Báo cáo nghiên cứu khoa học: "Một đánh giá của các phản ứng xử đối với dịch cúm A (H1N1) ở tỉnh Thừa Thiên Huế trong năm 2009"

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Tuyển tập các nghiên cứu khoa học của trường đại học Huế đề tài: Một đánh giá của các phản ứng xử đối với dịch cúm A (H1N1) ở tỉnh Thừa Thiên Huế trong năm 2009...

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Nội dung Text: Báo cáo nghiên cứu khoa học: "Một đánh giá của các phản ứng xử đối với dịch cúm A (H1N1) ở tỉnh Thừa Thiên Huế trong năm 2009"

JOURNAL OF SCIENCE, Hue University, N0 61, 2010 AN ASSESSMENT OF THE TREAMENT RESPONSE FOR THE EPIDEMIC OF INFLUENZA A (H1N1) IN THUA THIEN HUE PROVINCE IN 2009 Nguyen Dung, Hoang Huu Nam, Duong Quang Minh Nguyen Mau Duyen, Nguyen Khoa Nguyen Thua Thien Hue Provincial Health Department Nguyen Dinh Son, Nguyen Thai Hoa Thua Thien Hue Provincial Preventive Health Center SUMMARY The epidemic of Influenza A (H1N1) broke into Vietnam with the first case identified at Ho Chi Minh City Tropical Hospital on 31st May, 2009. It quickly spread nationwide, with a pattern of infection involving clusters of cases at schools, enterprises, and factories which affected community activities and social security.The epidemic hit the Province at the end of June, 2009 with the two peaks, one in September and mid-October and one in November. It then gradually reduced at the end of 2009. The first patient, a Vietnamese Australian coming from Australia, was hospitalized on the 24th June, 2009. After that, all of the District/City Health Centers (DHC) organized an area to receive patients, and set up emergency groups for treatment of influenza A (H1N1). Through an assessment of clinical progress of influenza A (H1N1) cases, the provincial health network devised a strategy to limit infection in the community, and limit the effects of the epidemic to the community and the departments/agencies activities. The total number of patients hospitalized from 24th June, 2009 to 30th Decmeber, 2009 was 2,051 cases which were almost all mild, well monitored, and isolated for treatment. There were 1,084 cases (52.8%) treated in hospitals, and 967 cases (47.2%) treated in controlled communities. The number of communes with patients that provided organised treatment in the community was 46%. Among 2,051 cases, the most affected age group was 10-19 (65.53%., The highest rate was among pupils and students(79.5%). The mean time for fever resolving after using Tamiflu was 1.75 days. There were no severe complications or deaths in the Province. The epidemic was controlled in the Province; till early 2010, cases were only scattered, and according to the evaluation indicators of a national focused influenza surveilance program in Huong Thuy, the rate of influenza A (H1N1) was sharply reduced. 1. Introduction The epidemic of influenza A (H1N1) arose in Mexico in April, 2009 and quickly spread out worldwide, and had a global pandemic alert level of 6/6 according to the WHO. According to the Announcement No. 83 from WHO, until 10th January, 2010, there were more than 208 nations and territories that reported patients positive with 93
influenza A (H1N1), of which 13,554 died. Areas which had high infection of influenza A (H1N1) in the community were North Africa, South Asia, East and Southeast Europe. In Asian areas, there were reports of high deaths in some countries due to influenza type A (H1N1) infection such as India (1,119), Japan (145), China (continent, 714), South Korea (170), Australia (191), Thailand (196), and Malaysia (77). In Vietnam, the first case was identified at the Ho Chi Minh City Tropical Hopsital on 31st May, 2009; until 20th January, 2010, Vietnam reported 11,166 positive cases, in which 56 were killed. In Thua Thien Hue Province, the epidemic occured at the end of June, 2009, with the two peaks, one in September, and one in mid October and November (15th and 17th weeks), it then gradually reduced in winter (November and December). At the beginning of the epidemic at the end of June 2009, the first patient was a Vietnamese Australian coming from Australia who was hospitalized on 24th June. After nearly two months, the epidemic spread widely to the community, where a cluster of cases first appeared in Huong Thuy district on the 14th August, 2009, and then many clusters of cases appeared at schools such as Nguyen Hue and Gia Hoi High schools, and Vinh Ninh Primary school. After that the disease spread out to many schools in the Province. Patients