10% of Vietnam’s population will be infected with H5N1 if

Field hospitals may need to be established, converting schools into hospitals.

By the end of the year, 1 million doses of Tamiflu will be imported for reserves.

After the Prime Minister declared that if an outbreak occurs, the Minister of Health, Agriculture & Rural Development must be held accountable, the atmosphere surrounding epidemic prevention has become more urgent. Our reporters had a discussion with the National Steering Committee (NSC) for SARS and avian influenza prevention (Ministry of Health)…

Regarding prevention methods and the “scenario” that would be applied if a pandemic occurs in Vietnam, Dr. Tran Duc Long, Deputy Head of the Communication Subcommittee of the NSC, stated:

The World Health Organization (WHO) has warned that a human avian influenza pandemic could realistically occur in Vietnam. In such a case, it’s important to note that the disease might not only be transmitted through respiratory routes but also via the digestive system and potentially through other means (direct contact). According to WHO recommendations, up to 10% of our population could become infected, with a mortality rate of 1% among those infected.

* Allowing a pandemic to occur would be extremely dangerous. To prevent this, the first requirement is to detect the outbreak. Has Vietnam managed to self-test for H5N1, and do we have tools for rapid detection of this virus?

– Currently, we do not have rapid detection tools. H5N1 testing in Vietnam is mainly conducted at large laboratories such as the Central Institute of Hygiene and Epidemiology, and the Pasteur Institute in Ho Chi Minh City, with samples sent abroad for confirmation. However, in anticipation of a potential pandemic, we are investing in establishing three Level 3 biosafety laboratories (capable of providing accurate H5N1 test results) to ensure timely diagnosis, detection, and treatment for infected individuals. These labs are expected to be completed by the end of 2005 or in the first quarter of 2006.

* Individuals infected with H5N1 can recover more effectively if treated within the first 48 hours with Tamiflu. However, how can early symptoms of the disease be detected?

– People who have had contact with poultry within the past seven days and exhibit the following symptoms should quickly go to the hospital and take measures to prevent disease transmission to others: persistent high fever (possibly with chills), cough (typically dry), chest pain, difficulty breathing, cyanosis, rapid heartbeat, headache, muscle pain, and possibly diarrhea or altered consciousness… Tamiflu will be highly effective if the patient is treated within 4-8 hours of the first symptoms.

* There are reports that taking Tamiflu will enhance immunity for seven days, leading many people to rush out to buy it. Where can the public purchase Tamiflu?

Dr. Tran Duc Long

– Currently, Vietnam has imported about 600,000 doses of Tamiflu out of the 1 million doses requested by the Government. We do not have enough medicine in stock, so all imported drugs are sent directly to the national reserve warehouse. Therefore, theoretically, Tamiflu is not available on the open market. However, due to concerns about the flu outbreak, many Vietnamese abroad have sought to purchase and send Tamiflu back home. But this is an unofficial route, and the quality and source cannot be verified.

* Vietnam has designated a reserve of 1 million doses of Tamiflu? Is that number too small compared to the demand if an outbreak occurs? And what difficulties are there in importing that 1 million doses? When will we finish importing?

– The funding for importing 1 million doses is an urgent budget allocated by the Government to the Ministry of Finance. However, the demand and the quantity needed will certainly be higher when an outbreak occurs. Importing the medication depends on the supplier’s stock and government funding, but the NSC for SARS and avian influenza prevention aims to complete this by the end of this year.

* Currently, there are two national steering committees operating simultaneously to prevent avian influenza?

– That is correct. Previously, at the government’s request, the Ministry of Health established a national steering committee for SARS. Now, with the addition of avian influenza, the government has expanded this committee’s responsibilities to prepare for avian influenza prevention in humans. Additionally, there is a national steering committee for avian influenza led by the Minister of Agriculture and Rural Development. Both committees include members from various sectors for better coordination. While their names and missions are similar, their focus areas differ.

The Ministry of Agriculture and Rural Development is the main point of contact for presenting all measures to prevent avian influenza among poultry. The committee led by the Minister of Health prepares responses for human influenza outbreaks. The relationship between the two committees is very close, so the government has directed both sides to coordinate closely.

