Cablegate: Update of Serious Acute Diarrhea Outbreak in Northern

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RR RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #1924/01 3170415
ZNR UUUUU ZZH
R 130415Z NOV 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 6688
INFO RUEHHM/AMCONSUL HO CHI MINH 3925
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
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUEHSUN/USUN ROME IT

UNCLAS SECTION 01 OF 03 HANOI 001924

SIPDIS

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 (WSTIEGER/LVALDEZ/CHICKEY), FIC/NIH
(GLASS), FDA (MPLAISER)
CDC/COGH FOR SBLOUT/KMCCALL/RARTHUR, 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(JWALLER)
BEIJING FOR HHS HEALTH ATTACHE (BROSS)
ROME FOR FAO

E.O. 12958: N/A
TAGS: TBIO AMED AMGT CASC EAGR PINR VM
SUBJECT: UPDATE OF SERIOUS ACUTE DIARRHEA OUTBREAK IN NORTHERN
VIETNAM

REF: Hanoi 1891

HANOI 00001924 001.2 OF 003

1. (SBU) Summary. Vietnam's acute diarrhea outbreak expanded from
11 to 14 provinces and municipalities throughout northern Vietnam
over the past week, with many victims testing positive for cholera.
However, informal information from one of Hanoi's major referral
centers indicates the epidemic may be easing. Though Vietnam
traditionally experiences sporadic, individual cholera cases from
time to time, this is the first large-scale outbreak since the
1970s. While initial cases have been linked to the consumption of
raw shrimp paste, the Government of Vietnam (GVN) is warning its
citizens about the possible dangers of all uncooked foods and
unsanitary water sources. The GVN has initiated an active response
and on November 12 the Ministry of Health (MOH) officially requested
World Health Organization (WHO) assistance. WHO, in turn, invited
U.S. Centers for Disease Control (CDC) participation in the WHO
response team. The U.S. Embassy disseminated a warden notice to
U.S. citizens about the epidemic on November 8. End Summary.

Serious Acute Diarrhea Continues to Spread
------------------------------------------

2. (U) On November 9, MOH confirmed the continued spread of "serious
acute diarrhea" in northern Vietnam. Official estimates of
hospitalizations have risen to about 1660 spread over 14 northern
municipalities and provinces, an increase of 3 provinces from those
reported in reftel on November 5, with over 530 persons seeking
medical attention in Hanoi. MOH has reported that the number of new
cases has decreased in Hanoi, Hai Duong, Thanh Hoa, Hai Phong, and
Hung Yen provinces and a contact at the National Institute of
Infectious and Tropical Diseases (NIITD)/MOH, a major referral
center in Hanoi, informally reported to a CDC-Hanoi staff member
that the number of new cases referred each day to NIITD has dropped
to 10 to 15. In Hanoi, hospitals have begun to discharge many
patients. However, the most recent reports from November 9 stated
that the outbreak continues to expand in Ha Tay and Vinh Phuc
provinces. In Hanoi, a chef at a five-star hotel reportedly tested
positive for cholera, leading MOH Vice-Minister Trin Quan Huan to
contemplate shutting down the establishment. Though still confined
to northern Vietnam, officials remain concerned that it may spread
nationwide through internal labor migration. Local newspapers
reported the hospitalization in Ho Chi Minh City of two patients
suffering from acute diarrhea. Test results for one patient came
back negative for cholera, while testing on the second patient is
not yet complete. Continued flooding in many areas of the country
also creates unsanitary conditions conducive to the further spread
of the disease.

Many Patients Test Positive for Cholera . . .
---------------------------------------------

3. (SBU) Despite public statements to the contrary in a November 8
press briefing by the Ministry of Foreign Affairs Spokesperson Le
Dzung, the MOH has reported to Embassy officers that it has isolated
the Vibrio cholera O1 El Tor strain from samples taken from several
patients. Further, in addition to earlier MOH statements (reftel),
the newly-created Central Committee for Acute Diarrhea Control
publicly announced that over 200 victims have tested positive for
cholera and while most headlines have referred to "acute diarrhea,"
the underlying articles note the presence of cholera. Nevertheless,
Vietnam clearly remains sensitive about referring the outbreak as
"cholera," and the MOH insisted in its negotiations with the WHO for
technical assistance that the two sides instead use the phrase
"serious acute diarrhea outbreak." Embassy has no information yet
on the susceptibility of this strain to antibiotic treatments.

