VZCZCXRO7444
PP RUEHCHI RUEHDT RUEHHM RUEHNH
DE RUEHVN #0163/01 0571018
ZNR UUUUU ZZH
P 261018Z FEB 07
FM AMEMBASSY VIENTIANE
TO RUEHC/SECSTATE WASHDC PRIORITY 0938
INFO RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 2100
RUEHBS/AMEMBASSY BRUSSELS 0311
RUEHBY/AMEMBASSY CANBERRA 0979
RUEHNE/AMEMBASSY NEW DELHI 0139
RUEHFR/AMEMBASSY PARIS 0222
RUEHRO/AMEMBASSY ROME 0105
RUEHKO/AMEMBASSY TOKYO 1140
RUEHCN/AMCONSUL CHENGDU 0196
RUEHCHI/AMCONSUL CHIANG MAI 0517
RUEHHK/AMCONSUL HONG KONG 7753
RUEHIN/AIT TAIPEI 0125
RUEAIIA/CIA WASHDC
RUEHPH/CDC ATLANTA GA
RHHMUNA/CDR USPACOM HONOLULU HI
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEKJCS/SECDEF WASHINGTON DC

UNCLAS SECTION 01 OF 04 VIENTIANE 000163 
 
SIPDIS 
 
SENSITIVE 
 
SIPDIS 
 
STATE FOR G, AVIAN INFLUENZA ACTION GROUP (AMBASSADOR LANGE, 
PATTERSON), CA/OCS/ACS/EAP (VAUSE), EAP/EX, EAP/MLS, EAP/EP, INR, 
OES/STC (PBATES), OES/IHA (SINGER AND COMELLA), MED, DS/IP/EAP, AND 
H; 
 
STATE PASS TO USAID FOR ANE AND GH (CARROLL, CLEMENTS, AND 
JENNINGS) 
 
STATE PASS TO USTR (DBISBEE) 
 
STATE PASS TO HHS/OGHA (WSTEIGER, EELVANDER, AND ABHAT) 
 
USDA PASS TO APHIS 
 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (LSTERN) 
 
BANGKOK FOR RMO, DCD, USAID (JMACARTHUR AND MBRADY) 
 
ROME FOR FAO 
 
PACOM ALSO FOR FPA HUSO 
 
E.O. 12958:  N/A 
TAGS: TBIO KFLU SOCI SCUL PREL AMED AMGT ASEC CASC EAGR
EAID, ETRD, LA 
SUBJECT: VIENTIANE EAC MEETING - HUMAN CASE OF AVIAN INFLUENZA 
 
VIENTIANE 00000163  001.2 OF 004 
 
 
¶1. (U) SUMMARY: Embassy Vientiane EAC met February 26 to discuss a 
WHO report of first-ever case of probable human infection of avian 
influenza (AI) in Laos.  Samples from the patient have been sent for 
H5N1 confirmation, which is still pending.  The Lao press is already 
highlighting this first "suspected" case.  The EAC reviewed current 
AI tripwires and decided to draft a warden message. 
 
¶2. (SBU) For Embassy Vientiane, the EAC saw three key differences 
with other human cases which have occurred in Southeast Asia: a) 
this case occurred in a district within Vientiane Municipality in 
close proximity to areas where Embassy officers live; b) this very 
small Embassy community has five new-born infants and one more baby 
expected this year; and c) the Embassy is heavily dependent on the 
Lao-Thai Friendship Bridge for land transportation to nearby medical 
facilities in neighboring Thailand, and the potential that Thailand 
will close this bridge in response to a larger outbreak may be 
higher than previously assessed.  END SUMMARY. 
 
¶3. The Embassy EAC met February 26 to discuss avian influenza (AI) 
developments.  The Ambassador had been notified during the weekend 
by Dr. Dong Il Ahn, WHO Representative in Laos, that the first human 
case of AI had been detected in Vientiane.  The English-language 
Vientiane Times newspaper of Monday, February 26, carried the news - 
"First human case of bird flu suspected" - on its front page, and 
other local newspapers also highlighted the case. 
 
The Case 
-------- 
¶4. (SBU) Embassy Vientiane's Infectious Disease Coordinator Dr. 
Andrew Corwin briefed the EAC on the details of this case.  A 
15-year-old girl on February 15 was brought by her family to 
Vientiane's Sethathirat Hospital for treatment.  She had been 
exhibiting symptoms including difficulty breathing beginning on 
February 10.   The family claimed she had had not contact with sick 
or dead chickens in the previous 14 days even though the family 
lived next door to a household where chickens had died February 1 of 
suspected H5N1 infection.  Although the hospital is located within 5 
kilometers of the AI "red zone" involved and despite extensive 
training about AI, the staff failed to check that the family lived 
in the "red zone" and did not diagnose possible AI.  The patient was 
released. 
 
¶5. (SBU) On February 17, the family took the girl across the border 
to a private clinic in Thailand's neighboring Nong Khai Province - 
where an AI outbreak in poultry has also been underway.  She was 
exhibiting pneumonia-like symptoms of congestion and difficulty 
breathing.  The private clinic doctor (thankfully) immediately 
initiated Tamiflu treatment.  She was treated at the private clinic 
for three days and then referred to the Nong Khai Provincial 
 
VIENTIANE 00000163  002.2 OF 004 
 
 
Hospital on February 20.  Two procedures have been done to help 
drain fluid from the girl's chest cavity.  She is currently in ICU 
responding to treatment with very slight improvement.  A leading 
epidemiology specialist from Bangkok is at the Nong Khai Provincial 
Hospital to help monitor treatment. 
 
