VZCZCXRO1817
RR RUEHAST RUEHCHI RUEHCN RUEHDH RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB
RUEHPOD RUEHTM RUEHTRO
DE RUEHHI #0418/01 1191036
ZNR UUUUU ZZH
R 291036Z APR 09
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 9598
INFO RUEHHM/AMCONSUL HO CHI MINH 5832
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHUL/AMEMBASSY SEOUL 3544
RUEHKO/AMEMBASSY TOKYO 6108
RUEHHK/AMCONSUL HONG KONG 1770
RUEHGZ/AMCONSUL GUANGZHOU 0044
RUEHCN/AMCONSUL CHENGDU 0391
RUEHIN/AIT TAIPEI 1657
RUEAIIA/CIA WASHINGTON DC
RUEHPH/CDC ATLANTA GA
RUEHRC/DEPT OF AGRICULTURE WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RHMFIUU/DEPT OF HOMELAND SECURITY IA WASHINGTON DC
RHMFIUU/CDR USPACOM HONOLULU HI//J00/J2/J3/J5//
RHMFISS/CJCS WASHINGTON DC//J2/J3/J5//
RHEFDIA/DIA WASHINGTON DC//DHO-3//
RHEFAFM/DIRAFMIC FT DETRICK MD//MA-1A//
RUEKJCS/SECDEF WASHINGTON DC//USDP/ISA/AP//
RUEHSUN/USUN ROME IT

UNCLAS SECTION 01 OF 02 HANOI 000418 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED 
STATE PASS TO DS/IP/EAP 
STATE PASS TO USAID TO ASIA (MELLIS/DSHARMA/CJENNINGS) AND GH 
(GSTEELE/DCARROLL) 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN) 
CDC FOR COGH (SBLOUNT), CCID (SREDD) AND DIV-FLU (NCOX/AMOHEN) 
HHS/OSSI/DSI PASS TO FIC/NIH (RGLASS) AND OGHA (DMILLER/MABDOO) 
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 (EYUAN) 
PHNOM PENH FOR CDC INFLUENZA COORDINATOR (PKITSUTANI) 
ROME FOR FAO 
VIENTIANE FOR CDC INFLUENZA COORDINATOR (ACORWIN) 
 
E.O. 12958: N/A 
TAGS: TBIO AMED PINR KFLU VM
SUBJECT: AVIAN INFLUENZA CASE NUMBER 111, FOURTH THIS YEAR, ALL 
FATAL, VIETNAM 
 
REF: Hanoi 260 
 
HANOI 00000418  001.2 OF 002 
 
 
¶1. (SBU) Summary.  On April 24, 2009, the MOH reported a fatal human 
case of highly pathogenic avian influenza A (HPAI) of the H5N1 
strain in a 23 year-old woman in northern Vietnam.  This is the 
fourth case reported from Vietnam in 2009, all of them fatal. 
Reporting to CDC Hanoi and the World Health Organization from the 
Ministry of Health (MOH) was prompt.  A government field 
investigation combined animal and human health sectors.  Local press 
coverage was prompt but with the usual scanty and conflicting 
information.  End summary. 
 
¶2. (SBU) The affected women lived in a rural commune in mountainous 
Quan Hao District, Thanh Hoa Province, approximately 170 km south of 
Hanoi.  She was an unmarried hair dresser who had recently moved to 
the area for work.  This is the fourth case reported from Vietnam in 
the 2009 calendar year, all of them fatal (Ref).  As in the past two 
years, these cases have been sporadic and unrelated.  In total, GVN 
has reported 111 cases and 56 case deaths from 2003 to present. 
 
¶3. (SBU) The patient had onset of illness on April 15 and salient 
findings included sudden onset of fever, headache, and sore throat. 
The same day, she sought care at local commune health station.  Over 
the following days, however, the patient became more severely ill 
with exhaustion and difficulty in breathing; she was admitted on 
April 20 to the Quan Hoa District Hospital with signs of acute 
infection and hypotension.  She was treated with antibiotcs and 
steroids.  On April 21, she was transferred to the Thanh Hoa 
Provincial Hospital where she was found to have pneumonia 
complicated by respiratory failure.  Provicinal health care 
providers suspected the diagnosis of HPAI A/H5N1 infection and 
notified the National Institutes of Hygiene and Epidemiology (NIHE), 
MOH.  She was supported with mechanical ventilation and treated with 
the anti-influenza drug, oseltamivir (brand name, Tamiflu).  She 
died with multiple organ failure on April 22.  Samples tested 
positive for H5N1 and prompted a formal investigated by a team from 
NIHE of the MOH and local health authorities on April 24.  [Note: 
This patient sought care on the first day of symptoms at the commune 
level; presented to the district hospital on day 5; recieved first 
doeses of anit-viral medication on day 6, and died the next day. 
Anti-viral medication should have been administered within the first 
48 hours of illness to have been maximally effective.  This 
highlights the need to educate health care workers and patients on 
the importance of a history of exposure to sick and dead poultry in 
patients with influenza-like illness.  End Note.] 
 
¶4. (SBU) Epidemiological investigation in the village where the 
patient lived revealed that in a 1-2 week period before becoming ill 
she had been exposed to dead and sick chickens in her household 
flock, which she slaughtered and disposed of in a nearby river 
without using gloves or other protection or reporting.  Further, she 
slaughtered and ate the remaining "healthy" chickens.  Neighbors 
reported to investigators that 40 chicken and 24 ducks died in their 
household flocks, although this was apparently not reported to by 
animal health authorities at the time.  The investigation revealed 
 
HANOI 00000418  002.2 OF 002 
 
 
no further instances of associated illness in humans.  Laboratory 
investigations of neighbors and close contacts revealed no further 
infections.  In subsequent surveillance, results of tests by 
regional animal health office of some birds were positive for HPAI 
H5N1 infection. 
 
¶5. (SBU) Control activities included culling of poultry (about 1000 
of the 8600 in the commune) and environmental sanitation of the 
affected village.  Pre-existing local animal health surveillance was 
reportedly poor, and the commune health unit capacity, limited. 
Enhanced surveillance was instituted for illness in persons and 
poultry.  MOH reported good collaboration in the investigation and 
control actions between local authorities, and between MOH and DAH. 
Currently, only Quang Ngai province in central Vietnam is reporting 
outbreaks of AI in poultry in the previous 21 days. 
 
¶6. (SBU) Comment.  As with nearly all 18 A/H5N1 human cases  in 
Vietnam since 2007, field investigations have demonstrated that 
suspicious animal outbreaks or illness were recognized by local 
residents before incidents of human illness.  To what degree these 
were or were not reported to local authorities is unclear.  However, 
in all instances, there was no formal response from higher level 
authorities prior to the recognition of these suspected human cases. 
 End Comment. 
 
MICHALAK