. . . Including One Non-American Expatriate
-------------------------------------------

4. (SBU) MOH testing confirmed that an expatriate treated at a Hanoi
medical clinic for severe watery diarrhea was infected with V.

HANOI 00001924 002.2 OF 003

cholera. The director of the medical facility, which conducted the
initial positive test, had reported to the case to the Embassy and
noted that the facility - which caters to expatriates -- had not
treated any Vietnamese patients. The patient had recently traveled
north of Hanoi. Mission's Health Attache Office verified that the
WHO has received this report. Embassy MED Unit confirmed no
reported cases in the other two major international medical clinics
in Hanoi that largely serve expatriates. The Embassy issued a
warden notice to the expatriate American community on November 8.

Largest Outbreak in Northern Vietnam since the 1970s
--------------------------------------------- -------

5. (U) Sporadic cases of cholera occur every year in Vietnam,
especially in rural areas. Though cholera is more endemic to
southern Vietnam, in the recent past, a few northern provinces and
the municipalities of Haiphong and Hue suffered a small number of
easily controlled cases. Outbreaks of non-cholera food-borne
associated diarrhea are relatively common in Vietnam. However, the
last large scale cholera outbreak to hit Haiphong and Hanoi occurred
in the 1970s.

GVN Response
------------

6. (U) Though early press reports stated that the outbreak initially
stemmed from products containing raw shrimp paste, GVN warnings have
expanded to cover raw vegetables, street food, and presumed
unsanitary water sources. The media also has reported infections of
caregivers and through the consumption of certain processed foods.
On November 11, Prime Minister Nguyen Tan Dung directed the MOH to
coordinate a multi-sector task force to respond to the issue. The
government has continued rigorous interventions, targeting citizens,
health care providers, and environmental control, including a
continued ban on the sale of shrimp paste, chemical disinfection of
exposed areas and provision of preventive antibiotic therapy to
exposed persons. Most recently, Vietnamese authorities began to
shut down non-licensed restaurants, increased health inspections of
rail travelers, and moved to ensure food quality on Vietnam
Airlines. Health authorities plan to provide one million gloves to
restaurants and establish an information hotline. Along with these
efforts, the GVN has instituted surveillance and preventive efforts
to prevent the expansion of the outbreak to the central and southern
parts of the country. The Ho Chi Minh City preventive medicine
department disinfected the residences and surrounding area of the
two recent diarrhea patients and has been proactively raising public
awareness, inspecting suspected foods, and preparing responses if
the epidemic moves south.

Vietnam Requests WHO Assistance
-------------------------------

7. (SBU) On November 8, the WHO Country Representative met with the
Minister of Health. On November 12, the MOH formally requested WHO
assistance, which will be coordinated by WHO Regional Office for the
Western Pacific (WPRO) based in Manila. CDC has maintained close
communications throughout the situation with WHO, which has
requested CDC-Hanoi to prepare to contribute to the WHO response to
the GVN request. WPRO has notified CDC-Vietnam that CDC-Bangkok's
Dr. Alden Henderson, an epidemiologist, will be part of the WHO
response team that will arrive this week.

U.S. Prepared to Participate in WHO Effort
------------------------------------------

8. (SBU) Health Attache and CDC-Hanoi Chief of Party have
coordinated with Department of Health and Human Services and CDC
principals to review the current situation and prepare an organized
USG response to the expected WHO request for assistance.
CDC-Bangkok also briefed Embassy health officers on recent cholera
activity in Thai refugee camps and CDC-Hanoi has lined up additional

HANOI 00001924 003.2 OF 003

suitable candidates from CDC-Bangkok with requested CV/resumes
in-hand who can deploy immediately. CDC-Hanoi has informed WHO/WPRO
of its continued readiness to assist.

9. (SBU) CDC participation in the response meets two critical
objectives: responding to a public health crisis and demonstrating
to WHO and MOH its ability to add value to a WHO emergency response
effort. Accordingly, the set of persons offered have strong
diplomatic skills and experience with an international team
approach. The primary public health objective is to control the
outbreak and improve treatment capacity to minimize mortality. To
this end, if successful, the first CDC responders may need to
request additional CDC resources in the areas of
food-and-water-borne illness, in-depth epidemiology, water
sanitation, laboratory, and informatics.

MICHALAK

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