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Situation of Avian Influenza A(H5N1) in VIETNAM

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Situation of Avian Influenza A(H5N1) in VIETNAM and role of National Institute of hygiene and epidemiology, hanoi, vietnam Dr. Nguyen thi Hong hanh – PowerPoint PPT presentation

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Title: Situation of Avian Influenza A(H5N1) in VIETNAM


1
  • Situation of Avian Influenza A(H5N1) in VIETNAM
  • and role of National Institute of hygiene and
    epidemiology, hanoi, vietnam
  • Dr. Nguyen thi Hong hanh
  • nihe,hanoi,vietnam

2
Contents
  • Situation of Avian Influenza A(H5N1).
  • Role of National Institute of Hygiene and
    epidemiology in Vietnam.

3
Situation of Avian Influenza A(H5N1)
4
General Information about vietnam
  • Area 332,600 km2
  • Provinces 64
  • Districts 668
  • Communes/wards 10,732
  • Population 82 millions

5
THE GROWTH OF POUTRY RAISING IN VIETNAM
million
6
POULTRY RAISING STRUCTURE
  • Poultry raising at small scale back-yards and
    small farms 65.
  • Poultry raising at semi-industry 20.
  • Poultry raising at industry 15.
  • Annual growth rate 6,5.

7
AVIAN INFLUENZA SITUATION IN VIETNAM, DEC 2003
january 2006
  • 3 epidemic waves of avian influenza A/H5N1.
  • 61 provinces reported outbreaks in poultry 44.5
    million poultry killed among more than 250
    millions poultry population.
  • 32 provinces have human cases Total 93 cases, 42
    deaths (CFR 45,2).

8
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9
map of avian flu in vietnam
10
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11
present time
  • until now
  • - Last case A(H5N1) 13 november 2005.
  • - From 14/11/2005 untill 13/01/2006, not any case
    is confirmed
  • From 8 january 2006 until now in the Vietnam free
    of Avian Influenza

12
MAGNITUDE OF THE EPIDEMIC
13
1ST AI EPIDEMIC AFFECTED COMMUNES AND RIVER
NETWORK
rivers
outbreaks
14
Timeline and Geographic distribution of h5n1
cases in Vietnam
wave 1 from dec 2003 to mar 2004
  • 57 provinces had poultry outbreaks 43.9 million
    poultry killed.
  • 13 provinces have human outbreaks 23 cases, 16
    deaths CFR 69.6.



15
Timeline and Geographic distribution of h5n1
cases in Vietnam
wave 2 from July 2004 to aug 2004
  • 17 provinces reported poultry outbreaks 84,000
    poultry killed).
  • 3 provinces had human outbreaks 4 cases, 4
    deaths CFR 100.

16
Timeline and geographic distribution of h5n1
cases, in Vietnam
wave 3 from dec 2004 until now
  • 36 provinces have poultry outbreaks 470,000
    poultry killed.
  • 25 provinces have human outbreaks 66 cases, 22
    deaths CFR 33.3).



17
NUMBER OF AVIAN INFLUENZA CASES AND DEATHS BY
MONTH
18
DISTRIBUTION OF CASES AND DEATHS BY AGE GROUP
distribution of death by age group
19
number of avian influenza cases and deaths by
gender
20
family-clusters of h5n1 cases in some northern
provinces, Wave 1 (2003-2004)
Hai Duong
Hung Yen
Hai Phong
Ha Nam
Thai Binh
Nam Dinh
Ninh Binh
Em gi
21
FAMILY-CLUSTERS OF H5N1 CASES IN THAI BINH
PROVINCE, WAVE 3 (2004-2005)
22
Family-cluster of H5N1 cases in hai phong city,
Wave 3 (2004-2005)
21 Mar 2005 Hung Dao, Kien Thuy 1. V. V. S
(patient) 2. N. T. L (wife) 3. V. T. N
(daughter) 4. V. T. T (daughter) 5. V. T. D
(daughter)
23
REMARKS ON EPIDEMIC SITUATION
  • 1. Epidemics among poultry
  • Linked with two main river systems (Red and
    Mekong delta) high density of ducks
  • 2nd and 3rd epidemics only small farm affected.,
    more ducks infected than chickens.
  • 2. H5N1 viruses seem to be more infectious for
    people
  • Human cases occured sporadically in more
    provinces.
  • Human cases occured in all age groups, with the
    increasing mean age.
  • 3. Majority of human cases have exposured history
    to infected poultry.

24
REMARKS ON EPIDEMIC SITUATION
  • 4. Disease patterns is changing Clinical
    symptoms become milder, more asymptomatic cases
    case-fatality rate is decreased.
  • 5. Genetic factors may play very important role
    in susceptibility to the virus.

