Economic burden of multidrug-resistant tuberculosis: a multicenter study across Vietnamese regions.

SETTING: Multidrug-resistant tuberculosis (MDR-TB) has become a major worldwide health problem. Various studies have been conducted on the cost of MDR-TB treatment; however, this has remained largely unexplored in Viet Nam. OBJECTIVE: To estimate the total cost of MDR-TB treatment at several health care facilities in Viet Nam. DESIGN: A prospective, prevalence-based study was conducted at three selected centers from March to June 2016 in 204 patients, 102 of whom were treated for 9 months and 102 for 20 months. Direct medical costs were calculated using electronic hospital databases, while a questionnaire was used to interview participants for evaluating direct non-medical and indirect costs. Total costs were estimated from a societal perspective in 2017 USD. RESULTS: Patients were mostly males aged 25-44 years. The average length of hospitalization in the 9-month treatment group was 168 ± 127 days; in the 20-month group, it was 671 ± 119 days. The average treatment cost for MDR-TB was respectively US$1480.34 ± 211.61 and US$2695.58 ± 294.98 for the 9- and 20-month treatment groups. Direct medical costs generally accounted for the highest proportion of the total costs, while the cost of pharmaceuticals and materials comprised the highest direct cost. CONCLUSION: There was a significant difference in total costs among the three hospitals in the 9- and 20-month treatment groups.

Management and treatment outcomes of patients enrolled in MDR-TB treatment in Viet Nam.

SETTING: The programmatic management of drug-resistant tuberculosis (TB) in Viet Nam has been rapidly scaled up since 2009. OBJECTIVES: To document the annual numbers of patients enrolled for multidrug-resistant tuberculosis (MDR-TB) treatment during 2010-2014 and to determine characteristics and treatment outcomes of patients initiating treatment during 2010-2012. DESIGN: A retrospective cohort study using national reports and data from the national electronic data system for drug-resistant TB. RESULTS: The number of patients enrolled annually for MDR-TB treatment increased from 97 in 2010 to 1522 in 2014. The majority of patients were middle-aged men who had pulmonary disease and had failed a retreatment regimen; 77% had received ⩾2 courses of TB treatment. Favourable outcomes (cured and treatment completed) were attained in 73% of patients. Unfavourable outcomes included loss to follow-up (12.5%), death (8%) and failure (6.3%). Having had ⩾2 previous treatment courses and being human immunodeficiency virus-positive were associated with unfavourable outcomes. CONCLUSION: Increasing numbers of patients are being treated for MDR-TB each year with good treatment outcomes under national programme management in Viet Nam. However, there is a need to increase case detection-currently at 30% of the estimated 5100 MDR-TB cases per year, reduce adverse outcomes and improve monitoring and evaluation.

Contexte : La prise en charge de la tuberculose (TB) pharmacorésistante au Viet Nam a bénéficié d'une accélération considérable depuis 2009.Objectifs : Documenter le nombre annuel de patients enrôlés pour un traitement de TB multirésistante (TB-MDR) entre 2010 et 2014, et déterminer les caractéristiques et les résultats du traitement des patients qui l'out commencé entre 2010 et 2012.Schéma : Etude rétrospective de cohorte basée sur les rapports nationaux et les données du système national de données électroniques pour la TB pharmacorésistante.Résultats : Le nombre de patients enrôlés chaque année pour traitement de TB-MDR a augmenté de 97 en 2010 à 1522 en 2014. La majorité des patients étaient des hommes d'âge moyen qui avaient une atteinte pulmonaire et chez qui un protocole de retraitement avait échoué ; 77% d'entre eux avaient reçu au moins deux traitements de TB. De bons résultats (guérison et achèvement du traitement) ont été obtenus chez 73% des patients. Les résultats défavorables incluaient les sujets perdus de vue (12,5%), les décès (8%) et les échecs (6,3%). Avoir eu plus de deux traitements préalables et être positif pour le virus de l'immunodéficience humaine étaient associés à des résultats défavorables.Conclusion : Un nombre croissant de patients est traité pour TB-MDR chaque année dans le cadre du programme national de prise en charge au Viet Nam, avec de bons résultats. Cependant, il est nécessaire d'augmenter la détection des cas (actuellement seulement 30% des 5100 cas de TB-MDR estimés par an), de réduire la proportion de résultats défavorables et d'améliorer le suivi et l'évaluation.

