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UNCLAS SECTION 01 OF 03 GUANGZHOU 000696 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/CM, , S/GAC, OES/IHA, MED 
STATE PASS TO ENVIRONMENTAL SCIENCE & TECHNOLOGY COLLECTIVE 
STATE PASS TO USAID FOR ANE AND GH 
HHS PASS TO OGHA, NIH/FIC, CDC/COGH 
BANGKOK FOR RMO, CDC, USAID 
BEIJING FOR HHS HEALTH ATTACHE AND RMO 
 
E.O. 12958: N/A 
TAGS: SOCI TBIO ELAB PGOV ECON CH
SUBJECT: Public Health in Fujian Province:  Dealing with Disease 
 
REF:  Guangzhou 628 
 
GUANGZHOU 00000696  001.2 OF 003 
 
 
This report is sensitive but unclassified.  Please protect 
accordingly. 
 
¶1.   (SBU) Summary.  Drawing on lessons learned from the 2003 SARS 
outbreak, public health officials in Fujian worked to establish a 
comprehensive emergency response and alert system for communicable 
diseases.  The current H1N1 outbreak has highlighted the limitations 
of the system and a need to improve the institutional capacity to 
manage health emergencies.  Influenza and hepatitis remain the most 
common types of contagious disease in Fujian, but the spread of HIV 
to new segments of the population (seniors and youth) is of concern 
to public health officials.  Two Fujian cities have abnormally high 
cancer rates.  Economic growth and improved living standards have 
created heightened public expectations regarding health care.  End 
summary. 
 
Developing an Emergency Response System 
--------------------------------------- 
 
¶2.  (U) Fujian province was hit badly by the outbreak of SARS in 
¶2003.  Caught largely unprepared, public health officials resolved 
to establish a comprehensive emergency response and alert system. 
According to Fujian Center for Disease Control (CDC) officials, a 
total of 13 different contingency plans were adopted since 2003 to 
guide the province's response to the spread of infectious diseases 
within the general population.  More than 260 disease monitoring 
stations were established at hospitals and clinics province-wide. 
This network monitors communities throughout the province on a 
24-hour basis.  Since 2007, an additional 1,000 monitoring points 
were established in rural areas. 
 
¶3.  (U) According to public health officials, Fujian's public health 
organizations and hospitals regularly conduct drills and exercises 
so that public health officials and medical personnel are familiar 
with the protocols for dealing with infectious diseases.  The 
province also provided funding to upper level medical institutions 
and hospitals so that they could improve their capacity to respond 
to pandemic and contagious diseases.  Fujian also established an 
infectious diseases information center within the Fujian CDC.  To 
minimize the possibility of disease transmission through its blood 
supply, Fujian banned the commercial collection of blood products. 
At present, all blood products in Fujian's blood banks are collected 
from volunteers and inspected by local blood centers before being 
transferred to local hospitals. 
 
¶4.  (SBU) During 2009, the spread of the H1N1 virus has tested 
Fujian's emergency response and alert system.  While the system 
effectively provided early alerts and an organized, systematic 
method of dealing with H1N1 cases--with certain hospitals in each 
area of the province designated to treat H1N1 cases--the system has 
had less success in preventing or slowing the spread of H1N1 
infection. 
 
Dealing with the H1N1 Virus 
--------------------------- 
 
¶5.  (SBU) Officials from Fujian's CDC equivalent say that Fujian 
residents returning to Fujian from North America prior to August of 
2009 were responsible for the first wave of H1N1 outbreaks. The 
third H1N1 case diagnosed in China was found in Fujian.  Officials 
say 99% of the cases found in Fujian during the first 2 months 
originated in the United States.  After August, however, most of the 
new H1N1 cases originated locally.  To deal with the H1N1 outbreak, 
Fujian designated 21 hospitals and established more than 10 
laboratories to deal with the virus.  Every district in Fujian has a 
clinic that can test for H1N1.  Currently, almost all of the H1N1 
cases diagnosed in Fujian are attributed to local transmission. 
 
¶6.  (U) Because of the widespread nature of H1N1 infection, 
hospitals and clinics now are not required to report H1N1 cases 
unless they develop into severe cases or result in death.  Mass 
outbreaks have been reported in several Fujian schools during the 
past several weeks.  As a result, schools throughout Fujian take 
 
GUANGZHOU 00000696  002.2 OF 003 
 
 
temperature scans of students before they are allowed to attend 
classes.  Still, Fujian officials claim that the number of H1N1 
cases in Fujian remains lower than the national average.  They say 
that in Fujian, an estimated 38% of flu patients are infected with 
H1N1, while the remaining 62% are infected with the seasonal flu. 
This compares to an estimated 80% H1N1 infection rate for flu 
patients in Guangdong province. 
 
Other Contagious Diseases and Diseases of Concern 
--------------------------------------------- ---- 
 
¶7.  (U) According to Fujian public health officials, influenza and 
hepatitis are the two most common types of contagious disease in 
Fujian and the biggest burdens on the public health care system. 
Fujian CDC officials say 28 different types of infectious diseases 
have been found in Fujian.  The diseases, grouped into three 
categories, are as follows:  A) plague and cholera; B) hepatitis, 
dysentery, typhoid, HIV, gonorrhea, syphilis, poliomyelitis, 
measles, pertussis, diphtheria, epidemic cerebrospinal meningitis, 
scarlet fever, hemorrhagic fever, rabies, leptospirosis, 
brucellosis, anthrax, typhus, encephalitis, leishmaniasis, malaria, 
and dengue; C) tuberculosis, schistosomiasis, filariasis, 
echninococcus, influenza, leprosy, mumps, rubella, neonatal tetanus, 
acute hemorrhagic conjunctivitis, and other types of diarrhea. 
Officials note that the following infectious diseases have been 
eliminated (with year eradicated in Fujian noted in parenthesis): 
plague (1953), schistosomiasis (1987), malaria (1992), polio (1995), 
and filariasis (2008). 
 
