Atlas bệnh truyền nhiễm PDF

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ATLAS CC BNH TRUYN NHIM TI VIT NAM

GIAI ON 2000-2011
AN ATLAS OF COMMUNICABLE DISEASES IN VIETNAM
FROM 2000 TO 2011
LI NI U
Tnh hnh bnh truyn nhim gy dch trn th gii din bin tng i phc tp trong nhng
nm gn y. N l kt qu ca mt h thng phc hp tc ng ln nhau gia cc yu t sinh hc,
x hi, sinh thi v k thut. Ch tnh ring trong 15 nm tr li y, nhiu dch bnh mi xut hin
gy nh hng ln ti sc khe con ngi. Dch cm A/H5N1 ly truyn t gia cm sang ngi
xut hin ln u tin ti Hng Kng nm 1997, tnh n 8/10/2013 xut hin ti 15 quc gia
thuc Chu , Chu Phi v Chu u vi 641 trng hp mc v 380 trng hp t vong. Nm
2003, dch SARS xy ra, trong thi gian ngn lan rng ra nhiu quc gia vi khoang 8000 ngi
mc, hn 700 trng hp t vong. Dch t trn th gii cng c xu hng tng lin tc trong nhng
nm tr li y c v quy m v phm vi gy dch. Thng k ca T chc Y t Th gii cho thy,
ch tnh ring giai on t 2004 - 2008 s ca bnh t trn th gii tng 24 % so vi giai on t
nm 2000 - 2004. Xu hng ca dch st xut huyt cng gia tng mnh nhiu nc trong thp
k qua, c bit l cc nc khu vc ng Nam , Trung ng v Ty Thi Bnh Dng, c tnh
trung bnh mi nm th gii ghi nhn ti 500.000 ngi mc st xut huyt. Hu qu ca cc bnh
nhim trng mi xut hin ca khu vc ng Nam Chu l rt ln. c tnh dch SARS khu
vc ng v Nam Chu lm thit hi khong 18 t la M (vo khong 2 triu la cho mt
bnh nhn). Ngoai ra, dich cum gia cm A/H5N1cung gy anh hng nng n ti cng nghip chn
nui gia cm va tip tuc anh hng ti ca nhiu nc trong khu vc v cn tip tc lan rng
Kt qu gim st Vit Nam trong 10 nm va qua cho thy, Vit Nam vn tip tc duy tr
tt nhng thnh qu v thanh ton bi lit v loi tr un vn s sinh, nhiu bnh truyn nhim nh
bch hu, ho g, vim no Nht Bn c xu hng gim r rt; nhiu v dch t, dch st xut
huyt, cm A/H1N1/09 i dch, tay chn ming ... c khng ch hiu qu. l nh cc hot
ng gim st phng chng dch bnh ch ng, cng tc truyn thng nng cao nhn thc ca cng
ng, s vo cuc kp thi v tch cc ca y t, chnh quyn v cc ban ngnh lin quan. H thng
cc vn bn php quy v gim st, phng chng bnh truyn nhim ngy cng c hon thin nh
Lut phng, chng bnh truyn nhim; Quy ch thng tin bo co dch bnh truyn nhim; Quy
trnh gim st, d phng, x l dch v iu tr bnh truyn nhim gp phn lm tng hiu qu
ca cng tc gim st, phng chng dch. Bn cnh nhng thnh qu t c, tnh hnh bnh bnh
truyn nhim vn din bin rt phc tp. S gia tng dn s, thay i kh hu, qu trnh th ha
nhanh, giao lu quc t, bin ng dn s, tnh trng nhp c, di c, nhim mi trng, s khng
thuc v bin chng ca cc tc nhn gy bnh, qun l vt nui, quy trnh kim dch ng vt, quy
trnh git m v tiu th thc phm t ng vt vn cn lng lo v cha hiu qu, cng vi nhng
thi quen v sinh cha tt v nhiu nguyn nhn khch quan khc khin cho bnh truyn nhim d
dng ly lan v tip tc l gnh nng sc kho cho cng ng. Nhiu bnh truyn nhim trc y
c s mc thp nay c nguy c quay tr li bng pht thnh dch.
