VZCZCXRO2020
RR RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #0383/01 0941005
ZNR UUUUU ZZH
R 031005Z APR 08
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 7536
INFO RUEHHM/AMCONSUL HO CHI MINH 4532
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 02 HANOI 000383 
 
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: CHOLERA REAPPEARS IN NORTHERN VIETNAM 
 
REF: A. HANOI 2071 B. HANOI 2012 C. HANOI 1953 D. HANOI 1924 E. 
 
HANOI 1891 
 
HANOI 00000383  001.2 OF 002 
 
 
¶1. (SBU) Summary.  Three months after the Government of Vietnam 
(GVN) announced the successful control of an outbreak of cholera 
(ref A), the disease has reappeared in several provinces in northern 
Vietnam, including Hanoi.  Though international health experts 
predicted the likelihood of small, episodic outbreaks in the months 
following the main epidemic, the GVN's response indicates that local 
officials take the spate of recent cases seriously and are 
initiating an aggressive response.  End Summary. 
 
Cholera Returns 
--------------- 
 
¶2. (SBU) In early March, hospitals in northern Vietnam began to 
report an uptick in cases of severe acute diarrhea, some of which 
are confirmed to be cholera.  Though Vietnamese officials have yet 
to provide official statistics, press reports and information from 
informal contacts with health authorities indicate the 
hospitalization of several hundred people, many at the National 
Institute for Infectious and Tropical Diseases, which has reached 
capacity with over 20 new patients each day.  Other hospitals in 
Hanoi report similar situations.  Ministry of Health authorities 
have confirmed that eight of the thirteen northern provinces that 
suffered from the 2007 outbreak have seen new cases, with Hanoi the 
most severely impacted.  (Note: Earlier media reports of "acute 
diarrhea" in Ho Chi Minh City appear unrelated and most likely 
involve a Rotavirus infection, though we will continue to track the 
situation in the south). 
 
¶3. (SBU) Though GVN officials again typically refer to the outbreak 
as "severe acute diarrhea" (ref C), and have minimized the nature of 
the outbreak, they acknowledge that considerable numbers of patients 
have tested positive for the Vibrio cholerae bacterium.  The most 
recent media reports list 85 persons in ten provinces as having 
tested positive for cholera, with most of these from Hanoi.  Once 
again, authorities are scrambling to detect the sources of 
infection.  Officials at the National Institute of Hygiene and 
Epidemiology (NIHE)/MOH reported informally to the World Health 
Organization (WHO) that its prospective case control study indicates 
the consumption of the combination of dog meat/shrimp paste/raw 
herbs consumption in two-thirds of all cases, with raw herbs the 
most likely culprit.  A recent on-line article in Vietnam Net quoted 
one doctor from NIITD claiming that raw vegetables caused the recent 
flare up. 
 
GVN Response 
------------ 
 
¶4. (U) GVN officials and international health experts expected some 
level of recurrence of the epidemic of severe acute diarrhea that 
last year affected 2,000 people in 17 northern provinces (of which 
close to 300 people tested positive for cholera).  While announcing 
the end of the six-week epidemic last December, Deputy Minister of 
Health Trinh Quan Huan warned that the disease would be likely to 
recur during spring and summer 2008.  However, while the media has 
played up every new report, health officials continue to minimize 
the severity of recent events.  Nguyen Huy Nga, Head of the 
Preventive Health and Environmental Agency under the MOH, stated 
that few persons were suffering from severe acute diarrhea and that 
the disease remained scattered.  He then refused to disclose to the 
press the total number of patients that had tested positive for 
cholera. 
 
¶5. (SBU) At the same time, central and provincial health officials 
have swung into action, beginning with the institution of 
consultations between NIHE, MOH and the WHO (Note: The CDC expert 
who assisted the 2007 WHO response will return to Hanoi shortly to 
provide additional assistance to the current WHO effort).  MOH has 
reissued messages warning everyone to avoid eating raw seafood and 
exercise caution with the preparation and handling of fresh foods. 
 
HANOI 00000383  002.2 OF 002 
 
 
On April 1, Deputy Minister of Health Huan issued an urgent dispatch 
seeking to ban the use of excrement to fertilize vegetables. 
Following the report of numerous cases within the city limits, the 
Hanoi Department of Health asked MOH to provide free cholera vaccine 
to the whole population of Hanoi, while preventive health agencies 
sterilized areas around the homes of patients.  The Haiphong 
Department of Health requested city authorities ban raw foods (such 
as duck's blood curds) during the epidemic period. 
 
Comment 
------- 
 
¶6. (SBU) GVN officials are taking steps to respond effectively to 
this growing outbreak, and press attention is keeping their feet to 
the fire.  Encouragingly, Vietnamese health officials have already 
communicated with the WHO.  Though the numbers of cases in 2008 have 
not yet reached (and may not reach) the levels of late 2007, we 
continue to track the situation, the GVN response, and possible 
impacts on the American community. 
 
MICHALAK