VZCZCXRO1525
RR RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #2071/01 3480419
ZNR UUUUU ZZH
R 140419Z DEC 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 6879
INFO RUEHHM/AMCONSUL HO CHI MINH 4062
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 002071 
 
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: VIETNAM MARKS SUCCESSFUL CONTROL OF CHOLERA OUTBREAK 
 
REF: A. HANOI 2012 B. HANOI 1954 C. HANOI 1953 D. HANOI 1924 E. 
HANOI 1891 
 
HANOI 00002071  001.2 OF 003 
 
 
¶1. (SBU) Summary.  Vietnamese officials recently announced the 
successful control of the outbreak of cholera (or, as the Government 
of Vietnam more generally referred to it, "severe acute diarrhea") 
that began in late October.  International public health experts 
agree with the GVN that Vietnam's quick and thorough response 
resulted in a short outbreak with relatively few victims and no 
deaths.  The GVN's limited, though significant, outreach to the 
World Health Organization (WHO) for assistance, further builds 
public health linkages and likely portends greater cooperation and 
openness in the future.  While Vietnam appears to have avoided a 
serious epidemic, health officials realize they will face future 
challenges in food and water-borne disease and must improve their 
capacity and responses.  End Summary. 
 
Vietnam Announces End of Chol.., um, Severe Acute 
Diarrhea Outbreak 
--------------------------------------------- ---- 
 
¶2. (U) At a public ceremony on December 10, Minister of Health 
Nguyen Quoc Trieu and other Vietnamese health officials announced 
the successful control of the outbreak of "severe acute diarrhea." 
According to GVN authorities, the outbreak started on October 23 
with a 73 year old man in Hanoi and soon spread to 12 other 
provinces.  Through October 31, public health authorities learned of 
30 separate outbreaks and by November hospitals were admitting up to 
200 severe diarrhea patients per day (ref D). In total, the GVN 
reported 1991 cases, of which 295 tested positive for cholera, and 
no deaths.  Only one known non-Vietnamese national - a Japanese 
resident in Hanoi, tested positive for cholera after eating dog 
meat.   Vietnamese officials believe "food safety" to be the likely 
cause of the outbreak.  Though the National Institute of Health and 
Epidemiology (NIHE) reported that 78 percent of those with severe 
acute diarrhea had recently eaten shrimp paste or dog meat (which, 
traditionally, are served together), GVN officials have yet to 
identify the source of the infection.  Since November 25, no new 
cases have been reported. Therefore, at the December 10 ceremony, 
Vice Minister of Health Trinh Quan Huan stated that, per World 
Health Organization (WHO) rules, after 14 days with no apparent new 
victims, Vietnam could now declare the outbreak over. 
 
When Is a Cholera Outbreak a Cholera Outbreak? 
--------------------------------------------- - 
 
¶3. (SBU) Though the MOH early on acknowledged that several victims 
tested positive for cholera, the GVN infrequently referred publicly 
to the term and determined that international technical experts 
support a mission to control "severe acute diarrhea."  Press 
headlines also used this term, though the text of newspaper and 
online articles clearly quoted GVN officials citing positive cholera 
test results.  At the December 10 ceremony, Minister Trieu and Vice 
Minister Huan referred to Vietnam's response to cholera, though 
official reports of the ceremony again focused on "severe acute 
diarrhea."  Per ref C, GVN officials likely decided to downplay the 
presence of cholera to protect the tourist and agricultural export 
sectors.  At the same time, however, international experts noted 
that Vietnam should acknowledge the general cholera outbreak to 
better emphasize its successful response and to ensure that public 
health officials responding to future cholera outbreaks refer to the 
GVN's response to learn how to successfully manage an emergency 
situation. 
 
