VZCZCXRO3062
RR RUEHAST RUEHCHI RUEHCN RUEHDH RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB
RUEHPOD RUEHSL RUEHTM RUEHTRO
DE RUEHHI #0722/01 2151016
ZNR UUUUU ZZH
R 031016Z AUG 09
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 9979
INFO RUEHHM/AMCONSUL HO CHI MINH 6044
RUEHZS/ASEAN REGIONAL FORUM COLLECTIVE
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHUL/AMEMBASSY SEOUL 3584
RUEHKO/AMEMBASSY TOKYO 6147
RUEHHK/AMCONSUL HONG KONG 1827
RUEHGZ/AMCONSUL GUANGZHOU 0051
RUEHCN/AMCONSUL CHENGDU 0398
RUEHIN/AIT TAIPEI 1664
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 04 HANOI 000722 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, MED 
STATE FOR AIAG (RLOFITS/CPATTERSON/CSHAPIRO) 
STATE PASS TO USAID FOR ASIA (MELLIS, DSHARMA, CJENNINGS) AND 
GH (GSTEELE, DCARROLL) 
DEPARTMENT OF DEFENSE FOR OSD/ISA/AP (STERN) 
HHS/OSSI/DSI PASS TO FIC/NIH (RGLASS), OGHA (JKULIKOWSKI/ 
/MABDOO/SCUMMINGS/DMILLER) 
CDC FOR COGH (SBLOUNT), CCID (SREDD) AND DIV-FLU(NCOX/AMOEN) 
USDA PASS TO APHIS, FAS (OSTA AND OCRA), FSIS 
BANGKOK FOR RMO, CDC (MMALISON), USAID (MACARTHUR/CBOWES), APHIS, 
REO (HHOWARD/RTANAKA) 
BEIJING FOR HHS HEALTH ATTACHE (EYUAN) AND CDC (JMCFARLAND) 
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 MOVING FROM CONTAINMENT TO QUENCHING SOUTHERN 
OUTBREAK CLUSTERS OF NOVEL A/H1N1 INFLUENZA 
 
REF:  A. HANOI 546 B. HO CHI MINH 429 C. HO CHI MINH 415 
 
HANOI 00000722  001.2 OF 004 
 
 
¶1. (SBU) Summary. As of August 2, 2009, Vietnam's Ministry of Health 
(MOH) reported a total of 936 cases of pandemic influenza A/H1N1 
¶2009.  Initially, H1N1 cases increased steadily, but almost 
exclusively, among persons entering Vietnam from known outbreak 
areas and their close contacts in country.  Aggressive actions on 
isolation, quarantine and treatment appeared to contain spread 
within Vietnam until mid-July when clusters of cases were identified 
in a Ho Chi Minh City boarding school. Since then, clusters linked 
to this outbreak have been identified in a number of provinces, 
mostly in the south and south-central regions.  In response, the 
Government of Vietnam (GVN) has adopted a suppression strategy to 
limit the outbreak's spread.  Despite GVN efforts, the disease has 
spread more widely throughout the southern area and increasingly in 
the northern and central regions, including large business 
facilities in Hanoi and Ho Chi Minh City.  While the MOH is 
developing measures to control the spread from businesses and 
schools, it has begun to move towards preparations for community 
mitigation.  To date, the disease has typically been mild, with no 
reports of serious complications of illness or deaths. End Summary. 
 
Early Infections and Response 
----------------------------- 
 
¶2. (SBU) Following the report of the first A/H1N1 case in Vietnam on 
May 31 2009, the numbers of confirmed cases in Vietnam rose steadily 
over the next several weeks as the pandemic spread throughout the 
world and increasing numbers of infected international travelers 
from outbreak areas entered Vietnam.  By mid-July, more than 300 
cases had been confirmed in Vietnam, almost all of whom were 
recently entering travelers and their close family contacts.  The 
majority of cases were visiting or returning Vietnamese, originating 
especially in Australia and North America, and most of these 
imported cases entered Vietnam via Ton Son Nhat international 
airport in Ho Chi Minh City.  Nearly 90 percent of cases in this 
early period were reported from the southern region, with much 
smaller numbers detected in the northern and central regions.  In 
response, the MOH pursued an aggressive containment policy, 
including early detection of symptomatic persons through border 
screening; distribution of advisories to all incoming travelers with 
instructions on self reporting of illness; mandatory quarantine in 
hospital of suspected cases; voluntary quarantine at home of healthy 
contacts of cases; and hospital isolation and oseltamivir treatment 
of persons found to be positive for infection using RT-PCR testing. 
Applying these measures, Vietnam was able to delay the spread of the 
disease into the community for a number of weeks. 
 
