VIETNAM REF: A. HANOI 2071 B. HANOI 2012 C. HANOI 1953 D. HANOI 1924 E. HANOI 1891 HANOI 00000383 001.2 OF 002 ¶1. (SBU) Summary. Three months after the Government of Vietnam (GVN) announced the successful control of an outbreak of cholera (ref A),the disease has reappeared in several provinces in northern Vietnam, including Hanoi. Though international health experts predicted the likelihood of small, episodic outbreaks in the months following the main epidemic, the GVN's response indicates that local officials take the spate of recent cases seriously and are initiating an aggressive response. End Summary. Cholera Returns -------------- ¶2. (SBU) In early March, hospitals in northern Vietnam began to report an uptick in cases of severe acute diarrhea, some of which are confirmed to be cholera. Though Vietnamese officials have yet to provide official statistics, press reports and information from informal contacts with health authorities indicate the hospitalization of several hundred people, many at the National Institute for Infectious and Tropical Diseases, which has reached capacity with over 20 new patients each day. Other hospitals in Hanoi report similar situations. Ministry of Health authorities have confirmed that eight of the thirteen northern provinces that suffered from the 2007 outbreak have seen new cases, with Hanoi the most severely impacted. (Note: Earlier media reports of "acute diarrhea" in Ho Chi Minh City appear unrelated and most likely involve a Rotavirus infection, though we will continue to track the situation in the south). ¶3. (SBU) Though GVN officials again typically refer to the outbreak as "severe acute diarrhea" (ref C),and have minimized the nature of the outbreak, they acknowledge that considerable numbers of patients have tested positive for the Vibrio cholerae bacterium. The most recent media reports list 85 persons in ten provinces as having tested positive for cholera, with most of these from Hanoi. Once again, authorities are scrambling to detect the sources of infection. Officials at the National Institute of Hygiene and Epidemiology (NIHE)/MOH reported informally to the World Health Organization (WHO) that its prospective case control study indicates the consumption of the combination of dog meat/shrimp paste/raw herbs consumption in two-thirds of all cases, with raw herbs the most likely culprit. A recent on-line article in Vietnam Net quoted one doctor from NIITD claiming that raw vegetables caused the recent flare up. GVN Response -------------- ¶4. (U) GVN officials and international health experts expected some level of recurrence of the epidemic of severe acute diarrhea that last year affected 2,000 people in 17 northern provinces (of which close to 300 people tested positive for cholera). While announcing the end of the six-week epidemic last December, Deputy Minister of Health Trinh Quan Huan warned that the disease would be likely to recur during spring and summer 2008. However, while the media has played up every new report, health officials continue to minimize the severity of recent events. Nguyen Huy Nga, Head of the Preventive Health and Environmental Agency under the MOH, stated that few persons were suffering from severe acute diarrhea and that the disease remained scattered. He then refused to disclose to the press the total number of patients that had tested positive for cholera. ¶5. (SBU) At the same time, central and provincial health officials have swung into action, beginning with the institution of consultations between NIHE, MOH and the WHO (Note: The CDC expert who assisted the 2007 WHO response will return to Hanoi shortly to provide additional assistance to the current WHO effort). MOH has reissued messages warning everyone to avoid eating raw seafood and exercise caution with the preparation and handling of fresh foods. HANOI 00000383 002.2 OF 002 On April 1, Deputy Minister of Health Huan issued an urgent dispatch seeking to ban the use of excrement to fertilize vegetables. Following the report of numerous cases within the city limits, the Hanoi Department of Health asked MOH to provide free cholera vaccine to the whole population of Hanoi, while preventive health agencies sterilized areas around the homes of patients. The Haiphong Department of Health requested city authorities ban raw foods (such as duck's blood curds) during the epidemic period. Comment -------------- ¶6. (SBU) GVN officials are taking steps to respond effectively to this growing outbreak, and press attention is keeping their feet to the fire. Encouragingly, Vietnamese health officials have already communicated with the WHO. Though the numbers of cases in 2008 have not yet reached (and may not reach) the levels of late 2007, we continue to track the situation, the GVN response, and possible impacts on the American community. MICHALAK