HANOI, 22 April 2010 (IRIN) - Several years ago, when patients arrived at hospital with pneumonia that did not respond to standard antibiotics, doctors in Vietnam began to get scared.   Attacking perfectly healthy people, it was obvious that this was no ordinary illness. Patients, as well as health workers caring for them, were dying as epidemiologists raced to identify what was causing the disease.

"We were in a panic," Nguyen Trung Cap, who was working at the National Institute for Tropical and Infectious Diseases in Hanoi when severe acute respiratory syndrome (SARS) struck Vietnam in 2003.

"We did not know if we would wake up in the morning and see people still alive."

But Vietnam did survive, and indeed it weathered more devastating diseases to come.   In 2004, avian influenza arrived, hitting Vietnam particularly hard.  

According to the World Health Organization (WHO) [http://www.who.int/csr/disease/avian_influenza/country/cases_table_2010_04_21/en/index.html] nearly 60 people in Vietnam had died of avian influenza as of 21 April, making Vietnam second only to Indonesia in terms of the number of human fatalities from the H5N1 virus.   When H1N1 influenza (popularly known as swine flu) emerged last year, Vietnam was hit yet again. But this time, say officials, it was prepared.   Early identification and quarantine measures helped curtail the spread of H1N1, officials say, reducing the number of people infected.

Disease surveillance

Since the outbreak of SARS, Vietnam dramatically stepped up its disease surveillance. WHO and the US government have invested heavily in new laboratory equipment and training.

Vietnam now has 15 sentinel surveillance sites that test sputum samples of patients suspected of having the flu, allowing health officials to detect and track the disease.

  Laboratories operate 24 hours a day, if necessary, making it one of the most advanced systems in the world.

"We have rapid investigation and response teams," says Nguyen Tran Hien, director of Vietnam"e;s National Institute of Hygiene and Epidemiology.   "If something new emerges, we can send our teams to get a specimen and conduct an investigation. A quick response means early containment."

Officials attending the International Ministerial Conference on Animal and Pandemic Influenza [http://www.imcapi-hanoi-2010.org/] in Hanoi this week warned that countries need to stay on this kind of war-like footing against emerging diseases in order to prevent a pandemic.

"The need to contain existing diseases and prevent new pathogens from jumping between species is set to increase as our environment changes and human and animal populations continue to grow," David Nabarro, senior UN system influenza coordinator, told the conference in a video message.

A draft report [http://un-influenza.org/files/Synopsis.pdf] prepared for the conference by the UN and World Bank notes that since 2005 there has been substantial worldwide progress in preventing and preparing for a pandemic.   No room for complacency   But complacency, which increased when H1N1 turned out to be not as virulent as first thought, threatens to undermine these achievements.

"I think the biggest challenge is how we communicate the risk," Jean-Marc Olive, WHO"e;s country representative in Vietnam, said addressing officials from more than 70 countries at the conference.

Le Minh Khanh, deputy director of the Animal Health Department in Vietnam"e;s southern Tien Giang Province admitted that poultry farmers are starting to get careless about avian influenza because there has been no outbreak in the province in two years.   "Farmers no longer cooperate with us," said Khanh, who noted that only 60 percent of flocks have been inoculated this year. "They think vaccination doesn"e;t matter."

Bird flu has largely been contained but it remains active in at least five countries, where tens of millions of birds are being raised, many on family farms, say health officials. With so many people living in close proximity to poultry and pigs, viruses have more opportunities to infect humans. Scientists fear they might mutate into a deadlier form.

If Vietnam is hit by yet another new infectious disease, Cap of Vietnam"e;s Institute for Tropical and Infectious Diseases believes the country is ready.   "It"e;s different now," he says. "We have a better understanding of these diseases and we are in an active position to cope. We are now well equipped with good facilities and trained personnel. We understand the danger is out there and we as doctors are ready."   mo/ds/cb

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