Strengthening global health security capacity--Vietnam demonstration project, 2013.

Over the past decade, Vietnam has successfully responded to global health security (GHS) challenges, including domestic elimination of severe acute respiratory syndrome (SARS) and rapid public health responses to human infections with influenza A(H5N1) virus. However, new threats such as Middle East respiratory syndrome coronavirus (MERS-CoV) and influenza A(H7N9) present continued challenges, reinforcing the need to improve the global capacity to prevent, detect, and respond to public health threats. In June 2012, Vietnam, along with many other nations, obtained a 2-year extension for meeting core surveillance and response requirements of the 2005 International Health Regulations (IHR). During March-September 2013, CDC and the Vietnamese Ministry of Health (MoH) collaborated on a GHS demonstration project to improve public health emergency detection and response capacity. The project aimed to demonstrate, in a short period, that enhancements to Vietnam's health system in surveillance and early detection of and response to diseases and outbreaks could contribute to meeting the IHR core capacities, consistent with the Asia Pacific Strategy for Emerging Diseases. Work focused on enhancements to three interrelated priority areas and included achievements in 1) establishing an emergency operations center (EOC) at the General Department of Preventive Medicine with training of personnel for public health emergency management; 2) improving the nationwide laboratory system, including enhanced testing capability for several priority pathogens (i.e., those in Vietnam most likely to contribute to public health emergencies of international concern); and 3) creating an emergency response information systems platform, including a demonstration of real-time reporting capability. Lessons learned included awareness that integrated functions within the health system for GHS require careful planning, stakeholder buy-in, and intradepartmental and interdepartmental coordination and communication.

Compliance to dietary guidelines on fruit and vegetable intake and prevalence of hypertension among Vietnamese adults, 2015.

AIMS: The aim of this study was to investigate whether the Western dietary guidelines on fruit and vegetable intake are associated with blood pressure parameters and hypertension among Vietnamese adults. METHODS: Participants included 1384 women and 1049 men aged 18-69 years from the 2015 Vietnam national survey on risk factors of non-communicable diseases. Associations between dietary intake score based on the Dietary Approaches to Stop Hypertension (DASH) guidelines and World Health Organization recommendations on fruit and vegetable consumption and blood pressure parameters and hypertension were evaluated by multivariate regression analyses. RESULTS: Approximately 17.0% and 40.1% of participants met the respective definitions of hypertension according to Joint National Committee 7 (JNC7) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) Hypertension Guideline. Highest tertiles of DASH scores for fruit intake were significantly associated with increased blood pressure parameters, particularly in women. Hypertension was associated with DASH score for fruit intake with odds ratios and 95% confidence intervals for tertiles 2-3 versus tertile 1: 1.31 (0.98, 1.76) and 1.43 (1.05, 1.93) for JNC7; 1.26 (1.01, 1.58) and 1.31 (1.04, 1.66) for 2017 ACC/AHA guideline (all p-trend <0.05). No association with blood pressure parameters and hypertension was observed for DASH score for vegetable intake and meeting World Health Organization recommendations for fruit and vegetable intake. CONCLUSION: We found an unexpected positive association between DASH score for fruit intake and blood pressure parameters and hypertension among Vietnamese adults. More research is needed in this population to understand the relationship between vegetable and fruit intake with hypertension before a firm conclusion and recommendation are made.

Acceptability of seasonal influenza vaccines among health care workers in Vietnam in 2017.

INTRODUCTION: A demonstration project in Vietnam provided 11,000 doses of human seasonal influenza vaccine free of charge to healthcare workers (HCWs) in 4 provinces of Vietnam. Through this project, we conducted an acceptability survey to identify the main reasons that individuals chose to be vaccinated or not to inform and improve future immunization activities. METHODS: We conducted a descriptive cross-sectional survey from May to August 2017 among HCWs at 13 selected health facilities. We employed logistic regression to determine the association between demographic and professional factors, and the decision to receive seasonal influenza vaccine. We performed post-hoc pairwise comparisons among reasons for and against vaccination using Chi square and Fisher's exact tests (for cell sizes <5). RESULTS: A total of 1,450 HCWs participated in the survey, with a higher proportion of females than males (74% versus 26%). The median age of the participating HCWs was 35 years (median range 25.8-44.2). Among those surveyed, 700 (48%) HCWs were vaccinated against seasonal influenza during the first half of 2017. Younger HCWs under 30 and 30-39 years old were less likely to get vaccinated against seasonal influenza than HCWs ≥50 years old (OR = 0.5; 95%CI 0.4-0.8 and OR = 0.6; 95%CI 0.4-0.8 respectively). Nurses and other employees were more likely to get seasonal influenza vaccination than physicians (OR = 1.5; 95%CI 1.0-2.4 and OR = 2.0; 95%CI 1.2-3.2 respectively). The most common reason for accepting vaccination was fear of getting influenza (66%) and the most common reason for not getting vaccinated was concern about vaccine side effects (23%). CONCLUSION: Acceptability of seasonal influenza vaccines in this setting varied among HCWs by age group and job category. Interventions to increase acceptance of vaccine among HCWs in this setting where influenza vaccine is being introduced free for the first time should include targeted risk communication on vaccine safety and efficacy.

