AVIAN INFLUENZA CASE NUMBER 111, FOURTH THIS YEAR, ALL

UNCLAS SECTION 01 OF 02 HANOI 000418

SENSITIVE
SIPDIS

STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED
STATE PASS TO DS/IP/EAP
STATE PASS TO USAID TO ASIA (MELLIS/DSHARMA/CJENNINGS) AND GH
(GSTEELE/DCARROLL)
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN)
CDC FOR COGH (SBLOUNT),CCID (SREDD) AND DIV-FLU (NCOX/AMOHEN)
HHS/OSSI/DSI PASS TO FIC/NIH (RGLASS) AND OGHA (DMILLER/MABDOO)
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 (EYUAN)
PHNOM PENH FOR CDC INFLUENZA COORDINATOR (PKITSUTANI)
ROME FOR FAO
VIENTIANE FOR CDC INFLUENZA COORDINATOR (ACORWIN)

E.O. 12958: N/A
TAGS: TBIO AMED PINR KFLU VM
SUBJECT: AVIAN INFLUENZA CASE NUMBER 111, FOURTH THIS YEAR, ALL
FATAL, VIETNAM

REF: Hanoi 260

HANOI 00000418 001.2 OF 002



1. (SBU) Summary. On April 24, 2009, the MOH reported a fatal human
case of highly pathogenic avian influenza A (HPAI) of the H5N1
strain in a 23 year-old woman in northern Vietnam. This is the
fourth case reported from Vietnam in 2009, all of them fatal.
Reporting to CDC Hanoi and the World Health Organization from the
Ministry of Health (MOH) was prompt. A government field
investigation combined animal and human health sectors. Local press
coverage was prompt but with the usual scanty and conflicting
information. End summary.


2. (SBU) The affected women lived in a rural commune in mountainous
Quan Hao District, Thanh Hoa Province, approximately 170 km south of
Hanoi. She was an unmarried hair dresser who had recently moved to
the area for work. This is the fourth case reported from Vietnam in
the 2009 calendar year, all of them fatal (Ref). As in the past two
years, these cases have been sporadic and unrelated. In total, GVN
has reported 111 cases and 56 case deaths from 2003 to present.


3. (SBU) The patient had onset of illness on April 15 and salient
findings included sudden onset of fever, headache, and sore throat.
The same day, she sought care at local commune health station. Over
the following days, however, the patient became more severely ill
with exhaustion and difficulty in breathing; she was admitted on
April 20 to the Quan Hoa District Hospital with signs of acute
infection and hypotension. She was treated with antibiotcs and
steroids. On April 21, she was transferred to the Thanh Hoa
Provincial Hospital where she was found to have pneumonia
complicated by respiratory failure. Provicinal health care
providers suspected the diagnosis of HPAI A/H5N1 infection and
notified the National Institutes of Hygiene and Epidemiology (NIHE),
MOH. She was supported with mechanical ventilation and treated with
the anti-influenza drug, oseltamivir (brand name, Tamiflu). She
died with multiple organ failure on April 22. Samples tested
positive for H5N1 and prompted a formal investigated by a team from
NIHE of the MOH and local health authorities on April 24. [Note:
This patient sought care on the first day of symptoms at the commune
level; presented to the district hospital on day 5; recieved first
doeses of anit-viral medication on day 6, and died the next day.
Anti-viral medication should have been administered within the first
48 hours of illness to have been maximally effective. This
highlights the need to educate health care workers and patients on
the importance of a history of exposure to sick and dead poultry in
patients with influenza-like illness. End Note.]


4. (SBU) Epidemiological investigation in the village where the
patient lived revealed that in a 1-2 week period before becoming ill
she had been exposed to dead and sick chickens in her household
flock, which she slaughtered and disposed of in a nearby river
without using gloves or other protection or reporting. Further, she
slaughtered and ate the remaining "healthy" chickens. Neighbors
reported to investigators that 40 chicken and 24 ducks died in their
household flocks, although this was apparently not reported to by
animal health authorities at the time. The investigation revealed

HANOI 00000418 002.2 OF 002


no further instances of associated illness in humans. Laboratory
investigations of neighbors and close contacts revealed no further
infections. In subsequent surveillance, results of tests by
regional animal health office of some birds were positive for HPAI
H5N1 infection.


5. (SBU) Control activities included culling of poultry (about 1000
of the 8600 in the commune) and environmental sanitation of the
affected village. Pre-existing local animal health surveillance was
reportedly poor, and the commune health unit capacity, limited.
Enhanced surveillance was instituted for illness in persons and
poultry. MOH reported good collaboration in the investigation and
control actions between local authorities, and between MOH and DAH.
Currently, only Quang Ngai province in central Vietnam is reporting
outbreaks of AI in poultry in the previous 21 days.


6. (SBU) Comment. As with nearly all 18 A/H5N1 human cases in
Vietnam since 2007, field investigations have demonstrated that
suspicious animal outbreaks or illness were recognized by local
residents before incidents of human illness. To what degree these
were or were not reported to local authorities is unclear. However,
in all instances, there was no formal response from higher level
authorities prior to the recognition of these suspected human cases.
End Comment.

MICHALAK