COMMUNICABLE DISEASE SURVEILLANCE IN VIETNAM: CURRENT SITUATIONS AND CHALLENGES ARF WORKSHOP ON DISEASE DETECTION AND SURVEILLANCE 13-15, September 2011, Manila, Philippine Tran Nhu Duong, MD National Institute of Hygiene and Epidemiology Presentation Overview 1.Communicable disease Situation in Vietnam 2.Communicable Disease Surveillance system 3.Health quarantine network 4.Sentinel surveillance system for Influenza 5.Laboratory network for surveillance 6.Challenges General Information (2010) Population: 86 millions Regions: 4 regions Provinces: 63 COMMUNICABLE DISEASES IN VIETNAM In the past ten years, a number of major infectious diseases in Vietnam has been remarkably reduced due to public health efforts Vaccine preventable diseases: pertussis, diphtheria, Japanese Encephalitis, measles have significantly reduced. Poliomyelitis was eradicated in 2000 Neonatal tetanus was eliminated in 2005. Districts: 700 Communes: 10,253 However, some communicable diseases have been emerging: Dengue fever, hand food and mouth disease, Rubella, cholera... remain major public health problems. 1
Recently emerging infectious diseases in Vietnam Diseases Period Cases/deaths COMMUNICABLE DISEASE SURVEILLANCE SYSTEM MOH SARS 2003 63 / 5 Avian influenza 2003 2010 119 / 59 Cholera 2007 2010 8.512 / 1 Dengue fever Every year 100.000 150.000 cases / 100 deaths per year Health Quarantine Centers/ Border gate Health Quarantine stations NIHE/ Pasteur Institutes Provincial center for Preventive Medicine District center for Preventive Medicine National and Regional Hospitals Provincial Hospitals, private hospital District Hospitals, Private clinics HFMD 2010 2011 52.865 / 99 Commune health Centre BORDER GATE HEALTH QUARANTINE NETWORK Total: 44 stations -Vietnam - China: 1281 km, 17 stations -Vietnam - Cambodia: 1228 km, 16 stations - Vietnam - Laos: 2130 km, 11 stations NOTIFIABLE DISEASES IN VIETNAM (MONTHLY REPORT) Cholera Malaria Neonatal Influenza Tetanus Typhoid Viral Hepatitis Other tetanus Adenoviral conjunctivitis Shigellogis Rabies AFP Plague Amoebiasis Meningitis Measles Influenza A(H5N1) Diarrhea Varicella Mump Rubella Viral encephalitis Diphtheria Leptospirosis Hand foot and mouth diseases Dengue fever Pertussis Anthrax Human streptococcus suis 2
Case definitions for surveillance The standard case definitions of Ministry of health and WHO are being applied nationwide Laboratory network in Vietnam Levels National level (NIHE) Regional Level (Tay Nguyen, Nha Trang, Ho Chi Minh Pasteur Institute) Provincial Level (63 Preventive Medicine Centers) Communicable Diseases HIV Food Hygiene &Safety 1 1 1 3 3 3 63 63 63 District level (>700 units) >700 0 >700 Laboratory capacity National and regional levels Provincial level District level Capacity -Specific analysis - Final confirmation - Researches - Final diagnosis for some diseases - Preliminary diagnosis for selected diseases -Sample collection and transportation Influenza Sentinel Surveillance System in Vietnam Techniques - Molecular biology - Immunology - Basic microbiology - Serology: ELISA (Dengue, JE, Hepatitis, Rubella) - Rapid test: Dengue, HBV - Molecular in a few provinces - Gram staining 3
15 sentinel sites for influenza surveillance in Vietnam, 2006 2011 NIID, Hanoi Natl. Ped. Hosp., Hanoi Ba Trieu Clinic, Hanoi L¹ ng S n Thµnh phè Hµ Néi Hßa B nh Th i B nh Cao Loc Dist. Hos. Lang Son Kien Xuong Dist. Hosp. Sentinel sites for Influenza Surveillance Thanh Xuan Clinic, Hanoi Thõa Thiª n-huõ µ N½ng Hoa Binh Dist. Hosp. Huong Thuy Dist. Hosp. Thanh Khe Dist. Hosp. Central hospital: 3 Provincial hospital: 2 District hospital: 8 Polyclinic: 2 Cai Be Dist. Hosp. Dac Lac Prov. Hosp. ¾k L¾k Kh nh Hßa ång Nai Thµnh phè Hå ChÝMinh TiÒn Giang Khanh Hoa Prov. Hosp. Xuan Loc Dist. Hosp. Ped. Hosp. #1 HCMC North: 7 sentinel sites Central: 3 sentinel sites Highland: 1 sentinel site South: 4 sentinel sites Hosp. of Trop. Dis. HCMC Objectives CHALLENGES IN COMMUNICABLE DISEASE SURVEILLANCE AND RESPONSE 1. To describe characteristics and to monitor influenza virus strains circulating in Vietnam 2. Early detection of human A/H5N1 cases and new influenza viruses through surveillance of severe viral pneumonia 3. Early identification of seasonal influenza outbreak 4. To assist MoH in developing policies on influenza prevention and control Vietnam is located in epi-center of number of dangerous communicable diseases in SEA region: Avian Influenza, Dengue, Cholera, HFMD Lab capacity for surveillance is week. Communicable diseases are reported mainly by clinical diagnosis Collaboration and cooperation between health sector and animal sector are very limited with no clear collaboration mechanism 4
CHALLENGES IN COMMUNICABLE DISEASE SURVEILLANCE AND RESPONSE Limited community perception and collaboration on communicable disease prevention Mode of reporting for surveillance system is backward which results in late reporting and response Shortage of human and financial resources for active surveillance and early response, especially at district and commune levels THANK YOU 5