MINISTRY OF
HEALTH
SOCIALIST REPUBLIC OF VIETNAM
Independence – Freedom - Happiness
ACTION PLAN
For prevention and control of influenza A(H7N9) in Vietnam
(Promulgated in conjunction with Decision No. 1126 /QD-BYT dated 5 April
2013 of the Minister of Health)
I. SITUATION OF INFLUENZA A(H7N9) IN THE WORLD AND IN
VIETNAM
1. In the world
According to WHO, from 29 March 2013 to 4 April 2013, China reported the
detection of 11 confirmed cases of influenza A(H7N9) including 5 fatal cases are
deaths: Shanghai (3/3), Anhui (1/0), Jiangsu (4/0), and Zhejiang (3/2). All of the
infected cases showed symptoms of respiratory tract infection that progressed into
pneumonia and respiratory distress. The CDC laboratory in China has confirmed
the above cases as positive with the influenza A(H7N9) virus with its gene
originated from poultry. Investigations was conducted on 400 people who have
come into close contact with the cases and no more new infected cases have been
detected.
These are the first cases ever of infection with influenza A(H7N9) causing
severe illness on humans and there has been no evidence of transmission from
human to human. The source of infection and mode of transmission are still
unknown and WHO's intensive investigations are continuing.
WHO has not made any recommendations on restriction of travelling between
countries in the world.
2. In Vietnam
Up to 4 April 2013, no cases of acute respiratory tract infection due to
influenza A(H7N9) have been reported in Viet Nam.
3. Judgment and forecast
Given the current situation and the epidemiological characteristics of the
disease, there is a risk that the disease may be imported into Vietnam as well as
break out into an epidemic in the community if we do not proactively take
prevention and control measures for the following reasons:
1. Influenza A(H7N9) is caused by the influenza A(H7N9) virus type
originated from poultry.
2. The source of infection has not been clearly identified and possible
connection of epidemiological factors among the cases has not been established
although the two influenza A(H7N9) cases in Shanghai (China) are from a same
household.
1
3. The influenza A virus is characterized of constant mutation to change to new
types that can easily transmit to human.
4. Historically, the world has recorded the influenza A(H7) epidemics with
many cases and deaths in human.
5. Vaccines for prevention and specific medicines for treatment are not
available; preventive measures are mainly based on personal hygiene and
prevention of transmission in the community.
II. EXPERIENCE IN PREVENTION AND CONTROL OF SARS,
INFLUENZA A(H5N1) AND THE INFLUENZA A(H1N1) PANDAMIC IN
VIETNAM
- Drastic leadership of the National Steering Committee for prevention and
control of human influenza pandemic and active support from international
organizations.
- Close collaboration between ministries, sectors, and unions with the
involvement of the whole political system in epidemic prevention.
- Proactive preparation pandemic prevention and control activities from the
central to local levels: surveillance, receipt, treatment and stockpile of
medication, supplies and equipment.
- Timely information sharing between local and international entities on the
update situation of the outbreak and its prevention and control measures.
- Development of the outbreak prevention and control plan based on possible
scenarios along with appropriate responsive measures.
- Timely laboratory detection and confirmation of virus types, variations and
their pathogenic transformation to develop appropriate responsive measures.
III. OBJECTIVES
1. Overall objective:
Aiming at early detection and timely treatment to contain disease
transmission and to minimize number of deaths caused by the influenza A(H7N9).
2. Specific objectives for specific outbreak scenarios:
2.1. Scenario 1: No human cases have occurred.
To early detect the initial cases of infection with influenza A(H7N9)
imported into Viet Nam or those emerged in the community for drastic handling,
avoiding transmission in the community.
2.2. Scenario 2: Human cases of infection with influenza A(H7N9) have
occurred but no human-to-human transmission has been identified.
To localize and handle in a timely and drastic manner disease outbreaks in
order to minimize transmission from animal to human and from human to human.
2
2.3. Scenario 3: Human-to-human transmission of infection with influenza
A(H7N9) has been detected but in a small scale or with sporadic cases.
To quickly respond by localizing and handling disease outbreaks in a drastic
and timely manner in order to contain disease transmission in the community.
2.4. Scenario 4: Widespread outbreak in the community.
To minimize impact of the outbreak on the people’s life.
IV. MAIN ACTIVITIES
1. Scenario 1: No human cases have occurred.
- Enhance the operation of the steering committees for prevention and control of
life-threatening and emerging diseases at different levels. Develop the plan for
outbreak prevention and control of different levels to be submitted to people’s
committees for approval; direct the implementation of activities at local health
entities.