Marco de referencia: Desde el 2009, se ha ampliado rápidamente la escala del tratamiento de la tuberculosis (TB) farmacorresistente en el marco del programa nacional de Viet Nam.Objetivos: Documentar el número de pacientes inscritos cada año en el tratamiento de la TB multidrogorresistente (TB-MDR) del 2010 al 2014 y determinar los desenlaces terapéuticos y sus características en los pacientes que iniciaron tratamiento del 2010 al 2012.Método: Fue este un estudio retrospectivo de cohortes a partir de los registros y los datos del sistema electrónico nacional de datos sobre la TB farmacorresistente.Resultados: El número de pacientes incorporados cada año al tratamiento de la TB-MDR aumentó de 97 en el 2010 a 1522 en el 2014. En su mayoría, se trató de hombres de mediana edad con afectación pulmonar, en quienes había fracasado una pauta de retratamiento y de los cuales el 77% había recibido dos o más ciclos de tratamiento antituberculoso. El 73% de pacientes alcanzó desenlaces favorables (curación y compleción del tratamiento). Los desenlaces desfavorables observados fueron la pérdida durante el seguimiento (12,5%), la muerte (8%) y el fracaso terapéutico (6,3%). El hecho de haber recibido dos o más ciclos de tratamiento antituberculoso y la positividad frente al virus de la inmunodeficiencia humana se asociaron con los desenlaces desfavorables.Conclusión: Cada año, un mayor número de pacientes recibe tratamiento por TB-MDR en el marco del programa nacional contra la TB y alcanza desenlaces terapéuticos favorables en Viet Nam. Sin embargo, es preciso aumentar la detección de casos (que alcanza actualmente el 30% de los 5100 casos estimados de TB-MDR por año), disminuir los desenlaces desfavorables y mejorar el seguimiento y la evaluación.

Field trial of a locally produced, killed, oral cholera vaccine in Vietnam.

BACKGROUND: Several studies have shown that orally administered killed cholera vaccines are safe and protective in populations at risk of cholera in developing countries. However, these vaccines have not been adopted for use in developing countries because of their expense and limited efficacy in young children. We have tested an inexpensive, killed whole-cell cholera vaccine developed and produced in Vietnam. METHODS: The efficacy of the vaccine was assessed in a large-scale, open field trial in people at least 1 year old residing in 22,653 households in the central coastal city of Hue. Alternate households were assigned vaccine (67,395 people; two doses per person) or no vaccine (67,058 people). Surveillance for cholera was conducted in all Ministry of Health facilities serving this population. Analysis was by intention to treat. FINDINGS: During an outbreak of El Tor cholera 8-10 months after vaccination, 37 cases of cholera requiring inpatient care occurred among age-eligible people allocated to the vaccine group, and 92 cases among age-eligible people allocated to the no-vaccine group (protective impact 60% [95% CI 40-73]). Among the 51,975 people who received the complete two-dose vaccine regimen, the protective efficacy was 66% (46-79): in this subset, the protective efficacy was similar for children aged 1-5 years (68%) and for older people (66%). INTERPRETATION: These findings suggest that oral killed whole-cell vaccines can confer substantial protection against El Tor cholera in young children, who are at highest risk of cholera in endemic settings. An inexpensive, locally produced, and effective oral cholera vaccine may be within reach of the limited health-care budgets of poor countries with endemic cholera, if our findings can be replicated in a randomised double-blind trial.

