Publications by authors named "Hung Nguyen-Viet"

80 Publications

Risk factors of dengue fever in an urban area in Vietnam: a case-control study.

BMC Public Health 2021 Apr 7;21(1):664. Epub 2021 Apr 7.

Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden.

Background: Dengue is a mosquito-borne flavivirus present in many metropolitan cities of tropical countries.

Methods: During and after the dengue season (September 2018 to January 2019), we conducted a case-control study in order to determine the risk factors for dengue fever in Hanoi city, Vietnam. 98 dengue patients and 99 patients with other acute infections, such as Hepatitis B virus infection, were recruited at Department of Infectious Disease of Bach Mai national hospital in Hanoi. Patients were interviewed using a structured questionnaire covering demographic, housing, environmental factors and knowledge, attitude, and practice on dengue prevention and control. Univariate analysis and multivariable logistic regression were used to determine the risk factors of dengue status.

Results: The mean score of knowledge items and practice items was only 7.9 out of total 19 points and 3.9 out of total 17 points, respectively. While the mean score of attitude items was 4.8 out of total 6 points. Multivariable logistic regression indicated that older patients had lesser risk of getting dengue infection as compared to younger adults aged 16-30, and patients living in peri-urban districts were less likely to suffer of dengue fever than patients living in central urban districts (OR = 0.31; 95% CI 0.13-0.75). This study could not find any association with occupation, water storage habit, knowledge, attitude, or practice on dengue prevention.

Conclusions: All patients had a relatively low level of knowledge and practice on dengue prevention and control. However, the attitude of the participants was good. We found that age group and living district were the risk factors correlated with the dengue status. Communication programs on raising dengue awareness should be repeated all year round and target particular groups of adolescents, younger adults, landlords and migrants from other provinces to improve their knowledge and encourage them to implement preventive measures against dengue fever.
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http://dx.doi.org/10.1186/s12889-021-10687-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028770PMC
April 2021

Dogs as Sentinels for Flavivirus Exposure in Urban, Peri-Urban and Rural Hanoi, Vietnam.

Viruses 2021 Mar 19;13(3). Epub 2021 Mar 19.

International Livestock Research Institute (ILRI), Hanoi 10000, Vietnam.

Diseases caused by flaviviruses, including dengue fever and Japanese encephalitis, are major health problems in Vietnam. This cross-sectional study explored the feasibility of domestic dogs as sentinels to better understand risks of mosquito-borne diseases in Hanoi city. A total of 475 dogs serum samples from 221 households in six districts of Hanoi were analyzed by a competitive enzyme-linked immunosorbent assay (cELISA) for antibodies to the pr-E protein of West Nile virus and other flaviviruses due to cross-reactivity. The overall flavivirus seroprevalence in the dog population was 70.7% (95% CI = 66.4-74.8%). At the animal level, significant associations between seropositive dogs and district location, age, breed and keeping practice were determined. At the household level, the major risk factors were rural and peri-urban locations, presence of pigs, coil burning and households without mosquito-borne disease experience ( < 0.05). Mosquito control by using larvicides or electric traps could lower seropositivity, but other measures did not contribute to significant risk mitigation of flavivirus exposure in dogs. These results will support better control of mosquito-borne diseases in Hanoi, and they indicate that dogs can be used as sentinels for flavivirus exposure.
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http://dx.doi.org/10.3390/v13030507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8003331PMC
March 2021

Microbial contamination and associated risk factors in retailed pork from key value chains in Northern Vietnam.

Int J Food Microbiol 2021 Mar 17;346:109163. Epub 2021 Mar 17.

International Livestock Research Institute, Hanoi, Viet Nam.

Pork and pork products are important staple food in the diet of Vietnamese consumers. The safety of pork, including biological contamination, is a concern to several public authorities and value chain actors. This cross-sectional study aimed to identify Salmonella and total bacterial count (TBC) contamination of cut pork sold in different outlets, and determine the potential factors leading to contamination. A total of 671 pork samples were collected from different retail channels in three provinces in Northern Vietnam. Hygiene conditions and practices at pork vending premises were also observed and recorded. Data analysis used descriptive statistics and regression analysis. Overall, Salmonella prevalence in retailed pork was 58.1%. Salmonella contamination in pork from traditional retail, modern retail and food services were 60.5%, 50.9% and 80.5%, respectively. Eighty percent and 68% of fresh pork in canteen and street food was contaminated with Salmonella. Only a small proportion of a subset of the pork samples (6.2%) tested met the Vietnamese standard requirement for TBC contamination. Average concentration of TBC in fresh pork in traditional retail, modern retail and food services were 6.51 (SD: 0.64), 6.38 (0.65), and 6.96 (0.85) LogCFU/g, respectively. Transport time, use of the same tools for pork and other types of meat, storage temperature, and environment hygiene are important factors that might affect microbial contamination. The findings underline the high level of microbial contamination, which requires practical interventions to improve food safety hygiene practices and behavior of pork retailers.
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http://dx.doi.org/10.1016/j.ijfoodmicro.2021.109163DOI Listing
March 2021

Live and Wet Markets: Food Access versus the Risk of Disease Emergence.

Trends Microbiol 2021 Mar 9. Epub 2021 Mar 9.

Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala SE-75237, Sweden; International Livestock Research Institute, Department of Biosciences, Nairobi 00100, Kenya; Swedish University of Agricultural Sciences, Department of Clinical Sciences, SE-750 07 Uppsala, Sweden. Electronic address:

Emerging zoonotic diseases exert a significant burden on human health and have considerable socioeconomic impact worldwide. In Asia, live animals as well as animal products are commonly sold in informal markets. The interaction of humans, live domestic animals for sale, food products, and wild and scavenging animals, creates a risk for emerging infectious diseases. Such markets have been in the spotlight as sources of zoonotic viruses, for example, avian influenza viruses and coronaviruses, Here, we bring data together on the global impact of live and wet markets on the emergence of zoonotic diseases. We discuss how benefits can be maximized and risks minimized and conclude that current regulations should be implemented or revised, to mitigate the risk of new diseases emerging in the future.
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http://dx.doi.org/10.1016/j.tim.2021.02.007DOI Listing
March 2021

International, Transdisciplinary, and Ecohealth Action for Sustainable Agriculture in Asia.