- Closely collaborate with the agriculture sector to monitor the disease situation
and the circulation of the influenza A(H7N9) virus type in populations of
poultry and water birds.
- Collaborate with the agriculture sector and the industry and trade sector to
enhance supervision and inspection on import of poultry and cross-border
trading of poultry products and preclude illegal import of poultry to stop unquarantined poultry from being imported into Vietnam. Enhance management
of poultry trading aimed at restrict distribution of unquarantined poultry of
unknown origin in the market.
- Enhance surveillance on acute respiratory tract infections of unknown causes,
especially surveillance on people, animals and goods at border gates and border
regions; conduct screening to detect suspected cases at border gates using
remote themoscanners.
- Enhance surveillance at national sentinel spots of influenza surveillance and in
high risk areas. Maintain adequate facilities and equipment, and medical
biologicals for confirmatory and diagnostic testing of the influenza A(H7N9)
virus.
- Strengthen influenza A(H7N9) virus testing and diagnostic laboratories at the
Institute of Hygiene and Epidemiology/Pasteur Institutes; develop testing
procedures; organize training for laboratory staff. For the first stage, 3 institutes
are involved: the National Institute of Hygiene and Epidemiology (NIHE),
Pasteur Institute in HCMC, and Nha Trang Pasteur Institute which are ready to
receive samples for confirmatory and diagnostic testing of influenza A(H7N9).
- Medical service facilities maintain stock piles of medication and arrange
quarantine areas for preparedness to properly conduct activities of receipt,
isolation, and treatment of patients and minimize deaths of patients. Establish a
network of entities/units for receipt and treatment of influenza A(H7N9)
patients.
3
- Develop technical guidance on surveillance, prevention and handling of
outbreaks, guidance on diagnosis and treatment, research on use of appropriate
and efficacious antiviral medication.
- Design communication messages and give recommendations on outbreak
prevention and control for the community. Promote risk communication
activities to timely provide people with updated information, avoiding unduly
panics and to take proper preventive measures.
- Consolidate mobile anti-outbreak teams and mobile first aid teams; arrange for
staff to be on duty at health facilities for outbreak prevention and control.
- Make adequate provision of funding, supplies, chemicals and facilities to
perform prevention and control measures in a timely manner upon occurrence
of the outbreak.
- Closely collaborate with WHO, IHR focal points and other international
organizations as well as other countries in the region, especially China, Hong
Kong (China) to promptly obtain information for implementing outbreak
prevention and control measures.
- Establish inspection, supervision and guiding teams at localities.
2. Scenario 2: Human cases of infection with influenza A(H7N9) have
occurred but no human-to-human transmission has been identified
- Steering committees for prevention and control of life-threatening and
emerging diseases at different levels hold weekly and ad hoc meetings to
consistently direct and roll out activities at local health entities/units.
- Enhance surveillance on acute respiratory tract infections of unknown causes,
especially surveillance on people, animals and goods at border gates and border
regions. Adhere to the procedures of health declaration at international border
gates.
- Implement measures of strict quarantine of infected cases as well as suspected
cases; investigate and closely monitor health conditions of the close contacts of
infected cases.
- Closely collaborate with the agriculture sector to completely stamp out
influenza A(H7N9) outbreaks in poultry and water birds.
- Enhance surveillance and diagnosis to determine the prevalence, mutation and
the extent of spread of the influenza A(H7N9) virus.
- Medical service facilities designate separate quarantine sections/ areas
specialized for treatment of influenza A(H7N9) patients.
- Arrange staff on duty for epidemic prevention and control at health
entities/units; establish mobile anti-outbreak teams and mobile first aid teams to
assist localities in handling outbreaks.
4
- Conduct regular evaluations for lessons learnt from surveillance, diagnosis,
treatment and control of outbreak in order to make timely revision/ adjustment
of guidelines and directions as appropriate to the characteristic of the outbreak.
- Regularly update information, revise communication messages, and give
recommendations on outbreak prevention and control measures as appropriate
to populations at risk.
- Continue to strengthen communication activities to promptly provide
information to the people for them to avoid panics and to take proper preventive
measures.
- Base on forecast of outbreak progression, continue to make provision of
additional funding, supplies, chemicals, facilities for timely implementation of
outbreak prevention and control measures and prevention of widespread
outbreaks in a large scale.
- Closely collaborate with WHO, IHR focal points and other international
organizations to promptly obtain information for implementing outbreak
prevention and control measures.
- Establish inspection, supervision and mentoring teams at localities.