¶8.  (U) Corresponding to the province's economic growth and 
prosperity, officials have discerned a noticeable trend away from 
diseases of "poverty" to diseases of "affluence."  They note that 
Fujian is currently witnessing significantly higher rates of heart 
disease, high blood pressure, diabetes, and near-sightedness. 
Demographic factors influencing the types of diseases found in 
Fujian also include the province's aging population and steady trend 
towards urbanization. 
 
HIV/AIDS in Fujian 
------------------ 
 
¶9.  (U) According to the Fujian Health Department, the number of 
identified HIV/AIDS cases in Fujian increased from 1952 cases in 
2008 to 2409 cases in 2009.  In addition, 176 Fujian residents 
living in other provinces in China have been identified as HIV 
carriers.  Broken down by sex, there are 1.9 HIV/AIDS cases 
involving males for every case involving a female.  The Health 
Department's statistics indicate that as of October 31, 2009 there 
have been 477 deaths attributed to AIDS in Fujian.  Most of the 
province's HIV/AIDS cases come from Fuzhou, Quanzhou, and Xiamen, 
with Fuzhou having the largest number of known HIV/AIDS cases.  In 
releasing the 2009 report on HIV/AIDS, public health officials 
expressed special concern over the growth in infection rates among 
youth and senior citizens.  In 2009, 20% of the newly reported cases 
involved persons over 50 in age; 5% of the new cases involved 
adolescents under age 20.  According to data gathered by the Health 
Department, 67.3% of those newly infected acquired the virus through 
heterosexual contacts, while 7.8% were attributed to homosexual 
contacts. Sharing needles among drug users accounted for 6.1% of the 
new infections. 
 
¶10.  (U) To help stem the spread of HIV among drug users, Fujian has 
established 15 special clinics that provide methadone-type 
medications. These clinics served an estimated 5,800 patients with 
drug addictions in 2009.  HIV/AIDS education campaigns have been 
extended to Fujian's rural areas.  In 2008, 3.8 million brochures 
and posters were produced and distributed to local residents. 
Health authorities have implemented national plans relating to 
providing HIV/AIDS medications to qualified individuals.  In 2008, 
308 patients received free medications.  In addition, authorities 
have established a central HIV laboratory that is linked with eleven 
satellite laboratories throughout the province.  In addition, 197 
HIV monitoring posts have been established through the province to 
provide information to the Fujian CDC.  Two cities in 
Fujian--Changle and Jinjiang--have been identified as national 
 
GUANGZHOU 00000696  003.2 OF 003 
 
 
experimental comprehensive assistance zones for dealing with 
HIV/AIDS cases.  Social welfare assistance programs in these cities, 
manned by social workers and counselors, help HIV/AIDS patients find 
jobs and return to normal schedules. 
 
Fujian Cities with Elevated Cancer Rates 
---------------------------------------- 
 
¶11.  (U) Fujian Public Health Department officials say that, in 
general, the average incidence rate of cancer in Fujian is roughly 
comparable to the rest of the world.  Liver cancer, gastric cancer, 
lung cancer, and cancers of the esophagus and colon are the most 
common varieties found in Fujian.  However, higher than normal rates 
of gastric cancer have been found in Fuzhou's Changle township; 
abnormally high rates of liver cancer have been uncovered in 
Xiamen's Tong'an District.  According to researchers, the gastric 
cancer in Changle (death rate of 93 per 100,000 people) may be 
connected with contamination from sources including helicobacter 
pylori, fungi, nitrites and the uneven distribution of minerals. 
Researchers believe that some of these contaminants come from 
preserved foods, including fish juice, which are traditionally 
consumed by Changle area residents.  Researchers have said Tong'an's 
abnormally high cancer rates may stem from industrial water 
pollution problems or from aflatoxin found in peanuts consumed in 
the Tong'an area. 
 
Economic Progress Brings Heightened Expectations 
--------------------------------------------- --- 
 
¶12.  (SBU) Fujian public health officials note that the province's 
rapid rate of economic development and improvement in standard of 
living over the past several decades have created heightened public 
expectations regarding medical standards and health care.  In 
addition to pressure for wider access and better health insurance 
coverage (see reftel), the heightened expectations also extend to 
effectively monitoring and treating communicable diseases.  In this 
regard, Fujian officials acknowledged a particular need to 
strengthen their ability to manage public health emergencies and 
contingency response plans.  Officials say that in addition to 
taking steps to strengthen institutional capacity--especially as it 
relates to extending medical care to rural areas, more must be done 
to improve the level of health-related education provided to the 
public.  They noted that H1N1-related public health education 
programs directed at children highlighting the need to wash hands 
represented a small step in the right direction.  One official noted 
that when it comes to educational outreach, it has generally been 
more effective to teach children and then let the children teach 
their parents. 
 
¶13.  (SBU)  Comment:  At the start of the H1N1 outbreak, Fujian 
officials used the outbreak as a reason for keeping consulate 
officers out of Fujian universities, explaining that public 
gatherings at the schools were restricted.  More recently, even as 
mass outbreaks were reported in some Fujian schools, this 
restrictive policy was eased and consulate officers were allowed to 
speak to sizeable groups of students at several universities. 
Public health officials, it seems, are now less "panicked" about the 
spread of H1N1 and less inclined to view foreigners as the agents of 
infection.  End comment. 
 
GOLDBECK