Front Public Health 2021 5;9:592311. Epub 2021 Feb 5.

Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya.

Sustainably intensifying agriculture to secure food for people, while minimizing the human, animal, and environmental health impacts is an unprecedented global food security challenge. Action research is needed to understand and mitigate impacts, with Ecosystem approaches to health (Ecohealth) emerging as a promising framework to support such efforts. Yet, few have critically examined the application of Ecohealth principles in an agricultural context, particularly in Southeast Asia where agricultural intensification is rapidly expanding. In this paper, we evaluate the strengths, challenges, and opportunities of agriculture-related Ecohealth projects in low-resource settings of Vietnam, Thailand, Indonesia, and China, drawing on a case study of the Field Building Leadership Initiative (FBLI). To do this, we used a developmental evaluation framework involving several iterative cycles of document reviews, interviews, focus groups, and outcome harvesting with researchers, partners, and community members involved in FBLI. Results highlight the importance of transdisciplinarity, participation, and knowledge-to-action principles in co-generating knowledge and co-developing practical solutions. Implementing such principles presents challenges in terms of coordinating regional collaborations, managing high workloads, meaningfully engaging communities, and ensuring ongoing monitoring and evaluation. To address these challenges, there is a need to strengthen capacity in integrated approaches to health, improve institutionalization of Ecohealth, foster community engagement, and systematically monitor and evaluate efforts. Ecohealth holds significant promise in improving food security, but only when considerable time is spent developing and implementing projects with communities.
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http://dx.doi.org/10.3389/fpubh.2021.592311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892777PMC
February 2021

Coping strategies and social support among caregivers of patients with cancer: a cross-sectional study in Vietnam.

AIMS Public Health 2021 11;8(1):1-14. Epub 2020 Dec 11.

Center for Population Health Sciences, Hanoi University of Public Health, Hanoi, Vietnam.

Research on coping strategies and social support among Vietnamese cancer caregivers remains limited. In this study, we aim to examine the relationships between types of coping strategies utilized and social support among cancer caregivers. This was a cross-sectional study conducted in three main cancer hospitals in the Northern, Central and Southern regions of Vietnam. The 28-item Brief COPE Inventory (BCI) Scale and the Multidimensional Scale of Perceived Social Support (MSPSS) were utilized. Descriptive statistics and multivariate linear regression were performed. Active coping, acceptance and positive reframing were the most used coping strategies among participants, while substance use was the least commonly used. Level of social support was positively correlated with the utilization of coping mechanisms. Receiving high social support and utilizing positive coping strategies enables caregivers to mitigate their caregiving burden, control the situation and enhance their own quality of life.
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http://dx.doi.org/10.3934/publichealth.2021001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870390PMC
December 2020

Knowledge and practice on prevention of mosquito-borne diseases in livestock-keeping and non-livestock-keeping communities in Hanoi city, Vietnam: A mixed-method study.

PLoS One 2021 4;16(2):e0246032. Epub 2021 Feb 4.

Department of Medical Biochemistry and Microbiology, Zoonosis Science Center, Uppsala University, Uppsala, Sweden.

Mosquito-borne diseases (MBDs) are causing high morbidity and mortality for humans. Urban livestock keeping is still common in cities around the world. The animals may serve as reservoirs for zoonotic MBDs, which increase the risks for humans. Here we assess the knowledge and practices related to MBDs in households with livestock and without livestock and explore the perceptions of the health care sector about MBDs and livestock keeping in Hanoi city of Vietnam in a cross-sectional study. A quantitative survey was conducted including 513 households with and without livestock-keeping in six districts and complemented with qualitative surveys with four health staff from Hanoi Center of Disease Control and three district health centers. The quantitative survey indicated that the participants possessed basic knowledge on MBDs with an average score of 18.3 out of 35, of which non-livestock-keeping households had a better knowledge than households keeping livestock (p<0.05). Both household categories had low score, 3.5 out of 11, regarding preventive practices against MBDs. The negative binomial model showed that occupation and location of living were factors associated to the knowledge on MBDs. Farmers were likely to have better preventive practices as compared to office workers (p<0.05). Those who had better knowledge also had more adequate preventive practices against MBDs (p<0.001). The qualitative survey revealed that livestock keeping was determined as increasing risks of MBDs due to the increase of mosquito population. It is recommended that community campaigns to raise the awareness and change behavior on MBDs should be organized based on collaboration between the health sector and the veterinary sector for households with and without livestock living in central urban and peri-urban areas. Further studies are needed to confirm the association between urban livestock keeping and potential increasing risks of MBDs such as dengue and Japanese encephalitis.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246032PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861445PMC
February 2021

Self-reported psychological distress among caregivers of patients with cancer: Findings from a health facility-based study in Vietnam 2019.

Health Psychol Open 2020 Jul-Dec;7(2):2055102920975272. Epub 2020 Dec 3.

Hanoi University of Public Health, Vietnam.

In Vietnam, little is elucidated in scientific literatures about the mental health of caregivers of people with cancer. We conducted a cross-sectional study to report the situation and correlates of self-reported psychological distress among caregivers of cancer patients in Vietnam in 2019. Multiple logistic and linear regression analyses were performed. A total of 16.5% of the study participants had psychological distress. Respondent's mean score of negative emotion was 7.6 ± 2. Educational level and type of support were significantly associated with having psychological distress among caregivers. Gender, occupation, financial difficulty, treatment belief and social support significantly correlated to psychological distress level of caregivers.
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http://dx.doi.org/10.1177/2055102920975272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720337PMC
December 2020

Livestock Development in Hanoi City, Vietnam-Challenges and Policies.