- Conduct daily reporting and timely sharing of information.
3. Scenario 3: Human-to-human transmission of infection with influenza
A(H7N9) has been detected but in a small scale or with sporadic cases.
- Steering committees for prevention and control of life-threatening and
emerging diseases at different levels hold daily meetings at 14:00 to
consistently direct and roll out activities at local health entities/units.
- Localize outbreaks of the disease; travel restriction measures may be applied
necessary; extensive preventive measures, which are compulsory for the whole
population in the outbreak area, are applied.
- Report the situation and development of the outbreak on a regular basis and
provide counsel to the Secretariat of the Communist Party of Vietnam (CPV)
Central Committee, the Prime Minister, the Office of the CPV Central
Committee, and the Government Office on outbreak prevention and control
measures so that they can promulgate timely directions.
- Enhance surveillance on clusters of acute respiratory tract infections of
unknown causes in the community. Review and expand testing laboratories at
Institutes of Hygiene and Epidemiology/Pasteur Institutes, central level
hospitals, and those entities/units that are capable for conducting confirmatory
and diagnostic testing of influenza A(H7N9).
- Implement measures of strict quarantine of infected cases as well as suspected
cases; investigate and closely monitor health conditions of the close contacts of
infected cases.
5
- Enhance surveillance and testing to determine the prevalence, mutation and the
extent of spread of the influenza A(H7N9) virus.
- Medical service facilities designate separate quarantine sections/areas
specialized for treatment of influenza A(H7N9) patients. Be prepared to
establish field hospitals as necessary.
- Arrange staff on duty for outbreak prevention and control at health entities/units;
establish mobile anti-outbreak teams and mobile first aid teams to assist
localities in handling outbreaks.
- Conduct regular evaluations for lessons learnt from surveillance, diagnosis,
treatment, prevention and control of outbreak for timely revision or adjustment
of guidelines and directions as appropriate to the characteristic of the outbreak.
- Regularly updated information, revise communication messages, and make
recommendations on outbreak prevention and control measures as appropriate
to populations at risk.
- Continue to strengthen communication activities to promptly provide
information to the people for them to avoid panics and to take proper preventive
measures.
- Base on forecast of outbreak progression, continue to make provision of
additional funding, supplies, chemicals, facilities for timely implementation of
outbreak prevention and control measures and prevention of widespread
outbreaks in a large scale.
- Request entities, manufacturers and essential service providers to develop plans
to ensure sufficient services are provided in the event of widespread
transmission of the disease.
- Closely collaborate with WHO, IHR focal points and other international
organizations to promptly obtain information for implementing outbreak
prevention and control measures.
- Establish inspection, supervision and mentoring teams at localities.
- Conduct daily reporting and timely sharing of information.
4. Scenario 4: Widespread outbreak in the community.
- Steering committees for prevention and control of life-threatening and
emerging diseases hold daily meetings at 14:00 to consistently direct and roll
out activities within sectors and localities.
- Collaborate with ministries and sectors to assist entities, manufacturers and
service providers to provide essential services to the people to avoid causing
chaos in socio-economic activities.
- Contain outbreaks of the disease, implement measures to restrict travelling,
apply extensive preventive measures, which are compulsory for the whole
population in the outbreak area.
6
- Report the situation and development of the outbreak on a daily basis and
provide counsel to the Secretariat of the Communist Party of Vietnam (CPV)
Central Committee, the Prime Minister, the Office of the CPV Central
Committee, and the Government Office on measures of epidemic prevention
and control so that they can promulgate timely directions. In the event of a
widespread outbreak of the disease at a dangerous level which is difficult to be
controlled, it is possible to give advice to the Prime Minister and to make a
submission to the Standing Committee of the National Assembly or the
President to announce a state of emergency.
- Mobilize different committees, sectors and unions for involvement in first aid
teams and in instructing patients and their family members how to take care and
to take preventive measures.
- Arrange staff on duty for outbreak prevention and control at health entities/units;
establish mobile anti-outbreak teams and mobile first aid teams to assist
localities in handling outbreaks.
- Establish field hospitals in areas with a high number of patients to avoid
overload at hospitals. Expand health entities/units to receive patients, classify
patients for treatment at different levels: mild cases should be monitored and
treated at commune health stations and movement of patients should be
restricted.
- Enhance surveillance and diagnosis to determine the prevalence, mutation and
the extent of transmission of the influenza A(H7N9) virus.
