CAMBODIA H1N1 UPDATE - FIRST 5 CASES DETECTED

UNCLAS PHNOM PENH 000421

SENSITIVE
SIPDIS

STATE FOR EAP/MLS, G/AIAG, OES/IHA, MED
STATE FOR USAID/ANE, OFDA AND GH
BANGKOK FOR REO/HHOWARD
BANGKOK FOR OFDA
CDC FOR NCIRD/NCOX, JBRESE, TMOUNTS

E.O. 12958: N/A
TAGS: KFLU AEMR ASEC CASC KFLO TBIO KSAF KPAO PREL PINR
AMGT, MG, EAGR, CB
SUBJECT: CAMBODIA H1N1 UPDATE - FIRST 5 CASES DETECTED


1. (SBU) SUMMARY. As of June 25, the Cambodian Ministry of Health
(MOH) has reported five cases of laboratory-confirmed novel
influenza A (nH1N1) in humans, representing the first identified
nH1N1 infections in Cambodia. Four of the five cases occurred among
a 40-member church mission delegation from the U.S. that arrived in
Phnom Penh on June 19. The fifth case, unrelated to the U.S.
delegation, arrived at the Poipet border crossing from Thailand on
June 24. All cases were initially hospitalized for mild to moderate
illnesses and have since shown clinical improvement, with the four
AmCits being discharged to their delegation's guest house in Phnom
Penh on June 25. The fifth case remains hospitalized but has shown
clinical improvement. The MOH and World Health Organization (WHO),
with technical support from Institut Pasteur in Cambodia (IPC) and
the U.S. Centers for Disease Control and Prevention (CDC),have
rapidly investigated all suspected and confirmed cases to date, and
continue to conduct surveillance for new suspect cases among
potential contacts of the confirmed cases. A MOH-WHO press release
issued on June 24 re-emphasized general prevention measures and
provided MOH Influenza Hotline numbers for public inquiries or
suspected case reporting. END SUMMARY.


2. (SBU) The first confirmed case, a 16-year-old female, developed
fever, cough, and headache on June 20 and was seen at a local health
clinic in Phnom Penh on June 22. A diagnosis of suspect nH1N1
infection was made, and clinical samples were collected for real
time polymerase chain reaction (rt-PCR) testing at IPC. Test
results on June 23 confirmed nH1N1 infection. The patient was
transferred to Calmette Hospital, a designated national nH1N1
referral hospital, later that evening for isolation and treatment
with Tamiflu (oseltamivir).


3. (SBU) Subsequent to the identification of the first case, three
additional cases among the U.S. delegation, ages 18 to 20 years,
developed fever and flu-like symptoms between June 21-24 and later
tested positive for nH1N1. All three were also hospitalized at
Calmette Hospital for isolation and treatment with Tamiflu.


4. (SBU) To prevent further transmission among the delegation, the
MOH, WHO, and CDC decided to provide prophylactic doses of Tamiflu
to the rest of the unaffected members, along with ample amounts of
disposable face masks and alcohol hand wash as part of general
infection control measures. The delegation was also instructed to
isolate the recently discharged confirmed cases in a separate area
of the guest house until at least seven days after the onset of
their illnesses have passed. Delegation supervisors agreed to this
plan after detailed discussions with MOH, WHO, and CDC on June 25.


5. (SBU) CON Chief, CDC Director and post health unit local employee
visited the four AmCit patients on June 25. All took appropriate
precautions to ensure no further risk of contagion during the visit.
The four AmCits provided verbal Privacy Act waivers allowing the
Consular Section to communicate with their parents and group leaders
regarding their condition. Written Privacy Act waivers could not be
obtained without entering the isolation ward. CON Chief observed
the four patients through a clear glass window into the isolation
ward and spoke with them via telephone. None reported any concerns
with their ongoing treatment or with their medical conditions, and
none requested that CON Chief pass any messages to family or
friends. All four patients had been in direct contact with their
parents and group leaders (they had a cell phone in their isolation
ward).


6. (SBU) The fifth case, a 53-year-old Filipino male, presented to
quarantine officials at the Poipet border crossing on June 24 with a
two-day history of fever and difficulty breathing. A MOH Rapid
Response Team (RRT) was dispatched to Poipet, and the patient was
promptly transferred to Siem Reap Referral Hospital by ambulance.
Clinical samples were collected upon hospital admission that
evening, and rt-PCR results from IPC the next day confirmed nH1N1
infection. The patient remains hospitalized but has demonstrated
clinical improvement.


RODLEY