AFTER ACTION REVIEW Dengue Outbreak in Hanoi, Vietnam 2017

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1 AFTER ACTION REVIEW Dengue Outbreak in Hanoi, Vietnam 2017 General Department of Preventive Medicine (GDPM) Viet Nam Ministry of Health (MOH) Meeting of the Bi-regional Technical Advisory Group on the Asia Pacific Strategy for Emerging Diseases and

2 Presentation outline Overview of dengue situation in Viet Nam Dengue outbreak in Hanoi in 2017 After Action Review: Methods, Participants, Implementation, Findings Lessons learnt Ways forward

3 M No. of cases No. of deaths Key facts of dengue in Vietnam, , , ,000 National Dengue Prevention and Control Program established 6,000 5,000 4, , , ,000 50,000 3,000 2,000 1, Dengue is endemic in Vietnam : on average, 200,000 cases reported annually including deaths Major outbreak in 1987 with > 300,000 cases reported including at more than 1,500 deaths (CFR 0.5%) : cases decreased, annual average around 100,000 cases per year, CFR 0.1%.

4 Situation of Dengue Outbreak Ha Noi, , 651 confirmed cases 7 deaths. All 30 districts affected.

5 Cases Situation of Dengue Fever in Hanoi, Vietnam by month ( ) Month TB 5 năm TB + 2 SD

6 AFTER ACTION REVIEW Objectives Methods Key Findings

7 Objectives To review surveillance and response activities for Denguge outbreak in Ha Noi in 2017 To document gaps and challenges in outbreak respone To provide recommended actions for future improvement of dengue prevention and response

8 Methods and Participants Methods: Rapid assessment, including to: Meet with relevant stakeholders involving in outbreak response Observe and evaluate performance of community voluntary groups for larvae removal and mosquito control Conduct field visits to communities, national and district hospitals Conduct interviews and group discussion with health staff, local authorities and community members, residents Review related documents and reports Participants: established Expert Council of 22 members (including 6 are in secretariat) whose are senior experts from: Ministries/Sectors: Ministry of Health and other relevant Ministries (Public Security, Defense, Education, Construction, etc. ), Regional Institutes, national Hospitals International organizations: WHO, US CDC

9 Implementation Time: September 2017 Location: Ha Noi local authorities, Ha Noi health sectors, Hospitals, community residents in communes and districts in Hanoi Implementation steps: Experts are divided into 3 teams: Epidemiology and leadership Entomology and vector control Case management and treatment Activities implemented: Development of assessment plan, protocol and tools Conduct parallel field assessment by team at localities Meet and discuss with Hanoi health authorities (DoH, PPMC, hospitals) Organize meetings to discuss and agree on the assessment results

10 Findings 1) Leadership and Management Leadership and management by Hanoi People s Committee and the authorities of all levels were exercises synchronously and drastically, which enabled inter-sectorial collaboration from the city level to the commune/ward level. Authorities at the grass-root level in some areas were not active or drastic in leadership and management

11 Major intervention measures and timelines Guiding activities for dengue control in Ha Noi, /01: KH PCD kèm KP của UBND 09/01: KH PCD của SYT 21/03, VSMT PC SXH 17/04, Hướng 22/05, Tăng cường PCSXH 23/6: Xác định 10 XP co số mă c tăng 27/07, 1106/CĐ-TTg 31/07, CV PCSXH 05/01 20/01 04/02 19/02 06/03 21/03 05/04 20/04 05/05 20/05 04/06 19/06 04/07 19/07 03/08 18/08 02/09 PC SXH theo kế hoạch Triển khai các biện pháp PC SXH Phòng chống và xử lý dịch SXH 1/8, thành lập đội xung kich Tham gia của chính quyền các cấp và các tổ chức CP 01 Văn bảnbyt 18 Văn VSDTTW 03 Văn bảntu-hn 05 Văn bảnubnd- HN 17 Văn bảnsyt-hn 33 Văn bảnban ngành 11 Văn bảnttytdp- HN 27 Văn bản

12 Findings 2) Surveillance and control activities Forecast: new short-term forecast (2 months), not predictable in the long term in terms of the outbreak scale and intensity Disease control was not good at the beginning of the outbreak It was a big challenge to maintain regular and continued outbreak control activities.

13 Findings 3) Vector control Poor vector monitoring Quality and coverage of environmental sanitation, detection and management of larva reservoirs, mosquito breeding sites, mosquito sprays were issues

14 No. of cases Major Intervention Measures and Timeline Clean-up campaign in whole City (21 March) ASEAN Dengue Day (6 May) week Routine surveillance: case surveillance, vector and viral laboratory surveillance Larvae removal at households and Mosquito control by insecticides Combined large-scale chemical spraying and Mosquito control at househokds Combined widely spraying in the whole city including public areas large-scale chemical spraying Mosquito and larvae control at househokds Combined establishment of the voluntary teams for monitoring of larvae removal at households widely spraying in the whole city including public areas large-scale chemical spraying Mosquito and larvae control at househokds

15 INVOLVEMENT OF THE WHOLE COMMUNITY

16 COMMUNICATION ACTIVITIES Timely and transparent Various communication means and methods deployed

17 CHEMICAL SPRAYS Public Health Emergencies (APSED III): Advancing Implementation of the International Health 17 Regulations (2005)

18 Findings 4) Case management Decentralization for admission and treatment of patient was not good leading to overload at tertiary hospitals

19 Lessons learned Government leadership and direction and participation of the mass organizations in prevention and control activities play an important role in the success of the outbreak response Establishing voluntary group for larvae control has brought about great effects in the community based dengue prevention Chemical Spraying on a large scale and in proper techniques have important effects in dengue control Hospital preparedness including surge capacity will help coping effective case management, limiting cross-infection and minimizing mortality. Early investment in disease prevention, resource mobilization of society and community in outbreak prevention and control help prevent outbreak from first place After Action Review is helpful in findings successes and gaps in outbreak response; drawing lessons learnt for future improvement in outbreak response and should be conducted after each event.

20 Ways forward Enhance and maintain leadership and inter-sectorial collaboration to ensure immediate efficiency of outbreak control activities Enhance capacity of surveillance, early warning and rapid response system Decentralization for admission and treatment of patients to prevent overload at tertiary hospitals Execute regulations on administrative penalties in the field of health (Decree No. 176/2013/ND-CP). Develop state-level scientific research topics on ecology and the forecasting model (disease/ outbreak modelling) for Dengue in Vietnam in the context of globalization, urbanization and climate change./. Invest during peace time PREVENTION is better than CURE

21 Thank You for Your Attention!