- Conduct regular evaluations for lessons learnt from surveillance, diagnosis,
treatment, prevention and control of outbreak for timely revision or adjustment
of guidelines and directions as appropriate to the characteristic of the outbreak.
- Regularly update information, revise communication messages, and make
recommendations for outbreak prevention and control measures as appropriate
to populations at risk.
- Continue to strengthen communication activities to promptly provide
information to the people for them to avoid panics and to take proper preventive
measures.
- Aggregate demands for funding, supplies, chemicals, and facilities from
entities/units affiliated to the Ministry of Health, provinces and cities to make a
submission to the Prime Minister for additional provision.
- Call upon international organizations to give timely support by providing
antiviral medicines, personal protective equipment, supplies and chemicals to
serve prevention and control of the outbreak.
- Establish inspection, supervision and mentoring teams at localities.
V. OVERALL SOLUTIONS
7
1. Organization and leadership
At the central level:
- Enhance the operation of the steering committees for prevention and control of
life-threatening and emerging diseases; enhance operation of sub-committees
with different frequencies of activities corresponding to different outbreak
scenarios, i.e. ad hoc, weekly or daily.
- Conduct weekly, daily, ad hoc on-line briefings between national and local
levels to ensure regular sharing of information on the outbreak situation.
- Regularly update the global outbreak situation, agree on responsive measures
according to the development of the outbreak; provide directives, urge and
inspect all localities across the country for implementation of the measures.
- Report the global situation and development of the outbreak and provide
counsel to the Secretariat of the Communist Party of Vietnam (CPV) Central
Committee, the Prime Minister, the Office of the CPV Central Committee, and
the Government Office on measures of epidemic prevention and control so that
they can promulgate timely directions.
- Collaborate with chairmen of provincial/municipal people’s committees to
enhance the operation of local Steering Committees for outbreak prevention.
- Direct departments of health, centers for preventive medicine, hospitals, and
affiliated entities/units to make provision of facilities, medicines, chemicals,
machinery and equipment, special-purpose supplies, personal protective
equipment, isolation sections/areas and human resources for outbreak responses.
- Enhance surveillance and examination of people, motor vehicles, and goods
immigrating and being imported through border gates. Upon detection of any
suspected case of infectious disease, conduct physical examination for
quarantine and apply timely prevention and control measures to minimize
possible transmission of the disease.
- Collaborate in mass media communication on prevention and control measures
of influenza A(H7N9) according to different outbreak scenarios to avoid panic
and worry among general population.
- Collaborate with ministries and sectors to direct entities, manufacturers and
essential service providers to develop plans and to provide services in the event
of widespread outbreak.
- Collaborate with the Ministry of Finance and relevant agencies to make
provision of funding, ready to respond to outbreak and to support localities as
necessary.
At the local level:
- Strengthen the role of provincial people’s committees. Provincial steering
committees for disease prevention and control should direct anti-outbreak
activities in line with the guidance of the steering committee for prevention and
control of life-threatening and emerging diseases of the Ministry of Health.
8
Conduct examinations and direct supervisions on the implementation of
influenza outbreak prevention and control activities at localities.
- Preventive, treatment and communication entities/units in the locality should
enhance surveillance and early detection; be prepared to receive and treat
patients; and scale up communication on the updates of outbreak situation and
of prevention and control measures to the people.
- Provincial/municipal centers for preventive medicine should assume
responsibility for directing their affiliated health centers and collaborate with
entities/units within the treatment system to perform surveillance on acute
respiratory tract infection cases of unknown causes in their respective localities,
collect samples and report and send them to respective Institutes of Hygiene
and Epidemiology/Pasteur Institutes, the Ministry of Health (General
Department of Preventive Medicine) and respective Departments of Health.
- Organize training courses on surveillance of severe acute respiratory infection
cases of unknown causes to local health district authorities.
- For localities having international border gates, perform strict heath quarantine
of entering passengers who are from outbreak areas to prevent import of the
disease.
- Collaborate with relevant agencies and entities in surveillance of influenza-like
syndrome cases in the community.
- Closely collaborate with the animal health sector to be well updated on disease
situation in poultry, water birds and wild birds in the localities. Timely report
to the steering committees and collaborate in handling outbreaks.
- Adequately apply fringe-benefit policies for staff who are involved in influenza
A(H7N9) control, i.e. anti-outbreak allowances and on-duty allowances, etc.
2. Plan development and financial investment
- The Ministry of Health shall develop the plan for prevention and control of
influenza A(H7N9) and disbursing funds for outbreak surveillance for 2013.