GVN Responded Quickly and Thoroughly 
------------------------------------ 
 
¶4. (U) GVN officials described a multi-pronged approach to the 
outbreak and noted that they had learned from their experiences with 
SARS and avian influenza.  The MOH responded to initial reports of 
an outbreak from Bach Mai Hospital in Hanoi by setting up a Central 
Committee for Dangerous Acute Diarrhea Prevention and Control, which 
 
HANOI 00002071  002.2 OF 003 
 
 
met up to three times per day.  The MOH then emphasized 
communication between central authorities, provinces, districts, and 
communes.  Once public health authorities reported that many victims 
had tested positive for cholera, the Vietnamese political system, 
including the Communist Party, joined the public health sector to 
fight the disease.  Central authorities and local People's 
Committees carried out a broad campaign to heighten citizen 
awareness of the outbreak, its symptoms, and how to improve personal 
and food hygiene to avoid infection.  In accordance with its 
international commitments, the GVN notified international health 
authorities and subsequently sought international assistance. 
 
Quick Response Led to Successful Control 
---------------------------------------- 
 
¶5. (U) Minister Trieu stated that the Vietnamese controlled the 
outbreak in record time (about one month) and again emphasized that 
no one died from cholera during the outbreak.  Cholera outbreaks, 
such as the one currently occurring in Iraq, normally last for over 
three months with an average two percent mortality rate.  National 
Institute for Infectious and Tropical Diseases Deputy Director Tran 
Hong Ha earlier told international health care workers that 
Vietnam's rapid, aggressive, and comprehensive clinical intervention 
prevented a more serious and lengthy epidemic. 
 
Limited, but Important, International Cooperation 
--------------------------------------------- ---- 
 
¶6. (SBU) GVN officials publicly acknowledged the important support 
role played by international public health experts, particularly 
from the WHO.  Despite some initial hesitancy, following a request 
by WHO for a briefing on the outbreak, the MOH on November 9 wrote 
to the WHO representative in Vietnam requesting assistance to 
develop community communication strategies, technical support for 
the "acute diarrhea" outbreak, and sample testing.  Though the GVN 
careful circumscribed the responsibilities of international experts 
(ref C), the MOH provided significant information to the WHO and 
included WHO team members in the GVN response. Following proactive 
communications from U.S. Centers for Disease Control and Prevention 
(CDC) to WHO, a Bangkok-based epidemiologist participated in the WHO 
team and helped set up a case-control epidemiological study (which 
will be partially funded by WHO) to determine the original source of 
the outbreak.  CDC-Atlanta additionally provided laboratory 
materials to the GVN to use for continued surveillance. 
 
Still a Need to Improve 
----------------------- 
 
¶7. (U) Despite Vietnam's successful response, officials noted that 
the threat of cholera still exists and that Vietnam faced a high 
possibility of reoccurrence of cases or of the emergence of other 
food and water-borne infectious diseases.  These officials also 
acknowledged several structural weaknesses and environmental dangers 
they will need to address in future outbreaks, including   Vietnam's 
inadequate food sanitation and hygiene protection (ref A). 
Vietnam's limited medical assets were stretched thin and Minister 
Trieu noted to the press that due to limited availability, during 
the peak of the outbreak, patients had to share beds.  Though the 
outbreak did not spread to the flooded central region, the GVN has 
only slowly been able to provide clean food and water to local 
residents (ref B), leaving ideal conditions for the spread of 
cholera or other diseases.  NIITD's Ha admitted that had the 
outbreak occurred in poorer and more rural areas, Vietnam likely 
would have seen several deaths.   Minister Trieu stated that all 
provinces, especially those in the flood-ravaged center of the 
country, needed to remain alert as Vietnam entered the Tet season 
when millions of people traveled throughout the country to return to 
their home villages. 
 
Comment 
------- 
 
 
HANOI 00002071  003.2 OF 003 
 
 
¶8. (SBU) Vietnam's successful response evidences growing public 
health capacity and competence.  Though the GVN continues officially 
to refer to the outbreak as "severe acute diarrhea" and at times 
downplayed the presence of cholera, this public relations concern 
did not impact its actions.  Additionally, the GVN continued slowly 
to allow greater participation in health crisis response efforts by 
international experts.  This example of cooperation strengthens the 
likelihood for closer and more complete links in responses to future 
public health emergencies. 
 
MICHALAK