VZCZCXRO2060
OO RUEHAST RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
RUEHTM
DE RUEHHI #0021/01 0081015
ZNR UUUUU ZZH
O 081015Z JAN 09
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 8986
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC IMMEDIATE
RUEHHM/AMCONSUL HO CHI MINH 5456
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHUL/AMEMBASSY SEOUL 3418
RUEHKO/AMEMBASSY TOKYO 5974
RUEHHK/AMCONSUL HONG KONG 1609
RUEHGZ/AMCONSUL GUANGZHOU 0010
RUEHCN/AMCONSUL CHENGDU 0375
RUEHIN/AIT TAIPEI 1634
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE 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 000021 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED, OGAC 
STATE PASS TO USAID FOR ANE AND GH 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN) 
HHS/OSSI/DSI PASS TO FIC/NIH (RGLASS) AND OGHA 
(WSTIEGER/LVALDEZDMILLER/MABDOO) 
USAID FOR ANE (CJENNINGS, MWARD) AND GH (KYAMASHITA, KHILL) 
CDC FOR COGH (SBLOUNT), CCID (SREDD) AND DIV-FLU(COX/MOHEN) 
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS 
BANGKOK FOR RMO, CDC (MMALISON), USAID (MACARTHUR/MBRADY/CBOWES), 
APHIS (NCARDENAS), REO (HHOWARD) 
BEIJING FOR HHS HEALTH ATTACHE (BROSS) 
PHNOM PENH FOR CDC INFLUENZA COORDINATOR(BBRADY) 
ROME FOR FAO 
VIENTIANE FOR CDC INFLUENZA COORDINATOR (ACORWIN) 
 
E.O. 12958: N/A 
TAGS: TBIO AMED EAGR PINR KFLU VM
SUBJECT: VIETNAM'S FIRST HUMAN AVIAN INFLUENZA INFECTION OF 2009 
 
REF: A. 08 Hanoi 319 B. 08 Hanoi 409 C. 08 Hanoi 398 
 
HANOI 00000021  001.2 OF 003 
 
 
¶1. (U) Summary:  Local officials confirmed a recent human infection 
with H5N1, Vietnam's first since March 2008.  The victim, an eight 
year old girl who resided in a rural, mountainous village in 
northern Vietnam, consumed sick poultry prior to becoming ill.  Her 
13 year old sister died on January 2 from respiratory failure, but 
without any testing, indicating a possible infection cluster.  After 
several months of light activity, Vietnam has seen focal animal 
outbreaks in three provinces in the past six weeks.  As northern 
Vietnam settles into winter and we approach the Tet (Vietnamese New 
Year) holiday, during which Vietnamese families typically serve 
chicken and duck, we expect to see continued poultry outbreaks and 
possible additional human infections.  End Summary. 
 
New Human Infection 
------------------- 
 
¶2. (SBU) The Ministry of Health (MOH) confirmed H5N1 infection in an 
eight year old girl exposed to sick poultry in a small family flock 
of chickens and Muscovy ducks in rural, mountainous Dien Trung 
commune, Ba Thuoc district, Thanh Hoa province (approximately 120 
kilometers southwest of Hanoi). The girl, a member of an ethnic 
minority, is recovering in the Thanh Hoa provincial hospital.  Per 
MOH, the girl suffered from fever, sore throat, coughing, breathing 
problems and tiredness on December 19, 2008 after her family 
consumed two chickens from the unvaccinated family flock. Several 
days earlier, on December 11, the patient's father had slaughtered 
the two chickens and two Muscovy ducks after they became ill.  After 
treatment at the commune clinic on December 20, she was discharged 
home.  She returned to the commune medical clinic on January 2, 
which transferred her to the district hospital, where she joined her 
ill, older sister who had been admitted on December 31.  Following 
death of the older girl later that day, medical personnel then 
transferred the eight year old victim  the provincial hospital from 
which the clinical specimens were sent to the National Institute of 
Hygiene and Epidemiology (NIHE), which found the H5N1 infection on 
January 3.  The deputy director of the Thanh Hoa Department of 
Health reported that the girl's health has almost returned to 
normal. 
 
Possible Cluster 
---------------- 
 
¶3. (SBU) As noted above, we have confirmed that the patient's 13 
year old sister, who also consumed the sick poultry, died on January 
2 after suffering from respiratory failure.  The older sister 
presented symptoms of high fever, cough and difficulty breathing on 
December 27 and her family took her to the commune medical station 
on December 31. She was transferred that day to the district 
hospital.  Medical personnel at the district hospital did not 
suspect H5N1 infection and did not take clinical specimens from the 
13 year old girl.   NIHE contacted the hospital, but was told that 
no sputum or blood specimens remained.  NIHE has initiated an 
epidemiological investigation of this case, though we have been told 
that cultural considerations make exhumation of the 13 year old 
victim unlikely. Finally, press reports state that a five year old 
 
HANOI 00000021  002.2 OF 003 
 
 
neighbor suffered from similar symptoms, though MOH told us that he 
tested negative for H5N1. 
 