- Provincial/municipal departments of health shall aggregate demands for
additional funding of surveillance, treatment and communication entities/units
within the respective localities to make submissions to people’s committees for
approval.
- In the event of imported and persistent epidemic, the Ministry of Health shall
aggregate demands for additional funding from entities/units affiliated to the
Ministry and provinces and cities to make a submission to the Prime Minister
for approval.
3. Technical areas
3.1 Solutions for reducing morbidity
9
- Enhance capacity of influenza A(H7N9) surveillance; ensure adequate capacity
for confirmatory testing and diagnosis; early detect initial infected cases for
prompt and appropriate quarantine, receipt and treatment.
- Be well informed of the disease situation globally and locally, including the
prevalence of the influenza A(H7N9) virus in populations of poultry, water
birds and wild birds to initiate timely appropriate response.
- Closely collaborate with the agriculture sector to completely stamp out
influenza A(H7N9) outbreaks in poultry, water birds, and wild birds to prevent
disease transmission to human and human-to-human transmission.
- Develop guidelines for surveillance, prevention and control of influenza
A(H7N9) outbreak; conduct epidemiological investigations of cases, of
contacts and the source of transmission in order to develop appropriate plans
and measures for prevention and control.
- Scale up national sentinel surveillance of influenza with focus on testing to
detect influenza A(H7N9) cases in the community.
- Consolidate and maintain the operation of mobile anti-outbreak teams at health
entities at different levels. Arrange staff on duty 24/24 hours during the
outbreak period.
- Conduct promotion campaigns to encourage the people to practise food safety
and hygiene and personal hygiene to prevent influenza A(H7N9).
- Enhance food hygiene and safety activities.
- Establish inter-sectorial teams to enhance inspection on preparedness to prevent
and control the outbreak in localities before, during and after the outbreak
period.
- Reserve funding, chemicals, medicines, and medical equipment and facilities
for timely provision for localities to implement anti-outbreak measures.
- Enhance laboratory capacity:
+ Improve and provide laboratory facilities and equipment to ensure adequate
capacity of conduct confirmatory testing of influenza A(H7N9).
+ Provide biologicals, testing and diagnostic equipment.
+ Ensure capacity to obtain quick and accurate confirmation of causative agents
from laboratories within Institutes of Hygiene and Epidemiology and Pasteur
Institutes.
+ Conduct training courses on sampling methods, storage and transport of
specimens and informing test results to different levels.
3.2. Solutions for reducing mortality
- Establish a network of hospitals available for receipt and treatment of influenza
A(H7N9) patients. Make plans for possible expansion of health facilities
10
network for receipt and treatment of influenza A(H7N9) patients in response to
each outbreak scenario.
- Develop guidelines on diagnosis and treatment of influenza A(H7N9).
- Build up national reserves of facilities and equipment, medicines, supplies,
chemicals, personal protective equipment, etc.
- Instruct, inspect and supervise hospitals in their preparation for outbreak
prevention and control.
- Direct health facilities:
+ Designate available sections/areas to receive influenza A(H7N9) patients
when an outbreak occurs and ensure adequate facilities and equipment, supplies,
medicine for emergency care of severe patients.
+ Establish mobile first aid teams ready to dispatch for localities in the event of
large number of patients.
+ Provide technical direction and assistance and mentoring support to hospitals
of lower levels.
- Strengthen capacity for hospitals of different levels and central hospitals to treat
extremely severe cases; provincial level hospitals shall treat severe cases and
district level hospitals shall treat moderate cases, referral should be limited to
minimize transmission.
- Provide training to treatment and nursing staff at hospitals on diagnosis and
treatment of influenza A(H7N9) and the use of emergency and intensive care
equipment.
- Equip hospitals with diagnostic, curative and emergency care facilities to
minimize number of fatal cases
4. Health communication and education
- Proactively conduct promotion activities on outbreak prevention and control
measures to community to ensure that people do not panic but are still
precautious and have sufficient knowledge to protect themselves, their families
and the community.
- Conduct promotion to target groups who may have a higher risk of being
infected through immigrating people and foreigners and prevent infected cases
from entering to Viet Nam via immigration.
- Enhance the responsive capacity of the communication worker forces within
and outside the health sector in terms of knowledge, facilities and human
resources. Mobilize ministries, committees, sectors and unions to be involved in
promotion activities for outbreak prevention and control.
- Post daily updates on outbreak situation and development of the affected
countries on mass media at the central and local levels, including websites.
11
- Regularly disseminate information regarding outbreak prevention and control
measures on mass media so that the people can take proactive self-protective
actions, to practice personal hygiene, improve their health condition and
minimize travelling to outbreak areas.
