After-action reviews for emergency preparedness and response to infectious disease outbreaks

@#After-action reviews (AARs) are a qualitative evaluation methodology conducted after a public health event recommended by the World Health Organization. Of 86 screened articles, we identified eight using AARs to evaluate public health responses to infectious disease outbreaks. Our findings suggested the toolkit is suitable to evaluate responses to infectious disease outbreaks but needs to be adapted for use in particular settings.

Re-positive testing, clinical evolution and clearance of infection: results from COVID-19 cases in isolation in Viet Nam

Objectives@#Asymptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and test re-positivity after a negative test have raised concerns about the ability to effectively control the coronavirus disease 2019 (COVID-19) pandemic. We aimed to investigate the prevalence of COVID-19 asymptomatic and pre-symptomatic infections during the second wave of COVID-19 in Viet Nam, and to better understand the duration of SARS-CoV-2 infection and the dynamics between the evolution of clinical symptoms and SARS-CoV-2 test positivity among confirmed COVID-19 cases.@*Methods@#We conducted a cohort analysis on the first 50 confirmed cases during the second COVID-19 wave in Viet Nam using clinical, laboratory and epidemiological data collected from 9 March to 30 April 2020. Kaplan-Meier estimates were used to assess time to clearance of SARS-CoV-2 infection, and log-rank tests were used to explore factors related to time to SARS-CoV-2 infection clearance.@*Results@#Most cases (58%) had no typical signs or symptoms of COVID-19 at the time of diagnosis. Ten cases (20%) were re-positive for SARS-CoV-2 during infection. Eight cases (16%) experienced COVID-19 symptoms after testing negative for SARS-CoV-2. The median duration from symptom onset until clearance of infection was 14 days (range: 6–31); it was longer in re-positive and older patients and those with pre-existing conditions.@*Conclusion@#Asymptomatic and pre-symptomatic infections were common during the second wave of COVID-19 in Viet Nam. Re-positivity was frequent during hospitalization and led to a long duration of SARS-CoV-2 infection.

The first 100 days of SARS-CoV-2 control in Vietnam

BackgroundOne hundred days after SARS-CoV-2 was first reported in Vietnam on January 23rd, 270 cases have been confirmed, with no deaths. We describe the control measures used by the Government and their relationship with imported and domestically-acquired case numbers, with the aim of identifying the measures associated with successful SARS-CoV-2 control. MethodsClinical and demographic data on the first 270 SARS-CoV-2 infected cases and the timing and nature of Government control measures, including numbers of tests and quarantined individuals, were captured by Vietnams National Steering Committee for COVID-19 response. Apple and Google mobility data provided proxies for population movement. Serial intervals were calculated from 33 infector-infectee pairs and used to estimate the proportion of pre-symptomatic transmission events and time-varying reproduction numbers. FindingsAfter the first confirmed case on January 23rd, the Vietnamese Government initiated mass communications measures, case-contact tracing, mandatory 14-day quarantine, school and university closures, and progressive flight restrictions. A national lockdown was implemented between April 1st and 22nd. Around 200 000 people were quarantined and 266 122 RT-PCR tests conducted. Population mobility decreased progressively before lockdown. 60% (163/270) of cases were imported; 43% (89/208) of resolved infections remained asymptomatic for the duration of infection. 21 developed severe disease, with no deaths. The serial interval was 3.24 days, and 27.5% (95% confidence interval, 15.7%-40.0%) of transmissions occurred pre-symptomatically. Limited transmission amounted to a maximum reproduction number of 1.15 (95% confidence interval, 0.37-2.36). No community transmission has been detected since April 15th. InterpretationVietnam has controlled SARS-CoV-2 spread through the early introduction of mass communication, meticulous contact-tracing with strict quarantine, and international travel restrictions. The value of these interventions is supported by the high proportion of asymptomatic and imported cases, and evidence for substantial pre-symptomatic transmission. FundingThe Vietnam Ministry of Health and Wellcome Trust, UK. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSVietnam was one of the first countries outside of China to detect imported and human-to-human transmitted SARS-CoV-2 within its borders. Yet, as of May 1st, a total of only 270 cases have been confirmed, no deaths have occurred, and no community transmission has been detected since April 15th despite intensive screening, tracing and testing. We did a PubMed database search to identify studies investigating COVID-19 response in Vietnam using the terms "Vietnam", "COVID-19", and "SARS-CoV-2". All relevant articles were evaluated. Studies describe cases of COVID-19 and their management, aspects of the government response from newspapers and online government sources, but there are no previous reports using national data to describe and investigate the national epidemic and the impact of control measures cases over time. Added value of this studyWe used data from the National Steering Committee for COVID-19 response to give a comprehensive account of the first 100 days of the SARS-CoV-2 epidemic in Vietnam, including case numbers and their symptomatology, the estimated reproductive number by week, and their relation to the multiple control measures instituted by the Vietnam Government over time. We show two distinctive features of Vietnams response. First, the Government took rapid actions to restrict international flights, closed schools and universities, and instituted meticulous case-contact tracing and quarantining from late January, well before these measures were advised by WHO. Second, they placed mass communication, education, and the identification, serial testing, and 14-day quarantine of all direct contacts of cases, regardless of symptom development, at the heart of the response. The value of strict contact-tracing and quarantine is supported by the high proportion of asymptomatic cases (43%) and imported cases (60%), and evidence for substantial pre-symptomatic transmission. Implications of all the available evidenceVietnam has had remarkable success in controlling the emergence of SARS-CoV-2. Our report provides a complete picture of the control of SARS-CoV-2 in Vietnam, with lessons for other Governments seeking to extend national SARS-CoV-2 control or prevent future epidemics. Our findings shows the importance of acting early, before the virus becomes established in the community, and before the case numbers overwhelm systems of case-contact tracing and mass quarantine. They also demonstrate the value of effective mass communication in rapidly educating the public in infection prevention measures and providing real-time information on the state of the epidemic.

