Identifier
Created
Classification
Origin
09HANOI21
2009-01-08 10:15:00
UNCLASSIFIED//FOR OFFICIAL USE ONLY
Embassy Hanoi
Cable title:  

VIETNAM'S FIRST HUMAN AVIAN INFLUENZA INFECTION OF 2009

Tags:  TBIO AMED EAGR PINR KFLU VM 
pdf how-to read a cable
VZCZCXRO2060
OO RUEHAST RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
RUEHTM
DE RUEHHI #0021/01 0081015
ZNR UUUUU ZZH
O 081015Z JAN 09
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 8986
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC IMMEDIATE
RUEHHM/AMCONSUL HO CHI MINH 5456
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHUL/AMEMBASSY SEOUL 3418
RUEHKO/AMEMBASSY TOKYO 5974
RUEHHK/AMCONSUL HONG KONG 1609
RUEHGZ/AMCONSUL GUANGZHOU 0010
RUEHCN/AMCONSUL CHENGDU 0375
RUEHIN/AIT TAIPEI 1634
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC//USDP/ISA/AP//
RHMFISS/CJCS WASHINGTON DC//J2/J3/J5//
RHEFDIA/DIA WASHINGTON DC//DHO-3//
RHMFIUU/CDR USPACOM HONOLULU HI//J00/J2/J3/J5//
RHEFAFM/DIRAFMIC FT DETRICK MD//MA-1A//
RUEHSUN/USUN ROME IT
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


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