PIP: Vibrio cholera 01, El Tor biotype, entered Vietnam in 1964 and during 1990-94 an average of 3240 cases were reported annually with a case-fatality rate of about 1%. The efficacy of an inexpensive, killed whole-cell cholera vaccine developed in Vietnam was assessed in a large-scale, open field trial in the city of Hue. The vaccine contained V. cholera 01 constituents: heat-killed V. cholera Inaba, heat-killed V. cholera Ogawa, and formalin-killed V. cholera Inaba. All 134,453 residents, aged 1 year or older, of 22,653 households in 19 communes were eligible to take part in the trial. Alternate households were assigned vaccine (67,395 people; 77% received 2 doses per person) or no vaccine (67,058 people serving as controls) during December 1992 and January 1993 by 80 vaccination teams. Following the vaccination no cases of cholera were detected until late August 1993. Between August 20 and October 4, 1993, there were 129 cases of cholera requiring inpatient care among age-eligible participants. The isolates were 01 serogroup and Ogawa serotype. There were 37 cases of cholera in the vaccine group and 92 cases in the control group. The risk of cholera was 0.5/1000 and 1.4/1000, respectively. The protective impact was 60% (95% confidence interval [CI] 40-73; p 0.001). Among 51,975 recipients of 2 vaccine doses the protective efficacy was 66% (CI 46-79; p 0.001). The protective efficacy was similar for children 1-5 years old (68%) and for older people (66%). The protective efficacy was somewhat higher among the vaccinated living in homes with unclean water sources (74% vs. 62%). The protective efficacy was also higher against severe than against non-severe cholera (76% vs. 58%). Oral killed whole-cell vaccines can protect against El Tor type cholera in children who are highest risk. The government has lately added a killed V. cholera 0139 strain to the existing formulation. Phase 2 tests of safety are under way, and a large-scale, randomized, double-blind field trial will start in 1997.

Persistent diarrhea in Vietnamese children: a preliminary report.

The clinical and laboratory features of persistent diarrhea were investigated in 83 children under three years of age who were treated in the Gastroenterology Division of the Institute for the Protection of Children's Health, Hanoi from August 1988 to August 1989. The number of cases of diarrhea was highest in the children aged 4-5 months. The mean age of the children studied was 6.6 +/- 3.4 months. The ratio of males to females was 2.6 and mean age of first episode of diarrhea was 4.3 +/- 3.4 months; persistent diarrhea was more common in children under six months of age than in older children. Persistent diarrhea occurred in the first diarrheal episode in 66.5% of cases. Recent nonenteric infections were found in 30% of the study group. Of the 83 children studied, 36% had stool specimens positive for enteric pathogens; 24% had enterotoxigenic Escherichia coli isolated, 8% had enteropathogenic E. coli, 5% rotavirus, 6% Candida, and 4% Giardia lamblia. The duration of diarrhea was longer in children who received antibiotics than in those who did not (p < 0.01).

Persistent diarrhea in Vietnamese children: a preliminary report.

The clinical and laboratory features of persistent diarrhea were investigated in 83 children under 3 years of age who were treated in the Gastroenterology Division of the Institute for the Protection of Children's Health, Hanoi, from August 1988 to August 1989. The number of cases of diarrhea was highest in the children aged 4-5 months. The mean age of the children studies was 6.6 +or- 3.4 months. The ratio of males to females was 2.6 and mean age of 1st episode of diarrhea was 4.3 +or- 3.4 months; persistent diarrhea was more common in children under 6 months of age than in older children. Persistent diarrhea occurred in the 1st diarrheal episode in 66.5% of cases. Recent nonenteric infections were found in 30% of the study group. Of the 83 children studies, 36% had stool specimens positive for enteric pathogens; 24% had enterotoxigenic Escherichia coli isolated, 8% had enteropathogenic E. coli, 5% rotavirus, 6% Candida, and 4% Giardia lamblia. The duration of diarrhea was longer in children who received antibiotics than in those who did not (p 0.01).

Determination of Haemophilus influenzae and Haemophilus parainfluenzae susceptibility to ampicillin and other antibiotics.

A sample comprising 40 H. influenzae and 74 H. parainfluenzae strains was used to verify methods for determining susceptibility to antibiotics. Modified Levinthal agar proved to be suitable for the agar dilution and agar diffusion method, while brain heart infusion with the thermally released components of sheep blood (X and V factor) and lysed horse blood performed well in the dilution micromethod. The iodometric method served well for beta-lactamase production. A substantial proportion of strains was resistant to penicillin, erythromycin, roxitromycin and sulfamethoxazole. Ampicillin susceptibility was of crucial importance. Resistance was largely due to beta-lactamase production. Since there are ampicillin-resistant strains which fail to produce beta-lactamase, it is necessary either to determine the MIC value or use a disk with 2 micrograms ampicillin. A disk containing 10 micrograms ampicillin may yield a false positive result.