Front Vet Sci 2020 10;7:566. Epub 2020 Sep 10.

Department of Biosciences, International Livestock Research Institute (ILRI), Hanoi, Vietnam.

The rapid urban growth of Hanoi city requires a livestock production system that ensures both food security and the livelihoods of dwellers. This paper reviews the existing policies for livestock production of Hanoi city and the changes in livestock population between 2014 and 2018 and identifies major challenges for livestock development of the city. While a remarkable increase of the livestock population in recent years is evident, the dominance of small-scale farms, the presence of animal diseases, the slow progress of transiting farms out of urban areas, as well as the lack of analysis of climate change and gender impacts are major challenges that could affect the livestock development of Hanoi.
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http://dx.doi.org/10.3389/fvets.2020.00566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511548PMC
September 2020

Understanding Antibiotic Residues and Pathogens Flow in Wastewater from Smallholder Pig Farms to Agriculture Field in Ha Nam Province, Vietnam.

Environ Health Insights 2020 5;14:1178630220943206. Epub 2020 Oct 5.

Center for Public Health and Ecosystem Research, Hanoi University of Public Health, Hanoi, Vietnam.

Background: Contact with livestock wastewater on farms and in communities can pose a risk to human and animal health.

Methods: This cross-sectional study was conducted in 180 households and 24 pig farms (96 wastewater samples) to explore information about pig production, livestock waste management, antibiotic use, and to analyze antibiotic residues and microbial contamination, respectively.

Results: Of the 120 households raising pigs, biogas systems were the most commonly used to treat animal waste (70%), followed by compositing (19%), and the remaining respondents discharged waste directly into drains or ponds (11%). The majority of respondents (78%) used antibiotics to treat and prevent disease in pigs, but 32% of them did not know of any disadvantages of antibiotic abuse. ELISA assays were performed on half of the wastewater samples (n = 48), demonstrating that residues of flouroquinolones and sulfonamides were present in 6.3% (3/48) and 22.9% (11/48) of tested samples, respectively. The average residual level of sulfamethazine was 27.8 ug/l. Further, concentrations exceeding regulatory levels in Vietnam were found in nearly all samples. spp. was also found in 57.3% of samples, though prevalence rates varied across the different sites. Finally, was found in 8.4% of samples, and was found in 5.2% of samples.

Conclusions: This study suggests that livestock wastewater carried potential harmful pathogens and antibiotic residues that could come into contact with humans in the community. Thus, appropriate operation and application of livestock wastewater treatment (such as biogas or composting) and management should be a continued focused.
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http://dx.doi.org/10.1177/1178630220943206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543113PMC
October 2020

Prevalence and phylogenetic analysis of hepatitis E virus in pigs in Vietnam.

BMC Vet Res 2020 Sep 14;16(1):333. Epub 2020 Sep 14.

School of Veterinary Medicine, Rakuno Gakuen University, 582 Bunkyodai, Ebetsu, Hokkaido, 069-8501, Japan.

Background: Hepatitis E virus (HEV) is a zoonotic disease and has been reported around the world. The main objective of this study was to evaluate the sero-prevalence and phylogenetic analysis of HEV in Vietnam. Pig blood and fecal pooled samples were collected to assess the prevalence of HEV. We assessed the true prevalence (TP) of HEV from apparent prevalence (AP) by taking into account the sensitivity and specificity of diagnostic tests using a Bayesian approach. For phylogenetic analysis, the data compared with worldwide HEV reference strains including all eight genotypes (G1-G8) which were identified in previous study.

Results: A total of 475 sera and 250 fecal pooled samples were collected at slaughterhouses and pig farms from five provinces, in Viet Nam. Overall, the sero-AP of HEV was 58.53% (95% confidence interval: 53.95-62.70) while the sero-TP was slightly higher (65.43, 95% credible interval: 47.19-84.70). In terms of pooled samples, overall, the RNA-AP was 6.80% (95% confidence interval: 4.01-10.66). One strain in Hanoi, two strains in Dak Lak, seven strains in An Giang, four strains in Son La and two strains in Nghe An were isolated. The phylogenetic tree demonstrated that 19 Vietnamese strains were clustered into HEV 3 and 4.

Conclusions: This study provided evidence that HEV is circulating in domestic pigs in Vietnam. From a public health perspective, it is very important to raise public awareness for high-risk groups (e.g. slaughterhouse workers, pig traders, farmers and market sellers) who have more opportunities to come in contact with pig and contaminated meats.
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http://dx.doi.org/10.1186/s12917-020-02537-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489210PMC
September 2020

Exploring the potential of using nudges to promote food hygiene in the pork value chain in Vietnam.

Prev Vet Med 2020 Aug 18;181:105003. Epub 2020 May 18.

Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, AL9 7TA, UK.

Interventions designed to reduce the burden of foodborne illness often require value chain actors to alter undesired and risky behaviours. This desired behavioural change may be supported by 'nudge theory', a sub-field of behavioural economics, which describes how individuals can be encouraged, or 'nudged', to act in ways which produce net societal benefits without restricting freedom of choice. This research aimed to investigate the use of nudges in the pork value chain in Vietnam. Key informant interviews (n = 12) were initially utilised to document the type of nudges being used within existing food safety interventions, followed by a questionnaire-based survey (n = 132) to describe the behavioural elements of pork value chain actors which could be amenable to nudging. Finally, a workshop was conducted to measure the response of stakeholders (n = 30) to various nudge elements which could be used to support future food safety interventions. Key informant interviews demonstrated that the use of behavioural nudges were a common aspect of food safety interventions in the pork value chain in Hanoi and Hung Yen Province. Survey participants reported that when considering food safety, veterinarians and actors' peers were highly trusted, and reputation was thought to be an effective incentive to illicit behavioural change. During the workshop, stakeholders appeared aware of the major slaughter and retail contamination points and cited lack of access to improved infrastructure as the limiting factor in their ability to improve hygiene. Value chain actors reported positive responses to the concept of using posters containing photographic images as nudges and stipulated that media should reflect the local context and contain language framed to suit the target audience. We suggest that the findings of this study are used to create site specific nudges for the Vietnamese pork industry targeting key value chain actors, such slaughterhouse workers and traditional retailers, which should be tested in the field to investigate their effectiveness.
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http://dx.doi.org/10.1016/j.prevetmed.2020.105003DOI Listing
August 2020

Six-year study on peripheral venous catheter-associated BSI rates in 262 ICUs in eight countries of South-East Asia: International Nosocomial Infection Control Consortium findings.