¶4. (SBU) This is the first human reported infection in this commune 
and the first human case in the province since 2007.  This case 
brings the total human H5N1 cases reported by Vietnam MOH to the 
World Health Organization (WHO) to 107, of which 52 have been fatal. 
 The most recent previous human H5N1 case in Vietnam occurred in 
March 2008 (Ref A).  Ten of the last 13 cases reported between May 
2007 and March 2008 were fatal. If either the elder sister or the 
neighbor boy was infected, it would represent Vietnam's first H5N1 
cluster subsequent to those during the initial outbreak in 2004/05. 
Vietnam's health ministry has issued a nationwide bird flu alert, 
urging cities and provinces to step up detection and epidemic 
control measures. 
 
Poultry Outbreaks 
----------------- 
 
¶5. (U) Over the past six weeks, Vietnam reported localized animal 
outbreaks in three northern provinces, including the infected 
chickens in the village where the most recent human victim resided. 
In reporting on the investigation of this case, the Thanh Hoa 
Department of health reported finding infected chickens in six 
villages in Ba Thuoc District.  Local authorities stated that 383 
infected chickens died and that all remaining poultry in the area 
(around 7,800 birds) were culled.  None of the chickens had been 
vaccinated. In mid-December, avian influenza surfaced in Thai Nguyen 
City (approximately 80 kilometers north of Hanoi), killing ducks and 
chickens at two farms.  Animal health officials first confirmed the 
H5N1 virus had killed several birds among a flock of more than 100 
ducks in Thai Nguyen city.  In January 2008, the virus was detected 
in dead chickens at a farm in the same city.  Officials then ordered 
the slaughter of nearly 4,200 chickens to prevent the virus from 
spreading. 
 
¶6. (U) In early December, the Vietnam Department of Animal Health 
(DAH) confirmed positive tests for avian influenza in a single, 
household flock of poultry in Nghi Phong commune, Nghi Loc district 
in Nghe An province.  Nghe An is located in north-central Vietnam, 
approximately 300 kilometers south of Hanoi.  The poultry die-off 
occurred on December 2 and totaled 194 birds in the flock. 
Subsequently, the Nghe An Provincial Department of Animal Health 
(PDAH) collected specimens, which it sent to the Region III Animal 
Health diagnostic lab for testing. December 3 test results were 
positive for H5N1.  The Nghe PDAH provided guidance to cull all sick 
poultry, prohibited transport, slaughter, selling and buying, and 
consumption of poultry in Nghi Phong commune. Simultaneously, DAH 
set up check points and sprayed disinfectant to prevent further 
spread. Dien Chau district in Nghe An had reported a similar, small 
poultry outbreak on November 8. 
 
'Tis the Season for Avian Influenza Outbreaks 
--------------------------------------------- 
 
¶7. (U) Animal outbreaks and human infections with H5N1 have 
historically spiked during the winter and spring in northern Vietnam 
 
HANOI 00000021  003.2 OF 003 
 
 
as H5N1 seems to thrive in cool, wet weather.  Additionally, the Tet 
Lunar New Year festival later this month is considered a high-risk 
time for the spread of bird flu as poultry slaughtering, trade, and 
consumption spikes.  Additionally, in the run up to Tet, smuggling 
chickens (which have tested positive for H5N1, in the past, refs B 
and C) from China rises sharply.  Earlier this month, authorities in 
northern Quang Ninh province detained a truck carrying more than 
three tons of chicken smuggled from China and destroyed the animals. 
 Local reports noted, however, that this was only one of many trucks 
transferring chickens from China throughout Vietnam. 
 
Comment 
------- 
 
¶8. (SBU)  In many counties, health ministries partner with 
international agencies, notably the World Health Organization (WHO) 
or the UN Food and Agricultural Organization (FAO), to form joint 
investigation teams to respond to reports of animal or human H5N1 
cases.  Though Vietnam continues to improve its transparency and 
international cooperation, the GVN has yet to invite experts from 
these organizations to participate in site investigations, despite 
their long partnership with the GVN and extensive funding of GVN 
avian influenza prevention and response efforts.  Such partnerships 
would improve the quality of investigations, ensure GVN responders 
received practical, on-the-ground guidance from international 
experts, and enhance the transparency of the GVN responses.  We will 
continue to urge our Ministry of Health and Department of Animal 
Health counterparts to take full advantage of the experience and 
expertise of the WHO and the FAO. 
 
MICHALAK