Antimicrobial resistance and serotype distribution of streptococcus pneumonia isolates among children under 5 years of age, Hai Phong city, Viet Nam, during the period of 2006- 2007

Background: Streptococcus pneumonia (S.pneumoniae) is the main cause of acquired pneumonia in the community along with otitis media, sinusitis, septicemia and meningitis. Objectives: The study determined antimicrobial resistance and serotype distribution of Streptococcus pneumonia isolates from hospitalized children at Hai Phong Children's Hospital, Vietnam. Subjects and method: From June 2006 to September 2007, 80 pneumococccal isolates were tested for susceptibility to the 13 antibiotics and 84 pneumococcal isolates were serotyped. Results:Seventy-five percent of strains showed multi-drug resistance. Ninety percent of strains showed resistance to penicillin (48% intermediate and 42% fully resistant). In addition, 100% of isolates were resistant to cotrimoxazole, 74% of isolates were resistant to cephalexin; 71 % of isolates were resistant to erythroomycin and 58% were resistant to cefuroxxime. Almost all the isolates were susceptible to amoxicillin, cefotaxime, ceftriaxone, ceefepime, ofloxacin and 100% of isolates were susceptible to vancomycin. Among the 84 serotypes, 82% were included in the 23 valent pneumococcal polysaccharide vaccine including: 19F (30%), 23F (21 %), 14 (13%) and 6B (13%). Six other serotypes (13, 15C, 18, 11A, 15B and 6A) accounted for 12% of strains and 9 (11%) strains were untypeable. Conclusion: Pneumococcal antibiotics is spreading most rapidly among children in Vietnam, especially strains typs 19F and 23 F. Concerted efforts are necessary to prevent it spreading.\r\n", u'\r\n', u'

Evaluation of prevention effectiveness of intracranial hemorrhage with vitamin K injection for newborns