J Vasc Access 2021 Jan 14;22(1):34-41. Epub 2020 May 14.

Cho Ray Hospital, Ho Chi Minh City, Vietnam.

Background: Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available.

Methods: Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.

Results: We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter-associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter-associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter-associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: (22.9%), spp (10.7%), (5.3%), spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were (11.4%).

Conclusions: Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter-associated bloodstream infections.
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http://dx.doi.org/10.1177/1129729820917259DOI Listing
January 2021

A Mixed-Methods Approach to Understanding Knowledge of Mosquito-Borne Infections and Barriers for Protection in Hanoi, Vietnam.

Trop Med Infect Dis 2020 May 1;5(2). Epub 2020 May 1.

Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala SE-751 05, Sweden.

Dengue is a growing problem in Hanoi, with cyclical epidemics of increasing frequency and magnitude. In June 2019, we conducted a cross-sectional survey using mixed methods to investigate how inhabitants of Hanoi perceive and respond to the risk of mosquito-borne diseases (MBD). A total of 117 participants recruited using a stratified random sampling method were interviewed in three districts of Hanoi. Knowledge and practices (KP) regarding MBDs were assessed using a pre-tested questionnaire. Inferential statistics were used to identify factors associated with KP scores and describe the relationship between variables. Additionally, a "risk-mapping" exercise was conducted in a subsample through semi-structured interviews and analyzed qualitatively and quantitatively using the System Effects platform. Factors significantly associated with knowledge scores were education and family history of MBDs. While knowledge and practice scores were found to be positively correlated in the statistical analysis, this was not corroborated by our observations on the field. The results also revealed gaps in knowledge about MBDs and vectors and highlighted a general feeling of powerlessness which prevented the adoption of protective behaviors. Therefore, educational interventions which provide concrete tools to empower communities should have a positive impact on improving vector control.
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http://dx.doi.org/10.3390/tropicalmed5020066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345065PMC
May 2020

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 727 intensive care units of 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific Regions: International Nosocomial Infection Control Consortium (INICC) findings.

Infect Control Hosp Epidemiol 2020 05 18;41(5):553-563. Epub 2020 Mar 18.

Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador.

Background: Short-term peripheral venous catheter-related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available.

Methods: Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.

Results: We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%).

Conclusions: PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries.
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http://dx.doi.org/10.1017/ice.2020.20DOI Listing
May 2020

The challenges of investigating antimicrobial resistance in Vietnam - what benefits does a One Health approach offer the animal and human health sectors?

BMC Public Health 2020 Feb 11;20(1):213. Epub 2020 Feb 11.

Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia.

Background: The One Health concept promotes the enhancement of human, animal and ecosystem health through multi-sectorial governance support and policies to combat health security threats. In Vietnam, antimicrobial resistance (AMR) in animal and human health settings poses a significant threat, but one that could be minimised by adopting a One Health approach to AMR surveillance. To advance understanding of the willingness and abilities of the human and animal health sectors to undertake investigations of AMR with a One Health approach, we explored the perceptions and experiences of those tasked with investigating AMR in Vietnam, and the benefits a multi-sectorial approach offers.

Methods: This study used qualitative methodology to provide key informants' perspectives from the animal and human health sectors. Two scenarios of food-borne AMR bacteria found within the pork value chain were used as case studies to investigate challenges and opportunities for improving collaboration across different stakeholders and to understand benefits offered by a One Health approach surveillance system. Fifteen semi-structured interviews with 11 participants from the animal and six from the human health sectors at the central level in Hanoi and the provincial level in Thai Nguyen were conducted.

Results: Eight themes emerged from the transcripts of the interviews. From the participants perspectives on the benefits of a One Health approach: (1) Communication and multi-sectorial collaboration; (2) Building comprehensive knowledge; (3) Improving likelihood of success. Five themes emerged from participants views of the challenges to investigate AMR: (4) Diagnostic capacity; (5) Availability and access to antibiotics (6) Tracing ability within the Vietnamese food chain; (7) Personal benefits and (8) Managing the system.

Conclusion: The findings of this study suggest that there is potential to strengthen multi-sectorial collaboration between the animal and human health sectors by building upon existing informal networks. Based on these results, we recommend an inclusive approach to multi-sectorial communication supported by government network activities to facilitate partnerships and create cross-disciplinary awareness and participation. The themes relating to diagnostic capacity show that both sectors are facing challenges to undertake investigations in AMR. Our results indicate that the need to strengthen the animal health sector is more pronounced.
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http://dx.doi.org/10.1186/s12889-020-8319-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014660PMC
February 2020

Seroprevalences of multi-pathogen and description of farm movement in pigs in two provinces in Vietnam.

BMC Vet Res 2020 Jan 14;16(1):15. Epub 2020 Jan 14.

International Livestock Research Institute (ILRI), Addis Ababa, Ethiopia.

Background: In Vietnam, lack of animal health information is considered a major challenge for pig production. The main objective of this study was to assess the seroprevalences of five pathogens [porcine circovirus type 2 (PCV2), porcine reproductive and respiratory syndrome virus (PRRSV), mycoplasma hyopneumoniae (M. hyo), Japanese encephalitis virus (JEV) and leptospirosis] and to better characterize the farm movements through a survey.