were treated following the protocol of the Ministry of Health with the results of recovery and no death. Influenza A (H1N1) of type A was a communicable disease that was especially dangerous. The disease was caused by a new virus of type A (H1N1). This was a new virus which had not been reported before. This new virus had genetic materials from a recombination of influenza viruses from pigs and birds (not H5) and humans. Especially in Vietnam, there was circulation of avian flu, influenza A (H5N1), thus the risk of patients might have been coinfected with the two strains of H1 and H5 influenza viruses. This migh have resulted in the risk of recombination from genoms of the two virus strains to form a new virus strain, which would be very dangerous due to its characteristics of being transmitted easily like influenza A (H1N1) and being a serious disease like influenza A (H5N1). The organization of receiving treatment for influenza A (H1N1) patients that was suitable to the local situation was an urgent problem, which required a feasible and effective response which prevented deaths and avoided disruptions to the community and other social activities. To ensure these needs were met, we conducted the following study “An assessment of the treatment response for the epidemic of influenza A (H1N1) in Thua Thien Hue Province in 2009” to describe the appropriateness of the organization of the treatment response for confirmed and suspected influenza A (H1N1) patients in Thua Thien Hue Province, describe some characterisitics of patients diagnosed with comfirmed or suspected influenza A (H1N1) in Thua Thien Hue in 2009 and assess the results of the organization of treatment for influenza A (H1N1) in controlled communities in Thua Thien Hue in 2009. 94
2. Methodology 2.1. Research subjects: All patients who were clinically diagnosed and treated for influenza A at all hospitals in the province of Thua Thien Hue in 2009 including: Suspected cases: Cases with fever (over 38ºC), having at least one respiratory symptom such as upper respiratory infection, sore throat, cough, and having related epidemiologic factors (close contact with confirmed cases; arrived or lived at epidemiologic area; a cluster of cases) Possible cases: Where a case with flu syndrome had laboratory tests positive with influenza A but no confirmation of the type classification with tests for common flu viruses. Confirmed cases: Were the cases positive to influenza A (H1N1) with test Real- time RT-PCR or RT-PCR 2.2. Research methodology: Cross -sectional combined with intervention research. 2.3. Research period of time: The research was conducted during the period the epidemic occured in Thua Thien Hue Province, from 24th June, 2009 to 31st December, 2009. 2.4. Implementation approach: A survey and treatment for influenza A (H1N1) following Decision No. 2762 /QD-BYT dated on 31st July, 2009 by the Minister of Ministry of Health on guidelines for diagnosis, treatment and prevention on spreading influenza A (H1N1) with the two following periods: 2.4.1. Period before the epidemic spreading to community: From the 24th June, 2009 to 31st August, 2009, the disease happened sporadically, without clusters of cases in the community, and treatment was organized through admission at Hue Central Hospital and Hospitals of District/City Health Centers. The protocol for treatment of influenza A/H1N1 from Ministry of Health was followed, while collecting data from daily reports on cases from District/City Health Centers and Thua Thien Hue Provincial Preventive Health Center. 2.4.2. The period when the disease spread to community: From 1st September, 2009 to 31st December, 2009, the disease quickly spread, and clusters of cases appeared in the community and in schools in the Province. In order to deal with the situation, an intervention to control the epidemic in the Province was implemented by the health sector as outlined below: 2.4.2.1. An assessment was conducted on treatment for influenza A/H1N1 at District/City Health Centers to determine clinical charisteristics of the epidemic. 2.4.2.2. The situation of the health network particitating in epidemic control and 95
