AVIAN INFLUENZA SPREADS IN VIETNAM: NEW HUMAN INFECTION AND

UNCLAS SECTION 01 OF 03 HANOI 000103 SENSITIVE SIPDIS STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED, OGAC STATE PASS TO USAID FOR ANE AND GH DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN) HHS/OSSI/DSI PASS TO FIC/NIH (RGLASS) AND OGHA (LVALDEZDMILLER/MABDOO) USAID FOR ASIA (MELLIS, DSHARMA, CJENNINGS) AND GH (KHILL, DCARROLL) CDC FOR COGH (SBLOUNT),CCID (SREDD) AND DIV-FLU(COX/MOHEN) USDA PASS TO APHIS, FAS (OSTA AND OCRA),FSIS BANGKOK FOR RMO, CDC (MMALISON),USAID (MACARTHUR/MBRADY/CBOWES), APHIS (NCARDENAS),REO (HHOWARD) BEIJING FOR HHS HEALTH ATTACHE (BROSS) PHNOM PENH FOR CDC INFLUENZA COORDINATOR(BBRADY) ROME FOR FAO VIENTIANE FOR CDC INFLUENZA COORDINATOR (ACORWIN) E.O. 12958: N/A TAGS: TBIO AMED EAGR PINR KFLU VM SUBJECT: AVIAN INFLUENZA SPREADS IN VIETNAM: NEW HUMAN INFECTION AND ANIMAL OUTBREAKS REF: A. Hanoi 65 B. Hanoi 21 HANOI 00000103 001.2 OF 003 1.(U) Summary: Vietnam reported that a young woman in northern Quang Ninh province tested positive for the H5N1 virus. This is Vietnam's second confirmed human infection in the last six weeks (refs A and B). Authorities also reported several poultry outbreaks in the southern Mekong Delta and in north-central Nghe An province. While we expect to see increased infections during this time of year, these cases also reflect continuing difficulties faced by the Government of Vietnam (GVN)in ensuring compliance with disease prevention initiatives. On a positive note, the National Institute of Hygiene and Epidemeology has included as representative from the World Health Organization (WHO) in its field investigation in Quang Ninh. End Summary. Human infection -------------- ¶2. (SBU) On February 6, tests confirmed that a 23-year-old woman in rural Dam Ha district in northern Quang Ninh province (about 150 kilometers northeast of Hanoi and 30 kilometers from the Chinese border) was infected with the H5N1 virus. The victim, a member of the Dao ethnic minority, had eaten the meat from sick neighborhood chickens that had been slaughtered several days prior to becoming ill. The patient was admitted to the hospital on February 3 and remains in critical condition, breathing with the assistance of a respirator. Five other family members who had also eaten the chicken showed no symptoms. Vietnam's Ministry of Health has sent experts from the National Institute of Hygiene and Epidemiology and the National Institute for Infectious and Tropical Diseases, both in Hanoi, to Quang Ninh to investigate the case. WHO officials report good coordination among animal and human health officials in responding to the infection and stated that NIHE had invited a WHO expert to join its investigation team in Quang Ninh. from either the World Health Organizaton or the UN Food and Agricultural Organization in these investigative teams. There have now been 108 reported AI cases and 52 deaths in Vietnam. Animal outbreaks start in Ca Mau -------------- ¶3. (U) Three provinces in the southern Mekong Delta recently reported poultry outbreaks, along with the northern province of Nghe An. First reported in a single flock of ducks in Cau Mau province at the nation's southern tip, H5N1 now has been found in several other districts in Ca Mau and in neighboring Soc Trang and Hau Giang. In the initial outbreak in Ca Mau, more than 460 ducks tested positive for the disease at the end of January. Dozens of ducks in a largely unvaccinated flock began dying on January 19 though the farmer did not inform local officials until the following week. Soon thereafter, H5N1 was found in birds in ten flocks in four communes spread over three districts. Eventually, local officials culled more than 4,000 chickens and ducks in the area. The last poultry outbreak was reported in Ca Mau in September 2008. HANOI 00000103 002.2 OF 003 And then Spread into Other Mekong Provinces -------------- ¶4. (U) Last week, authorities reported possibly-related outbreaks in Soc Trang and Hau Giang provinces, along with additional outbreaks within Ca Mau. The risk of additional contagion remains high) as farmers in the Mekong Delta harvest their spring-winter rice crops and allow flocks of ducks to move from farm to farm to eat the leftover rice kernels; not all flocks have been vaccinated or vaccinated properly; cold weather; 4) lack of awareness and responsibility of farmers; and lack of veterinary resources. After the initial outbreak in Ca Mau, animal health officials in Soc Trang reported an H5N1 outbreak in a flock of 700 