Results: A total of 600 samples were collected from 120 farms from Bac Giang and Nghe An. Among unvaccinated herds, the highest seroprevalence was found for JE with 73.81% (95% CI: 68.39-78.74) in Bac Giang and 53.51% (95% CI 47.68-59.27) in Nghe An. Seroprevalences for PCV2 and M.hyo were 49.43% (95% CI: 45.06-53.80) and 46.06% (95% CI: 41.48-50.69) among unvaccinated animals. Accumulative co-infections for JE (86.25%) showed the highest level followed by M. hyo (66.25%) and PCV2 (62.50%). Three co-infections with JE had the highest positive rate (28.75%) followed by four co-infections (25.0%). Medium farms had relatively higher herd prevalences for all pathogens, except from leptospirosis. Overall, farmers exported/imported their pigs at the most 1-2 times every 6 months. Some respondents (5% for exportation and 20% for importation) had moved pigs more than 6 times over the last 6 months.

Conclusions: Our study provided another pool of evidence that showed that PCV2, PRRS and H. hyo are endemic in pigs in Vietnam. Given the economic impacts of these pathogens elsewhere, the findings confirm the need for studies to evaluate the association between antibody response and clinical relevance as well as to assess the economic impact of co-infections at farm level. We also found that high seroprevalences of JE and leptospirosis were detected in pigs. From a pubic health point of view, it is crucial to raise public awareness especially for high risk occupations (mainly pig farm workers).
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http://dx.doi.org/10.1186/s12917-020-2236-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958752PMC
January 2020

Development of two-dimensional gas chromatography (GC×GC) coupled with Orbitrap-technology-based mass spectrometry: Interest in the identification of biofuel composition.

J Mass Spectrom 2020 Mar 6;55(3):e4495. Epub 2020 Feb 6.

Laboratoire SMS-EA3233, UNIROUEN, Normandie Université, Place Emile Blondel, F-76821, Mont-Saint-Aignan Cedex, France.

Comprehensive gas chromatography (GC) has emerged in recent years as the technique of choice for the analysis of volatile and semivolatile compounds in complex matrices. Coupling it with high-resolution mass spectrometry (MS) makes a powerful tool for identification and quantification of organic compounds. The results obtained in this study showed a significant improvement by using GC×GC-EI-MS in comparison with GC-EI-MS; the separation of chromatogram peaks was highly improved, which facilitated detection and identification. However, the limitation of Orbitrap mass analyzer compared with time-of-flight analyzer is the data acquisition rate; the frequency average was about 25 Hz at a mass resolving power of 15.000, which is barely sufficient for the proper reconstruction of the narrowest chromatographic peaks. On the other hand, the different spectra obtained in this study showed an average mass accuracy of about 1 ppm. Within this average mass accuracy, some reasonable elemental compositions can be proposed and combined with characteristic fragment ions, and the molecules can be identified with precision. At a mass resolving power of 7.500, the scan rate reaches 43 Hz and the GC×GC-MS peaks can be represented by more than 10 data points, which should be sufficient for quantification. The GC×GC-MS was also applied to analyze a cellulose bio-oil sample. Following this, a highly resolved chromatogram was obtained, allowing EI mass spectra containing molecular and fragment ions of many distinct molecules present in the sample to be identified.
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http://dx.doi.org/10.1002/jms.4495DOI Listing
March 2020

Spatiotemporal analysis of historical records (2001-2012) on dengue fever in Vietnam and development of a statistical model for forecasting risk.

PLoS One 2019 27;14(11):e0224353. Epub 2019 Nov 27.

National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.

Background: Dengue fever is the most widespread infectious disease of humans transmitted by Aedes mosquitoes. It is the leading cause of hospitalization and death in children in the Southeast Asia and western Pacific regions. We analyzed surveillance records from health centers in Vietnam collected between 2001-2012 to determine seasonal trends, develop risk maps and an incidence forecasting model.

Methods: The data were analyzed using a hierarchical spatial Bayesian model that approximates its posterior parameter distributions using the integrated Laplace approximation algorithm (INLA). Meteorological, altitude and land cover (LC) data were used as predictors. The data were grouped by province (n = 63) and month (n = 144) and divided into training (2001-2009) and validation (2010-2012) sets. Thirteen meteorological variables, 7 land cover data and altitude were considered as predictors. Only significant predictors were kept in the final multivariable model. Eleven dummy variables representing month were also fitted to account for seasonal effects. Spatial and temporal effects were accounted for using Besag-York-Mollie (BYM) and autoregressive (1) models. Their levels of significance were analyzed using deviance information criterion (DIC). The model was validated based on the Theil's coefficient which compared predicted and observed incidence estimated using the validation data. Dengue incidence predictions for 2010-2012 were also used to generate risk maps.

Results: The mean monthly dengue incidence during the period was 6.94 cases (SD 14.49) per 100,000 people. Analyses on the temporal trends of the disease showed regular seasonal epidemics that were interrupted every 3 years (specifically in July 2004, July 2007 and September 2010) by major fluctuations in incidence. Monthly mean minimum temperature, rainfall, area under urban settlement/build-up areas and altitude were significant in the final model. Minimum temperature and rainfall had non-linear effects and lagging them by two months provided a better fitting model compared to using unlagged variables. Forecasts for the validation period closely mirrored the observed data and accurately captured the troughs and peaks of dengue incidence trajectories. A favorable Theil's coefficient of inequality of 0.22 was generated.

Conclusions: The study identified temperature, rainfall, altitude and area under urban settlement as being significant predictors of dengue incidence. The statistical model fitted the data well based on Theil's coefficient of inequality, and risk maps generated from its predictions identified most of the high-risk provinces throughout the country.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224353PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6881000PMC
April 2020

Urban livestock-keeping and dengue in urban and peri-urban Hanoi, Vietnam.

