VZCZCXRO9869
OO RUEHAST RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
RUEHTM RUEHTRO
DE RUEHHI #0116/01 0430904
ZNR UUUUU ZZH
O 120904Z FEB 09
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 9131
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC IMMEDIATE
RUEHHM/AMCONSUL HO CHI MINH 5568
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

UNCLAS SECTION 01 OF 02 HANOI 000116 
 
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 (CDC/COGH FOR 
SBLOUT/KMCCALL/RARTHUR/RCHITALE), 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 (HHOWARD) 
BEIJING FOR HHS HEALTH ATTACHE (BROSS) 
 
E.O. 12958: N/A 
TAGS: TBIO AMED AMGT CASC EAGR PINR VM
SUBJECT: HANOI MEASLES OUTBREAK 
 
REF: A. 08 HANOI 588 B. 08 HANOI 381 
 
HANOI 00000116  001.2 OF 002 
 
 
¶1. (U) Summary:  Despite a comprehensive national vaccination 
program since the early 1990s, Hanoi is suffering from a measles 
(German measles, Rubeola virus infection) outbreak in which unusual 
numbers of patients are exhibiting severe symptoms.  The Government 
of Vietnam (GVN) is considering responses and has consulted with 
international health officials.  The Embassy is finalizing internal 
guidance and a warden message stating that Americans who do not meet 
criteria for protection obtain vaccinations as recommended pursuant 
to Centers for Disease Control and Prevention (CDC) guidance. CDC 
has also offered technical assistance to the World Health 
Organization (WHO) and GVN health officials.  End Summary. 
 
Measles Outbreak 
---------------- 
 
¶2. (SBU) The National Institute of Hygiene and Epidemiology (NIHE) 
reported over 320 cases of measles in Hanoi and neighboring northern 
provinces over the past several weeks.  Though Vietnam periodically 
reports measles infections, national immunization programs have been 
comprehensive and outbreaks of this size in Hanoi are large compared 
with the previous several years. Although some cases have been 
children with typical rash illness, a strikingly unusual feature of 
this outbreak is that most reported cases are in young adults, many 
with severe disease requiring hospitalization, including 
encephalitis, an inflammation affecting the brain, and pneumonia. 
One Hanoi referral hospital recently reported seeing 6 or 7 adult 
patients a day with complications of measles virus infection. 
Hospital infection control measures are not strictly adhered to and 
at least one health care worker has been infected.  The Ministry of 
Health reported last week that over 150 adult patients had been 
admitted to hospitals in Hanoi and neighboring provinces with 
serious neurological and respiratory complications. Although measles 
has not been reported by press or GVN authorities in Ho Chi Minh 
City or other large urban areas in Vietnam, an international medical 
newswire noted measles cases occurring elsewhere the region with 
some possibly traced back to Hanoi. 
 
Severe Cases 
------------ 
 
¶3. (SBU) In early February, CDC epidemiologists saw a number of 
cases of measles encephalitis receiving treatment at the National 
Institute of Infectious and Tropical Diseases (NIITD).  The director 
of NIITD, Professor Nguyen Van Kinh, stated that most measles cases 
occurred in young adults who have moved from remote areas to Hanoi 
where they have been newly exposed to the measles strain circulating 
in children. He speculated that these young adults had escaped 
natural infection and had been inadequately vaccinated. Pneumonia is 
a not uncommon complication of German measles in children, 
especially malnourished children, and can be fatal. Although 
encephalitis rarely complicates measles in otherwise healthy 
children (about one in a thousand cases), it is recognized as a more 
commonly occurring complication of infection in adults. 
 
GVN Vaccination Campaign 
------------------------ 
 
¶4. Beginning in the early 1990s, Vietnam launched an aggressive 
campaign to eliminate measles that included a comprehensive 
vaccination program.  However, despite a measles immunization 
coverage rate that has surpassed 93% since 1993 with a one-dose 
schedule, measles outbreaks have occurred every 7-8 years.  In 2002 
and 2003, the GVN conducted a nationwide mass measles immunization 
campaign with reported coverage of over 99 percent mainly to provide 
a second dose of vaccine to children aged 9 months to 9 years. 
 
While GVN Public Statements Mixed . . . 
---------------------------------------- 
 
¶5. (U) NIHE officials confirmed the seriousness of the outbreak to 
various CDC health professionals.  Officials at the National 
Expanded Program for Immunizations (EPI) and at NIHE provided public 
warnings about the seriousness of the outbreak and described 
 
HANOI 00000116  002.2 OF 002 
 
 
preventive measures for at risk populations.  However, at the same 
time, the Director of the Vietnam Administration of Preventive 
Medicine (VAPM), Dr. Nguyen Huy Nga, told the media that the ongoing 
outbreak was not abnormal and did not involve children, and was, 
instead, limited to a small cohort of young adults who were not 
vaccinated.  Vietnamese officials have not recommended new 
vaccinations as the reported cases remain somewhat scattered and not 
contained in a specific geographical area in which targeted 
vaccinations would be most effective. 
 
. . . GVN Has Initiated Response 
-------------------------------- 
 
¶6. (SBU) NIHE has initiated and investigation of the outbreak and 
has recommended vaccinations for high risk groups, particularly 
health care workers.  The Government of Vietnam (GVN) has pushed 
NIHE to craft a vaccination response, first focusing on health care 
workers.  We have not heard credible details about a wider 
vaccination program. Although the GVN does not have adequate 
supplies for an immediate large-scale response, they are able to 
produce sufficient vaccine for a more measured response. NIHE 
briefed the World Health Organization (WHO) last week and has asked 
for assistance obtaining vaccines, though WHO still would like more 
information before determining how it might assist. 
 
USG Response 
------------ 
 
¶7. (SBU) Due to the potential severity of the outbreak, the Embassy 
has crafted a warden message for the American community in Vietnam 
recommending all review their immunization status. Those who do not 
meet the protected criteria, based on prior measles illness or a 
history of receiving at least 2 doses of vaccine at appropriate 
intervals, or are unsure of their status are recommended to seek 
advice on vaccination from a health care provider.  We will provide 
similar advice to Embassy personnel via Management Notice. 
Embassy-based CDC experts have consulted with their counterparts in 
Bangkok and Atlanta.  CDC's Global Immunization Division has offered 
technical assistance to investigate the outbreak, to include sending 
a team from the United States, if needed. 
 
Comment 
------- 
 
¶8. (SBU) The surprisingly high number of serious cases and infected 
persons in a country with immunization rates of 99 percent 
potentially raises questions about the success of Vietnam's earlier 
measles vaccination program.  As GVN officials noted, many of the 
infected patients have come from remote rural areas, possibly 
indicating that coverage was not as high as thought or that the 
vaccine protection may have been reduced by improper vaccination 
(e.g., inadequate number of doses or improper timing of 
vaccination), or problems with vaccine efficacy from such causes as 
inadequate cold chain. At the same time, GVN health officials 
understand the severity of the outbreaks and are working to control 
the situation.  We hope that, as with recent cholera outbreaks (refs 
A and B), this situation provides an opportunity to further GVN 
cooperation with the international community on public health 
issues. 
 
MICHALAK