ducks, resulting the deaths of over 500 birds. Before the Tet holiday period began on January 26, the birds had shown symptoms of the disease and began dying. Samples from some of the dead birds then tested positive for the H5N1 virus. As of February 7, AI has affected three communes in two districts of Soc Trang, causing 1,435 chicken and ducks culled. On 8 February the Department of Animal Health (DAH) reported poultry outbreak in four communes in one district in Hau Giang, adjacent to Soc Trang province, infecting 840 birds. This pattern of outbreak activity first appearing in southernmost Cau Mau province and moving northward toward Ho Chi Minh City along major transport lines, may repeat similar pattern of occurrences in December 2006 and January 2007 when as many as 10 southern provinces were affected. (Note: Earlier this month in north-central Nghe An province, nearly 200 ducks bred at a local farm died). Poor Response May Have Facilitated Outbreaks -------------- ¶5. (U) The recent outbreaks in the Mekong Delta have left officials scrambling to prevent a wider outbreak and to deflect criticism for the ongoing cases. Officials in Ho Chi Minh City have temporarily halted import of poultry from the infected provinces to prevent the spread of H5N1. The Ho Chi Minh City People's Committee Chairman also asked local veterinary forces to crack down on illegal poultry trading areas. Following reports of the possible spread of H5N1 throughout Ca Mau and into Soc Trang and Hau Giang, Ministry of Agriculture and Rural Development (MARD) officials publicly blamed local farmers officials for their slow response. Local officials, in turn, fingered the owner of the flock, noting that many locals had become complacent as animal outbreaks decreased. Both noted that, while public awareness of the risks has increased, some farmers simply dispose of ducks and chickens that sicken and die, at times throwing the carcasses into canals. Despite this latest outbreak, local media reported that the central DAH, within MARD remained skeptical that local officials would implement all GVN guidelines. ¶6. (U) An attempt by the Hanoi People's Committee to ban the widespread use of motorbikes or bicycles to transport poultry and livestock to prevent an epidemic was withdrawn less than one week after its implementation. Despite the ban, meat products continue to stream into the city by motorbike as officials try to figure out HANOI 00000103 003.2 OF 003 an enforcement scheme. Second, the Ministry of Justice questioned the legal basis for the ban and stated that the ban was impractical. Related requirements for upgraded animal slaughtering practices were geared towards larger, commercial operations and did not take into account the small-scale nature of many poultry operations. Villagers Prevent Poultry Destruction -------------- ¶7. (U) As widely reported in local and regional press, recent efforts to destroy 1,500 chickens (about three tons) smuggled from China descended into chaos as over 100 villagers overwhelmed police and health authorities to loot the chickens. As officials in Hanoi removed the dead birds from a truck to burn in a pit, villagers grabbed the chickens and ran off, despite the fact that the officials explained that the chickens might be infected with H5N1 and had been sprayed with various disinfectants rendering them inedible. While some villagers ran off with their booty, many others later discarded the birds, which remained on the ground the next day. Local media highlighted poor public awareness of the risks of avian influenza. Comment -------------- ¶8. (SBU) This was a tough week for Vietnamese efforts to combat avian influenza. Though the delayed reporting and response was likely exacerbated by the Tet holiday, which officially ran from January 26 to 30, the most recent human infection and animal outbreaks typify weak links in Vietnam's prevention scheme. Villagers, particularly those belonging to minority tribes, continue to slaughter and consume sick poultry, despite government public awareness programs. Small-scale poultry breeders easily become complacent if they do not experience an outbreak for a season or two and local officials do not always respond promptly or provide adequate notification to central authorities or neighboring provinces. Poor Vietnamese are willing to risk contracting H5N1 for free chickens. Finally, the small-scale nature of much of the informal poultry trade makes it difficult for officials to design feasible and enforceable prevention initiatives. MICHALAK