PLoS Negl Trop Dis 2019 11 26;13(11):e0007774. Epub 2019 Nov 26.

Uppsala University, Department of Medical Biochemistry and Microbiology, Uppsala, Sweden.

Urban livestock provides an important source of food and income, but it may increase the risks for disease transmission. Vectors, such as mosquitoes, might increase and thereby cause an enhanced transmission of infectious diseases, such as dengue fever; considered the most important mosquito-borne viral disease globally. This cross-sectional study evaluated the awareness of dengue fever and investigated how the presence of dengue vectors is affected by the keeping of livestock in urban households in the city of Hanoi, Vietnam. From February to March 2018, during the season of lowest occurrence of dengue in Hanoi, 140 households were interviewed, of which 69 kept livestock. A general trend was observed; respondents living in the Dan Phuong district, a peri-urban district, had better knowledge and practice regarding dengue as compared to the urban Ha Dong district. In total, 3899 mosquitoes were collected and identified, of which 52 (1.33%) were Aedes species. A significant difference between the two districts was observed, with more households in Ha Dong having Aedes spp. mosquitoes (p = 0.02) and a higher incidence of dengue fever (p = 0.001). There was no significant association between livestock-rearing and the presence of Aedes spp. mosquitoes (p = 0.955), or between livestock-rearing and the incidence of dengue fever (p = 0.08). In conclusion, this study could not find any indication that households keeping livestock were at higher risk of dengue virus infections in Hanoi during the season of lowest occurrence of dengue, but clearly indicated the need of more information provided to urban inhabitants, particularly on personal protection.
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http://dx.doi.org/10.1371/journal.pntd.0007774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879131PMC
November 2019

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module.

Am J Infect Control 2020 04 29;48(4):423-432. Epub 2019 Oct 29.

Ondokuz Mayis University Medical School, Samsun, Turkey.

Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

Methods: During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

Conclusions: Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.
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http://dx.doi.org/10.1016/j.ajic.2019.08.023DOI Listing
April 2020

Identifying hotspots for antibiotic resistance emergence and selection, and elucidating pathways to human exposure: Application of a systems-thinking approach to aquaculture systems.

Sci Total Environ 2019 Oct 11;687:1344-1356. Epub 2019 Jun 11.

Veterinary Epidemiology, Economics and Public Health Group, Royal Veterinary College, Hawkshead Lane, Hatfield AL9 7TA, UK. Electronic address:

Aquaculture systems are highly complex, dynamic and interconnected systems influenced by environmental, biological, cultural, socio-economic and human behavioural factors. Intensification of aquaculture production is likely to drive indiscriminate use of antibiotics to treat or prevent disease and increase productivity, often to compensate for management and husbandry deficiencies. Surveillance or monitoring of antibiotic usage (ABU) and antibiotic resistance (ABR) is often lacking or absent. Consequently, there are knowledge gaps for the risk of ABR emergence and human exposure to ABR in these systems and the wider environment. The aim of this study was to use a systems-thinking approach to map two aquaculture systems in Vietnam - striped catfish and white-leg shrimp - to identify hotspots for emergence and selection of resistance, and human exposure to antibiotics and antibiotic-resistant bacteria. System mapping was conducted by stakeholders at an interdisciplinary workshop in Hanoi, Vietnam during January 2018, and the maps generated were refined until consensus. Thereafter, literature was reviewed to complement and cross-reference information and to validate the final maps. The maps and component interactions with the environment revealed the grow-out phase, where juveniles are cultured to harvest size, to be a key hotspot for emergence of ABR in both systems due to direct and indirect ABU, exposure to water contaminated with antibiotics and antibiotic-resistant bacteria, and duration of this stage. The pathways for human exposure to antibiotics and ABR were characterised as: occupational (on-farm and at different handling points along the value chain), through consumption (bacterial contamination and residues) and by environmental routes. By using systems thinking and mapping by stakeholders to identify hotspots we demonstrate the applicability of an integrated, interdisciplinary approach to characterising ABU in aquaculture. This work provides a foundation to quantify risks at different points, understand interactions between components, and identify stakeholders who can lead and implement change.
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http://dx.doi.org/10.1016/j.scitotenv.2019.06.134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905156PMC
October 2019

Seroprevalence of leptospirosis and Japanese encephalitis in swine in ten provinces of Vietnam.

PLoS One 2019 1;14(8):e0214701. Epub 2019 Aug 1.

International Livestock Research Institute, Nairobi, Kenya.

Background: Leptospirosis is an important zoonotic disease with a global distribution, affecting a wide range of mammalian animals and humans. Japanese encephalitis (JE) virus is the major vector-borne zoonotic disease in the Asia-Pacific region. The main objective of this study was to evaluate the seroprevalence of serovar-specific Leptospira and JE in swine from 10 provinces in Vietnam.

Methods: Samples were initially collected for swine influenza surveillance from March to April 2017 at large-scale farms (with at least 50 sows and/or 250 fattening pigs) with pigs that tested positive for influenza in the previous surveillance period (2015-16).

Findings: A total of 2,000 sera samples were analyzed from 10 provinces. Overall, the seroprevalence of leptospirosis was 21.05% (95% CI: 19.28-22.90) using a cut-off titer of ≥ 1:100. The apparent prevalence of JE was 73.45% (95% CI: 71.46-75.37) while the true prevalence was slightly higher (74.46%, 95% credible interval: 73.73-86.41). We found a relatively high presence of leptospirosis and JE in pigs kept on large farms. Prevalence was comparable with other studies suggesting opportunistic testing of samples collected for other surveillance purposes can be a valuable tool to better understand and prevent the potential transmission of these zoonotic diseases from pigs to people in Vietnam.