prevention in the province was surveyed, including: - National and departments/sectors level + Hue Central Hospital with experienced health staff had enough capacity to direct the epidemic prevention as well as treatment admission for serious, complicated cases. They had organized an isolated area for treatment admission designed one- dimentionally following standards of Ministry of Health. They began with a scale of 20 beds, and has built a plan to meet a larger number of patients for screening and treatment when required. + Hospitals: Hue University of Medicine and Pharmacy, Transportation, Military Health 268 hospitals organized areas for screening check-ups of influenza A (H1N1) and were ready to participate to meet the epidemic prevention when necessary. - Provincial level: This included the Provincial Healh Department office, Preventive Health Center, and Social Disease Prevention Center, which had enough staff experienced in planning, directing, and organizing monitoring and management of epidemics at all levels. - District/City level + 100% of district hospitals organized isolated areas for treatment, designed one- dimentionally following Ministry of Health standards, and had built a plan to meet a larger number of patients for screening and treatment when required. + 100% of district hospitals had enough experienced health staff to treat common and high risk flu cases. + 100% of district hospitals had enough health staff to participate in supervision, support, treatment and management of epidemics in the community. - Commune/ward/town + 100% of communes/wards/towns hhad doctors at Commune Health Centers (CHC) who had been trained on epidemic surveillance, treatment and management, and enough capacity to meet the treatment in controlled communities. + 100% of CHCs have enough health staff to participate in epidemic management in the community. 2.4.2.3. Built a plan on treatment admission for influenza A (H1N1) in controlled communities, including 2.4.2.3.1. Objective: Supervision for early detection, managment and treatment of cases in the community. Ensuring treatment is in place for mild cases, referring for more serious cases, ensuring safety for patients and limiting the spread of the epidemic in the community. 96
2.4.2.3.2. Criteria on treatment of influenza A (H1N1) in controlled communities All DHCs arranged a screening room for all cases of flu and respiratory infection coming to the Centers for check-ups, or being referred from CHCs due to suspected influenza A (H1N1). If there was a diagnosis of possible influenza A (H1N1), tests, patient records and files, and consultations would be completed to confirm the diagnosis, and the treatment would be conducted following the protocol of the Ministry of Health. For those cases which were transferred to treat in a controlled community, the following criteria were necessary to ensure: Clinical disease conditions - Having epidemiologic factors: Within 7 days, the patient: + Lived or came from areas with avian influenza A (H1N1) (especially in areas where the epidemic spread out to community such as Hanoi, Ho Chi Minh City, Khanh Hoa, and Dong Nai). + Living in localities with cases which were confirmedly diagnosed with influenza A (H1N1) + Close contact with patients, or sources of disease: possible or confirmed influenza A (H1N1) + Clusters of cases: Where there were many cases of people with influenza infection or respiratory infections coming for check-ups within the same period of time. - Having clinical symptoms: Acute progress with some following symptoms: + Fever (fever ≤ 39ºC) + Respiratory symptoms: Acute respiratory infection, sore throat, dry cough (lungs without pathological sounds and no trouble in breathing). + No pathological background of chronic diseases (heart disease, diabetes, asthma, chronic bronchitis, etc.) + No the elderly, children under 5 years of age, pregnant women - Paraclinical tests: RT-PCR tests have confirmed positively for the virus strain of influenza A (H1N1) (if conditions permit). Conditions of family and patient: Treatment and measures to prevent infection must be complied with. If there were not adequate conditions for infection control (no isolation room, no antiseptic solution for cleaning supplies and treating personal effects) or no commitment to treatment, the patient must be transferred to isolated areas at the District/City Health Centers. 97