Recent Spread 
------------- 
 
¶3. (SBU) As of July 16, there were no reported serious complications 
of illness or deaths, and it was reported that the clinical illness 
was generally mild and self-limited.  Stringent containment measures 
still appeared to be successful in slowing the spread in Vietnam of 
 
HANOI 00000722  002.2 OF 004 
 
 
the disease.  However, on July 17, the MOH reported 14 new cases in 
a single location, Xuan Hiep Commune, Xuan Hoa District, Dong Nai 
Province, which borders Ho Chi Minh City.  This cluster of cases was 
linked to a student of a private school holding summer classes in Ho 
Chi Minh City, which on investigation revealed a cluster of cases 
among its boarding student body.  By July 20, 34 students and 
teachers at the school were found to be infected, and the school 
became the first education facility in Vietnam to be shut down 
because of the flu. Seventy-nine students were placed under 
quarantine at the school, where isolation and treatment facilities 
were established to treat some of the ill students.  More than 1,000 
healthy students from the school, mostly from Ho Chi Minh City and 
adjacent provinces, but some scattered throughout southern Vietnam, 
were advised to stay at home and avoid communicating with the 
public.  The authorities warned against further spread once the 
normal school year began.  On 27 July, the government reported that 
10 provinces, mostly in the southern Mekong Delta region, had 
identified positive cases who were students of two Ho Chi Minh City 
schools.  Authorities also reported several cases in Hanoi who had 
traveled on 24 July by train from Ho Chi Minh City, and alerted 
other passengers on this train to voluntarily quarantine themselves 
at home. 
 
GVN Strategy as Pandemic Spreads 
-------------------------------- 
 
¶4. (U) With evidence of the pandemic spreading in Vietnam, on July 
27, the Prime Minister, Nguyen Tan Dung, mobilized the entire 
political system to curb the flu's progress and prevent fatalities, 
stating that, "The pandemic is spreading in the community, thus the 
entire political system and mass media have to publicize A/H1N1 
prevention and protection measures for the participation of all 
people in the fight against the potentially fatal disease."  This 
represented a major shift forward from stringent containment to 
broader education and community mitigation strategies.  The MOH sent 
an official letter to all provinces on July 28, requesting local 
health departments to work with local authorities to strengthen 
communication activities regarding A/H1N1 through mass media, 
communication training for health workers and collaborators, and 
distribution of communication materials and hotline information.  In 
addition, the MOH planned to propose a budget to buy Tamiflu and 
Zanamivir to provide to provinces and has requested manufacturers 
and importers to prepare enough medical face masks for the 
increasing need of health staff and the public. 
 
Vietnamese Testing Suggests Few Differences 
from Other Pandemic H1N1 Strains 
------------------------------------------- 
 
¶5. (SBU) Confirmatory RT-PCR testing is being conducted at NIHE (the 
WHO-designated National Influenza Center) and at the three other 
regional public health institutes in the national reference 
laboratory network.  Testing is also being carried out at the 
National Institute of Infectious and Tropical Diseases (NIITD), in 
Hanoi, and at the Hospital for Tropical Diseases (HTD), in Ho Chi 
 
HANOI 00000722  003.2 OF 004 
 
 
Minh City.  This confirmatory testing has been made possible by 
provision of primers, probes and other diagnostic reagents by WHO 
CC, CDC, Atlanta, and by a national training workshop conducted in 
early June by NIHE for laboratory scientists from the other regional 
institutes and from the reference hospitals which was sponsored by 
CDC and WHO in Nha Trang.  NIHE is maintaining the national archive 
of pandemic Influenza A/H1N1 2009 isolates and has performed 
critical sequencing analyses showing that isolates in Vietnam have 
no mutations associated with oseltamivir resistance but that most 
are resistant to the adamantine class of antivirals.  Preliminary 
examination of a few isolates suggests minor genetic differences 
between isolates from strains introduced from North America and 
Australia.  Preliminary observations on cell culture suggest that 
the pandemic strain has a higher cytopathogenic effect than seasonal 
A/H1N1 isolates from Vietnam. 
 