Conclusion: Our study provides evidence to veterinarians and animal health professionals for evidence-based practice such as diagnosis, vaccination and zoonotic control. Further investigation into the possible role of different domestic animals, wildlife species or environmental factors is needed to identify the potential risk factors and transmission routes in Vietnam.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0214701PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6675114PMC
March 2020

Simulating Cross-Contamination of Cooked Pork with from Raw Pork through Home Kitchen Preparation in Vietnam.

Int J Environ Res Public Health 2018 10 22;15(10). Epub 2018 Oct 22.

Veterinary Epidemiology Unit, School of Veterinary Medicine, Rakuno Gakuen University, 582 Bunkyodai Midorimachi, Ebetsu, Hokkaido 069-8501, Japan.

Pork is the most commonly consumed meat in Vietnam, and is a common contaminant. This study aimed to assess potential cross-contamination between raw and cooked pork in Vietnamese households. Different scenarios for cross-contamination were constructed based on a household survey of pork handling practices (416 households). Overall, 71% of people used the same knife and cutting board for both raw and cooked pork; however, all washed their hands and utensils between handling raw and cooked pork. The different scenarios were experimentally tested. First, was inoculated on raw pork and surfaces (hands, knives and cutting boards); next, water used for washing and pork were sampled to identify the presence and concentration of during different scenarios of food preparation. Bootstrapping techniques were applied to simulate transfer rates of cross-contamination. No cross-contamination to cooked pork was observed in the scenario of using the same hands with new cutting boards and knives. The probability of re-contamination in the scenarios involving re-using the cutting board after washing was significantly higher compared to the scenarios which used a new cutting board. Stochastic simulation found a high risk of cross-contamination from raw to cooked pork when the same hands, knives and cutting boards were used for handling raw and cooked pork (78%); when the same cutting board but a different knife was used, cross-contamination was still high (67%). Cross-contamination between was not seen when different cutting boards and knives were used for cutting raw and cooked pork. This study provided an insight into cross-contamination of , given common food handling practices in Vietnamese households and can be used for risk assessment of pork consumption.
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http://dx.doi.org/10.3390/ijerph15102324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210979PMC
October 2018

Risk factors associated with Salmonella spp. prevalence along smallholder pig value chains in Vietnam.

Int J Food Microbiol 2019 Feb 6;290:105-115. Epub 2018 Oct 6.

Veterinary Epidemiology Unit, School of Veterinary Medicine, Rakuno Gakuen University, 582 Bunkyodai Midorimachi, Ebetsu, Hokkaido 069-8501, Japan. Electronic address:

The objective of this study was to investigate the prevalence of, and risk factors for, Salmonella contamination along the smallholder pig value chain in northern Vietnam. Repeat cross-sectional (for farm and pork shops) and longitudinal (for slaughterhouses) studies were carried out in Hung Yen and Nghe An provinces in four sampling periods over a year (April 2014 to February 2015). In total, 72 pig farms and 217 pork shops were visited during the period, and 13 slaughterhouses were visited four times. Information on management and hygiene practices was collected using checklists and questionnaires, and risk factor analyses at the farm, slaughterhouse, and pork shop levels were performed using generalized mixed-effects models with the significant levels 10%. Salmonella prevalence was 36.1%, 38.9%, and 44.7% on pig pen floors, pig carcasses in slaughterhouses, and cut pork in pork shops, respectively. The risk factor for Salmonella prevalence on pig pen floors were having a pig pen next to a household (p = 0.06) and free access to the farm by visitors (p = 0.06). Our slaughterhouse model found a single risk factor for carcass contamination: slaughter area close to lairage without hygienic measures (p = 0.03). For pork shops, presence of flies or insects on pork at shop (p = 0.02) and use of a cloth at pork shop (p = 0.02) were risk factors. The Salmonella prevalence on pig carcass and cut pork was significantly lower in winter compared to that in other seasons. Our study results highlighted the need of improving farm hygiene at farm level, and pork hygiene practices to avoid cross-contamination at the slaughterhouse and market levels, to reduce the risk of salmonellosis through pork consumption in northern Vietnam.
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http://dx.doi.org/10.1016/j.ijfoodmicro.2018.09.030DOI Listing
February 2019

Bioaerosol Sampling to Detect Avian Influenza Virus in Hanoi's Largest Live Poultry Market.

Clin Infect Dis 2019 03;68(6):972-975

Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore.

Background: Newly emergent and virulent strains of H7N9 avian influenza virus are rapidly spreading in China and threaten to invade Vietnam. We sought to introduce aerosol sampling for avian influenza viruses in Vietnam.

Methods: During October 2017, National Institute for Occupational Safety and Health 2-stage aerosol samplers were assembled on a tripod and run for 4 hours. Concomitantly, up to 20 oropharyngeal (OP) swab samples were collected from chickens and ducks distanced at 0.2-1.5 m from each sampler.

Results: The 3 weeks of sampling yielded 30 aerosol samples that were 90% positive for influenza A, by quantitative reverse-transcription polymerase chain reaction, and 116 OP swab sample pools (5 samples per pool) that were 47% positive. Egg cultures yielded 1 influenza A virus (not H5 or H7) from aerosol and 25 influenza A viruses from OP swab sample pools (5 were H5 positive). The association between positive sample types (over time and position) was strong, with 91.7% of positive OP pooled swab samples confirmed by positive aerosol samples and 81% of influenza A positive aerosol samples confirmed by positive OP swab samples.

Conclusions: We posit that aerosol sampling might be used for early warning screening of poultry markets for novel influenza virus detection, such as H7N9. Markets with positive aerosol samples might be followed up with more focused individual bird or cage swabbing, and back-tracing could be performed later to locate specific farms harboring novel virus. Culling birds in such farms could reduce highly pathogenic avian influenza virus spread among poultry and humans.
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http://dx.doi.org/10.1093/cid/ciy583DOI Listing
March 2019

Integrated approaches to tackling health issues-related to agri-food systems.

Int J Public Health 2019 Jan 10;64(1):5-6. Epub 2018 Aug 10.