* Vietnam has invested thousands of billions of VND to vaccinate poultry against avian influenza. Does the Ministry of Health have any recommendations for people who prefer consuming poultry products?

– In principle, vaccines have the potential to create immunity. However, no one can guarantee that all poultry have been vaccinated, that no birds have been missed, or that 100% of vaccinated poultry will have good immunity. Although there have been no outbreaks of avian influenza in Vietnam for several months, the disease has not been completely eradicated. Since July 25, 2005, no one has been hospitalized due to H5N1 infection, but the disease still lingers, showing potential signs of resurgence.

There could be a duck living normally but testing positive for H5N1. Consuming blood pudding and poultry products of unknown origin when the risk of an outbreak is high is certainly very dangerous. The public should be aware of the avian influenza threat not only for their own health but also for the safety of the entire community.

* Is the Ministry of Health confident about the risk of a pandemic occurring in Vietnam as advised by WHO?

– WHO has almost certainly warned that a pandemic will occur as winter approaches. The disease has already spread among poultry across Asia and Europe. While there have been isolated cases of human fatalities in some countries, there have been no reported infections in Vietnam for several months. We are also actively vaccinating poultry, so recommendations remain just that—recommendations.

No one can confidently assert whether an outbreak will occur in Vietnam. However, if the H5N1 avian influenza virus mutates to spread from human to human, a pandemic could easily ensue. This is unpredictable, so we are in the most proactive state to prevent it. Even if we prepare extensively and the disease does not occur, that would still be a fortunate outcome for the country.

* Previously, when there were a few H5N1 cases, they were transferred directly to the Institute of Tropical Medicine in Hanoi or the Tropical Diseases Hospital in Ho Chi Minh City. If a pandemic occurs, these facilities may not be able to meet the demand. Where will the public be treated?

– Currently, as the outbreak has not occurred, the Ministry of Health has prepared very specific plans. If scattered cases arise, with the total number of H5N1 cases across the country not exceeding 100, then in the North, the Institute of Tropical Medicine and the Central Pediatric Hospital will be designated to receive and treat patients from Ha Tinh and above. In the Central region, Hue Central Hospital will receive patients from Quang Binh to Khanh Hoa. Those infected with H5N1 from Ninh Thuan southward will be treated at the Tropical Diseases Hospital, Children’s Hospital 1, and Children’s Hospital 2 in Ho Chi Minh City.

If the outbreak reaches a moderate level (101-300 cases nationwide), in addition to the aforementioned hospitals, in the North, Bac Thang Long Hospital, Duc Giang Hospital, and Dong Da Hospital (Hanoi) will support and receive patients with mild clinical symptoms. Furthermore, central hospitals such as Thai Nguyen General Hospital, Thai Binh Hospital, and Thanh Hoa Hospital; Vietnam-Sweden Hospital (Uong Bi), Viet-Tiep Hospital (Hai Phong) will accept patients from bordering regions. In the Central region, Hue Central Hospital will expand its isolation area to accommodate about 50 additional patients (both adults and children). In the South, additional support will come from Cho Ray Hospital, Can Tho General Hospital, and Kien Giang Hospital.

In the event of a large-scale outbreak (ranging from 300 to 3,000 infections), according to the “scenario,” central provincial general hospitals, regional general hospitals, central and provincial tuberculosis hospitals, district hospitals, and specialized hospitals will all need to mobilize. Each of these hospitals must arrange for 10-30 isolation beds (half for adults and half for children). When a pandemic occurs, they will be provided with equipment, medication, and resources from the national emergency reserve.

* However, sir, if a pandemic occurs, it may not be limited to 3,000 cases of H5N1 but could exceed 8 million. If just 5% of this number requires hospitalization, that would amount to over 400,000 patients. Meanwhile, the total number of hospital beds in our country (both public and private) is only 127,236. Are we prepared for this scenario?

– We will make every effort to prevent the outbreak of a pandemic. However, the National Steering Committee for the Prevention of Sars and Avian Influenza (Ministry of Health) has also planned for the worst-case scenario. In the event of a massive outbreak, we will request military hospitals to join the effort, establish field hospitals, utilize communal health stations, and if necessary, convert schools into hospitals to accommodate and treat patients.