25
REMARKS ON EPIDEMIC SITUATION
  • 6. No clear evidence of human to human
    transmission is available, but its possibility
    should be considered
  • Number of human cases increased, including number
    of healthy carriers.
  • Number of infected family cluster is increasing
  • Number of infected individuals in each family
    cluster is increasing.
  • Some cases without clear exposure history to sick
    poultry.

26
REMARKS ON EPIDEMIC SITUATION
  • 7.Virus may have slightly changed its
    antigenicity and pathogenicity
  • HA gene homogeneity reduced from 99.1 in 2004 to
    98.2 in 2005.
  • One amino acid deletion occurred in the
    multi-basic amino acid cluster (cleavage site),
    which may be associated with reduced
    pathogenicity.

27
RESPONSES
  • National and Provincial Steering Committee for AI
    epidemic prevention and control (as SARS
    Committee)
  • The leadership of the Communist Party, and
    Government.
  • Meeting every two weeks, especially every day
    during intensive epidemic.
  • 2. Set up the system for the identification,
    investigation, diagnosis and treatment of AI
  • Enhancing the community-based surveillance system
    by providing financial incentives for AHWs
  • Cooperation closely with Public Health
    authorities.

28
STRUCTURE OF THE NATIONAL STEERING COMMITTEE FOR
SARS CONTROL
29
RESPONSES
  • Strengthening of disease surveillance.
  • Upgrading diagnostic capability.
  • Improving disease reporting system.
  • 3. Extensive IEC on 4 measures for AI prevention
    and control mass media (newspaper, TV,
    internet....), distribution of pamphlets,
    booklets.
  • 3.1 Early detection of poultry epidemic and
    inform the local authorities.
  • Culling of all birds in flocks if found
    sero-positive with H5N1 virus or virus isolated.
    Compensation for farmers.

30
CONSTRAINTS/CHALLENGES
  • A/H5N1 avian influenza is a new and emerging
    disease lack of full knowledge about
    transmission mechanism, clinical spectrum,
    treatment and prevention.
  • Capacity and resources for surveillance, research
    and responses are still limited.
  • Some studies data show that virus maintain among
    ducks as asymptomatic hosts with very high
    prevalence, from 70-80.
  • There are still lack of animal health laws on
    transportation, quarantine, slaughtering of
    poultry

31
CONSTRAINTS/CHALLENGES
  • Most households raise ducks and chickens at
    backyard, for income and food. Outbreaks may
    escape detection, are difficult to control, and
    increase the likelihood of human exposures, which
    may occur when children play in areas shared by
    poultry or when families slaughter or prepare
    birds for consumption.
  • Awareness of people about the risks of infection
    with H5N1 avian influenza is still low.
  • More effective collaboration between human and
    animal health sectors is needed.
  • The national preparedness plan for influenza
    pandemic prevention and control should be
    completed as soon as possible.

32
STRATEGIC PLAN FOR INFLUENZA PANDEMIC PREVENTION
AND CONTROL IN VIETNAM
33
OVERARCHING GOAL
To ensure rapid characterization of the new
virus subtype and early detection, notification
and rapid response to additional cases.
34
OVERARCHING GOAL

35
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36
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37
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38
Role of National Institute of Hygiene and
epidemiology in Vietnam.
39
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40
Development History
  • Founded in 1926 Pasteur Institute of Hanoi
  • 1945 1961 Institute of Microbiology
  • 1962 1996 Hanoi Institute of Hygiene and
    Epidemilogy
  • 1997- Until now National Institute of Hygiene
    and Epidemiology

41
Board of directors
  • Admin. and logistic
  • departments

Technical departments
Epidemiology Dept.
Administration Dept.
Microbiology Dept.
Personnel Dept.
Virology Dept.
Network Coordinating Dept.
Molecular Bio. and Immuno. Dept.
Training and Research Man.Dept.
Planning Dept.
National Health Program Offices
Material and Medical Equipment Dept.
Center of Experimental Animals
Finance Accounting Dept.
Company for Vaccines and Biological Production
No.1
42
Staff
  • Total 472
  • Professor 7
  • Assistant Professor 13
  • PhD 40
  • Master 26

43
Functions
  • A leading research institution responsible for
    scientific and technical issues related to
    transmissible diseases control as well as vaccine
    research and development nationwide.
  • Technical consultant for the government of
    Vietnam for national policies of preventive
    medicine and vaccination strategies.

44
Functions
  • Act as leading part to direct the provincial and
    district level (preventive medicine centers,
    epidemic preventive hygiene groups and units)
  • organize and mobilize the population as well as
    other associated authorities and sectors in
    effectively penetrated infectious diseases
    prevention and eradication.