2.4.2.3.3. Organization of treatment in controlled communities For District/City Health Centers - Guiding and supervising CHCs to monitor and care for confirmed cases and implementing treatment following the protocol from the Ministry of Health. - Quickly assigning staff to coordinate with CHCs for timely referral of complicated cases - Arranging medical supplies, means of personal protection, sterilization chemicals, etc. for CHCs to treat the confirmed cases. - Organizing supervision and treating the environment at areas with confirmed cases in accordance with the Ministry of Health regulations. For Commune Health Centers - Receiving suspected or confirmed cases of influenza virus A (H1N1) or people with virus of influenza A which were eligible for the treatment in controlled communities to be transferred from DHCs, and deligating qualified staff to monitor the treatment of patients at home. - Tracking the status of patients twice a day: fever, general vital signs, dyspnea status, lung examination to detect abnormal sounds, general examination to detect new diseases that might arise, etc. (write results in the patient’s records). If one of the serious signs are detected such as fever over 39ºC, dyspnea, abnormal sounds in lungs or having other abnormal progress, CHCs must promptly report to DHC and referred to upper levels for appropriate treatment. - CHC staff provide medicine daily for home treatment, to guide and monitor patients on how to use medicine, and advise them on how to eat and rest, etc. - Advising patients and their families about isolation, limited exposure, wearing a mask, respiratory hygiene with ordinary antiseptic solutions, and routine hand washing with soap containing antiseptic ingredients. For patients and their family - Must commit to and comply with the treatment and measures to prevent infection, and arrange an isolation room, and antiseptic solutions to clean utensils and treat personal stuff. - In the course of treatment: patients must be isolated separately and exposure must be limited, a mask must be worn when in contact or going out. Patients have to sanitize their respiratory tract with ordinarily antiseptic solutions, use their own personal utensils, and wash hands frequently with soap with antiseptic. - They must clean the house daily with antiseptic solutions, keeping the doors 98
open. 2.4.2.3.4. Organization on surveillance and treatment of the epidemic in community Following Decision No. 1846/QD-BYT dated on 27th May, 2009 by the Minister of Ministry of Health on guidelines on monitoring and prevention of the influenza A (H1N1) epidemic. 2.4.2.4. Organization on implementing the plan of treatment admission for influenza A/H1N1 in controlled communities, implementing monitoring and data collection from daily reports of District/City Health Centers and Thua Thien Hue Provincial Preventive Health Center. 2.5. Methods of data collection - Data from daily reports of District/City Health Centers and Thua Thien Hue Provincial Preventive Health Center. - Results of serological surveillance in Nha Trang Pasteur Institute and the National Epidemiology and Hygiene Institute. - Synthesized data on the treatment of influenza A (H1N1) epidemic of District/City Health Centers and Thua Thien Hue Provincial Preventive Health Center. 2.6. Data processing: Using Micosoft Office Excel 2003, SPPS 11.5. 3. Results and discussions 3.1. Description the suitability of the solution on organization of the treatment admission for confirmed and suspected influenza A (H1N1) patients in Thua Thien Hue Province 3.1.1. Description results of treatment on confirmed and suspected cases of influenza A (H1N1) in hospitals before implementation of the treatment in controlled communities: Table 1. Treatment results of confirmed and suspected cases of influenza A (H1N1) in hospitals before implementation of the treatment in controlled communities: No. of cases Total cases Recovery Complication Mortality Age group (%) (%) (%) (%) < 9 years 3 (2.72) 3 (2.72) 0 0 10-19 years 65 (59.1) 65 (59.1) 0 0 20-29 years 27 (24.5) 27 (24.5) 0 0 30-39 years 5 (4.56) 5 (4.56) 0 0 99
40-49 years 5 (4.56) 5 (4.56) 0 0 > 50 year 5 (4.56) 5 (4.56) 0 0 Total 110 (100) 110 (100) 0 0 Among 110 cases which were screened and had a suspected diagnosis of influenza A (H1N1) and were treated with Tamiflu recovered without complications through monitoring. The age group most infected was 10-19 year olds, accounting for 59.1%, the age group 20-29 comprised of 24.5%, and the lowest rate was in children aged less than 10 years. In the United States the age group of 0-4 was 19%, the age group of 5-18 was 26%, the age group of 25-49 was 24% and those over 50 years of age were 22%. This rate was consistent with epidemiological characteristics of how the disease spreads when in direct and close contact, especially in crowded places such as schools, factories, etc. There were two clusters of cases in Huong Thuy and Nguyen Hue