FIRST CHOLERA CASE IN HO CHI MINH CITY

UNCLAS SECTION 01 OF 02 HANOI 000421 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 SECRETARY LEAVITT AND 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: FIRST CHOLERA CASE IN HO CHI MINH CITY REF: A HANOI 408 B. HANOI 383 C. 07 HANOI 2071 HANOI 00000421 001.8 OF 002 ¶1. (SBU) Ho Chi Minh City reported its first case of cholera in the current outbreak, a 71 year old woman from Thu Duc district. According to Dr. Nguyen Van Chau, Director of the Ho Chi Minh City Health Department, the woman was admitted to Ho Chi Minh City Medical Hospital on April 6 suffering from severe diarrhea. On April 9, she tested positive for Vibrio cholerae Ogawa serotype. Ho Chi Minh City health authorities have initiated an epidemiological investigation to determine the source of her exposure. Possible sources include raw vegetables purchased at a local market or close contact with two neighbors, who recently returned from northern Nam Dinh province - one of the eleven northern provinces reporting severe acute diarrhea outbreaks. No other patients under treatment at other hospitals in Ho Chi Minh City (refs A and B),including Children's Hospitals 1 and 2 and the Tropical Diseases Center have tested positive for cholera. National Numbers -------------- ¶2. (U) The Ministry of Health reported yesterday reported nearly 900 cases of severe acute diarrhea in 17 provinces nationwide. Though the northern region (particularly Hanoi, Haiphong, Ha Tay, and Thanh Hoa provinces) suffered the most cases, other provinces including Quang Binh, Quang Ninh, and Thua Thien-Hue in the central region most recently reported severe cases. According to Vietnam Television (VTV),the National Institute of Tropical and Infectious Diseases in Hanoi has now admitted 533 diarrhea patients, of which 254 tested positive for cholera bacteria. VTV further reported that 85 to 90 percent of new patients have tested positive for cholera - a substantial increase over the 2007 outbreak. Tran Van Tho, Deputy Director of the Haiphong Department of Health, told the press that 
up to 90 percent of cases of severe acute diarrhea in that province had tested positive for cholera. Hard to Stop the Spread of Cholera -------------- ¶3. (U) Vietnamese health officials show growing concern that the outbreaks could spread even further. The National Institute of Hygiene and Epidemiology (NIHE) detected cholera bacterium in 15 water samples taken from Hanoi, Hai Phong, Thanh Hoa and Ha Tay, in three vegetable samples taken from a market in Hai Phong and in a sample of boiled dog meat in Hai Phong. Dr. Nguyen Tran Hien, Director of NIHE, told the press that the broad geographic dispersion of cholera patients, combined with the ability of cholera bacteria to live in water, makes it difficult to prevent the expansion of cholera cases. For example, provincial officials along the Hanoi-Ho Chi Minh City railway worry that excrement from infected train passengers could pollute local waterways, causing further spread. Responses Continue -------------- ¶4. (U) GVN response efforts continue. However, while the Ministry of Health (MOH) reportedly has finalized its master plan on cholera prevention, it has yet to promulgate standard procedures for controlling contamination of lakes, ponds, and canals that can be a source of cholera bacteria. In response to positive tests at Linh Quang Lake in Hanoi, city health workers dredged and cleaned the lake, pouring in 1.4 tons of Choloramin B at a cost of 70 million dong (approximately USD 4,400),and removed a market and tore down temporary housing that had sprung up on its boundaries. Haiphong has banned the selling of shrimp paste, raw vegetables, and raw meat salads. Underlying Factors Unchanged -------------- ¶5. (U) According to Dr. Tran Dang, Head of the Food Hygiene Safety HANOI 00000421 002.8 OF 002 Agency, six factors have caused the boom of diarrhea and cholera: unhygienic eating habits, unhygienic raw or processed foods, poor treatment of excrement and waste, failure to wash hands prior to meals, poor food maintenance, and control of waste from existing diarrhea or cholera patients. Dang stated that the Ministry of Health could only control the final factor. The problem is particularly difficult in poor or rural areas where many households do not have sanitary facilities or do not obey health agency instructions. For example, in one hard hit hamlet where 43 patients tested positive for cholera, residents do not have toilets and use river water, which tested positive for the cholera bacteria, to irrigate their paddy fields. Embassy Believes Current Notice Remains Sufficient -------------- -------------- ¶6. (U) The Embassy has reviewed our current notice to American citizens regarding cholera prevention. The Medical Unit and Health Attache continue to believe that this guidance, which is consistent with recommendations from Vietnamese health officials, remains appropriate and does not need updating at this time. MICHALAK