Findings and lessons from establishing Zika virus surveillance in southern Viet Nam, 2016.

OBJECTIVE: To document the evolution and optimization of the Zika virus (ZIKV) disease surveillance system in southern Viet Nam in 2016 and to describe the characteristics of the identified ZIKV-positive cases. METHODS: We established a sentinel surveillance system to monitor ZIKV transmission in eight sites in eight provinces and expanded the system to 71 sites in 20 provinces in southern Viet Nam in 2016. Blood and urine samples from patients who met the case definition at the sentinel sites were tested for ZIKV using real-time reverse transcription polymerase chain reaction at the Pasteur Institute in Ho Chi Minh City (PI-HCMC). We conducted descriptive analysis and mapped the ZIKV-positive cases. RESULTS: In 2016, 2190 specimens from 20 provinces in southern Viet Nam were tested for ZIKV at PI-HCMC; 626 (28.6%), 484 (22.1%), 35 (1.6%) and 1045 (47.7%) tests were conducted in the first, second, third and fourth quarters of the year, respectively. Of these tested specimens, 214 (9.8%) were ZIKV positive with 212 (99.1%) identified in the fourth quarter. In the fourth quarter, the highest positivity rate was those in age groups 30-39 years (30.0%) and 40-59 years (31.6%). Of the 214 ZIKV-positive patients, 210 (98.1%) presented with rash, 194 (90.7%) with fever, 149 (69.6%) with muscle pain, 123 (57.5%) with joint pain and 66 (30.8%) with conjunctivitis. DISCUSSION: The surveillance system for ZIKV disease underwent several phases of optimization in 2016, guided by the most up-to-date local data. Here we demonstrate an adaptable surveillance system that detected ZIKV-positive cases in southern Viet Nam.

Expanding severe acute respiratory infection (SARI) surveillance beyond influenza: The process and data from 1 year of implementation in Vietnam.

BACKGROUND: In 2016, as a component of the Global Health Security Agenda, the Vietnam Ministry of Health expanded its existing influenza sentinel surveillance for severe acute respiratory infections (SARI) to include testing for 7 additional viral respiratory pathogens. This article describes the steps taken to implement expanded SARI surveillance in Vietnam and reports data from 1 year of expanded surveillance. METHODS: The process of expanding the suite of pathogens for routine testing by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) included laboratory trainings, procurement/distribution of reagents, and strengthening and aligning SARI surveillance epidemiology practices at sentinel sites and regional institutes (RI). RESULTS: Surveillance data showed that of 4003 specimens tested by the RI laboratories, 20.2% (n = 810) were positive for influenza virus. Of the 3193 influenza-negative specimens, 41.8% (n = 1337) were positive for at least 1 non-influenza respiratory virus, of which 16.2% (n = 518), 13.4% (n = 428), and 9.6% (n = 308) tested positive for respiratory syncytial virus, rhinovirus, and adenovirus, respectively. CONCLUSIONS: The Government of Vietnam has demonstrated that expanding respiratory viral surveillance by strengthening and building upon an influenza platform is feasible, efficient, and practical.

The impact of prevention and control of infectious disease law on diarrhoea control: a 5-year evaluation in multiple provinces in Vietnam.

To address to burden of infectious diseases such as diarrhoea, the Vietnamese government has enacted the Law on Prevention and Control of Infectious Diseases (LPCIDs) since July 2008. However, no evaluation of the impact of the LPCID has been conducted. This study aims to evaluate the impact of the LPCID on diarrhoeal control for the 5 years following the implementation of LPCID in Vietnam. We used an interrupted time series design using a segmented regression analysis to estimate the 'province-level' impact of LPCID and then used random-effect meta-analysis to estimate the pooled effect sizes of the 'country-level' impact of LPCID on diarrhoeal control throughout Vietnam. The results show that the impacts varied by provinces. They were classified in four groups: 'positive impact, positive impact without sustainability, possibly positive impact, no or negative impact' of the LPCID. The meta-analysis indicated that the country-level impact of the LPCID became significant at 11 months after the LPCID took effect, with a decrease in level of diarrhoea of 9.7% (coefficient, -0.097; 95% CI: -19.1 to - 0.002) and a permanent downward trend of diarrhoea at a rate of 1.1% per month (coefficient, -0.011; 95% CI: -0.02 to - 0.003); whereas the trend in diarrhoea before the LPCID took effect was unchanging (coefficient, 0.002; 95% CI, 0-0.004). At 12, 24, 36, 48 and 60 months following the LPCID implementation date the levels of diarrhoea decreased by 10.9% (coefficient, -0.109; 95% CI: -0.203 to - 0.015), P < 0.01), 21.8% (coefficient, -0.218; 95% CI: -0.338 to - 0.098), P < 0.01), 31% (coefficient, -0.31; 95% CI: -0.474 to - 0.145), P < 0.01), 46.8% (coefficient, -0.468; 95% CI: -0.667 to - 0.27), P < 0.01), 48.2% (coefficient, -0.482; 95% CI: -0.708 to - 0.256), P < 0.01) respectively. The findings of this study reveal the effectiveness of the LPCID in reducing diarrhoea incidence in Vietnam. However, further studies should be conducted to better understanding the cost-effectiveness, acceptability, and sustainability of each component of the LPCID.