VZCZCXRO9266
RR RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #0177/01 0461016
ZNR UUUUU ZZH
R 151016Z FEB 08
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 7186
INFO RUEHHM/AMCONSUL HO CHI MINH 4304
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHUL/AMEMBASSY SEOUL 3239
RUEHKO/AMEMBASSY TOKYO 5817
RUEHHK/AMCONSUL HONG KONG 1351
RUEHGZ/AMCONSUL GUANGZHOU 0846
RUEHCN/AMCONSUL CHENGDU 0343
RUEHIN/AIT TAIPEI 1553
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
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//
RHEFAFM/DIRAFMIC FT DETRICK MD//MA-1A//
RUEHSUN/USUN ROME IT

UNCLAS SECTION 01 OF 03 HANOI 000177 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED 
STATE PASS TO USAID FOR ANE AND GH 
STATE PASS TO HHS/OGHA (STIEGER/VALDEZ/DMILLER/HICKEY) 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN) 
HHS/OSSI/DSI PASS TO OGHA (WSTIEGER/LVALDEZ/CHICKEY) AND 
FIC/NIH (RGLASS) AND DIV-FLU (COX/MOHEN) 
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS 
BANGKOK FOR RMO, CDC (MALISON), USAID (MACARTHUR/BRADY) BANGKOK FOR 
APHIS (NCARDENAS), REO(JWALLER) 
BEIJING FOR HHS HEALTH ATTACHE (ROSS) 
PHNOM PENH FOR CDC INFLUENZA COORDINATOR(BRADY) 
ROME FOR FAO 
VIENTIANE FOR CDC INFLUENZA COORDINATOR (CORWIN) 
 
 
E.O. 12958: N/A 
TAGS: TBIO AMED AMGT CASC EAGR PINR KFLU VM
SUBJECT: AVIAN INFLUENZA UPDATE - VIETNAM'S SECOND AI FATALITY OF 
2008 
 
REF: A. HANOI 80 B. 07 HANOI 2116 
 
HANOI 00000177  001.2 OF 003 
 
 
¶1. (U) Summary: Government of Vietnam (GVN) officials confirmed the 
second and third human Avian Influenza (AI) fatalities of 2008, both 
from northern provinces close to Hanoi.  A 40-year old male from Hai 
Duong province died on February 13 after cooking and eating dead 
chickens.  A 27-year old male from Ninh Binh province died on 
February 15 after slaughtering sick chickens. The Ministry of Health 
(MOH) and the Department of Animal Health (DAH) within the Ministry 
of Agriculture and Rural Development have sent response teams to the 
victims' villages.  However, once again the MOH failed to provide 
timely notification to the World Health Organization (WHO).  End 
Summary. 
 
50 Fatalities Since Onset of Avian Influenza 
-------------------------------------------- 
 
2.(U) The GVN confirmed the second and third AI-related human 
fatalities of 2008, a 40-year old man from Quang Bi hamlet, Pham 
Chau Village, Gia Loc District, Hai Duong province, roughly 50 
kilometers from Hanoi, and a 27-year old man from Ninh Binh 
province, approximately 100 kilometers south of Hanoi.  Vietnam now 
has suffered eight deaths and 11 infections since the most recent 
wave of AI outbraks began in May 2007 and 50 fatalities and 104 
human infections since the initial outbreak of AI in 2003. Each of 
the last eight reported human infections resulted in death. 
 
Hai Duong Fatality 
------------------ 
 
¶3. (U) A 40-year old man from Hai Duong province died at noon on Feb 
13 at the National Institute for Infectious and Tropical Diseases 
(NIITD) following four days of treatment, including mechanical 
ventilation and hemoperfusion. According to press reports, the 
patient arrived on February 9 already suffering from severe 
pneumonia and internal organ failure.  He had been ill for six days 
prior to initial hospitalization at Hai Duong Provincial Hospital. 
The Director General of the Vietnam Administration of Preventative 
Medicine within the MOH, Nguyen Huy Nga, stated that the man had 
cooked and consumed, along with his family, at least two dead 
chickens.  Authorities subsequently found numerous dead chickens 
around the man's residence and DAH noted that nine of the man's 12 
fighting cocks had died since late January. 
 