High School, which showed that the epidemic was spreading out to the community. Table 2. Duration from using Tamiflu until ending fever of influenza A (H1N1) patients: Duration of treatment until patients’ Number of Rate (%) fever resolves patients Fever ending right after hospitalization 18 16.36 Fever ending after one day 34 30.91 Fever ending after two days 46 41.82 Fever ending after three days 9 8.18 Fever ending after four days 2 1.82 Fever ending after five days 1 0.91 Average time for ending fever at patients after taking Tamiflu was 1.5 days (1:51 ± 0.915), showed that the disease responded well to Tamiflu, progressing with mild disease. Comments: Influenza A (H1N1) had almost mild clinical condition, and responded well to Tamiflu, which occurred mainly in pupil and student groups and was spreading out to community. 3.1.2. Descripton the situation of the health network in the Province on the prevention of influenza A (H1N1) Thua Thien Hue Province is a specialized medical center of Central and Highland areas with Hue Central Hospital, the hospitals of departments/agencies and the health network of the health sector from the provincial to commune/ward/town. 100
Table 3. Distribution on capacity of the health network in the province in implementing the prevention of influenza A (H1N1) Capacity of operations and supervision on Treatment capacity for influenza A (H1N1) influenza A (H1N1) prevention Level of treatment, Implement supervision, treating Mild Mild Formulate supervision epidemic disease disease plans and Serious and disease with with with direct treatment complication risk no risk epidemic of factors factors prevention epidemic National level Yes Yes Yes Yes Yes Provincial level No No No Yes Yes District/City level No Yes Yes Yes Yes Commune/Ward/Town No No Yes No Yes level The health network in the province ensured the implementation of the epidemic prevention at all levels, especially at the grass roots health facility level to implement the treatment for cases of influenza A (H1N1) which were mild and without risk factors. The network had sufficiently professional and experienced staff in directing and organizing the treatment, and monitoring the treatment of epidemics in the community. 3.1.3. Description the treatment admission model of influenza A (H1N1) when the epidemic spread to community with large numbers of patients hospitalized every day Table 4. Surveying impact possibility of the treatment admission models of Influenza A (H1N1) when the epidemic spread to the community with large numbers of patients hospitalized every day Influence Influence possibilities possibilities Infection to daily life to health Treatment Mobilized Supporting controlling model resources resources and care at capacity community health activites facilities Influence to In Hue Cause In place No Controllable families, Central overload in relatives, 101
Hospital health staff hospital Influence to In Cause Provincial families, District/City In place Controllable overload in level relatives, Hospitals hospital health staff In community Provincial Little Little under In place and District Controllable influence influence control levels (CHC) Cause Influence to shortage of teaching and human Need to mobilize study at resource at Field Not well participation of many hospital controllable schools; stop health departments/agencies operations of facilities agencies, etc. mobilized to participate The response was according to the provisions of guidelines on surveillance and prevention of influenza A (H1N1) in Decision No. 1846/QD-BYT and guidelines on diagnosis, treatment and prevention of infection with influenza A (H1N1) in Decision No. 2762/QD-BYT by the Ministry of Health. In order to investigate possible impacts of the treatment admission model of Influenza A (H1N1) it has been shown that the establishment of field hospitals in the treatment of influenza A (H1N1) required more resources, particularly when a series of cases occured at many schools, enterprises, factories, offices, etc., and influence social and community activities, as well as issues of social security. The appropriate therapy model should have a low impact no health care in hospitals, community activities and issues of social security. This was the case with the approach in controlled communities. Comments: The clinical progression and the spread of Influenza A (H1N1) was surveyed, as was the capabilities of the health network. From this survey comparisons of the effectiveness of the therapy solutions of influenza A (H1N1 ) were made and used for provincial planning. Under the direction of the Ministry of Health and the Provincial Party Committee, from 31st August, 2009, the Provincial Health Department used this information to direct the implementation of plans regarding the organization of treating influenza A (H1N1) in controlled communities in the province of Thua Thien Hue. The aim was to reduce overload in hospitals, actively managing resources, limit exposure, prevent the spread of disease and limit the influence of the epidemic on community 102