¶6. (SBU) Thai/Lao cooperation at this point appears to be excellent. 
 A team from Nong Khai has visited Vientiane to inspect the 
neighborhood of the outbreak.  There are ten households with 37 
people involved.  Of the 37, 20 were identified as close contacts of 
the girl and are being monitored daily for symptoms including rise 
in temperature. 
 
¶7. (SBU) Testing in Vientiane on a sample taken from the girl has 
been inconclusive.  Samples have been sent from Nong Khai to Bangkok 
for further testing, and we expect they will also be sent to NIID 
(Japan).  Dr. Corwin, the Embassy's Infectious Disease Coordinator, 
was invited by Lao health officials to join them when they visited 
the Nong Khai Provincial Hospital.  He was able to view the patient 
on a monitor screen.  Dr. Corwin's expectation, based among other 
criteria on the speed of the pleurism involved, is that this case 
will likely be confirmed as AI. 
 
EAC Meeting 
----------- 
¶8. (SBU) The EAC was pleased with the level of trust being placed in 
Dr. Corwin by both the Lao and Thai medical communities.  The EAC 
decided to draft a warden message in coordination with Bangkok RMO 
McCoy and Embassy Bangkok.  The text of message allows for 
alternative language to be used if the test results are confirmed. 
The EAC also decided to seek blanket country clearance and blanket 
orders for travel to Thailand to ensure Dr. Corwin can cross the 
border immediately as needed.  (In this case, the DCM informed the 
Embassy Bangkok Duty Officer of Dr. Corwin's travel across the 
border.) 
 
¶9. (SBU) Dr. Corwin will ask the Lao health authorities to issue 
weekly updates to all hospital emergency rooms and out-patient 
department listing all village and districts where AI outbreaks may 
be occurring.  The Embassy will issue an Admin Notice with latest AI 
information for our staff, repeat protective gear training for 
Embassy staff, and review shelter-in-place procedures for newer 
Embassy officers and their families.  The Embassy will maintain 
close contact with the Vientiane International School.  When RMO 
McCoy next visits Vientiane, she will be asked to provide an AI 
overview for the full Embassy staff.  PDS will prepare press 
guidance about this case. 
 
¶10. (SBU) The EAC noted that, while this appears to be the first 
 
VIENTIANE 00000163  003.2 OF 004 
 
 
known human AI case in Laos, other deaths or current illnesses may 
be linked to AI.  The weakness of the Lao surveillance system, the 
prevalence of other diseases among poultry (such as Newcastle 
Disease and duck plague), the fear that reporting AI poultry deaths 
will cause a person to be identified by neighbors as the one who 
caused the culling of all poultry in the area, the lack of adequate 
compensation for culled poultry by the Lao Government, and the 
custom of many Lao families to cremate their dead without formal 
death reports all combine to make AI reporting - among poultry or 
among humans - difficult here. 
 
¶11. (SBU) The EAC reviewed AI tripwires and found them still to be 
appropriate in general.  However, the EAC did note several factors 
here that make this situation different from those faced elsewhere 
in the region.  The current AI outbreak is happening within 
Vientiane Municipality, less than ten kilometers from the Embassy 
and less than five kilometers from Embassy homes.  And among the 
Embassy staff of seventeen officers there have been five new-born 
children during the past six months.  Another baby is expected this 
year.  The effectiveness of Tamiful on infants or on pregnant women 
is unclear. 
 
¶12. (SBU) In addition, the EAC noted Dr. Corwin's additional 
information that the Nong Khai Provincial Hospital had considered 
releasing the patient because her Lao family was not covered by Thai 
health insurance and did not have enough money for the expensive ICU 
treatment required.  The Nong Khai Governor intervened to prevent 
the release and ensure continued treatment in this case.  However, 
this highlights the fact that ICU treatment is extremely expensive. 
The EAC expressed concern that the potential cost of treatment for 
Lao people flocking across the border to Thailand if human cases 
were to increase here might lead the Thai authorities to close the 
cross-Mekong Friendship Bridge earlier than might otherwise be the 
case - at a point of popular fear of a major outbreak rather than 
the actual occurrence of such an outbreak.  The EAC agreed to watch 
AI developments very closely. 
 
Comment 
------- 
¶13. (SBU) Clearly the 15-year-old girl's life was saved by the quick 
decision to start Tamiflu treatment by the doctor at the private 
clinic in Nong Khai.  Despite extensive training and development of 
clear case criteria, the staff at Sethathirat Hospital did not make 
the AI link as it should have.  Part of this was caused by the 
family's misstatement about exposure to dead chickens, but in real 
life situations, families will not always be willing to tell the 
truth about AI exposure.  Even though the private clinic in Nong 
Khai referred the patient to the Provincial Hospital as a possible 
AI case, apparently the Provincial Hospital staff did not use 
 
VIENTIANE 00000163  004.2 OF 004 
 
 
protective gear when first treating her, so more training apparently 
needs to be done with hospital staffs on both sides of the border. 
 
¶14. (SBU) The EAC was troubled by the three special factors 
mentioned above.  This outbreak is close to home.  The Embassy staff 
has very vulnerable members.  And our land transportation and access 
to professional-level hospitals on the Thai side of the border is 
easily cut by a Thai decision to close the Friendship Bridge.  The 
EAC expects its attention to the AI issue to remain high for the 
indefinite future. 
 
HASLACH