Vietnam Summary Outbreak: Actions Speak Louder Than Words

It lasted 7 days. The number of suspected cases went from 2 to 33. In the end, 2 were confirmed, no evidence of human-to-human transmission, no explanation of what exactly ailed the 33 people......and life went on.

In this summary, you will see excerpts from a Document entitled Avian and Pandemic Influenza: Vietnam's Experience
Underneath the excerpts, you will see the actual text in blue as it appeared in the local news articles.

I believe the actions were that of an outbreak of H5N1. The truth, we will never know.

First, a brief summary of events:

8th: Medical Center of Cho Moi district has received nine cases have manifested as fever, cough, shortness of breath. 5 family members.

http://www.flutrackers.com/forum/showpost.php?p=350746&postcount=1

9^th: District Health Centers had 21 people on Tamiflu. Cho Moi district health was granted 700 doses of Tamiflu [http://www.flutrackers.com/forum/showpost.php?p=351222&postcount=49]

13^th: Cho Moi district hospital discharges 8 people after 1 week of treatment. Tested 3 times. Health status going well, no cough, fever, difficulty breathing.

Particularly the case of Nguyen Thi Thanh Thu patients - patients who have tested positive for influenza A (H5N1), was tested through the 2nd and 3rd have tested negative for influenza A (H5N1) . Currently the patient is being continued monitoring and treatment in the future. http://www.flutrackers.com/forum/showpost.php?p=351271&postcount=51

13^th: H5N1 rages on in Cho Moi: To combat bird flu spread out wide, up to this point, Cho Moi district has set up four checkpoints in the route out to the outbreak, destroying more than 5,200 birds, spraying chemical disinfection identical in six communes disinfection, vaccination for nearly 22 thousand birds in the vicinity. http://www.flutrackers.com/forum/showpost.php?p=351282&postcount=54

13^th: He said the 11 others, some of whom were relatives of the confirmed cases, had fallen ill with fever, coughing and shortness of breath. They were given the antiviral Tamiflu and have since recovered. He said they were tested for bird flu, but the results have not come back. http://www.flutrackers.com/forum/showpost.php?p=351304&postcount=56

14^th: At the meeting of the National Steering Committee against pandemic influenza in the afternoon 14 / 4 at the Ministry of Health… According to two reports of working groups of the Institute in Bac Kan, two patients at about 100 meters apart but there is no direct contact with each other. 33 people have contact with patients on two samples have been tested and are negative for influenza A/H5N1. 2 patients were exposed to bird flu alone. http://www.flutrackers.com/forum/showpost.php?p=351489&postcount=71

Now for the Summary:

Supporting treatment facilities include district hospitals and health centers, and commune health stations. District-level facilities receive, isolate and treat pandemic influenza patients with mild or moderate illness; provide direction and support, and conduct training courses in the community; and, cooperate in setting up level I field hospitals if required.
Commune health stations are responsible for the early identification of suspected cases of influenza in communities, the temporary isolation and then referral of patients to higher level hospitals, and the implementation of influenza prevention and control measures in cooperation with higher level hospitals and preventive health units.
In addition, when directed by the National Steering Committee on Human Influenza Pandemic Prevention and Control, commune health stations are also responsible for receiving and monitoring (home-based) influenza patients when all hospitals are overloaded.
After the patient Chu Van Hoa, 22, residing in rural Cao Na (as) - first patient, have tested positive for influenza A (H5N1) Steering Committee for prevention of respiratory infections acute health sector virus Bac Kan, Cho Moi district has directed the professional sector, in particular the district health center inspection organization, to the list of people who have had contact with patients and poultry and aquatic birds sick. Simultaneous deployment of medical examination and treatment in time for the cases show signs of fever, cough, shortness of breath in the locality. Up to date 8 / 4, the district health center has received nine more cases have manifested as fever, cough, shortness of breath. Of these 8 patients are residing in villages Na Tao, a patient residing in Yen Dinh. Cases of patients with Luc Van Ha (Yen Ting), hospitalized in a state of fever, cough, dyspnea and diarrhea.

Comrade Liu Xuan Hoa, deputy director of the district health center, said: "Immediately after Chu Van Hoa patients admitted to hospital, district health centers were examined, timely treatment for cases of cough , fever, difficulty breathing, the presence of influenza A (H5N1). Of the 21 cases the presence of HPAI was taking Taminflu there were 14 cases of stable health, the rest are cases where continued therapy at the Center.

Mobile response teams in provincial and district preventive medicine units have been established to carry out outbreak containment and situation monitoring 24 hours a day.

Related to the treatment of influenza A/H5N1 epidemic, he said Khue, Health Administration has asked the hospital last line of influenza treatment systems should be ready to receive the treatment of severe cases and difficult to treat, and support facilities on the lower level of health prevention services.

Accordingly, the receive and treat patients and the average online by the hospital treating influenza primarily in charge of the system.

