VZCZCXRO4288
RR RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #1924/01 3170415
ZNR UUUUU ZZH
R 130415Z NOV 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 6688
INFO RUEHHM/AMCONSUL HO CHI MINH 3925
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUCPDOC/DEPT OF COMMERCE WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHSUN/USUN ROME IT

UNCLAS SECTION 01 OF 03 HANOI 001924 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED 
STATE PASS TO USAID FOR ANE AND GH 
HHS/OSSI/DSI PASS TO OGHA (WSTIEGER/LVALDEZ/CHICKEY), FIC/NIH 
(GLASS), FDA (MPLAISER) 
CDC/COGH FOR SBLOUT/KMCCALL/RARTHUR, PASS TO NCZVED/DFBMD/EDEB 
(RTAUXE/EMINTZ) AND GDD, IEIP, DEOC 
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS 
BANGKOK FOR RMO, CDC (MMALISON/SMALONEY/AHENDERSON), USAID/RDM/A 
(CBOWES/JMACARTHUR), APHIS (NCARDENAS), REO(JWALLER) 
BEIJING FOR HHS HEALTH ATTACHE (BROSS) 
ROME FOR FAO 
 
E.O. 12958: N/A 
TAGS: TBIO AMED AMGT CASC EAGR PINR VM
SUBJECT:  UPDATE OF SERIOUS ACUTE DIARRHEA OUTBREAK IN NORTHERN 
VIETNAM 
 
REF: Hanoi 1891 
 
HANOI 00001924  001.2 OF 003 
 
 
¶1. (SBU) Summary.  Vietnam's acute diarrhea outbreak expanded from 
11 to 14 provinces and municipalities throughout northern Vietnam 
over the past week, with many victims testing positive for cholera. 
However, informal information from one of Hanoi's major referral 
centers indicates the epidemic may be easing.  Though Vietnam 
traditionally experiences sporadic, individual cholera cases from 
time to time, this is the first large-scale outbreak since the 
1970s.  While initial cases have been linked to the consumption of 
raw shrimp paste, the Government of Vietnam (GVN) is warning its 
citizens about the possible dangers of all uncooked foods and 
unsanitary water sources.  The GVN has initiated an active response 
and on November 12 the Ministry of Health (MOH) officially requested 
World Health Organization (WHO) assistance.  WHO, in turn, invited 
U.S. Centers for Disease Control (CDC) participation in the WHO 
response team.  The U.S. Embassy disseminated a warden notice to 
U.S. citizens about the epidemic on November 8.  End Summary. 
 
Serious Acute Diarrhea Continues to Spread 
------------------------------------------ 
 
¶2. (U) On November 9, MOH confirmed the continued spread of "serious 
acute diarrhea" in northern Vietnam.  Official estimates of 
hospitalizations have risen to about 1660 spread over 14 northern 
municipalities and provinces, an increase of 3 provinces from those 
reported in reftel on November 5, with over 530 persons seeking 
medical attention in Hanoi.  MOH has reported that the number of new 
cases has decreased in Hanoi, Hai Duong, Thanh Hoa, Hai Phong, and 
Hung Yen provinces and a contact at the National Institute of 
Infectious and Tropical Diseases (NIITD)/MOH, a major referral 
center in Hanoi, informally reported to a CDC-Hanoi staff member 
that the number of new cases referred each day to NIITD has dropped 
to 10 to 15.  In Hanoi, hospitals have begun to discharge many 
patients.  However, the most recent reports from November 9 stated 
that the outbreak continues to expand in Ha Tay and Vinh Phuc 
provinces.  In Hanoi, a chef at a five-star hotel reportedly tested 
positive for cholera, leading MOH Vice-Minister Trin Quan Huan to 
contemplate shutting down the establishment.  Though still confined 
to northern Vietnam, officials remain concerned that it may spread 
nationwide through internal labor migration.  Local newspapers 
reported the hospitalization in Ho Chi Minh City of two patients 
suffering from acute diarrhea.  Test results for one patient came 
back negative for cholera, while testing on the second patient is 
not yet complete.  Continued flooding in many areas of the country 
also creates unsanitary conditions conducive to the further spread 
of the disease. 
 
Many Patients Test Positive for Cholera . . . 
--------------------------------------------- 
 
¶3. (SBU) Despite public statements to the contrary in a November 8 
press briefing by the Ministry of Foreign Affairs Spokesperson Le 
Dzung, the MOH has reported to Embassy officers that it has isolated 
the Vibrio cholera O1 El Tor strain from samples taken from several 
patients.  Further, in addition to earlier MOH statements (reftel), 
the newly-created Central Committee for Acute Diarrhea Control 
publicly announced that over 200 victims have tested positive for 
cholera and while most headlines have referred to "acute diarrhea," 
the underlying articles note the presence of cholera.  Nevertheless, 
Vietnam clearly remains sensitive about referring the outbreak as 
"cholera," and the MOH insisted in its negotiations with the WHO for 
technical assistance that the two sides instead use the phrase 
"serious acute diarrhea outbreak."  Embassy has no information yet 
on the susceptibility of this strain to antibiotic treatments. 
 
