1. PANDEMIC H1N1 IN HANOI-VIETNAM: OVERVIEW AND RESPONSE

2. OUTLINE Some introduction of Hanoi Capital Overview of Pandemic influenza A(H1N1) in Hanoi Pandemic preparedness and responses Lessons learned

3. A glance of Hanoi The capital of Vietnam Area: 3,315km 2. The 10 th largest city worldwide Population (2010): 6.7 million, and 2 million students & free-workers Close connection with other countries by International Noibai Airport

4. Hanoi is the heart of the country

5. A glance of Hanoi Hanoi health system: ▫43 public hospitals (25 general hospitals, 17 specialist hospitals) ▫26 private hospitals. ▫20 other units (specialist centers, center of preventive medicine, center of International health quarantine..) ▫29 District medical centers ▫47 Regional clinics ▫577 Commune health stations

6. … facing many epidemics during recent years  SARS (2003): 63 cases and 5 deaths  Influenza A/H5N1 (2003-2011): 21 cases and 9 deaths  Pandemic A/H1N1 (2009): 1,718 confirmed cases/6,500 suspected cases  Cholera (2007-2010): 35 confirmed cases/5,093 clinical cases

7. … facing many epidemics during recent years  Dengue fever: 16,090 clinical cases and 4 deaths in 2009; 3,152 cases in 2010  Rabies (2006-2011): 47 cases  Meningocogue 2011: 3 cases and 2 deaths  Hand Foot and Mouth disease (2011): 600 cases

9. OVERVIEW OF PANDEMIC INFLUENZA A(H1N1) IN HANOI 9 th June, 2009 the first pH1N1 case imported in Hanoi Hanoi was the 2 nd city in the country infected by the Pandemic 31 st July, 2009, the fist pH1N1 cluster in Lomonoxop secondary school - the evidence of virus transmission in community

10. pH1N1 in Hanoi from Jun,2009 to Sep,2010. Changes in surveillance strategy

11. Epidemiology of pH1N1 cases Age distribution of cases

12. Clinical presentation Symptom Domestic cases No (%) Fever > 38 o C9385.3 Dry cough7871.6 Sore throat3532.1 Rhinorrhea/nasal congestion1311.9 Headache1513.8 Fatigue1211.0 Muscle pain32.8 Vomiting21.8 Wheezing10.9 Difficult breathing21.8 Diarrhea

13. SignDuration (day) Average Fever1-62.3 + 1.5 Cough1-73.0 + 2.3 Virus shedding3-115.8 + 2.1 Clinical presentation

14. PANDEMIC H1N1 PREPAREDNESS AND RESPONSE

15. Multi-Sector Approach Medical Interventions Non-Medical Interventions Social Services (keep a society running)  Antiviral drugs  Vaccines, etc  Medical care  Personal hygiene  Travel restrictions  Quarantine  Social distancing  Risk communications  Security  Food & water supply  Power supply  Transportation  Other essential services Public Health Measures Pandemic H1N1 preparedness & responses

16. Interventions implemented according to different stages of the pandemic Outbreak spreading nationwide Outbreak spreading to community Outbreak in schools + limited areas Sporadic cases Health care for all Public health measures Surveillance Communication

17. DIRECTION & MANAGEMENT The local authorities directly directs pandemic preparedness and response. Political system and multi-sectors involve in pandemic preparedness and response. Health sector plays as the leading actor in conducting public health measures.

18. Directive documents on pandemic control & prevention issued accordingly ▫Law on communicable disease control and prevention, 2008 ▫Directives issued by the Gov. ▫Technical guidelines issued by MOH National plan for Pandemic control and prevention approved on 12/06/2009 DIRECTION & MANAGEMENT

19. Intensifying surveillance activities in airports, hospitals, schools, offices and community ▫Influenza Sentinel surveillance ▫Routine surveillance system for communicable disease ▫Health quarantine system SURVEILLANCE

20. National Institute of Hygiene & Epidemiology MOH Hanoi Preventive Medicines Centre 29 District Health Centre District hospitals, policlinic health centers 17 National, provincial hospitals Commune health stations City Health Department Private clinics Village health workers ROUTINE SURVEILLANCE SYSTEM IN HANOI Intensifying surveillance in health facilities and communities Timely reporting (email, phone, fax) Rapid responses

21. Setting up mobile teams 24/24 hours on duty Hotline system SURVEILLANCE  Strengthening laboratory system

22. Organizing rehearsals to assess the management skills of the steering committee for A/H1N1 flu prevention in humans and draw up experiences from health workers involved in the field. SURVEILLANCE

23. The rehearsal to prevent A/H1N1 flu infections in humans in school

24. Medical intervention ▫Vaccines: availability at late stage with small amount ▫Antiviral drugs, medical care available at hospital levels Non medical intervention: Major application ▫Environmental, personal hygiene ▫Social distancing (early stage) ▫Risk communications PUBLIC HEALTH MEASURES

25. Strengthening medical care at all level health facilities Setting up mobile clinics Decentralizing curative care at different levels CURATIVE CARE

26. COMMUNICATION Developing IEC materials for different target audiences Providing messages via different channels ▫Mass media/internet ▫Workshops/meetings ▫Direct communication Setting up hotline system

27. COMMUNICATION

28. Training ▫Planning ▫Surveillance and outbreak investigation ▫Case management ▫Laboratory techniques Providing materials and equipments Mobilizing resources for Pandemic control & prevention ▫Support from donor agencies ▫National/Local budget LOGISTICS

29. LESSONS LEARNT The leading of Government, support from political system and collaboration with partners are critical for effective pandemic preparedness and response Application of lesson learnt from controlling SARS, Avian influenza A(H5N1) Plan for Pandemic control and prevention at different levels soon approved & implemented Gaining great supports from MOH and National Institute of Hygiene and Epidemiology, International agencies.

30. LESSONS LEARNT Directive documents, technical guidelines, plan of action developed and adjusted accordingly to the development of the pandemic and reality Strengthening capacity for surveillance systems, sharing information, communication Drugs, material, equipment provided accordingly.

31. FUTURE PLAN Closely assessment of risk & the evolution of pandemic virus Seasonal influenza Avian influenza Pandemic H1N1 ? ? ?

32. FUTURE PLAN Strengthening surveillance systems ▫Maintaining Influenza Sentinel surveillance ▫Scaling up routine surveillance for communicable diseases ▫Strengthening health quarantine systems Strengthening laboratory system Collaborating with partners in capacity building, doing research

33. THANK YOU !