Cablegate: Vietnam Marks Successful Control of Cholera Outbreak

VZCZCXRO1525
RR RUEHCHI RUEHCN RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB RUEHPOD
DE RUEHHI #2071/01 3480419
ZNR UUUUU ZZH
R 140419Z DEC 07
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 6879
INFO RUEHHM/AMCONSUL HO CHI MINH 4062
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 002071

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: VIETNAM MARKS SUCCESSFUL CONTROL OF CHOLERA OUTBREAK

REF: A. HANOI 2012 B. HANOI 1954 C. HANOI 1953 D. HANOI 1924 E.
HANOI 1891

HANOI 00002071 001.2 OF 003

1. (SBU) Summary. Vietnamese officials recently announced the
successful control of the outbreak of cholera (or, as the Government
of Vietnam more generally referred to it, "severe acute diarrhea")
that began in late October. International public health experts
agree with the GVN that Vietnam's quick and thorough response
resulted in a short outbreak with relatively few victims and no
deaths. The GVN's limited, though significant, outreach to the
World Health Organization (WHO) for assistance, further builds
public health linkages and likely portends greater cooperation and
openness in the future. While Vietnam appears to have avoided a
serious epidemic, health officials realize they will face future
challenges in food and water-borne disease and must improve their
capacity and responses. End Summary.

Vietnam Announces End of Chol.., um, Severe Acute
Diarrhea Outbreak
--------------------------------------------- ----

2. (U) At a public ceremony on December 10, Minister of Health
Nguyen Quoc Trieu and other Vietnamese health officials announced
the successful control of the outbreak of "severe acute diarrhea."
According to GVN authorities, the outbreak started on October 23
with a 73 year old man in Hanoi and soon spread to 12 other
provinces. Through October 31, public health authorities learned of
30 separate outbreaks and by November hospitals were admitting up to
200 severe diarrhea patients per day (ref D). In total, the GVN
reported 1991 cases, of which 295 tested positive for cholera, and
no deaths. Only one known non-Vietnamese national - a Japanese
resident in Hanoi, tested positive for cholera after eating dog
meat. Vietnamese officials believe "food safety" to be the likely
cause of the outbreak. Though the National Institute of Health and
Epidemiology (NIHE) reported that 78 percent of those with severe
acute diarrhea had recently eaten shrimp paste or dog meat (which,
traditionally, are served together), GVN officials have yet to
identify the source of the infection. Since November 25, no new
cases have been reported. Therefore, at the December 10 ceremony,
Vice Minister of Health Trinh Quan Huan stated that, per World
Health Organization (WHO) rules, after 14 days with no apparent new
victims, Vietnam could now declare the outbreak over.

When Is a Cholera Outbreak a Cholera Outbreak?
--------------------------------------------- -

3. (SBU) Though the MOH early on acknowledged that several victims
tested positive for cholera, the GVN infrequently referred publicly
to the term and determined that international technical experts
support a mission to control "severe acute diarrhea." Press
headlines also used this term, though the text of newspaper and
online articles clearly quoted GVN officials citing positive cholera
test results. At the December 10 ceremony, Minister Trieu and Vice
Minister Huan referred to Vietnam's response to cholera, though
official reports of the ceremony again focused on "severe acute
diarrhea." Per ref C, GVN officials likely decided to downplay the
presence of cholera to protect the tourist and agricultural export
sectors. At the same time, however, international experts noted
that Vietnam should acknowledge the general cholera outbreak to
better emphasize its successful response and to ensure that public
health officials responding to future cholera outbreaks refer to the
GVN's response to learn how to successfully manage an emergency
situation.

GVN Responded Quickly and Thoroughly
------------------------------------

4. (U) GVN officials described a multi-pronged approach to the
outbreak and noted that they had learned from their experiences with
SARS and avian influenza. The MOH responded to initial reports of
an outbreak from Bach Mai Hospital in Hanoi by setting up a Central
Committee for Dangerous Acute Diarrhea Prevention and Control, which

HANOI 00002071 002.2 OF 003

met up to three times per day. The MOH then emphasized
communication between central authorities, provinces, districts, and
communes. Once public health authorities reported that many victims
had tested positive for cholera, the Vietnamese political system,
including the Communist Party, joined the public health sector to
fight the disease. Central authorities and local People's
Committees carried out a broad campaign to heighten citizen
awareness of the outbreak, its symptoms, and how to improve personal
and food hygiene to avoid infection. In accordance with its
international commitments, the GVN notified international health
authorities and subsequently sought international assistance.

Quick Response Led to Successful Control
----------------------------------------

5. (U) Minister Trieu stated that the Vietnamese controlled the
outbreak in record time (about one month) and again emphasized that
no one died from cholera during the outbreak. Cholera outbreaks,
such as the one currently occurring in Iraq, normally last for over
three months with an average two percent mortality rate. National
Institute for Infectious and Tropical Diseases Deputy Director Tran
Hong Ha earlier told international health care workers that
Vietnam's rapid, aggressive, and comprehensive clinical intervention
prevented a more serious and lengthy epidemic.

Limited, but Important, International Cooperation
--------------------------------------------- ----

6. (SBU) GVN officials publicly acknowledged the important support
role played by international public health experts, particularly
from the WHO. Despite some initial hesitancy, following a request
by WHO for a briefing on the outbreak, the MOH on November 9 wrote
to the WHO representative in Vietnam requesting assistance to
develop community communication strategies, technical support for
the "acute diarrhea" outbreak, and sample testing. Though the GVN
careful circumscribed the responsibilities of international experts
(ref C), the MOH provided significant information to the WHO and
included WHO team members in the GVN response. Following proactive
communications from U.S. Centers for Disease Control and Prevention
(CDC) to WHO, a Bangkok-based epidemiologist participated in the WHO
team and helped set up a case-control epidemiological study (which
will be partially funded by WHO) to determine the original source of
the outbreak. CDC-Atlanta additionally provided laboratory
materials to the GVN to use for continued surveillance.

Still a Need to Improve
-----------------------

7. (U) Despite Vietnam's successful response, officials noted that
the threat of cholera still exists and that Vietnam faced a high
possibility of reoccurrence of cases or of the emergence of other
food and water-borne infectious diseases. These officials also
acknowledged several structural weaknesses and environmental dangers
they will need to address in future outbreaks, including Vietnam's
inadequate food sanitation and hygiene protection (ref A).
Vietnam's limited medical assets were stretched thin and Minister
Trieu noted to the press that due to limited availability, during
the peak of the outbreak, patients had to share beds. Though the
outbreak did not spread to the flooded central region, the GVN has
only slowly been able to provide clean food and water to local
residents (ref B), leaving ideal conditions for the spread of
cholera or other diseases. NIITD's Ha admitted that had the
outbreak occurred in poorer and more rural areas, Vietnam likely
would have seen several deaths. Minister Trieu stated that all
provinces, especially those in the flood-ravaged center of the
country, needed to remain alert as Vietnam entered the Tet season
when millions of people traveled throughout the country to return to
their home villages.

Comment
-------

HANOI 00002071 003.2 OF 003

8. (SBU) Vietnam's successful response evidences growing public
health capacity and competence. Though the GVN continues officially
to refer to the outbreak as "severe acute diarrhea" and at times
downplayed the presence of cholera, this public relations concern
did not impact its actions. Additionally, the GVN continued slowly
to allow greater participation in health crisis response efforts by
international experts. This example of cooperation strengthens the
likelihood for closer and more complete links in responses to future
public health emergencies.

MICHALAK

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