Private line extensions and treatment system in place in the treatment of influenza, will take on the detection of suspected cases in the community to guide and coordinate, online social support in surveillance, treatment and fight against epidemic. Currently avian appear scattered in several provinces. http://www.flutrackers.com/forum/showpost.php?p=351127&postcount=41

MoH has reviewed and directed the logistical preparation of institutions in its hierarchy and at other locales for establishing, maintaining, and distributing stockpiles of equipment,supplies, medications, chemicals and biologicals for outbreak investigation, surveillance and containment, and for the testing, diagnosis, emergency care, treatment and transportation of patients. Mr. Tran Trung Kien, Deputy Chairman of the DPC, Head PSC flu A (H5N1) in poultry, said: "Before complicated by flu A (H5N1) in poultry, Cho Moi district has directed handling and destruction of the outbreak and conduct disinfection spray. Besides boosting the district is also activity and propaganda for the people to understand, since the initiative for prevention, avoid mental confusion, reduced subjective ideas about the epidemic of influenza A (H5N1) in people; to mobilize people to monitor, detect and alert authorities when timely handling sick poultry is manifested strengthen examine the purchase, sale and transportation of poultry and aquatic birds to limit to the extent lowest state of widespread epidemic. http://www.flutrackers.com/forum/showpost.php?p=351123&postcount=40

Strengthening supervision cases first infected with influenza A (H5N1) in treatment at all levels, from the commune health centers to district hospitals, provincial general hospital. In the process of receiving, diagnosing and treating patients must strictly comply with the guidance in the Decision on 19.08.2008 30/2008/QD-BYT guiding the diagnosis, treatment and prevention of flu A (H5N1) in humans;

Medical Center of Cho Moi district has received nine cases have manifested as fever, cough, difficulty breathing, Deputy Director Medical Center of Cho Moi Liu Xuan Hoa said: "Even after Chu Van Hoa patients admitted to hospital, district health centers were examined, timely treatment for cases of cough, fever, difficulty breathing, the presence of influenza A (H5N1).Of the 21 cases the presence of flu have been taking Taminflu there were 14 cases of stable health, the remaining cases is continuing treatment at the Medical Center district.

Vietnam has four regional reference laboratories, three are rated as biosafety level (BSL) 2+ and one has a BSL3 designation. Two of the laboratories have been designated by WHO as National Influenza Centres and as H5N1 reference facilities. In response to the pandemic, 22 National Institutes, 8 referral hospitals and 32 preventive medicine centres were certified to perform PCR testing for Influenza A(H1N1). Much of this increased capacity was established as a result of the emergence of avian influenza; as a consequence, case confirmation can usually occur within 24-48 hours.

Female patients, 02 years old Address: Nà Tào, village Nhu Co, district Cho Moi, Bac Kan. Onset of disease manifestation on 02/4/2010 with 40 0 C high fever, cough, sore throat, runny nose. On 04/4/2010 patients the home were taken to hospital treatment Cho Moi district.

On 07/4/2010, Institute of Hygiene and Epidemiology answer test results positive for influenza virus A (H5).
http://pandemicinformationnews.blogspot.com/2010/04/vietnam-ministry-of-health-website.html">

April 13
He said the 11 others, some of whom were relatives of the confirmed cases, had fallen ill with fever, coughing and shortness of breath. They were given the antiviral Tamiflu and have since recovered. He said they were tested for bird flu, but the results have not come back.
http://pandemicinformationnews.blogspot.com/2010/04/vietnam-confirms-2-bird-flu-cases-11.html
Also, on April 13^th…
“So far eight people have symptoms of cough, sore throat, fever, treated at health centers and from Cho Moi has returned home.”
http://pandemicinformationnews.blogspot.com/2010/04/announced-bird-flu-outbreaks-tuesday-in.html

April 13:
“After 1 week of treatment on 12 / 4 has 8 patient discharge. Through treatment with 3 tests, the patients have tested negative for influenza A (H5N1), health status going well, no doubt the expression as: cough, fever, difficulty breathing .”

There clearly was a problem in the poultry…
“On 8 / 4, Department of Animal Health says it has bird flu appeared in two provinces of Quang Ninh and Bac Kan, Thai Binh province also appeared on the blue ear pig.
Specifically, in Bac Kan province on 19 / 3 as of 04/06/2010, avian influenza has occurred in 16 rural farming households in Cao Na, As Stock commune, Phu Luong district. Total number of poultry deaths and destruction in the 318 households on a child.”
http://pandemicinformationnews.blogspot.com/2010/04/avian-flu-occurs-in-quang-ninh-and-bac.html

MoH has reviewed and directed the logistical preparation of institutions in its hierarchy and at other locales for establishing, maintaining, and distributing stockpiles of equipment, supplies, medications, chemicals and biologicals for outbreak investigation, surveillance and containment, and for the testing, diagnosis, emergency care, treatment and transportation of patients.