activities and social welfare. 3.2. Description some characteristics of influenza A (H1N1) in Thua Thien Hue Province in 2009 3.2.1. Distribution on the treatment results of influenza A (H1N1) by gender Table 5. Treatment results of patients with diagnosed or suspected influenza A (H1N1) in Thua Thien Hue Province in 2009 No. of cases Number of Number of Number of Number of recovery complicated mortality/Rate cases cases/ Rate cases/ Rate (%) Gender (%) (%) Male 1101 1101(53.7) 0 0 Female 950 950(46.3) 0 0 Total 2051 2051(100) 0 0 All of the 2051 treated cases responded well to Tamiflu, there no cases of complications or deaths. Nationwide, the death rate was 0.5% [1] of which 43.59% were under 15 years old, 82.05% were hospitalized after 3-10 days, 23.8% were pregnant women, 54.7% had a history of chronic diseases; and 17.95% had history of cardiovascular disease. The difference was not statistically significant between males and females (P> 0.05), nationwide: 57.3% of cases were male, and 42.7% were female. 3.2.2. Distribution on the treatment results of influenza A (H1N1) by age group % 65.53 70 60 50 40 30 19.11 20 7.31 10 3.07 0.15 0.07 0 Figure 1. Rate by age group (%) and confirmed and suspected cases of influenza A (H1N1) which were treated in 2009 103
Among 2051 cases, the age group of 10-19 years was the most infected, accounting for 65.53%, the age group of 20-29 years had 7.31%, and infection rates were lower in the age group over 50 years. In the United States the age group of 0-4 years was 19%, the age group of 5-18 years was 26%, and the age group of 25-49 years was 24%, and 22% for people over 50 years. 3.2.3. Distribution on the treatment results of influenza A (H1N1) patients by occupation: Table 6. The rate of treated influenza A (H1N1) patients by occupation Occupation Frequency Rate (%) Pupil 1635 79.72 Student 42 2.05 Staff 39 1.9 Young age 61 2.97 Worker, self-employed worker 149 7.26 Elderly 7 0.34 Teacher 33 1.61 Others 92 4.49 The highest rate was among pupils and students, accounting for 81.77% this is similar to Canada, which had a rate of 71.4% amongst secondary school pupils (aged 13-17 years). The rate of spread was strong when in direct and close contact, especially in crowded places such as schools and kindergartens. Comments: For the treatment results of influenza A (H1N1) in the province of Thua Thien Hue in 2009, clinical progress was mild, responded with Tamiflu, and with no complications or mortality. The age group and occupation most affected was pupils and students ,which was the group of people in the most crowded environment, which facilitated the fastest spread of the disease. 3.3. Some evaluation on the effectiveness of organization on the treatment admission for influenza A (H1N1) in controlled communities in Thua Thien Hue Province in 2009 3.3.1. Progress on the situation of patients and phases of influenza A (H1N1) epidemic 104
Initial phase: Treatment 450 Spreading phase: Treatment in controlled communities 400 in hospitals 350 300 250 200 150 100 50 0 Number of… Tuần3(6-12/7) T5(20-26/7) T9(17-23/8) T17(12-18/10) T23(23-29/11) T11(31/8-6/9) T13(14-20/9) T15(28-4/10) T19(26-1/11) T21(9-15/11) Tuần1(24-30/6) T25 (7-13/12) T7 (3-9/8) T27 (21-27/12) Figure 2. Progress on the situation of patients and phases of influenza A (H1N1) epidemic in 2009 The outbreak had two peaks in September and in mid-October and November (the 15th and 17th weeks). In this period, the health sector implemented the uniform treatment of influenza A (H1N1) in hospitals as well as in controlled communities, while enhancing the monitoring and treatment of the outbreak. Therefore the outbreak situation was controlled and gradually reduced in late 2009. 3.3.2. Evolution on the serological strains of influenza in Huong Thuy District in 2008-2009 Figure 3. Distribution on the serological strains of influenza through focused surveillance in Huong Thuy in the years of 2008-2009. Influenza B is usually most common in summer from March to May. Influenza AH1 usually increases in autumn and winter months from July to December. Influenza AH3 usually occurs in spring and summer months from January to July. In 2009, an 105