45
Functions
  • Upgrade and perfect the system of preventive
    medicine throughout Vietnam, ensure the training
    in technical skills, equipment supply for junior
    levels with priority given to mountain and island
    remote areas and to ethnic minorities.

46
Functions
  • Participate in international scientific
    co-operation in order to be conversant with the
    latest progress of preventive medical technology,
    including monitoring of emerging and re-emerging
    infectious diseases, developing vaccines and
    biological, training professional staff.

47
Role of National Institute of Hygiene and
epidemiology
  • NIHE has made considerable contribution to health
    sector in general and public health in
    particular.
  • NIHE cooperated with other related ministries and
    agencies to establish the preventive medicine
    system for the whole country which has helped
    Vietnam obtain a remarkable success in
    improvement of people health especially in the
    field of preventive health

48
Role of National Institute of Hygiene and
epidemiology
  • Mortality and morbidity rates due to communicable
    diseases which are NIHEs responsibilities have
    been reducing annually. Epidemics are combated
    relatively efficiently
  • Suffering from SARS epidemic as many other
    territories and countries of the world, Vietnam
    was the first country retaining the SARS
    outbreak. Despite of lacking necessary tools and
    equipments, NIHEs staff has detected SARS virus.
    This has clearly contributed to the success of
    Vietnam in containing the epidemic.

49
Role of National Institute of Hygiene and
epidemiology
  • As assigned by the MOH, NIHE has been responsible
    for implementing studies on virology,
    bacteriology and immunology, epidemiology and so
    on to prevent and control infectious diseases
    comprising circulating diseases, eliminated ones
    which tend to come back and also other emerging
    ones

50
Problem and barrier
  • the facilities are still poor some of them are
    outdated because of non-synchronized and
    inappropriate investment, unable to meet the
    working demands.
  • Some modern molecular biological techniques
    cannot be implemented yet in Vietnam because of
    lacking necessary equipments.

51
Problem and barrier
  • incapable of conducting profound studies on the
    viral nature and pathogenic mechanism as the
    biosafety place with accompanying essential
    facilities is not available
  • At the moment, NIHE still does not have a
    laboratory of standard biosafety (BSL 3) in order
    to work peacefully with hazardous microorganisms
    (group 4) such as anthrax, SARS avian influenza
    viruses, or another ...

52
Problems and barrier
  • due to the financial shortage, the training for
    NIHE staff appears to be spontaneous and
    part-time
  • To quickly master advanced technology in the
    field of medical biology, better meet the
    professional demand/ requirement such as
    providing timely reliable diagnostic tests
  • it is extremely important to train and enhance
    the research ability of the staff in developed
    countries with highly advanced science and
    technology

53
Proposals for activities
  • Reorganize and strengthen network for early
    detection, confirmative diagnosis and rapid
    intervention. Set up a National Reference and
    High Tech Center at NIHE in order to improve and
    reassure the quality of confirmative diagnosis.

54
Proposals for activities
  • Confirmative diagnosis
  • Confirmative diagnosis known as the
    re-confirmation of early detection is performed
    by the combination of epidemiological
    investigations, clinical consultation and
    higher-level laboratory test.

55
Proposals for possible collaborations
  • Being a country leading organization in the field
    of preventive medicine and public health, the
    National Institute of Hygiene and Epidemiology
    (NIHE) has been also responsible for providing
    graduate studies in public health, epidemiology,
    virology and bacteriology.

56
Proposals for possible collaborations
  • Currently NIHE would like to cooperate with 4
    Medical Universities, who has responsibility
    providing medical personals for Northern Region
    in order to enhance its training quality

57
possible collaborations
  • 1. Undergraduate study
  • to improve education quality by co organizing
    training programs, workshops, providing books and
    journals, educational materials, exchanging
    students and faculties in all specialties
    including bacteriology, virology, epidemiology
    and public health for undergraduate students,
    faculties at medical schools and health
    professionals as well.

58
possible collaborations
  • 2 Graduate study
  • In order to meet the need for health
    professionals in the fields of public health and
    preventive medicine for the national preventive
    medicine network as an assigned duty of NIHE,
    graduate study at NIHE in cooperation with
    medical schools will be enhanced by improving
    training quality for Ph.D. program and launching
    Master program.

59
possible collaborations
  • 3. Research
  • Enhancing close collaboration amongst NIHE,
    medical schools and Preventive Medicine Centers
    to carry out scientific researches, apply new
    techniques in field trials.

60
Surveillance system for communicable disease in
Vietnam
Ministry of health General dept. of preventive
medicine
61
THANK YOU FOR YOUR ATTENTION
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