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Viewing cable 08HANOI421, FIRST CHOLERA CASE IN HO CHI MINH CITY

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Reference ID Created Released Classification Origin
08HANOI421 2008-04-11 09:56 2011-08-25 00:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Hanoi
VZCZCXRO3612
OO RUEHAST RUEHCHI RUEHCN RUEHDH RUEHDT RUEHHM RUEHLN RUEHMA RUEHPB
RUEHPOD RUEHSL RUEHTM RUEHTRO
DE RUEHHI #0421/01 1020956
ZNR UUUUU ZZH
O 110956Z APR 08 ZDK
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 7595
INFO RUEAUSA/DEPT OF HHS WASHINGTON DC IMMEDIATE
RUEHHM/AMCONSUL HO CHI MINH 4570
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
RUEHSUN/USUN ROME IT
UNCLAS SECTION 01 OF 02 HANOI 000421 
 
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 SECRETARY LEAVITT AND 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: FIRST CHOLERA CASE IN HO CHI MINH CITY 
 
REF: A HANOI 408 B. HANOI 383 C. 07 HANOI 2071 
 
HANOI 00000421  001.8 OF 002 
 
 
1. (SBU) Ho Chi Minh City reported its first case of cholera in the 
current outbreak, a 71 year old woman from Thu Duc district. 
According to Dr. Nguyen Van Chau, Director of the Ho Chi Minh City 
Health Department, the woman was admitted to Ho Chi Minh City 
Medical Hospital on April 6 suffering from severe diarrhea.  On 
April 9, she tested positive for Vibrio cholerae Ogawa serotype.  Ho 
Chi Minh City health authorities have initiated an epidemiological 
investigation to determine the source of her exposure.  Possible 
sources include raw vegetables purchased at a local market or close 
contact with two neighbors, who recently returned from northern Nam 
Dinh province - one of the eleven northern provinces reporting 
severe acute diarrhea outbreaks.  No other patients under treatment 
at other hospitals in Ho Chi Minh City (refs A and B), including 
Children's Hospitals 1 and 2 and the Tropical Diseases Center have 
tested positive for cholera. 
 
National Numbers 
---------------- 
 
2. (U) The Ministry of Health reported yesterday reported nearly 900 
cases of severe acute diarrhea in 17 provinces nationwide.  Though 
the northern region (particularly Hanoi, Haiphong, Ha Tay, and Thanh 
Hoa provinces) suffered the most cases, other provinces including 
Quang Binh, Quang Ninh, and Thua Thien-Hue in the central region 
most recently reported severe cases.  According to Vietnam 
Television (VTV), the National Institute of Tropical and Infectious 
Diseases in Hanoi has now admitted 533 diarrhea patients, of which 
254 tested positive for cholera bacteria.  VTV further reported that 
85 to 90 percent of new patients have tested positive for cholera - 
a substantial increase over the 2007 outbreak.  Tran Van Tho, Deputy 
Director of the Haiphong Department of Health, told the press that 
up to 90 percent of cases of severe acute diarrhea in that province 
had tested positive for cholera. 
 
Hard to Stop the Spread of Cholera 
---------------------------------- 
 
3. (U) Vietnamese health officials show growing concern that the 
outbreaks could spread even further.  The National Institute of 
Hygiene and Epidemiology (NIHE) detected cholera bacterium in 15 
water samples taken from Hanoi, Hai Phong, Thanh Hoa and Ha Tay, in 
three vegetable samples taken from a market in Hai Phong and in a 
sample of boiled dog meat in Hai Phong.  Dr. Nguyen Tran Hien, 
Director of NIHE, told the press that the broad geographic 
dispersion of cholera patients, combined with the ability of cholera 
bacteria to live in water, makes it difficult to prevent the 
expansion of cholera cases.  For example, provincial officials along 
the Hanoi-Ho Chi Minh City railway worry that excrement from 
infected train passengers could pollute local waterways, causing 
further spread. 
 
Responses Continue 
------------------ 
 
4. (U) GVN response efforts continue.  However, while the Ministry 
of Health (MOH) reportedly has finalized its master plan on cholera 
prevention, it has yet to promulgate standard procedures for 
controlling contamination of lakes, ponds, and canals that can be a 
source of cholera bacteria. In response to positive tests at Linh 
Quang Lake in Hanoi, city health workers dredged and cleaned the 
lake, pouring in 1.4 tons of Choloramin B at a cost of 70 million 
dong (approximately USD 4,400), and removed a market and tore down 
temporary housing that had sprung up on its boundaries.  Haiphong 
has banned the selling of shrimp paste, raw vegetables, and raw meat 
salads. 
 
Underlying Factors Unchanged 
---------------------------- 
 
5. (U) According to Dr. Tran Dang, Head of the Food Hygiene Safety 
 
HANOI 00000421  002.8 OF 002 
 
 
Agency, six factors have caused the boom of diarrhea and cholera: 
unhygienic eating habits, unhygienic raw or processed foods, poor 
treatment of excrement and waste, failure to wash hands prior to 
meals, poor food maintenance, and control of waste from existing 
diarrhea or cholera patients.  Dang stated that the Ministry of 
Health could only control the final factor.  The problem is 
particularly difficult in poor or rural areas where many households 
do not have sanitary facilities or do not obey health agency 
instructions.   For example, in one hard hit hamlet where 43 
patients tested positive for cholera, residents do not have toilets 
and use river water, which tested positive for the cholera bacteria, 
to irrigate their paddy fields. 
 
Embassy Believes Current Notice Remains Sufficient 
--------------------------------------------- ----- 
 
6. (U) The Embassy has reviewed our current notice to American 
citizens regarding cholera prevention.  The Medical Unit and Health 
Attache continue to believe that this guidance, which is consistent 
with recommendations from Vietnamese health officials, remains 
appropriate and does not need updating at this time. 
 
MICHALAK