At present, local authorities and health agencies are intensifying emergency measures to sterilise infected areas and strictly monitor new outbreaks of the disease.
Cho Moi district has been given 700 doses of Tamiflu vaccine and enough medical equipment to ensure that necessary checkups and treatment can be provided to local patients. http://www.flutrackers.com/forum/showpost.php?p=351137&postcount=44

Medical Center of Cho Moi district has directed preventive medicine team deployed work focused spray disinfection in Na Tao village. Simultaneously center also directed the commune health centers, village nurse supervision, monitoring closely the situation in local disease to detect, on routes to transfer patients timely treatment. Known at this time, Cho Moi district health was granted 700 doses of Tamiflu, the protection equipment, medical supplies have been adequate preparation for the examination and treatment locally. http://www.flutrackers.com/forum/showpost.php?p=351222&postcount=49

4.2.4 Ministry of Information and Communication

The Ministry of Information and Communication has regulated the dissemination, communication and promotion of the pandemic situation through the domestic media, and communicated with international organizations to prevent negative impacts on socio-economic activities, international exchanges, tourism, and public opinion. The Ministry has kept the public updated on the global and national situation and prevention and control measures through daily mass media broadcasts by MoH spokesperson, especially in peak hours and during popular programs. In addition, the Ministry has provided prompt reports to the National Steering Committee when urgent interventions are needed.

“On 05/04/2010, Steering prevention of acute respiratory tract infections caused by viruses of Bac Kan province issued emergency notices 47/TB-BCD number of cases of patients with influenza A (H5N1) in Bac Kan and some preventive measures for avian influenza A (H5N1) emergency.”
To actively in the work for prevention of influenza A (H5N1) in people over the province, the Steering Committee asked the health sector, the Agriculture and Rural Development, the departments concerned and the People's Committee districts, some urgently implement the following key tasks:

For Health Services:
Strengthening supervision cases first infected with influenza A (H5N1) in treatment at all levels, from the commune health centers to district hospitals, provincial general hospital. In the process of receiving, diagnosing and treating patients must strictly comply with the guidance in the Decision on 19.08.2008 30/2008/QD-BYT guiding the diagnosis, treatment and prevention of flu A (H5N1) in humans;

To direct the provincial Preventive Medicine Center, TTYT the districts:
Prepare machinery, chemicals, protective equipment and strengthening of Preventive Medicine team, ready to support local anti-epidemic when required. Implementing anti-guide service in accordance with Decision No. 1812/QD-BYT on 05/23/2005 by the Health Ministry issuing process outbreak of avian influenza A (H5N1).

If a patient's death, burial must be held as stipulated in Circular No.: 02/2009/TT-BYT of the Health Ministry in guiding the cleaning operation burial, cremation.
Enhance communication to raise awareness of people about flu in poultry. To well implement the Health Ministry's recommendations on prevention of influenza A (H5N1) from birds to infect humans.

For the Department of Agriculture and Rural Development:
To expeditiously examine and supervise the local situation in the province of HPAI in poultry; enhance direct veterinary staff at all levels on prevention of avian influenza ; coordinate well with the public health sector in the prevention and control outbreaks in poultry and avian influenza A (H5N1) in humans.

Two Health and Agriculture and Rural Development to urgently formulate a regulation to coordinate their operation against disease spread from cattle and poultry to humans, especially flu A (H5N1) to respond proactive preventive measures right from the stage occurred in poultry.

For the People's Committees of districts and towns:
To organize the inspection and supervision of the management of state animal health in the province; reorganize the work report, translate reports from villages, communes to district levels; Emergency School Steering Committee to consolidate prevention and control of local direct the departments of professional, relevant departments of local People's Committees of communes, wards and towns strictly implement the direction of the health sector , Agriculture and Rural Development and the Provincial Steering Committee, which plans to timely prevention and control to limit the spread of avian influenza A (H5N1) from poultry to people, minimize the number of patients died .

In this announcement, Steering prevention of acute respiratory tract infections caused by viruses requires Bac Kan provinces, the departments concerned to expeditiously implement.

http://www.flutrackers.com/forum/showpost.php?p=350760&postcount=3

4.2.11 Mass Media Agencies at Central Level

The “Nhan Dan” newspaper (People’s Newspaper), Vietnam News Agency, Vietnam Television, and

The Voice of Vietnam, as members of the Communication Sub-committee, and other press and news agencies have coordinated with MoH to provide updated information about the pandemic situation and prevention and control measures through mass media channels, especially in peak hours and in popular programs.

Advocacy on issues of mass media for people to understand and comply with the Health Ministry's recommendations on measures against bird flu should be "temperamental predominance" again.

http://www.flutrackers.com/forum/showpost.php?p=351127&postcount=41