VIETNAM'S FIRST HUMAN AVIAN INFLUENZA INFECTION OF 2009

UNCLAS SECTION 01 OF 03 HANOI 000021 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 (WSTIEGER/LVALDEZDMILLER/MABDOO) USAID FOR ANE (CJENNINGS, MWARD) AND GH (KYAMASHITA, KHILL) 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: VIETNAM'S FIRST HUMAN AVIAN INFLUENZA INFECTION OF 2009 REF: A. 08 Hanoi 319 B. 08 Hanoi 409 C. 08 Hanoi 398 HANOI 00000021 001.2 OF 003 ¶1. (U) Summary: Local officials confirmed a recent human infection with H5N1, Vietnam's first since March 2008. The victim, an eight year old girl who resided in a rural, mountainous village in northern Vietnam, consumed sick poultry prior to becoming ill. Her 13 year old sister died on January 2 from respiratory failure, but without any testing, indicating a possible infection cluster. After several months of light activity, Vietnam has seen focal animal outbreaks in three provinces in the past six weeks. As northern Vietnam settles into winter and we approach the Tet (Vietnamese New Year) holiday, during which Vietnamese families typically serve chicken and duck, we expect to see continued poultry outbreaks and possible additional human infections. End Summary. New Human Infection -------------- ¶2. (SBU) The Ministry of Health (MOH) confirmed H5N1 infection in an eight year old girl exposed to sick poultry in a small family flock of chickens and Muscovy ducks in rural, mountainous Dien Trung commune, Ba Thuoc district, Thanh Hoa province (approximately 120 kilometers southwest of Hanoi). The girl, a member of an ethnic minority, is recovering in the Thanh Hoa provincial hospital. Per MOH, the girl suffered from fever, sore throat, coughing, breathing problems and tiredness on December 19, 2008 after her family consumed two chickens from the unvaccinated family flock. Several days earlier, on December 11, the patient's father had slaughtered the two chickens and two Muscovy ducks after they became ill. After treatment at the commune clinic on December 20, she was discharged home. She returned to the commune medical clinic on January 2, which transferred her to the district hospital, where she joined her ill, older sister who had been admitted on December 31. Following death of the older girl later that day, medical personnel then transferred the eight year old victim the provincial hospital from which the clinical specimens were sent to the National Institute of Hygiene and Epidemiology (NIHE),which found the H5N1 infection on January 3. The deputy director of the Thanh Hoa Department of Health reported that the girl's health has almost returned to normal. Possible Cluster -------------- ¶3. (SBU) As noted above, we have confirmed that the patient's 13 year old sister, who also consumed the sick poultry, died on January 2 after suffering from respiratory failure. The older sister presented symptoms of high fever, cough and difficulty breathing on December 27 and her family took her to the commune medical station on December 31. She was transferred that day to the district hospital. Medical personnel at the district hospital did not suspect H5N1 infection and did not take clinical specimens from the 13 year old girl. NIHE contacted the hospital, but was told that no sputum or blood specimens remained. NIHE has initiated an epidemiological investigation of this case, though we have been told that cultural considerations make exhumation of the 13 year old victim unlikely. Finally, press reports state that a five year old HANOI 00000021 002.2 OF 003 neighbor suffered from similar symptoms, though MOH told us that he tested negative for H5N1. ¶4. (SBU) This is the first human reported infection in this commune and the first human case in the province since 2007. This case brings the total human H5N1 cases reported by Vietnam MOH to the World Health Organization (WHO) to 107, of which 52 have been fatal. The most recent previous human H5N1 case in Vietnam occurred in March 2008 (Ref A). Ten of the last 13 cases reported between May 2007 and March 2008 were fatal. If either the elder sister or the neighbor boy was infected, it would represent Vietnam's first H5N1 cluster subsequent to those during the initial outbreak in 2004/05. Vietnam's health ministry has issued a nationwide bird flu alert, urging cities and provinces to step up detection and epidemic control measures. Poultry Outbreaks -------------- ¶5. (U) Over the past six weeks, Vietnam reported localized animal outbreaks in three northern provinces, including the infected chickens in the village where the most recent human victim resided. In reporting on the investigation of this case, the Thanh Hoa Department of health reported finding infected chickens in six villages in Ba Thuoc District. Local authorities stated that 383 infected chickens died and that all remaining poultry in the area (around 7,800 birds) were culled. None of the chickens had been vaccinated. In mid-December, avian influenza surfaced in Thai Nguyen City (approximately 80 kilometers north of Hanoi),killing ducks and chickens at two farms. Animal health officials first confirmed the H5N1 virus had killed several birds among a flock of more than 100 ducks in Thai Nguyen city. In January 2008, the virus was detected in dead chickens at a farm in the same city. Officials then ordered the slaughter of nearly 4,200 chickens to prevent the virus from spreading. ¶6. (U) In early December, the Vietnam Department of Animal Health (DAH) confirmed positive tests for avian influenza in a single, household flock of poultry in Nghi Phong commune, Nghi Loc district in Nghe An province. Nghe An is located in north-central Vietnam, approximately 300 kilometers south of Hanoi. The poultry die-off occurred on December 2 and totaled 194 birds in the flock. Subsequently, the Nghe An Provincial Department of Animal Health (PDAH) collected specimens, which it sent to the Region III Animal Health diagnostic lab for testing. December 3 test results were positive for H5N1. The Nghe PDAH provided guidance to cull all sick poultry, prohibited transport, slaughter, selling and buying, and consumption of poultry in Nghi Phong commune. Simultaneously, DAH set up check points and sprayed disinfectant to prevent further spread. Dien Chau district in Nghe An had reported a similar, small poultry outbreak on November 8. 'Tis the Season for Avian Influenza Outbreaks -------------- ¶7. (U) Animal outbreaks and human infections with H5N1 have historically spiked during the winter and spring in northern Vietnam HANOI 00000021 003.2 OF 003 as H5N1 seems to thrive in cool, wet weather. Additionally, the Tet Lunar New Year festival later this month is considered a high-risk time for the spread of bird flu as poultry slaughtering, trade, and consumption spikes. Additionally, in the run up to Tet, smuggling chickens (which have tested positive for H5N1, in the past, refs B and C) from China rises sharply. Earlier this month, authorities in northern Quang Ninh province detained a truck carrying more than three tons of chicken smuggled from China and destroyed the animals. Local reports noted, however, that this was only one of many trucks transferring chickens from China throughout Vietnam. Comment -------------- ¶8. (SBU) In many counties, health ministries partner with international agencies, notably the World Health Organization (WHO) or the UN Food and Agricultural Organization (FAO),to form joint investigation teams to respond to reports of animal or human H5N1 cases. Though Vietnam continues to improve its transparency and international cooperation, the GVN has yet to invite experts from these organizations to participate in site investigations, despite their long partnership with the GVN and extensive funding of GVN avian influenza prevention and response efforts. Such partnerships would improve the quality of investigations, ensure GVN responders received practical, on-the-ground guidance from international experts, and enhance the transparency of the GVN responses. We will continue to urge our Ministry of Health and Department of Animal Health counterparts to take full advantage of the experience and expertise of the WHO and the FAO. MICHALAK