¶4. (SBU) The National Institute of Hygiene and Epidemiology (NIHE) 
was notified of the suspect case on February 9, responded promptly, 
and reported confirmatory laboratory test results on February 10. 
However, MOH only notified the WHO on February 14 -- a day after the 
local press reported the case - although WHO International Health 
Regulation guidelines stipulate reporting within 24 hours. The Hai 
Duong Preventative Medicine Center sent an investigation and control 
team to the man's village to conduct case detection and surveillance 
and sterilize the environment (including wells) surrounding the 
patient's residence with chloramine.  The response team reportedly 
was unable to provide osetmavir (Tamiflu) to family members and 
neighbors due to the available medication already passing its 
 
HANOI 00000177  002.2 OF 003 
 
 
expiration date necessitating VAPM sending additional mediction from 
its central stocks.  To date, we have seen no reports of additional 
human infections in this village.  Both the DAH and the MOH have 
since sent investigation and control teams to the area and MOH 
invited a WHO epidemiologist to join. 
 
Death in Ninh Binh 
------------------ 
 
¶5. (SBU) VAPM confirmed today to USAID that a 27-year old man 
infected by the H5N1 virus died yesterday.  According to NIHE, the 
Ninh Binh resident slaughtered sick chickens on January 31 and 
became ill two days later.  His fever worsened on February 7 and he 
was admitted to Army Hospital Number 5 in Ninh Binh on February 11 
and transferred to Bach Mai hospital in Hanoi on February 12.  Bach 
Mai received a positive H5N1 confirmation test on February 13.  NIHE 
collected an additional sample but has not yet reported results. 
The MOH sent a response team today to the residence.  Though MOH has 
discussed this case with the local WHO office, it has not yet 
provided official notification. 
 
Recent Animal outbreaks 
----------------------- 
 
¶6. (U) In addition to the two recent human fatalities (and related 
poultry deaths), Vietnam currently has ongoing animal outbreaks in 
northern Thai Nguyen and central Quang Binh province, according to 
DAH.  Most recently, on February 11, DAH reported an outbreak in Tan 
Lap ward of Thai Nguyen city where local authorities culled 700 
ill-looking ducks.  A January 29-30 outbreak in Hong Thuy province 
in Quang Binh killed 100 ducks in three flocks totaling 5,300 birds. 
 Though 3,800 of the ducks had received vaccinations, not enough 
time had elapsed to build up immunity.  DAH and local authorities 
culled the flocks and took other preventive actions.  Also on 
January 29, 1,200 chickens in a 4,165 bird flock died in Thai 
Nguyen.  The remaining birds subsequently were culled. The two to 
four month old chickens had been vaccinated on December 21.  Quang 
Binh had suffered an additional animal outbreak on January 23, when 
over 1,000 50-day old and unvaccinated ducks became infected in Hong 
Thuy Commune, Le Thuy district. 
 
Comment: 
------- 
 
¶7. (SBU) Unlike the two previous human fatalities (reftels), these 
two patients resided in high-risk provinces in the Red River delta 
close to Hanoi and in which the GVN has focused its AI response 
campaign (including mandatory vaccinations of chickens and ducks). 
Nevertheless, the facts of this case are quite familiar - and 
involve the handling, preparation, and consumption of sick or 
already dead poultry.  Although the overall number and intensity of 
animal outbreaks remains substantially lower than this time period 
last year, human exposure through high risk behaviors, such as 
handling and preparing sick or already dead poultry, appear common 
in some areas. 
 
 
HANOI 00000177  003.2 OF 003 
 
 
¶8. (SBU) Comment cont'd: During the Lunar New Year, or Tet, which 
stretched from February 5 to February 11, huge numbers of Vietnamese 
return to their ancestral villages and the consumption of chicken is 
an important holiday ritual.  The holidays also leave medical 
facilities and government agencies short staffed and sick persons 
often are reluctant to seek care during the celebrations.  This may 
account for the late diagnosis of the disease and for what appears 
to be another failure by the MOH to promptly notify the WHO of the 
infection. Though we are pleased by the inclusion of a WHO 
epidemiologist as part of the MOH response team, once again, we will 
work with WHO to remind our Vietnamese interlocutors of the need for 
prompt notification to ensure proper international response. 
 
¶9. (SBU) Comment cont'd:  Importantly and disturbingly, in several 
recent cases, we have seen human infections in the absence of 
detection of or reporting by authorities of pre-existing animal AI 
outbreaks in the patient's village or commune.  Only after human 
victims were hospitalized did local authorities note ill or dead 
poultry.  In essence, human cases have been serving as sentinels of 
avian infection, which is the opposite of how the sentinel 
surveillance system should work. End comment. 
 
MICHALAK