VZCZCXRO6459
RR RUEHCHI RUEHDT RUEHHM RUEHNH
DE RUEHHI #2099/01 3540916
ZNR UUUUU ZZH
R 200916Z DEC 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 6907
INFO RUEHHM/AMCONSUL HO CHI MINH 4083
RUCNASE/ASEAN MEMBER COLLECTIVE
RUEHHI/SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHKT/AMEMBASSY KATHMANDU 0100
RUEHRO/AMEMBASSY ROME 0262
RUEHSV/AMEMBASSY SUVA 0026
RUDKIA/AMCONSUL CHIANG MAI 0017
RUEHCN/AMCONSUL CHENGDU 0333
RUEHGZ/AMCONSUL GUANGZHOU 0836
RUEHHK/AMCONSUL HONG KONG 1312
RUEHSH/AMCONSUL SHENYANG 0339
RUEHIN/AIT TAIPEI 1542
RUEHGV/USMISSION GENEVA 1220
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEHRC/USDA FAS WASHDC 0062
RUEKJCS/SECDEF WASHINGTON DC//USDP/ISA/AP//
RHMFISS/CJCS WASHINGTON DC//J2/J3/J5//
RHEFDIA/DIA WASHINGTON DC//DHO-3//
RHMFIUU/CDR USPACOM HONOLULU HI//J00/J2/J3/J5//
RUEAIIA/CIA WASHINGTON DC

UNCLAS SECTION 01 OF 05 HANOI 002099 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
DEPARTMENT FOR EAP/EX; EAP/MLS; EAP/EP; EAP/PD 
DEPARTMENT FOR OES/STC/MGOLDBERG AND PBATES; OES/PCI/ACOVINGTON; 
OES/IHA/DSINGER AND NCOMELLA 
DEPARTMENT FOR CA/OCS/ACS/EAP 
DEPARTMENT PASS TO USAID/ANE/CLEMENTS AND GH/CARROLL 
CDC ATLANTA FOR COGH (SDOWELL/RARTHUR) AND DVID(LPETERSEN) 
HHS/OSSI/DSI PASS TO OGHA (WSTIEGER/LVALDEZ/CHICKEY) 
USDA FOR OSEC AND APHIS 
USDA FOR FAS/DLP/HWETZEL AND FAS/ICD/LAIDIG 
USDA/FAS FOR FAA/YOUNG, MOLSTAD, ICD/PETTRIE, ROSENBLUM 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP FOR LEW STERN 
PARIS FOR FAS/AG MINISTER COUNSELOR/OIE 
ROME FOR FAO 
BANGKOK FOR REO WALLER AND RDM/A (CBOWES/JMACARTHUR) 
KATHMANDU FOR REO ADAMS 
SUVA FOR REO MURPHY 
 
E.O. 12958: N/A 
TAGS: TBIO EAID SOCI PGOV AMED AMGT CASC KPAO VM
 
SUBJECT: DESPITE EFFECTIVE GOVERNMENT RESPONSE, DENGUE CONTINUES TO 
PLAGUE VIETNAM 
 
REF: A. HANOI 1954 B. BANGKOK 4603 
 
HANOI 00002099  001.2 OF 005 
 
 
¶1. (SBU) Summary.  Annual numbers of dengue cases continue to rise 
in Vietnam, particularly in the Mekong Delta region.  Though the 
Government of Vietnam (GVN) has a comprehensive national program to 
control dengue, it cannot eliminate the disease.  Instead, 
ecological factors, including the growth of urban characteristics in 
rural areas, promote dengue's continued occurrence.  With no vaccine 
in sight, Vietnam is looking at creative methods to limit the 
population of dengue-carrying mosquitoes, though the feasibility and 
effectiveness of large-scale application of these methods remains 
unclear.  The United States provides modest but critical dengue 
assistance via USAID/RDM/A, though a Vietnam-based World Health 
Organization (WHO) public health specialist questioned the need for 
substantially increased support.  End summary. 
 