- Conduct direct promotion activities (with leaflet distribution and radio
broadcasting) to certain high risk groups that have come into contact with
Vietnamese people or foreigners coming to Viet Nam from outbreak areas.
- Enhance communication, risk communication, health education, and
knowledge dissemination with respect to preventive measures via central and
local information channels.
- News agencies and press, television, radio, and newspaper agencies should
collaborate with the health sector to conduct communication activities for
influenza A(H7N9) prevention and control.
- Central and provincial centers for health communication and education should
focus on communication contents as required for influenza A(H7N9)
prevention and control.
5. Inter-sectorial collaboration
- Mobilize participation from different committees, sectors and unions (women,
youth, farmers, the Red Cross) to encourage the people to implement influenza
A(H7N9) prevention and control measures.
- Enhance collaboration with the agriculture sector in monitoring the prevalence
of the influenza A(H7N9) virus in populations of poultry, water birds and wild
birds and handling influenza outbreaks in poultry and human. Collaborate in
active surveillance on populations of poultry and water birds aiming at early
detection of asymptomatic infected cases.
- Collaborate with the agriculture sector and the industry and trade sector to
enhance supervision and inspection on cross border import of poultry and
poultry products and preclude illegal import of poultry to stop un-quarantined
poultry from being imported into Vietnam. Enhance management of poultry
trading aiming at restrict circulation of unquarantined poultry of unknown
origin in the market.
- Enhance promotion activities to provide guidance to the people on using clean
fowl of known origin to ensure food safety and hygiene.
- Timely sharing of information with the Ministry of Health on the situation of
the outbreak for collaboration in implementing prevention and control measures
to prevent transmission to human.
- Establish inter-sectorial teams to enhance inspection on prevention and control
of influenza A(H7N9) outbreak in poultry and human in localities.
12
6. International cooperation
Closely collaborate with WHO and international organizations for
information sharing on the outbreak situation and prevention and control
measures; seek support for provision of antiviral medicines, facilities and
equipment, and supplies to serve outbreak prevention and control.
7. Scientific research
- Institutes of Hygiene and Epidemiology/Pasteur Institutes should proactively
conduct epidemiological studies on the influenza A(H7N9) virus molecular to
assess the origin, mutation and mode of transmission so as to propose
prevention and control measures.
- Conduct research studies on epidemiological and clinical characteristics,
evaluate treatment results so as to propose measures to reduce morbidity and
mortality as appropriate to the actual development of the disease.
VI. IMPLEMENTATION
1. At the central level
a) General Department of Preventive Medicine
- Provide counsel to the Ministry of Health in directing health entities/units
across the country in implementing influenza A(H7N9) prevention and control
activities as appropriate to each outbreak scenario.
- Develop guidelines on surveillance, prevention and control of influenza
A(H7N9) outbreak to be submitted to leaders of the Ministry of Health for
approval.
- Provide counsel to the Minister for Health to declare the existence of an
outbreak when all conditions for announcing an outbreak are met in accordance
with regulations issued by the Prime Minister.
- Direct, urge and inspect all localities and entities/units within the preventive
medicine system with regards to implementation of influenza A(H7N9)
prevention and control measures.
- Direct Institutes of Hygiene and Epidemiology/Pasteur Institutes to make
provision of facilities and equipment, and medical biologicals for confirmatory
and diagnostic testing of the influenza A(H7N9) virus; actively implement
national sentinel surveillance of influenza for early detecting the presence of the
influenza A(H7N9) virus.
- Collaborate with ministries/sectors in implementing A(H7N9) prevention and
control activities.
- Act as the focal point to establish task forces that directly lead and supervise
outbreak prevention and control in localities.
b) Medical Service Administration (MSA)
13
- Provide counsel to the Minister of Health in leading and directing influenza
A(H7N9) treatment.
- Develop guidelines on diagnosis and treatment of influenza A(H7N9) to be
submitted to leaders of the Ministry of Health for approval.
- Establish a network of health facilities for receipt and treatment of influenza
A(H7N9) patients as appropriate to each outbreak scenario to avoid overload;
movement of patients should be restricted.
- Directly lead and urge all medical facilities within the treatment system from
the central to local levels with regard to treatment and prevention and control of
influenza A(H7N9).
- Direct training activities to health staff of the treatment system, conduct
inspections on treatment of the disease across the country. Review all the fatal
cases to draw lessons learned.