Background: Intracranial hemorrhage (lCH) is a common disease with high rate of mortality and neurological sequel. Objectives:to estimate preventive effectiveness of intracranial hemorrhage by vitamin K1 and K3 for newborns just after birth". Subjects and methods: An epidemiological, randomized control study with intervention was conducted. The study included all children under 3 months with and without ICH during period 1/1/2000 -30/6/2004 living in Hatay province. Among them all the newborns during period 1/6/2002 - 30/6/2004 were injected either 1 mg vitamin K1 or K3. Results: Children injected with vitamin K in the intervention period were followed up in three months and evaluated by a united process. Effects of intervention were calculated by preventive value. 62.057/82069 newborns were injected vitamin K1 or Vitamin K3 (25.725 newborns were injected Vitamin K1; 36.332 newborns were injected vitamin K3). Single dose 1M reduced the rate of ICH in infants: The morbidity changed from 3.3\ufffd?to 0.82\ufffd? the prevention value was 96%. There were no complications and side effects of vitamin K injections reported. Conclusions: Injection of vitamin K1 and K3 have similar preventive effectiveness. Vitamin K injection 1M with recommended dose was safe for newborns.\r\n', u' \r\n', u'\r\n', u'

Characteristics of the antibiotic resistance gene of S.pneumoniae isolated from nasopharyngeal swab of the pneumonia patients in Ha Noi

Background: Acute lower respiratory tract infection, mainly pneumonia, were the main reasons cause death for children under 5 years old. Objectives: Determine the isolated rate of bacteria inpatients under 5 years old with acute lower respiratory tract infection in Ha Noi and antibiotic resistance of pneumococcal isolated form patients. Subjects and method: Patients under 5 years old with acute lower respiratory tract infection in National hospital of pediatrics and Bach Mai hospital from 01/2002. Using quantitative culturedand PCR method. Results: Out of total 164 patients with lower respiratory tract infection, there were 91 diagnosed pneumonia by chest X-ray, 73 cases of acute bronchitis. 73,6% of the pneumococcal isolated were penicillin resistance (gPRSP) with different genes such as pbp 1a+2x+ab. Most of the S.pneumoniae strains were serotype 19F or 23F. There were no statistic differences by comparison charactersistics of weight, vessel, subclinical symptoms such as: dissolved oxygen level (S\xac\xacp\xac\xac\xac\xacO\xac2\xac), the amount of leucocyte in blood. However, temperature of pneumonia patients was higher than bronchitis patients, breathing of pneumonia patients was also faster than bronchitis patients. Isolated bacteria with amount \ufffd?106 cfu/ml was H.influenzae, S.pneumoniae and Moraxell catarrhalis in pneumonia group, bronchitis group was 28,8% and control group was 17,1%. Conclusion: Penicillin, erythoromycin and co-trimoxazole resistance rate of S.pneumoniaein patients with acute lower respiratory tract infection was high. Quantitative cultured method has prognostic value in diagnosis pneumonia.

Splenectomy in children

Spleen plays important functions in the body. There were many indications for splenectomy, including spleen traumas, splenorenal shunt, vascular accident due to the spleen, splenic cyst, splenomegaly compressing other organs, congenital hemolytic anemia, acquired immunohematological diseases, hypersplenism leading to the peripheral blood cell deficiency. The major risk after splenectomy was severe infection. The hypersplenism was improved after splenectomy.

Anemia related with hemoglobin diseases in Thai children in Lao Cai

Totally 179 children aged from 6 months to 15 years from 2 villages Taja and Na Cang, Than Uyen district, Lao Cai province was investigated clinically and hematologically. Among them, 99 were boys and 80 girls. The results show that prevalance of anemia among these children was as high as 49.7%. 50 anemic from children 89 had hemoglobin disorder. All children with moderate and severe anemia had hemoglobin-diseases. From the result above we suggest that thalassemia and HbE are serious cause for anemia in children from the region. It is nesecery to establish the thalassemia prevention programme for this region.

Beta-thalassemia

The rate of general population carries the gene of Beta-thalassemia in some countries was high such as North of Italia (20%), Sardinia (11-34%), and Cyprus (5-15%). The frequency of gene carrier of Beta-thalassemia was quite common such as Laos (9.6%), Thailand (6%), and South of China and Cambodia. This rate in Kinh Nation of Vietnam was 1.5-2% higher than other minorities. It was estimated that there were 1.17-1.56 millions of Vietnamese who carry the gene of Beta-thalassemia.