Trong bi cnh , vi s h tr v k thut ca t chc Y t th gii ti Vit Nam v h tr v
mt ti chnh ca USAID, vin V sinh Dch t Trung ng hp tc vi Trng i hc Oxford
(Vng quc Anh), bin son cun Atlas cc bnh truyn nhim Vit Nam. Mc tiu ca cun
Atlas (Bn ) ny l cung cp thng tin v s phn b theo a l ca cc bnh truyn nhim trn
ngi v ng vt, cng nh cc mi nguy c e da sc khe khc. Ti liu ny trnh by cc bn
v mt s bnh truyn nhim (bao gm bnh mi ni, bnh ly truyn t ng vt sang ngi,
bnh thuc din phi bo co) v cc yu t lin quan Vit Nam; cc thng tin m t ngn gn v
triu chng, tc nhn gy bnh, din bin, phng thc ly truyn, iu tr lm sng, phng bnh v
kim sot bnh; v cc bn v cc yu t lin quan n lan truyn bnh truyn nhim. S liu s
dng trong cun Atlas ny c ly t cac ngun s liu chnh thc nh: Nin giam thng k bnh
truyn nhim; cc bao cao cua Cuc An toan V sinh Thc phm, Cc Y t D phng, Cuc Thu y,
Vin V sinh Dich t Trung ng, Vin Pasteur HCM, Vin Pasteur Nha Trang, Vin V sinh Dich
t Ty Nguyn, Vin St ret Ky sinh trung-Cn trung Trung ng, Chng trinh phong chng lao
quc gia, chng trinh phong chng phong quc gia; cac tai nghin cu khoa hc cp nha nc,
cp b; cac bai bao ng trn cc tp ch khoa hc trong nc v quc t.
Hy vng cun Atlas ny s l mt ti liu quan trng gp phn hiu r hn cc dch bnh nhm
tng cng h thng gim st v p ng dch bnh truyn nhim Vit nam. N cng gip cc nh
nghin cu kim tra gi thuyt v cc yu t nh hng n s phn b bnh theo a d, v gip
cho cc nh hoch nh chnh sch u tin ngun lc v p ng nhng khu vc c nguy c cao
nht. Ngoi ra, cun Atlas c th s dng nh mt ti liu c bn h tr vic hc tp v o to trong
lnh vc phng chng bnh truyn nhim.
Mc du nhm cc chuyn gia bin son c gng tm kim, khai thc, s dng cc ngun
thng tin bin tp ln u tin cun Atlas ny, nhng khng khi khng c nhng thiu st v
hn ch. Cht lng s liu cc bn c th cn hn ch v khc nhau ty thuc vo thit k
nghin cu, phng phap thu thp s liu, v vo tnh sn c ca s liu. Do o, cun Atlas cung
co th c coi la khi u nng cao cht lng s liu gop phn anh gia s phn b va ganh
nng cua nhng bnh truyn nhim quan trong Vit Nam.
Chng ti rt mong nhn c kin ng gp ca c gi v ng nghip c th nng cao
cht lng ca ti liu ny cho ln xut bn sau.
Thay mt nhm bin son
GS.TS Nguyn Trn Hin
FOREWORD
The global control of communicable diseases has become more complicated in recent years.
It is the result of an interplay between biological (pathogen), social (behavior), and ecological
(environment) factors. In the last 15 years, emerging infectious diseases have repeatedly challenged
public health systems. Since the first case of influenza A/H5N1, which transmitted from poultry to
humans in Hong Kong in 1997, avian influenza has caused human cases in 15 countries in Asia,
Africa and Europe with 641 infected cases and 380 deaths by 8th October 2013. In 2003, the Severe
Acute Respiratory Distress Syndrome (SARS) virus spread rapidly to many countries with about
8 thousands of infected patients and over 700 deaths. In addition, some classic pathogens such as
Vibrio cholerae are re-emerging, causing increased disease across the world. Statistics from the
World Health Organization show that from 2004 to 2008 the number of cholera cases worldwide
has increased by 24% in comparison with the period 2000-2004. The burden of dengue fever also
continues to increase. Over the last decade, many countries, especially in South East Asia, the
Middle East and Western Pacific, have witnessed an upward trend of dengue fever, with an average
number of 500,000 dengue cases recorded every year.
