Avian Influenza in Vietnam: Lessons and Strategies

1. AVIAN INFLUENZA IN VIETNAM‘Cum ga” Le Thi Kim Thoa MD. MPH Senior lecturer of Hygiene and Epidemiology Ha Noi Medical University 1 Ton That tung Ha noi Viet Nam Telephone: 84 4 5744 556 Fax: 84 4 5744 557 E-mail: lethikimthoa_hmu@yahoo.com lethikimthoa@hmu.edu.vn

2. AVIAN INFLUENZA IN VIETNAM Purpose: To provide the lessons on avian flu in Viet Nam Contents: • Introduction • Short terms strategy • Long-terms strategy • Lessons learnt • How to keep sustainable

3. Introduction • Avian influenza A (AIA) is an infectious disease, caused by H5N1 virus that can survive for long periods [ in bird faeces for at least 35 days at temperature (40C] • The disease occurs worldwide "bird flu" • H5N1 virus transmitted from farm to farm by the movement of live poultry (faeces), people (when contaminated shoes, clothing, vehicles, equipment, feed, and cages) • Restriction on the movement of live poultry, both within and between countries. WHO 2006

4. AIA [H5N1] outbreaks • Began in Asia in mid-2003 reported by nine Asian countries (Viet Nam listed 2) • Now spread to Europe • Become endemics in several countries including Viet Nam among most chicken population ‘Cum ga’ • In late July 2005, focus in Asia to affect poultry and wild birds in Russia • Greatest present concern for human health (number of cases and deaths) WHO 2006

5. Global avian influenza

7. ‘Cum ga’ OUTBREAKS in Viet Nam • ‘Cum ga’ outbreaks among poultry population before humans • Three ‘cum ga’ outbreaks among humans paralleled with three ‘cum ga’ outbreaks in poultry population • ‘Cum ga’ outbreaks among humans started the beginning 2004 http://www.moh.gov.vn/Cumga

8. ‘Cum ga’ OUTBREAKS among poultry population • ‘Cum ga’ outbreaks among poultry started 2003 • Appear at the South first and then the North • Very fast speed • Spread out quickly • All (61 provinces) reported outbreaks in poultry; 44,5 millions poultry killed among 300 millions poultry population http://www.moh.gov.vn/Cumga

9. “Cum ga” OUTBREAKS among humans in Viet Nam • Very severe disease, high mortality among infected patients • Children first and then adults • Rural and then urban • The first case on December , 2003 • Total 93 cases and 42 deaths • CFR: 45.2 %

10. Exposures detected • Directly contacted • Slaughtered ill poultry • Resided in poultry outbreak regions • Eaten swan’s blood curd • Contacted patients with H5N1 • Care patients

11. Initial syndromes Fever Myalgia Headaches Cough Coryza Diarrhea Respiratory syndromes Chest paint Crepitation Pleura effusion Pneumothorax Respiratory failure Others Hepatomegaly Delirium Cerebral hemorrhage Multiple organ failure Clinical featuresamong ‘cum ga’ patients Viet Nam National Institute for Clinical Research in Tropical Medicine

14. Short term strategyEmergency actions • Communication • Build up a network for ‘cum ga’ prevention • Provided relevant documents • Supervision at different levels • Destroy poultry and domestic birds • Meetings and training • Vaccinated for poultry • Supports from organizations and other countries

15. Contents ‘cum ga’ information Relevant documents Control measures Relevant documents Policies Roles and tastes of all sectors and organizations at different levels Mass media Television Newspapers Radio Meetings Training Internet Communication

16. Body networking Multi sectors participated Health sector to be as a main coodinator Central level: Provincial level District level Commune level Village level Group level

17. Relevant documents • Instructions • Government at different level • Health sector • Agriculture sector • Guidelines • Ministry of health • Ministry of argricultrure • Reports

18. Supervisions • Destroy poultry and their production including eggs at the outbreak areas, in a radius of 3 km • Do not allow: poultry transport, buy and sell poultry and process poultry during outbreaks • Vaccination for poultry • Disinfestations for breeding facilities • Isolated uninfected poultry

19. Destroy poultry • Destroy completely in outbreak areas around • Forced destroy • Voluntary destroy • Destroyed numbers of poultry: From 10 Jan 2005 to 30 Jan 2006: Total poultry destroyed: 3 962 528: - chickens: 1 334 499 - ducks, swans and grooses: 2 128 134 • Destroy measures: • Dig bury holes all suspected poultry • Burn infected and dead poultry

20. Supports: • International organizations • USDP • WHO • UNICEF • 5 Countries: 6.8 million USD • Australia • Holland • Finland • Switzerland • Luxembourg MOH

21. Effects • Community participation in all activities from the central levels to individual level. • A lot of documents provided • Stop outbreaks among poultry in all provinces • No new human case in December 2005. • Vaccination has been process for all provinces

22. Impacted • To make the fear of eating poultry and their products • Severe losses economics • Loss a large and good foods • Markets in disorder (most prizes of food up) • Poultry farmers loss their incomes after “dry storm”, become the poor. • A big amount of valuable birds were killed

23. Long terms prevention • Objective: No epidemic occur in both poultry and humans • Strengthen the supervision system at different level • Review and develop the policies realistic • To encourage all communities participating in prevention • Education of prevention measures • Continue to support from international organizations and countries • Sharing experiences

24. Lessons learnt • Identify the first case in both poultry and humans as soon as possible • Information on ‘cum ga’ correctly in time • Participation • Produce the timely decisions • Develop policies in terms of compensations and loan fund supports • How to sustain the effects

25. ‘cum ga’ outbreaks In Viet Nam • outbreaks among poultry in 61 provinces (all) • outbreaks among humans in 32 provinces (>50%)