(SBU) Avian H5N1 influenza A human fatality, Vietnam

UNCLAS SECTION 01 OF 02 AMEMBASSY HANOI 001290 SENSITIVE SIPDIS STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED,AND OES/IHB (DFANTOZZI, CPATTERSON, CSHAPIRO) STATE PASS TO USAID GH (GSTEELE, DCARROLL, ACLEMENTS) DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN) HHS/OSSI/DSI PASS TO FIC/NIH (RGLASS),OGHA (JMONAHAN, MABDOO, SCUMMINGS, DMILLER),ASPR (MPERDUE, RROBINSON) CDC FOR COGH (SBLOUNT),CCID (SREDD) AND DIV-FLU (NCOX, AMOEN) USDA PASS TO APHIS, FAS (OSTA AND OCRA),FSIS BANGKOK FOR USAID (MACARTHUR/AATHWIN),APHIS (HHOWARD/RTANAKA) AND CDC (MSIMMERMAN) BEIJING FOR HHS HEALTH ATTACHE (EYUAN) AND CDC (JMCFARLAND) PHNOM PENH FOR CDC INFLUENZA COORDINATOR (PKITSUTANI) ROME FOR FAO (JZINGESER) VIENTIANE FOR CDC INFLUENZA COORDINATOR (ACORWIN) E.O. 12958: N/A TAGS: TBIO EAID EAGR PREL KFLU VM SUBJECT: (SBU) Avian H5N1 influenza A human fatality, Vietnam REF: Hanoi 418; 2008 Hanoi 409 SENSTIVE BUT UNCLASSIFIED REF A. Hanoi 418; B. 2008 Hanoi 409 ¶1. (U) Summary: On November 30, 2009, Vietnam's Ministry of Health (MOH) reported the death of a 23 year-old man in Dien Bien province (in northern Vietnam) from the avian H5N1 strain of influenza A. Over one month earlier, on October 21, Dien Bien had reported a poultry outbreak. This is the first human case in this province and the first in Vietnam since the onset of cooler weather. The last human case was reported on April 24 (REF A) and this is the fifth case reported from Vietnam in 2009, each of them fatal. Reporting from the MOH was prompt and a field team will be deployed December 2. Since December 2003, the MOH has reported a total of 112 cases of human infection with 57 deaths. End Summary. ¶2. (U) The 23 year-old man was from Sam Min commune, Dien Bien City, Dien Bien province, which borders China and Laos. On November 18 the patient had onset of high fever, cough, and breathing difficulty. He went to two outpatient health facilities, first a commune health station on November 24, and then a district level polyclinic on November 25. He was referred to the Dien Bien provincial hospital on November 26. At the hospital he was diagnosed with severe pneumonia and was administered intravenous antibiotics. It is not yet known whether he was also given antiviral medication. Health care providers suspected the diagnosis of H5N1 infection, so respiratory samples were taken and sent to MOH's National Institute of Hygiene and Epidemiology (NIHE). His condition deteriorated and he died on November 28. On November 29, NIHE reported that the respiratory samples were positive for H5N1. ¶3. (SBU) There are few historic details available at this point, but the MOH website reported that the patient ate duck blood pudding (traditionally uncooked) one week prior to the onset of symptoms. MOH reports no additional suspect cases; a MOH field team will be deployed December 2 to investigate. Based on a conversation with an MOH official, there are no reports of sick or dead poultry in the area of patient's home. However, the victim's commune is located along a stream from an area where dead poultry had been discarded in the past. ¶4. (SBU) Dien Bien province borders both China and Laos, with few checkpoints to prevent the transborder illegal poultry trade (REF B). On October 21, 2009, within 10 km of the deceased's household, Dien Bien province had a outbreak in chickens and ducks caused by H5N1, in two communes, totaling nine households, the first since HANOI 00001290 002 OF 002 February. Approximately 2,300 poultry were destroyed on October ¶24. Prior to the poultry outbreak, the province had been considered "low risk," and not routinely targeted for vaccination. Subsequently, a limited vaccination program was started. Investigations were underway to determine whether the disease may be endemic in the area or may have been transported from other provinces. After the outbreak in October, NIHE requested the local Preventative Medicine Center to provide additional community education on H5N1 prevention, and to enhance existing Severe Viral Pneumonia (SVP) surveillance to monitor for possible H5N1 infections in humans. This SVP surveillance is a nationwide project done in cooperation with CDC, and has detected 18 of Vietnam's 19 reported human cases of H5N1 (including this one) since its inception in 2006. This is the first case of human H5N1 since April in Vietnam, and the first confirmed in Dien Bien province. Michalak