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Last Updated: Friday, 4 November 2005, 11:33 GMT
Lessons from Vietnam

By Fiona Blair
Assistant Producer, Panorama

Jane Corbin in Vietnam

One of the reasons why the Panorama team were so keen to go to Vietnam was so that they could meet the healthcare workers who have had direct experience of treating patients suffering from the H5N1 virus, which is currently endemic in poultry in parts of South East Asia and has proved capable of jumping species and infecting humans as well.

Vietnam has had more human cases of H5N1 than any other country and in Hanoi and Ho Chi Minh the team met doctors and nurses in two infectious disease hospitals. When they visited there were no H5N1 patients in the country and the hospitals were mainly treating patients suffering from diseases like malaria, dengue fever, tuberculosis and HIV.

However, this does not mean that H5N1 has gone away. Flu is seasonal. The majority of cases in Vietnam have occurred in colder weather and the hospitals they visited were gearing up for the possibility that the same would happen this year.
Facing The Pandemic
Sunday 6 November 2005
22:15 GMT, BBC One
In Hanoi the team met one doctor who had actually caught H5N1 himself. This was discovered not because he became severely ill with the flu but because they decided to screen all the medical staff in the department which treated flu patients, in order to gauge the transmissibility of the disease.

The doctor had had a cough for a couple of months, but other than that had not suffered from the virus. He believes that he caught the virus from a patient because, although his family does keep poultry, the birds all tested negative for the virus.

A health worker who catches the flu are likely to be one of the early warnings that the virus is developing into an easily transmittable 'human' form. As yet it has only displayed very limited ability to do so, but the more cases there are, the more chances there are for the virus to mutate into a 'humanised' form.

Ducks in a cage at a Vietnamese street market

In Vietnam, as in other South East Asian countries, live poultry is a common sight even in the centre of cities. In Hanoi caged birds were for sale in a market, which also sold butchered meat. People buy live animals and bring them home to slaughter them there.

Because of the avian flu outbreak, the government has issued numerous directives to try and stop the selling of live birds but some parts of the country have not cracked down on the practice effectively enough.

A Food and Agriculture Organisation (FAO) official, based in Vietnam explained to the team that wet markets can lead to the spread of disease because of the contact between dead and live birds. There is a worry that live birds which are not sold at the end of the day will be brought home and then back to the market the next day, when they could have picked up the virus.

It also worries officials that the birds are transported live to the market, sometimes on the back of motorbikes. The droppings which carry the virus are therefore being spread on tyres and onto roads.

In Ho Chi Minh the situation was different. Markets where months ago you could easily buy live ducks and chickens were selling only butchered meat when the Panorama team visited in October. There is now a rule that all poultry should be slaughtered before it is brought into the city.

left to right, Nguyen Thi Thanh, her daughter and her mother-in-law

From Ho Chi Minh the team travelled South West to the Mekong delta and a province called Ben Tre. Here they travelled to the home of Nguyen Thi Thanh, a 35-year-old widow whose husband, Phan Van Luu, died from H5N1. It was the most recent fatal case of the flu in Vietnam.

Thanh has a six-year-old daughter to support who has just started school. The daughter, Phan Thi Thach Thao is pictured along with Thanh's mother-in-law who lives with them in this roadside house. Thanh and her husband used to work together to sell a breakfast broth to village residents and people driving through. She continues this work alone now.

She believes her husband was infected by a fighting cock which he butchered. He became ill very quickly afterwards. She tried to nurse him at home but his fever kept getting worse and eventually he had to be brought to hospital. He is buried just down the road from their house.

No one else in the family caught the disease and no other bird in the area was found to be carrying it.

A duck being vaccinated against Avian Influenza

Vietnam is in the process of trying to vaccinate all domestic animals in order to get rid of H5N1. The vaccine they are using comes from China and every bird has to get two shots, the second a month after the first.

In Ben Tre farmers are generally happy to have their animals vaccinated to prevent H5N1 coming back. In the past few years when the virus broke out locally their ducks and chickens had to be culled.

Culling was vastly expensive for the farmer as the government only compensated them for a quarter of the market price of each bird. Animal health workers told us that during culls farmers would sometimes try and hide their flocks so they could keep them.

The FAO supports the vaccination strategy as the only way to prevent the spread of the disease in animals in Vietnam. If you can wipe out or curb the disease in poultry, then the chances of it ever mutating into a human form are greatly reduced.

Jane Corbin in front of a statue of Ho Chi Minh
Reporter Jane Corbin is pictured (right) in front of a statue of Ho Chi Minh, after whom the city formerly called Saigon was renamed in 1975 following the unification of the country. This statue is outside the 'Peoples Committee Building' in Vietnam. Vietnam is a communist country and we were accompanied by an official from the ministry of foreign affairs throughout our trip, who helped set up our filming.

Panorama's "Bird Flu - Facing the Pandemic" is broadcast on Sunday 6 November 2005, at 22:15 GMT, on BBC One and online at bbc.co.uk/panorama where it is also available on demand and in broadband.

Why the UN in Vietnam believe a bird flu pandemic is likely


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