Exploring Shigella vaccine priorities and preferences: Results from a mixed-methods study in low- and middle-income settings.

Background: Shigella is the leading bacterial cause of diarrheal mortality in children and can cause long-term effects on growth and development. No licensed Shigella vaccines currently exist but several promising candidates are in development and could be available in the next five years. Despite Shigella being a well-known public health target of the World Health Organization for decades, given current burden estimates and competing preventable disease priorities in low-income settings, whether the availability of an effective Shigella vaccine will lead to its prioritization and widespread introduction among countries at highest risk is unknown. Methods: We conducted a mixed-methods study of national stakeholders and healthcare providers in five countries in Asia and Africa and regional stakeholders in the Pan American Health Organization to identify preferences and priorities for forthcoming Shigella vaccines. Results: In our study of 89 individuals, diarrhea was the most frequently mentioned serious health concern for children under five years. Antimicrobial resistance (AMR) was more often considered very concerning than diarrhea or stunting. Shigella awareness was high but not considered a serious health concern by most stakeholders. Most participants were willing to consider adding a new vaccine to the routine immunization schedule but expressed reservations about a Shigella vaccine because of lower perceived burden relative to other preventable diseases and an already crowded schedule; interest was highest among national stakeholders in countries receiving more financial support for immunization. The priority of a Shigella vaccine rose when participants considered vaccine impacts on reducing stunting and AMR. Participants strongly preferred oral and combination vaccines compared to injectable and a single-antigen presentations, citing greater perceived community acceptability. Conclusions: This study provides a critical opportunity to hear directly from country and regional stakeholders about health priorities and preferences around new vaccines. These findings should inform ongoing Shigella vaccine development efforts and eventual vaccine introduction and implementation planning.

A case-control study of agricultural and behavioral factors associated with leptospirosis in Vietnam.

INTRODUCTION: Leptospirosis is a neglected disease in Vietnam. Until now, there has been limited knowledge about risk factors of this disease in Vietnam. The study was carried out to identify agricultural and behavioral factors associated with the transmission of leptospirosis in Vietnam. METHODS: This matched retrospective hospital-community-based case-control study was conducted from 1 October 2018 to 31 October 2019. We recruited cases from 11 selected government hospitals in three provinces of Vietnam, while controls were selected from the same communes of cases and matched by age (± 2 years) and sex. Microscopic agglutination test (MAT) and enzyme-linked immunosorbent assay (ELISA) were applied to determine confirmed cases, while only MAT was used to identify controls with a single high MAT titer < 1:100. RESULTS: 504 participants (252 cases and 252 controls) were identified. Cultivating (OR 2.83, CI 1.38-5.79), animal farming (OR 8.26, CI 2.24-30.52), pig owners (OR 10.48, CI 5.05-21.73), cat owners (OR 2.62, CI 1.49-4.61) and drinking unboiled water (OR 1.72, CI 1.14 -2.59, p = 0.010) were significantly associated with human leptospirosis in Vietnam. Hand washing after farming/ gardening (OR 0.57, CI 0.38-0.86, p = 0.007) and bathing after farming, gardening, contact with cattle and poultry (OR 0.33, CI 0.19-0.58, p = 0.000) were determined as protective factors for this disease. CONCLUSIONS: In short, the case-control study has revealed the risks in agricultural and animal practices and protective behavioral factors related to human leptospirosis in Vietnam. The findings suggested promotion of communication and health education programs targeting health behaviors in daily life and agricultural practices. Using personal protective equipment such as gowns, gloves, and boots during agricultural practices, especially cultivating and animal farming, is most recommended.

Characteristics of human leptospirosis in three different geographical and climatic zones of Vietnam: a hospital-based study.