Dengue Cases Increasing 
----------------------- 
 
¶2. (U) Dengue fever is endemic in Vietnam, circulating throughout 
the year, but particularly prevalent in the hot, rainy months of 
July and August.  Historically, dengue cases are concentrated in 
southern Vietnam but occur in all regions. Nationally, an estimated 
70 million people (out of a total population of 84 million) are at 
risk from the disease. Annual numbers fluctuate in a cyclic fashion 
over time, and in some years the disease may be epidemic. During the 
last large outbreak in 1998, Vietnam reported 192,796 cases with 408 
fatalities.  Although cases subsequently fell, they again appear to 
be on the upswing. Over the first ten months of 2007, Vietnam 
reported over 75,000 cases of dengue, with 64 deaths, increases of 
51 percent and 45 percent respectively compared with the same period 
in 2006.  Consistent with the past, 86 percent of these cases 
occurred in the south, with the majority in Ho Chi Minh City or 
provinces located in the Mekong Delta.  Central provinces accounted 
for almost 9,000 cases, while the central highlands and northern 
provinces reported few infections.  Though dengue fever cases 
typically peak in the summer, Ministry of Health (MOH) officials 
reported nearly 2,000 cases per week through October. 
 
Dengue Epidemiology 
------------------- 
 
¶3. (U) The Aedes mosquitoes, which feed outdoors throughout the day 
with peaks of activity in the early morning and late afternoon, 
spread dengue.  The virus life cycle requires to-and-fro passage 
between mosquitoes and humans for survival.  The flight range of the 
Aedes is within a few households, limiting the scope of outbreaks. 
In Vietnam, household water containers are the classic Aedes 
breeding sites, along with discarded objects that can hold water, 
 
HANOI 00002099  002.2 OF 005 
 
 
such as tires, bottles, jars, and cans.  Extension of piped water 
services has not limited dengue, as many locals store water in 
inadequately covered jars in order to let sediments settle. Most 
Vietnamese in the south have been exposed as children to infection 
with one or more of the four serotypes of dengue virus, resulting in 
some protection in adulthood.  However, persons can become infected 
with one serotype, develop immunity, but still be susceptible to 
other serotypes, which makes it difficult to analyze and interpret 
data related to morbidity and the effectiveness of dengue preventive 
measures. 
 
¶4. (SBU) Dengue thrives in urban environments, but is not strictly 
an urban disease.  Indeed, experts see increased spread of dengue 
into rural areas that develop "urban" characteristics such as 
uncovered collections of clear water that serve as breeding sites 
for Aedes mosquitoes.  According to Dr. Antonio Montresor, Public 
Health Specialist at the WHO, as long as there are humans and clear 
water breeding sites, dengue can thrive.  Recent flooding in central 
Vietnam will have little impact on dengue disease activity as the 
turbulent and dirty floodwaters are not suited for dengue mosquito 
breeding (ref A).  Dr. Duane Gubler, Director of the Asia Pacific 
Institute of Tropical Medicine and Infectious Diseases at the 
University of Hawaii, stated that human ecology (mobility and social 
factors), housing construction, herd immunity and mosquito density 
constituted the primary factors affecting a dengue outbreak. 
Additionally, according to Gubler, contrary to popular belief, no 
solid evidence supports the theory that the re-emergence of dengue 
is due to climate change. Per Montresor, economic development 
appears to have limited impact on dengue as evidenced by continued 
outbreaks in Singapore, a city-state with high public hygiene 
standards.  Consistent with comments by Montresor and Gubler, 
Vietnamese public health officials noted several possible reasons 
for difficulties in control of dengue, including complex weather 
patterns favorable for mosquito breeding, the lack of dengue fever 
vaccines, the occurrence of multiple dengue serotypes, and the 
impact of urbanization and human migration. 
 
Vietnamese Response Manages, 
But Does Not Eliminate Dengue 
----------------------------- 
 
¶5. (SBU) The Vietnamese response to dengue has focused on pragmatic 
solutions to manage, not eliminate, the disease.  In 2001, Vietnam 
adopted a WHO-recommended prevention strategy stressing 
surveillance, behavioral change, and mosquito control, which covers 
nearly all provinces.  According to WHO's Montresor, over time, 
Vietnam has developed significant practical experience identifying 
and treating dengue.  Vietnam focuses on education programs for 
medical professionals and impacted populations and encourages 
 
HANOI 00002099  003.2 OF 005 
 
 
hospitals and health clinics to share information.  The GVN has 
developed standardized protocols for dengue identification and 
treatment, which importantly contribute to low mortality.  Per 
Montresor, Vietnam spends a "few" million dollars each year on 
dengue programs. 
 
GVN Considering New Responses 
----------------------------- 
 
¶6. (U) Vietnam's health minister has raised concerns about a 
spreading dengue outbreak and the MOH is seeking government approval 
to include dengue along with HIV/AIDS in a national prevention 
program that targets social and dangerous diseases.  In response to 
the recent increase, Vice Minister Huan asked the MOH Preventive 
Medicine Department to revise dengue prevention regulations and 
instructions to make them more appropriate to reality on the ground, 
including more prompt spraying in response to reports of dengue 
(Note: public health experts question the efficacy of spraying to 
control dengue). 
 