International Food Policy Research Institute, Washington, DC, USA.

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http://dx.doi.org/10.1007/s00038-018-1156-9DOI Listing
January 2019

Geographical and temporal patterns of rabies post exposure prophylaxis (PEP) incidence in humans in the Mekong River Delta and Southeast Central Coast regions in Vietnam from 2005 to 2015.

PLoS One 2018 10;13(4):e0194943. Epub 2018 Apr 10.

International Livestock Research Institute, Hanoi, Vietnam.

Background: In Vietnam, rabies has been a notifiable disease for more than 40 years. Over the last five years, on average, more than 350,000 people per year have been bitten by dogs and cats while more than 80 human deaths have been reported yearly. No studies have been conducted to evaluate the geographical and temporal patterns of rabies in humans in Vietnam. Therefore, the main objective of this study was to assess the geographical and temporal distributions of rabies post exposure prophylaxis (PEP) incidence in humans in Vietnam from 2005 to 2015.

Methods: Average incidence rabies (AIR) PEP rates for every 3 or 4 years (2005-2008, 2009-2012 and 2013-2015) were calculated to describe the spatial distribution of rabies PEP. Hotspot analysis was implemented to identify patterns of spatial significance using the Getis-Ord Gi statistic. For temporal pattern analysis, two regions [Mekong River Delta (MRD) and Southeast Central Coast (SCC)], with the highest incidence rates, and the seasonal-decomposition procedure based on loess (STL), were compared to assess their temporal patterns of rabies PEP.

Findings: We found hotspots in southern Vietnam and coldspots in northern Vietnam during the study period. Rabies cases were limited to specific areas. In addition, the hotspot analysis showed that new risk areas were identified in each period which were not observed in incidence rate maps. The seasonal plots showed seasonal patterns with a strong peak in February/July and a minor peak in October/December in the MRD region. However, in the SCC, a small peak was detected at the early part of each year and a strong peak in the middle of each year.

Conclusion: Our findings provide insight into understanding the geographical and seasonal patterns of rabies PEP in Vietnam. This study provides evidence to aid policy makers when making decisions and investing resources. Such information may also be utilized to raise public awareness to prevent rabies exposures and reduce unnecessary PEP.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0194943PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5892892PMC
July 2018

Emerging health risks from agricultural intensification in Southeast Asia: a systematic review.

Int J Occup Environ Health 2017 07 21;23(3):250-260. Epub 2018 Mar 21.

a Hanoi University of Public Health , Center for Public Health and Ecosystem Research , Hanoi , Vietnam.

Background Agricultural intensification is having profound impacts on food security and rural livelihoods; however, concerns remain about the potential implications on public health. Objectives We aim to examine and synthesize the evidence for human health risks of agricultural intensification in Southeast Asia. Methods We conducted a systematic review of peer-reviewed articles published between January 2000 and December 2015 from two electronic databases (PubMed, CAB Direct). Results A total of 73 relevant studies were included and evaluated. More than half of the studies used epidemiological methods while others applied alternative methods to quantify or estimate risks. Studies mainly focused on occupational and consumer exposure to pesticides, without often specifying the actual health risk. Conclusion Overall, the current knowledge on health risks appears to be limited. More research on long-term health implications and a wider range of contaminants are needed if sustainable benefits are to be obtained from agricultural intensification.
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http://dx.doi.org/10.1080/10773525.2018.1450923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060873PMC
July 2017

Carrying water may be a major contributor to disability from musculoskeletal disorders in low income countries: a cross-sectional survey in South Africa, Ghana and Vietnam.

J Glob Health 2018 Jun;8(1):010406

Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom.

Background: The Sustainable Development Goals include commitments to end poverty, and promote education for all, gender equality, the availability of water and decent work for all. An important constraint is the fact that each day, many millions of women and children, and much less frequently men, carry their household's water home from off-plot sources. The burden of fetching water exacerbates gender inequality by keeping women out of education and paid employment. Despite speculation about the potential health impacts of fetching water, there is very little empirical evidence. We report the first large study of the health impacts of carrying water on women and children.

Methods: A cross-sectional survey was conducted in South Africa, Ghana and Vietnam during 2012. It investigated water carrying methods and health status. Because areas of self-reported pain were correlated we undertook factor analysis of sites of reported pain, to interpret patterns of pain reporting. Regression analysis using Generalised Estimating Equations (GEE) investigated water carrying as a risk factor for general health and self-reported pain.

Results: People who previously carried water had increased relative risk of reporting pain in the hands (risk ratio RR 3.62, 95% confidence interval CI 1.34 to 9.75) and upper back (RR 2.27, 95% CI 1.17 to 4.40), as did people who currently carry water (RR hand pain 3.11, 95% CI 1.34 to 7.23; RR upper back pain 2.16, 95% CI 1.25 to 3.73). The factor analysis results indicate that factor 1, 'axial compression', which is correlated with pain in the head and upper back, chest/ribs, hands, feet and abdomen/stomach, is associated with currently (0.30, 95% CI 0.17 to 0.43) or previously (0.21, 95% CI 0.01 to 0.42) carrying water. Factor 2, 'soft tissue strain', which is correlated with pain in the neck, shoulders/arms, lower back and hips/pelvis or legs, is marginally negatively associated with currently (-0.18, 95% CI -0.32 to -0.04) carrying water. The factor 'axial compression' was more strongly associated with carrying water containers on the head.

Conclusions: Participants who reported a history of current or past water carrying more frequently reported pain in locations most likely to be associated with sustained spinal axial compression in the cervical region. Given the fact that cervical spinal conditions are globally one of the more common causes of disability, our findings suggest that water carrying, especially by head loading is a major contributing factor in musculoskeletal disease burden in low income countries. Our findings support the proposed indicator for monitoring SDG6.1: "Percentage of population using safely managed drinking water services at home."
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http://dx.doi.org/10.7189/jogh.08.010406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825974PMC
June 2018