Vietnam to Coordinate with Foreign Embassies 
When Quarantining Foreign Citizens 
--------------------------------------------- 
 
¶6. (SBU)  In a meeting with the Danish Ambassador, Bui Quoc Thanh, 
Deputy Director of the Consular Department at the Ministry of 
Foreign Affairs, promised to provide prompt notification of such 
quarantine to Embassies of a foreign national.  Thanh also promised 
better treatment for those selected for quarantine, specifically: to 
inform tourists upon arrival at an international airport about the 
procedures for quarantine related to A/H1N1; to provide tourists 
with a detected fever to pick up their luggage prior to be taken 
into quarantine; and to ensure that hospitalized tourists receive 
prompt information regarding their diagnosis and the possible length 
of quarantine.  Consular officials from several nations had received 
numerous complaints from their citizens about GVN quarantine 
procedures. 
 
Centers for Disease Control and Prevention Support 
--------------------------------------------- ----- 
 
¶7. (SBU) The Centers for Disease Control and Prevention (CDC) has 
supported national influenza surveillance and pandemic preparedness 
with substantial Cooperative Agreement support and considerable and 
continued epidemiological and laboratory technical assistance. 
Capacity-strengthening and establishment of good public health 
practices have boosted the Vietnamese ability to rapidly detect, 
characterize and report on cases of endemic influenza and the 
incursion and spread of the pandemic strain in Vietnam.  CDC 
assistance has helped build the capacity to provide urgently needed 
information, education and communications for the public and health 
workers; improve border surveillance, isolation and quarantine; 
expand disease reporting and investigation; develop case management, 
infection control and biosafety procedures and policies; and 
strengthen communications within the government regarding the 
rapidly emerging situation.  Most recently, CDC has provided 
emergency assistance to support enhanced surveillance for early 
detection, and for case investigations of the first 200 cases to 
rapidly characterize the clinical, epidemiologic and virologic 
 
HANOI 00000722  004.2 OF 004 
 
 
characteristics of the disease in Vietnam.  Virus samples are being 
shared by Vietnam with CDC, Atlanta for advanced molecular 
characterization and monitoring for possible antiviral resistance or 
increased pathogenicity. 
 
USAID Support 
------------- 
 
¶8. (SBU) USAID has supported the GVN to strengthen the capacity of 
human health and animal health workers in early detection, 
surveillance and rapid response, awareness-raising and behavior 
change.  Through WHO, IOM and the Kenan Institute, USAID is helping 
GVN to develop influenza pandemic plans at the national and local 
levels, increase the capacity of the school sector, and increase 
capacity of health quarantine and other sector staff in controlling 
A/H1N1, H5N1 and other diseases, including at border crossings. 
With support from USAID, WHO, the MOH will conduct pandemic plan 
development workshops and simulation exercises between 
September-November, 2009.  In July, two major simulation exercises 
were funded in Can Tho and Hung Yen provinces to test local response 
to animal and human outbreaks of H5N1 or A/H1N1. 
 
¶9. (SBU) USAID has provided a significant number of PPEs and 
disinfectant to Ministry of Agriculture and Rural Development (MARD) 
and MOH to help front line workers prevent H1N1 and H5N1 influenza 
transmission.  In addition, USAID continues to support the GVN and 
civil society to better prepare for a pandemic at different levels. 
USAID's global AI Communications project (AI.COMM, managed by AED) 
has recently worked with Ogilvy & Mather/Vietnam to finalize the 
production of a general pandemic preparedness emergency 
communication training video (not Vietnam-specific), which will soon 
be available for global use. 
 
Comment 
------- 
 
¶10. (SBU) As in many other countries, Vietnam now faces an 
entrenched disease that is spreading throughout the country.  As 
such, the GVN has begun to adjust its strategy from exclusion and 
containment to management.  Both CDC and USAID have played an active 
role in assisting Vietnam's initial efforts and both expect to 
continue their support as the outbreak evolves.  Vietnam's 
experiences in responding to A/H1N1, combined with many years of 
efforts to contain and prevent H5N1, highlight the capacity of 
Vietnam to provide useful practical guidance to the participants in 
the April 2010 International Ministerial Conference on Avian and 
Pandemic Influenza, which it will host. 
 
¶11. (U)  This cable was coordinated with Consulate General Ho Chi 
Minh City. 
 
MICHALAK