Visit to CDC Helps Strengthen Early Warning and Response in Vietnam

Global health security relies on a system of early warning and rapid response to control outbreaks. This is especially true for Vietnam due to its geographic location, climate, and high levels of travel and trade across borders with China, Laos, and Cambodia, all of which make the country more vulnerable to the rapid spread of outbreaks. Vietnam is also located in a high-risk region for emerging infectious disease threats, which include avian influenza, SARS, rabies, hand-foot-and-mouth disease, Dengue, and Zika.

To enhance global health security and to ensure control of disease outbreaks before they spread internationally, CDC is providing technical assistance to Vietnam in a partnership aimed at creating a more effective outbreak early warning and response system. As part of this effort, CDC welcomed delegates from Vietnam’s Ministry of Health (MoH) to the agency’s Atlanta headquarters in June 2016.

Vietnam’s enhanced early warning and response system brings together many parts of public health, including community and hospital event-based surveillance; laboratory networks; hospital surveillance for severe acute respiratory infections (SARIs); and a trained public health workforce. During the visit the delegation wanted to learn how to improve the links that support these systems and to increase their knowledge about CDC’s work to stop diarrheal diseases like norovirus and rotavirus, and viral respiratory diseases like MERS.

Linking surveillance systems to stop outbreaks

Like the U.S., Vietnam has different levels of public health systems that need to work together effectively to rapidly detect, respond to, and control disease threats. Because of these similar needs, Vietnam sought to learn about how public health infrastructure is organized in the U.S., particularly how CDC works with state and local health departments to optimize disease tracking, testing, and reporting.

“To have more effective implementation of public health activities, we want to learn about the relationship between the different levels here, like the relationship between CDC at the federal level and the state level.” says Dr. Trần Đắc Phu, Director General of the Department of Preventive Medicine in Vietnam’s MoH. “In Vietnam we have the national level and then the provincial level so we want to see the linkage between those levels.”

Linking the national and the provincial levels will improve the country’s ability to detect and test for influenza and other SARIs. Building on more than a decade of partnership with CDC in influenza surveillance and laboratory work, the country is increasing SARI testing capacity to include seven additional non-influenza viruses. Because avian influenza poses a high risk for human outbreaks in Vietnam, it is important to collect and analyze data related to this virus, since it can cause severe illness and can spread quickly across countries.

“For the southern region in particular, we see that SARI surveillance can benefit us a lot. Ho Chi Minh City is a hub for travelers, particularly every year we see more than 3 million travelers from the U.S. so there’s a lot of exchange and movement in this region,” notes Dr. Phan Trọng Lân, Director of the Pasteur Institute in Ho Chi Minh City. “In the southern region, there’s a great chance for animal and human interaction. In the same household, you can see humans and pigs and other animals live in the same habitats, so it can really affect mutations. We hope that with this SARI surveillance platform, it can help us detect those mutations or maybe early detection of an outbreak caused by these novel strains.”

Connecting laboratory technologies for better response

CDC’s laboratory teams have also partnered with Vietnam’s MoH to improve the country’s ability to detect and respond to infectious disease outbreaks. This collaboration has included participation in ongoing discussions as well as site visits in Vietnam.

During the delegates’ visit to CDC headquarters, CDC experts shared the history of the surveillance and laboratory protocols for MERS, norovirus, and rotavirus. They discussed technologies such as next-generation genomic sequencing and bioinformatics as part of advanced molecular detection and gave the delegates a tour of CDC’s laboratories so they could see the protocols in action.

Dr. Đặng Đức Anh, Director of the National Institute of Hygiene and Epidemiology, said of the visit, “The labs in different groups are very impressive. They try to develop the testing platforms to help the labs in the U.S. and also labs in other countries in case of an epidemic. I think it’s very useful. I think we need support from the CDC to develop this bioinformatics system in our labs.”

Dr. Arunmozhi Balajee, CDC’s Associate Director of Global Health Systems in the Division of Viral Diseases, stressed the importance of the work in Vietnam and the delegate visit. “Early Warning and Response (EWAR) systems enable countries to detect outbreaks early and intervene quickly. Laboratories are central to the response to outbreaks. CDC’s Division of Viral Diseases and CDC Vietnam are working closely to strengthen laboratory systems in Vietnam, specifically building capacity in order to test for gastrointestinal and respiratory viruses. Having this delegation at CDC headquarters visiting with disease-specific subject matter experts allowed the Ministry to understand the crucial role of laboratories in EWAR systems.”