epidemic of the new Influenza A (H1N1) occured worldwide. The Influenza A (H1N1) completely replaced the influenza AH1 and other influenza strains from July to October, and decreased in November and then the influenza B and H3 recurrented. 3.3.3. Treatment results of patients in hospitals and in controlled communities: Table 8. Distribution on the treated influenza A/H1N1 patients by district/city Number of Number of commune Number of No. Location commune having having treated patient patients patients in community 1 Phong Dien 10 4 88 Quang Diền 2 10 4 294 3 Huong Tra 14 5 361 4 Hue City 27 27 730 5 Phu Vang 20 1 152 6 Huong Thuy 12 6 266 7 Phu Loc 6 0 20 Nam Đong 8 10 1 80 9 A Luoi 13 8 58 10 Other provinces 0 0 2 Total 122 56 2051 The total number of hospitalized patients was 2,051 cases, which was distributed through 122/152 communes/wards/towns across the province, with 56/122 of them having patients treated in controlled communities, and a number of communes with many patients, areas convenient for monitoring and treatment. The areas which had the highest number of patients were Hue City, Huong Thuy and Huong Tra and the lowest ones were A Luoi and Phu Loc. Table 9. Treatment results of influenza A (H1N1) patients in hospitals and in controlled communities Treatment levels and results Number Recovery Recovery No. Location of treated In In rate rate patients hospitals community (%) (%) 1 Phong Dien 88 63 100 25 100 106
2 Quang Dien 294 183 100 111 100 3 Huong Tra 361 125 100 236 100 4 Hue City 730 420 100 310 100 5 Phu Vang 152 146 100 6 100 6 Huong Thuy 266 56 100 210 100 7 Phu Loc 20 13 100 7 100 8 Nam Dong 80 59 100 21 100 9 A Luoi 58 18 100 40 100 Other 10 2 1 100 1 100 provinces 1,084 967 Total 2,051 100 100 (52.8%) (47.2%) The treatment results in hospitals were 1,084 cases (52.8%) and in controlled communities were 967 cases (47.2%), in which all recovered from the disease, without complications or mortality. while all levels continued health care in health facilities and health programs as planned. Comments: Organisation for the treatment of influenza A (H1N1) in controlled communities in the province of Thua Thien Hue has successfully treated 47.2% of patients in hospitals, thereby reducing health facility overload at other levels (especially in District/City Hospitals). The hospitals were deployed in parallel with routine health care in health facilities in addition to, and not disrupting daily life or activities in the community. The evaluation on progression of the disease situation in 2009 and the results of the serological tests of influenza strains by focused surveillance in Huong Thuy in the years 2008-2009 showed that the disease situation has been controlled and decreased. 4. Conclusions 4.1. The identified characteristics of the epidemic of influenza A (H1N1), was that it occurred mostly in the pupil and student group, and it spread rapidly through direct contact, especially in crowded places. Cases were mostly clinically mild, ,responded well to Tamiflu. 4.2. Solutions for the treatment of influenza A (H1N1) in controlled communities in the province of Thua Thien Hue was consistent with the clinical progression of the disease and the situation throughout the province. Treatment was effectively administered for 47.2% of patients with influenza A (H1N1), and contributed 107
to minimising overload at higher health facility levels (especially at Central and District levels), while limiting the impact of the epidemic to activities of the community and departments/agencies. This facilitated stable social security and savings for the state budget. REFERENCES 1. Announcement No. 2694/TB-DPMT dated on 29th December, 2009 by Ministry of Health on the situation of avian influenza A (H1N1). 2. Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333, USA 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, 24 Hours/Every Day - cdcinfo@cdc.gov. 3. Weekly epidemiological record. Relevé épidémiologique hebdomadaire. 20 November 2009, 84th year / 20 novembre 2009, 84e année.No. 47, 2009, 84, 485–492. 4. Guidelines on Diagnosis, Treatment and Prevention of influenza A (H1N1) infection (Issued following Decision No. 2762 /QD-BYT dated on 31st July, 2009 by Minister of the Ministry of Health). 108