VIETNAM MOVING FROM CONTAINMENT TO QUENCHING SOUTHERN

UNCLAS SECTION 01 OF 04 HANOI 000722

SENSITIVE
SIPDIS

STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED
STATE FOR AIAG (RLOFITS/CPATTERSON/CSHAPIRO)
STATE PASS TO USAID FOR ASIA (MELLIS, DSHARMA, CJENNINGS) AND
GH (GSTEELE, DCARROLL)
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN)
HHS/OSSI/DSI PASS TO FIC/NIH (RGLASS),OGHA (JKULIKOWSKI/
/MABDOO/SCUMMINGS/DMILLER)
CDC FOR COGH (SBLOUNT),CCID (SREDD) AND DIV-FLU(NCOX/AMOEN)
USDA PASS TO APHIS, FAS (OSTA AND OCRA),FSIS
BANGKOK FOR RMO, CDC (MMALISON),USAID (MACARTHUR/CBOWES),APHIS,
REO (HHOWARD/RTANAKA)
BEIJING FOR HHS HEALTH ATTACHE (EYUAN) AND CDC (JMCFARLAND)
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 MOVING FROM CONTAINMENT TO QUENCHING SOUTHERN
OUTBREAK CLUSTERS OF NOVEL A/H1N1 INFLUENZA

REF: A. HANOI 546 B. HO CHI MINH 429 C. HO CHI MINH 415

HANOI 00000722 001.2 OF 004



1. (SBU) Summary. As of August 2, 2009, Vietnam's Ministry of Health
(MOH) reported a total of 936 cases of pandemic influenza A/H1N1

2009. Initially, H1N1 cases increased steadily, but almost
exclusively, among persons entering Vietnam from known outbreak
areas and their close contacts in country. Aggressive actions on
isolation, quarantine and treatment appeared to contain spread
within Vietnam until mid-July when clusters of cases were identified
in a Ho Chi Minh City boarding school. Since then, clusters linked
to this outbreak have been identified in a number of provinces,
mostly in the south and south-central regions. In response, the
Government of Vietnam (GVN) has adopted a suppression strategy to
limit the outbreak's spread. Despite GVN efforts, the disease has
spread more widely throughout the southern area and increasingly in
the northern and central regions, including large business
facilities in Hanoi and Ho Chi Minh City. While the MOH is
developing measures to control the spread from businesses and
schools, it has begun to move towards preparations for community
mitigation. To date, the disease has typically been mild, with no
reports of serious complications of illness or deaths. End Summary.

Early Infections and Response
--------------


2. (SBU) Following the report of the first A/H1N1 case in Vietnam on
May 31 2009, the numbers of confirmed cases in Vietnam rose steadily
over the next several weeks as the pandemic spread throughout the
world and increasing numbers of infected international travelers
from outbreak areas entered Vietnam. By mid-July, more than 300
cases had been confirmed in Vietnam, almost all of whom were
recently entering travelers and their close family contacts. The
majority of cases were visiting or returning Vietnamese, originating
especially in Australia and North America, and most of these
imported cases entered Vietnam via Ton Son Nhat international
airport in Ho Chi Minh City. Nearly 90 percent of cases in this
early period were reported from the southern region, with much
smaller numbers detected in the northern and central regions. In
response, the MOH pursued an aggressive containment policy,
including early detection of symptomatic persons through border
screening; distribution of advisories to all incoming travelers with
instructions on self reporting of illness; mandatory quarantine in
hospital of suspected cases; voluntary quarantine at home of healthy
contacts of cases; and hospital isolation and oseltamivir treatment
of persons found to be positive for infection using RT-PCR testing.
Applying these measures, Vietnam was able to delay the spread of the
disease into the community for a number of weeks.

Recent Spread
--------------


3. (SBU) As of July 16, there were no reported serious complications
of illness or deaths, and it was reported that the clinical illness
was generally mild and self-limited. Stringent containment measures
still appeared to be successful in slowing the spread in Vietnam of

HANOI 00000722 002.2 OF 004


the disease. However, on July 17, the MOH reported 14 new cases in
a single location, Xuan Hiep Commune, Xuan Hoa District, Dong Nai
Province, which borders Ho Chi Minh City. This cluster of cases was
linked to a student of a private school holding summer classes in Ho
Chi Minh City, which on investigation revealed a cluster of cases
among its boarding student body. By July 20, 34 students and
teachers at the school were found to be infected, and the school
became the first education facility in Vietnam to be shut down
because of the flu. Seventy-nine students were placed under
quarantine at the school, where isolation and treatment facilities
were established to treat some of the ill students. More than 1,000
healthy students from the school, mostly from Ho Chi Minh City and
adjacent provinces, but some scattered throughout southern Vietnam,
were advised to stay at home and avoid communicating with the
public. The authorities warned against further spread once the
normal school year began. On 27 July, the government reported that
10 provinces, mostly in the southern Mekong Delta region, had
identified positive cases who were students of two Ho Chi Minh City
schools. Authorities also reported several cases in Hanoi who had
traveled on 24 July by train from Ho Chi Minh City, and alerted
other passengers on this train to voluntarily quarantine themselves
at home.

GVN Strategy as Pandemic Spreads
--------------


4. (U) With evidence of the pandemic spreading in Vietnam, on July
27, the Prime Minister, Nguyen Tan Dung, mobilized the entire
political system to curb the flu's progress and prevent fatalities,
stating that, "The pandemic is spreading in the community, thus the
entire political system and mass media have to publicize A/H1N1
prevention and protection measures for the participation of all
people in the fight against the potentially fatal disease." This
represented a major shift forward from stringent containment to
broader education and community mitigation strategies. The MOH sent
an official letter to all provinces on July 28, requesting local
health departments to work with local authorities to strengthen
communication activities regarding A/H1N1 through mass media,
communication training for health workers and collaborators, and
distribution of communication materials and hotline information. In
addition, the MOH planned to propose a budget to buy Tamiflu and
Zanamivir to provide to provinces and has requested manufacturers
and importers to prepare enough medical face masks for the
increasing need of health staff and the public.