BACKGROUND: To our knowledge, this study is the first report on the seroprevalence of human leptospirosis and its epidemiological profile in 3 different geographical and climatic zones of Vietnam. METHODOLOGY: A hospital-based surveillance in 11 public hospitals in 3 provinces in Vietnam enrolled 3,815 patients with suspected leptospirosis. Two consecutive enzyme-linked immunosorbent assay IgM and a single microscopic aggregation test were applied at a 1:100 to 1:800 dilution for probable or confirmed cases. RESULTS: The findings showed that of the 3,815 suspected cases, 68 (1.8%) were Leptospira-confirmed and 248 (6.5%) probable cases, whereas more than a third were positive for acute ELISA-IgM sera. Furthermore, 20 different serovars were found, of which Wolffi (14.2%), Hebdomadis (13.8%), and Icterohaemorrhagiae (12.6%) were the most predominant. The ratio of probable and confirmed cases of leptospirosis between females and males was 1.4:1, and their clinical manifestation was not specific. Cases were more likely to be detected in groups that are farmers, pet raising or livestock farming, of working age, practicing either wading in mud or walking barefoot, or exposed to heavy rainfall. CONCLUSIONS: Analysis of human leptospirosis has indicated fairly high seroprevalence and diversity of Leptospira serovars circulating in all studied geographical zones in Vietnam. The findings suggest an imperative need for effective measures of disease prevention, especially in high-risk groups.

Investigation of SARS-CoV-2 presence on environmental surfaces and waste in healthcare and non-healthcare facilities.

Objective: The objective of the paper is to investigate the presence of SARS-CoV-2 on inanimate surfaces in four healthcare facilities treating patients with COVID-19 and four quarantine regiments of provincial military commands. Methods: From August to October 2020, a total of 468 one-off environmental samples consisting of inanimate surfaces, garbage, and wastewater were collected. The real-time RT-PCR assay targeting E and RdRp genes to detect SARS-CoV-2 and checklist and questionnaire of disinfection practices were employed. If detected by RT-PCR, then positive samples are subjected to cell culture to determine viability. Results: The test results showed all samples (100%) to be negative with SARS-CoV-2 resulting in unperformed virus culture. As for recent disinfection practices, chlorine-based products dissolved at a concentration of 0.1% (1000 ppm) in the general context or 0.5% (5000 ppm) for blood and body fluid spills are routinely applied twice a day and at the discharge of patients or quarantined people. Conclusions: The finding may illustrate the importance of disinfection practices in removing pathogens or significantly reducing SARS-CoV-2 contamination on environmental surfaces and waste.

Leptospira infection among human-close-contact animals in different geographical areas in Vietnam.

Leptospirosis is a neglected disease in Vietnam. Only a few studies have evaluated the status of Leptospira infection in both humans and animals. To our knowledge, this is the first serological survey of Leptospira in both domestic and wild animals, which may act as reservoirs of this agent. This study aimed to evaluate the seroprevalence of Leptospira in animals that are in close contact with humans in different geographical areas in Vietnam. Sera were collected from 1205 individual animals of six species, including buffaloes, cattle, cats, dogs, swine, and rats. The microscopic agglutination test (MAT) against 25 serovars of Leptospira spp. has been employed to detect serovars of Leptospira among the studied population. Overall, 44.2% of buffaloes, 24.9% of cattle, 10.2% of swine, 32.9% of dogs, 12.2% of cats, and 16% of rats were seropositive. A total of 17 different serovars were detected, of which serovars Hebdomadis and Canicola circulated in all the studied animal species. Variability of the predominant serovars circulating in animal species and in different geographical areas of Vietnam has been noted. We conclude that this study showed a high prevalence of Leptospira circulating in animals that are in close contact with humans, raising an alert of the important sources of pathogenic leptospires transmission to humans in Vietnam. These findings prove an imperative need for effective measures for disease prevention.

Community knowledge, attitudes, and practices toward rabies prevention in North Vietnam.

In recent years, despite the accessibility to vaccines (both for humans and animals), rabies remains a problem in many areas of Vietnam. While the number of rabies deaths decreased by 90% from 1994 to 2003, the number of rabies deaths increased from 2004 to 2007. In 2007, the number of rabies victims was 2-3 times higher than in 2003 and 131 people died as a result of rabies. In order to better understand Knowledge, Attitudes, and Practices (KAP) toward rabies in areas of both high and low incidence of rabies mortality in Vietnam, and KAP between pet and non-pet owners, a cross-sectional study was carried out by administering a structured questionnaire to 585 respondents from selected households in Thanh Son District-Phu Tho Province and Viet Yen District-Bac Giang Province, Vietnam. KAP in both high and low incidence areas, especially in groups with pets, need to be improved, particularly regarding treatment practices after a dog-bite and recommended pet care. We recommend not only enhanced IEC activities, but also the development of a Behavior Change Communication Strategy (BCC).