. . . Including One Non-American Expatriate 
------------------------------------------- 
 
¶4. (SBU) MOH testing confirmed that an expatriate treated at a Hanoi 
medical clinic for severe watery diarrhea was infected with V. 
 
HANOI 00001924  002.2 OF 003 
 
 
cholera.  The director of the medical facility, which conducted the 
initial positive test, had reported to the case to the Embassy and 
noted that the facility - which caters to expatriates -- had not 
treated any Vietnamese patients.  The patient had recently traveled 
north of Hanoi.  Mission's Health Attache Office verified that the 
WHO has received this report.  Embassy MED Unit confirmed no 
reported cases in the other two major international medical clinics 
in Hanoi that largely serve expatriates.  The Embassy issued a 
warden notice to the expatriate American community on November 8. 
 
Largest Outbreak in Northern Vietnam since the 1970s 
--------------------------------------------- ------- 
 
¶5. (U) Sporadic cases of cholera occur every year in Vietnam, 
especially in rural areas.  Though cholera is more endemic to 
southern Vietnam, in the recent past, a few northern provinces and 
the municipalities of Haiphong and Hue suffered a small number of 
easily controlled cases.  Outbreaks of non-cholera food-borne 
associated diarrhea are relatively common in Vietnam.  However, the 
last large scale cholera outbreak to hit Haiphong and Hanoi occurred 
in the 1970s. 
 
GVN Response 
------------ 
 
¶6. (U) Though early press reports stated that the outbreak initially 
stemmed from products containing raw shrimp paste, GVN warnings have 
expanded to cover raw vegetables, street food, and presumed 
unsanitary water sources.  The media also has reported infections of 
caregivers and through the consumption of certain processed foods. 
On November 11, Prime Minister Nguyen Tan Dung directed the MOH to 
coordinate a multi-sector task force to respond to the issue.  The 
government has continued rigorous interventions, targeting citizens, 
health care providers, and environmental control, including a 
continued ban on the sale of shrimp paste, chemical disinfection of 
exposed areas and provision of preventive antibiotic therapy to 
exposed persons.  Most recently, Vietnamese authorities began to 
shut down non-licensed restaurants, increased health inspections of 
rail travelers, and moved to ensure food quality on Vietnam 
Airlines.  Health authorities plan to provide one million gloves to 
restaurants and establish an information hotline.  Along with these 
efforts, the GVN has instituted surveillance and preventive efforts 
to prevent the expansion of the outbreak to the central and southern 
parts of the country.  The Ho Chi Minh City preventive medicine 
department disinfected the residences and surrounding area of the 
two recent diarrhea patients and has been proactively raising public 
awareness, inspecting suspected foods, and preparing responses if 
the epidemic moves south. 
 
Vietnam Requests WHO Assistance 
------------------------------- 
 
¶7. (SBU) On November 8, the WHO Country Representative met with the 
Minister of Health.  On November 12, the MOH formally requested WHO 
assistance, which will be coordinated by WHO Regional Office for the 
Western Pacific (WPRO) based in Manila.  CDC has maintained close 
communications throughout the situation with WHO, which has 
requested CDC-Hanoi to prepare to contribute to the WHO response to 
the GVN request.  WPRO has notified CDC-Vietnam that CDC-Bangkok's 
Dr. Alden Henderson, an epidemiologist, will be part of the WHO 
response team that will arrive this week. 
 
U.S. Prepared to Participate in WHO Effort 
------------------------------------------ 
 
¶8. (SBU) Health Attache and CDC-Hanoi Chief of Party have 
coordinated with Department of Health and Human Services and CDC 
principals to review the current situation and prepare an organized 
USG response to the expected WHO request for assistance. 
CDC-Bangkok also briefed Embassy health officers on recent cholera 
activity in Thai refugee camps and CDC-Hanoi has lined up additional 
 
HANOI 00001924  003.2 OF 003 
 
 
suitable candidates from CDC-Bangkok with requested CV/resumes 
in-hand who can deploy immediately.  CDC-Hanoi has informed WHO/WPRO 
of its continued readiness to assist. 
 
¶9. (SBU) CDC participation in the response meets two critical 
objectives: responding to a public health crisis and demonstrating 
to WHO and MOH its ability to add value to a WHO emergency response 
effort.  Accordingly, the set of persons offered have strong 
diplomatic skills and experience with an international team 
approach.  The primary public health objective is to control the 
outbreak and improve treatment capacity to minimize mortality.  To 
this end, if successful, the first CDC responders may need to 
request additional CDC resources in the areas of 
food-and-water-borne illness, in-depth epidemiology, water 
sanitation, laboratory, and informatics. 
 
MICHALAK