Vietnamese Testing Suggests Few Differences
from Other Pandemic H1N1 Strains
--------------


5. (SBU) Confirmatory RT-PCR testing is being conducted at NIHE (the
WHO-designated National Influenza Center) and at the three other
regional public health institutes in the national reference
laboratory network. Testing is also being carried out at the
National Institute of Infectious and Tropical Diseases (NIITD),in
Hanoi, and at the Hospital for Tropical Diseases (HTD),in Ho Chi

HANOI 00000722 003.2 OF 004


Minh City. This confirmatory testing has been made possible by
provision of primers, probes and other diagnostic reagents by WHO
CC, CDC, Atlanta, and by a national training workshop conducted in
early June by NIHE for laboratory scientists from the other regional
institutes and from the reference hospitals which was sponsored by
CDC and WHO in Nha Trang. NIHE is maintaining the national archive
of pandemic Influenza A/H1N1 2009 isolates and has performed
critical sequencing analyses showing that isolates in Vietnam have
no mutations associated with oseltamivir resistance but that most
are resistant to the adamantine class of antivirals. Preliminary
examination of a few isolates suggests minor genetic differences
between isolates from strains introduced from North America and
Australia. Preliminary observations on cell culture suggest that
the pandemic strain has a higher cytopathogenic effect than seasonal
A/H1N1 isolates from Vietnam.

Vietnam to Coordinate with Foreign Embassies
When Quarantining Foreign Citizens
--------------


6. (SBU) In a meeting with the Danish Ambassador, Bui Quoc Thanh,
Deputy Director of the Consular Department at the Ministry of
Foreign Affairs, promised to provide prompt notification of such
quarantine to Embassies of a foreign national. Thanh also promised
better treatment for those selected for quarantine, specifically: to
inform tourists upon arrival at an international airport about the
procedures for quarantine related to A/H1N1; to provide tourists
with a detected fever to pick up their luggage prior to be taken
into quarantine; and to ensure that hospitalized tourists receive
prompt information regarding their diagnosis and the possible length
of quarantine. Consular officials from several nations had received
numerous complaints from their citizens about GVN quarantine
procedures.

Centers for Disease Control and Prevention Support
-------------- --------------


7. (SBU) The Centers for Disease Control and Prevention (CDC) has
supported national influenza surveillance and pandemic preparedness
with substantial Cooperative Agreement support and considerable and
continued epidemiological and laboratory technical assistance.
Capacity-strengthening and establishment of good public health
practices have boosted the Vietnamese ability to rapidly detect,
characterize and report on cases of endemic influenza and the
incursion and spread of the pandemic strain in Vietnam. CDC
assistance has helped build the capacity to provide urgently needed
information, education and communications for the public and health
workers; improve border surveillance, isolation and quarantine;
expand disease reporting and investigation; develop case management,
infection control and biosafety procedures and policies; and
strengthen communications within the government regarding the
rapidly emerging situation. Most recently, CDC has provided
emergency assistance to support enhanced surveillance for early
detection, and for case investigations of the first 200 cases to
rapidly characterize the clinical, epidemiologic and virologic

HANOI 00000722 004.2 OF 004


characteristics of the disease in Vietnam. Virus samples are being
shared by Vietnam with CDC, Atlanta for advanced molecular
characterization and monitoring for possible antiviral resistance or
increased pathogenicity.

USAID Support
--------------


8. (SBU) USAID has supported the GVN to strengthen the capacity of
human health and animal health workers in early detection,
surveillance and rapid response, awareness-raising and behavior
change. Through WHO, IOM and the Kenan Institute, USAID is helping
GVN to develop influenza pandemic plans at the national and local
levels, increase the capacity of the school sector, and increase
capacity of health quarantine and other sector staff in controlling
A/H1N1, H5N1 and other diseases, including at border crossings.
With support from USAID, WHO, the MOH will conduct pandemic plan
development workshops and simulation exercises between
September-November, 2009. In July, two major simulation exercises
were funded in Can Tho and Hung Yen provinces to test local response
to animal and human outbreaks of H5N1 or A/H1N1.


9. (SBU) USAID has provided a significant number of PPEs and
disinfectant to Ministry of Agriculture and Rural Development (MARD)
and MOH to help front line workers prevent H1N1 and H5N1 influenza
transmission. In addition, USAID continues to support the GVN and
civil society to better prepare for a pandemic at different levels.
USAID's global AI Communications project (AI.COMM, managed by AED)
has recently worked with Ogilvy & Mather/Vietnam to finalize the
production of a general pandemic preparedness emergency
communication training video (not Vietnam-specific),which will soon
be available for global use.

Comment
--------------


10. (SBU) As in many other countries, Vietnam now faces an
entrenched disease that is spreading throughout the country. As
such, the GVN has begun to adjust its strategy from exclusion and
containment to management. Both CDC and USAID have played an active
role in assisting Vietnam's initial efforts and both expect to
continue their support as the outbreak evolves. Vietnam's
experiences in responding to A/H1N1, combined with many years of
efforts to contain and prevent H5N1, highlight the capacity of
Vietnam to provide useful practical guidance to the participants in
the April 2010 International Ministerial Conference on Avian and
Pandemic Influenza, which it will host.


11. (U) This cable was coordinated with Consulate General Ho Chi
Minh City.

MICHALAK