A Mesocylops a Day Keeps the Dengue Away 
---------------------------------------- 
 
¶7. (SBU) Vietnam is looking at other interventions to control 
dengue-carrying mosquitoes and has become a world leader in 
community control studies using an indigenous natural mosquito 
predator, Mesocyclops (ref B).  These microscopic crustaceans are 
placed in mosquito breeding sites where they attack and kill 
developing mosquitoes.  While pilot projects have shown some 
success, urban control has been elusive.  Montresor noted 
difficulties in expanding beyond the pilot stage and stated that 
such a project may be too labor intensive to justify.  Montresor 
worried that Vietnam might be overspending on this public health 
research project, which, even though it is developing technical 
research capacity, might not lead to substantial reductions in 
dengue. 
 
Successful Anti-Malaria Campaign 
Not Applicable to Dengue 
-------------------------------- 
 
¶8. (U) Due to differences between the carrier mosquitoes, Vietnam 
cannot use its successful malaria control efforts to address dengue. 
 Vietnam has limited malaria through vector control, primarily 
artemisinin-impregnated mosquito nets.  However, the dengue-carrying 
Aedes mosquito bites during the day, making mosquito nets and 
spraying much less effective (Note: the GVN continues to spray as 
part of its dengue prevention efforts).  Instead, routine control 
efforts focus on preventing mosquito breeding in water containers. 
 
HANOI 00002099  004.2 OF 005 
 
 
Dengue treatment also lags behind that of malaria, and public health 
practitioners try to reduce symptoms and save lives.  Further, while 
treatment reduces dengue mortality, it does not interrupt 
transmission. 
 
Vietnam's Efforts Appear to Have Limited Dengue 
--------------------------------------------- -- 
 
¶9. (SBU) Montresor noted that dengue infection rates vary greatly 
over time due to ecological reasons unrelated to human 
interventions.  Therefore, it is very difficult to determine if 
interventions work.  At the same time, however, Vietnam's extremely 
low mortality rate likely indicates the effectiveness of its 
training for medical professionals in best treatment practices, 
especially the management of patients with dengue hemorrhagic fever 
(DHF).  By means of comparison, Vietnam has reported the same number 
of deaths as Cambodia, despite four times the number of infections. 
 
 
Vietnam Not In Desperate Need for More Resources 
--------------------------------------------- --- 
 
¶10. (SBU) According to Montresor, the Vietnamese dengue effort does 
not need significant new funds, though it could use some additional 
money to improve existing educational efforts and improve training. 
Although some public health experts disagree, Montresor saw little 
value to putting money into increased surveillance, as once a dengue 
outbreak detected, it would be too late to apply control measures. 
When a vaccine has been developed, Vietnam will need support to 
scale up and integrate dengue vaccinations into overall its overall 
vaccination campaign, but this likely will not happen for several 
years. 
 
U.S. Assistance 
--------------- 
 
¶11. (SBU) The USAID Regional Mission in Bangkok, as part of a 
regional initiative, funds WHO programs in Vietnam to 1) strengthen 
dengue diagnosis (clinical and laboratory) and case management at 
provincial and district levels, 2) pilot a school-based vector 
control model at commune level, 3) enhance capacity in and support 
the implementation of containing dengue outbreaks and 4) strengthen 
technical and managerial capacity of the national dengue control 
program.  WHO also provides in-kind technical support to GVN dengue 
projects and seeks to pair the GVN with overseas sources of money 
targeted to promote Vietnamese health education programs, 
particularly those that improve the capacity of medical personnel to 
quickly recognize and treat dengue. Additionally, the Division of 
Vector-borne Infectious Diseases (DVBID) of the Centers for Disease 
 
HANOI 00002099  005.2 OF 005 
 
 
Control (CDC), in the past actively collaborated with the Pasteur 
Institute and the National Institute of Hygiene and Epidemiology on 
dengue prevention. 
 
Comment 
------- 
 
¶12. (U) While dengue infections are up, mortality remains low, 
evidencing the effectiveness of Vietnam's strategy to promote high 
standards of clinical care of the disease.  At the same time, lack 
of a vaccine and increased breeding grounds for the mosquitoes that 
carry the disease ensure that Vietnam's efforts will not seriously 
reduce infections.  While foreign assistance should continue to 
support Vietnam's pragmatic efforts, funds that support global 
vaccine research will have the greatest long-term impact on dengue 
in Vietnam. 
 
MICHALAK