- Direct institutes and hospitals affiliated to the Ministry of Health, and
provincial and city hospitals to make adequate provision of medicines,
equipment for emergency and intensive care and necessary facilities and
equipment to be ready for receipt, emergency care and treatment of patients.
- Enhance inspection and supervision on hospital-associated infection control,
cross-transmission in hospitals and anti-outbreak on-duty tasks.
c) Department of Communications – Emulation and Reward
- Lead and collaborate with communication entities in conducting promotion and
education activities on influenza A(H7N9) prevention and control before,
during and after the recognition and occurrence of the disease outbreak in Viet
Nam.
- Develop communication messages to be communicated to localities as
appropriate to each outbreak scenario.
- Hold press conferences as necessary.
d) Department of Planning - Finance
- Proactively provide counsel to leaders of the Ministry of Health on generating,
utilizing and coordinating resources from the state budget, from domestic and
international organizations for influenza A(H7N9) outbreak prevention and
control.
- Make an early submission to the Ministry of Health to allocate funding for
outbreak prevention and control for 2013 to Departments and Administrations
for them to proactively implement outbreak prevention and control activities.
- Coordinate the reserves of tamiflu and make plans for supplementary
procurement of medication in the event of widespread and persistent outbreaks
of human influenza.
14
- Act as the focal point to consolidate demands for additional funding from
entities/units affiliated to the Ministry and provinces and cities to make a
submission to the Prime Minister for additional provision in case the outbreak is
imported, widespread and persistent in Viet Nam.
e) Vietnam Food Administration
- Direct and instruct entities/units to enhance food safety and hygiene measures
for the community: instruct consumers to select safe food, not to use dead or ill
poultry to process foods.
- Enhance inspection and examination on food safety and hygiene.
f) Health Environment Management Agency (VIHEMA)
Direct and roll out campaigns on environmental sanitation and personal
hygiene to confine the outbreak and to prevent widespread of disease to the
environment and to human.
g) Department of International Cooperation
Act as the focal point to contact with and seek support from international
organizations for prevention and control of the influenza A(H7N9) outbreak:
financial and technical support, medication, facilities and equipment.
h) Institutes of Hygiene and Epidemiology and Pasteur Institutes
- Proactively make provision of facilities and equipment and biologicals to
ensure capacity to conduct confirmatory and diagnostic testing of the influenza
A(H7N9) virus in human; enhance collection and testing of specimens to detect
the causative virus.
- Direct and support centers of preventive medicine in respective areas under
their management in implementing prevention and control of influenza
A(H7N9) outbreak. Conduct training courses on outbreak prevention and
control to localities under their management.
- Establish task forces that directly provide support and supervision to localities
with presence of infected cases and deaths due to influenza A(H7N9).
- Conduct training courses on technical issues, surveillance and prevention and
control of influenza A(H7N9).
- Reserve disinfectants, chemicals, equipment, and special-purpose supplies,
implement anti-outbreak activities and be ready to assist localities in the event
of an outbreak.
- Conduct epidemiological, virological and immunological studies.
i) Central level hospitals
- Strictly and consistently comply with the direction and management of the
Medical Service Administration in treatment and outbreak prevention and
control.
15
- Conduct training for clinical staff on receipt, quarantine, treatment and
emergency care of patients as assigned by the Medical Service Administration.
- Support provincial and district general and specialized hospitals and some
sectorial hospitals to make adequate provision of medicines and equipment for
emergency and intensive care and other necessary facilities to be ready for
receipt, emergency care and treatment of patients.
- Proactively prepare adequate patient beds, make plans for maintaining regular
operation of the hospitals in the event of a severe outbreak.
- Strengthen capacity of diagnostic testing of causative agents.
- Implement nosocomial infection control, prevent cross-infection, and support
lower level hospitals.
- Proactively collaborate with preventive medicine entities/units in information
sharing and reporting of infectious cases in an adequate, accurate and timely
manner as required.
2. Localities
a) Directors of provincial/municipal departments of health
- Provide counsel to provincial/municipal people’s committees for enhancing
influenza A(H7N9) prevention and control at different levels in localities;
enhance the operation of steering committees for outbreak prevention and
control, consistently adopt influenza A(H7N9) prevention and control measures
as directed by the steering committee for prevention and control of lifethreatening and emerging diseases of the Ministry of Health. Adequately apply
benefit policies for staff and officers who are involved in influenza A(H7N9)
control: anti-outbreak allowances and on-duty allowances, etc.
- Make plans for influenza A(H7N9) outbreak prevention and control of
provinces and cities. Act as the focal point to consolidate demands for
additional funding of health entities/units to make a submission to
provincial/municipal people’s committees for approval.
