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AVIAN INFLUENZA IN VIETNAM‘Cum ga”

Le Thi Kim Thoa MD. MPHSenior lecturer of Hygiene and Epidemiology

Ha Noi Medical University1 Ton That tung Ha noi

Viet NamTelephone: 84 4 5744 556

Fax: 84 4 5744 557

E-mail: lethikimthoa_hmu@yahoo.com

lethikimthoa@hmu.edu.vn

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AVIAN INFLUENZA IN VIETNAM

Purpose: To provide the lessons on avian flu in Viet Nam

Contents: 1. Introduction 2. Short terms strategy 3. Long-terms strategy4. Lessons learnt5. How to keep sustainable

WHO 2006 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)

Global avian influenza 5

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http://www.moh.gov.vn/Cumga 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

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“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 %

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Exposures detected

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

Viet Nam National Institute for Clinical Research in Tropical Medicine

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Clinical featuresamong ‘cum ga’ patients

• 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

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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

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Communication

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

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Body networking

Multi sectors participatedHealth sector to be as a main

coodinatorCentral level:

Provincial levelDistrict level

Commune level

Village level

Group level

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Relevant documents

• Instructions– Government at different level– Health sector – Agriculture sector

• Guidelines– Ministry of health– Ministry of argricultrure

• Reports

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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

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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

MOH 20

Supports:

• International organizations– USDP– WHO– UNICEF

• 5 Countries: 6.8 million USD– Australia– Holland– Finland– Switzerland– Luxembourg

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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

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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

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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

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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

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‘cum ga’ outbreaksIn Viet Nam

• outbreaks among

poultry in 61 provinces (all)

• outbreaks among humans in 32 provinces (>50%)