- For localities having international border gates, lead the strict heath quarantine
of passengers who immigrate from outbreak areas to prevent import of the
disease.
- Closely collaborate with relevant agencies and entities in surveillance of
influenza syndrome cases in the community.
- Closely collaborate with the animal health sector to get updates about the
situation of diseases in poultry, water birds and wild birds in the localities, and
make timely reports to the steering committees and collaborate in handling
outbreaks.
- Collaborate with the agriculture sector to establish inter-sectorial inspection
teams in provincial localities. Strictly examine environmental sanitation in
localities.
16
- Conduct promotion and instruct the people to implement outbreak prevention
and control measures.
- Inspect and evaluate the effectiveness of outbreak prevention and control
activities performed by entities/units of the provinces/cities.
b) Provincial/municipal general hospitals and provincial/municipal regional
hospitals
- Make plans for receipt, emergency care and treatment of patients, and for
maintaining regular operation of the hospitals in the event of an outbreak.
- Direct district hospitals to make adequate provision of medicines, equipment
for emergency and intensive care and necessary facilities and equipment to be
ready for receipt, emergency care and treatment of patients.
- Conduct training on regimens for emergency care and treatment and provide
guidance to treatment facilities for implementation.
- Provide direction and support to lower levels on technical aspects, human
resources, financial resources as necessary; monitor and supervise outbreak
prevention and control activities conducted by local medical service facilities.
- Implement nosocomial infection control and prevent cross-infection in hospitals.
- Proactively collaborate with preventive medicine entities/units in information
sharing and reporting of infectious cases in an adequate, accurate and timely
manner as required.
c) Provincial/municipal preventive health centers
- Develop and update plans for influenza A(H7N9) prevention and control of the
provinces and cities.
- Conduct strict surveillance on the outbreak all the way down to the level of
hamlet, commune/ward and household. Report the development of the outbreak
in a timely manner in accordance with regulations.
- Consolidate mobile anti-outbreak teams to support localities as necessary.
- Conduct investigations and complete stamp out outbreaks in accordance with
the MOH's regulations.
- Conduct promotion and instruct the people to implement influenza A(H7N9)
outbreak prevention and control measures.
d) Provincial/municipal international quarantine centers
- Perform strict surveillance on people immigrating into our country. Especially
upon detection of suspected cases of communicable diseases, perform medical
examination for quarantine and apply prevention and control measures in a
timely manner to minimize transmission.
- Enhance supervision, examination and handling of motor vehicles immigrating
and goods imported into Vietnam.
17
- Closely collaborate with designated forces at border gates in examining and
monitoring people and motor vehicles immigrating and goods imported through
border gates.
e) District health centers
- Provide counsel to district steering committees for outbreak prevention and
control to enhance epidemic prevention and control activities in localities.
- Conduct strict surveillance to early detect the initial infected case in hamlets,
communes/wards, and households to localize for timely handling. Report the
development of the outbreak in a timely manner in accordance with regulations.
- Implement activities to completely stamp out outbreaks in accordance with the
MOH's regulations.
- Conduct promotion and instruct the people to implement influenza A(H7N9)
outbreak prevention and control measures.
f) District general hospitals
- Make plans for receipt, quarantine and treatment of patients, and for
maintaining regular operation of the hospitals in the event of an outbreak.
- Make adequate provision of medicines, equipment for emergency and intensive
care and necessary facilities and equipment to be ready for receipt, emergency
care and treatment of patients.
- Conduct training on regimens for emergency care and treatment and provide
guidance to commune health stations and private clinics in localities for
implementation.
- Proactively collaborate with preventive medicine entities/units in information
sharing and reporting of infectious cases in an adequate, accurate and timely
manner as required.
g) Commune health stations
- Conduct timely investigation, surveillance, detection, quarantine and handling
to avoid transmission of the disease.
- Conduct primary emergency care and treatment of patient when they are
infected. Monitor and perform surveillance of those cases under treatment at
home.
- Establish commune anti-outbreak teams comprising health workers, youth
union members, women, etc. to implement prevention and control measures at
families.
- Conduct promotion to the people so that they will report detected ill and dead
poultry in a self-conscious manner and implement outbreak prevention and
control measures.
18
This Plan will be updated and revised in a regular and timely manner to
adapt to the development and situation of the outbreak as well as to actual
implementation of outbreak prevention and control activities.
FOR MINISTER
VICE-MINISTER
(Signed)
Nguyen Thanh Long
19