The consequences of such emerging and re-emerging infectious diseases in the South East
Asia region is tremendous. The SARS pandemic in East and South Asia lead to US$ 18 billion in
damages, about $2 million per patient, Avian influenza A/H5N1 has had a severe impact on the
poultry industry and continues to trouble many countries in the region.
Disease surveillance in Vietnam over the past 10 years shows that Vietnam has successfully
eliminated polio and neonatal tetanus. Several infectious diseases such as diphtheria, whooping
cough, and Japanese encephalitis have declined significantly. Furthermore, SARS and avian
influenza A/H5N1 have been controlled effectively. These successes can in part be attributed
to the surveillance and epidemic prevention systems, and to active communication programs that
raise awareness amongst the community. Regulations on the surveillance, prevention and control
infectious diseases are continually being improved, such as the Law on Infectious Disease Control
(November 21st, 2007) which regulates the reporting of specific infectious diseases, monitoring
procedures, prevention, outbreak management and treatment. The law has contributed to reinforcing
the effectiveness of the monitoring, prevention and control of communicable diseases in Vietnam.
Despite these accomplishments, infectious diseases in Vietnam remain an important issue and
there are reasons to continue to strengthen the systems for surveillance and control. Factors that
may increase the burden of infectious diseases include: an increasing population, climate change,
urbanization, international and domestic population mobility, environmental pollution, drug
resistance, changing livestock management systems, inadequate animal quarantine procedures,
weak control of livestock slaughtering and food preparation and consumption pratices, poor food
hygiene practices.
In this context, the National Institute of Hygiene and Epidemiology with technical support
of World Health Organization in Viet Nam and financial support of USAID has collaborated with
Oxford University Clinical Research Unit in Vietnam to compile the book Atlas of communicable
diseases in Vietnam. The objective of the Atlas (Map) is to provide the best available information on
the geographical distribution of infectious diseases in humans in Vietnam. This atlas provides maps
on a number of infectious diseases and associated factors in Vietnam, with each map accompanied
by a fact sheet that provides a systematic summary of the disease. Data used in this Atlas is derived
from various sources such as the communicable disease yearbooks, and reports from the Vietnam
Food Administration and Safety, General Department of Preventive Medicine, Animal Health
Department, National Institute of Hygiene and Epidemiology, Pasteur Institute Ho Chi Minh City,
Nha Trang Pasteur Institute, Institute of Hygiene and Epidemiology Highlands, National Institute of
Malariology Parasitology and Entomology, National Tuberculosis Control Programme of Vietnam,
and the National Leprosy Program. We also used reports from scientific research conducted at state
or ministerial level, and articles published in national and international scientific journals.
We hope that this Atlas will become a vital document contributing to a better understanding of
the epidemiology of infectious diseases in Vietnam and strengthen the national infectious disease
surveillance and response system. It can also support researchers in the area of infectious diseases,
and support policy makers to optimize resources and prioritize high risk areas. Besides, the Atlas
can be used as a basic material in education and training in the field of infectious diseases and
control.
Despite our best efforts to compile and integrate a wide range of data sources to publish this
first edition of the Atlas of infectious diseases in Vietnam, the document undeniably has some
deficiencies. The quality of the data available with which to prepare the maps are limited, vary
greatly between diseases and depend on the availability of data. Therefore, this Atlas should be seen
as a starting point and as a stimulus to collect better data with which to track the distribution and
burden of these important diseases.
In order to improve the quality of the next editions, we are looking forward to your precious
feedback.
On behalf of Editorial Board ,
Nguyen Tran Hien
Users guide/Hng dn s dng

Cun sch Atlas c chia thnh 4 phn: (1) Cc
yu t thc y bnh truyn nhim, (2) Cc bnh
truyn nhim do vi khun, (3) Cc bnh truyn
nhim do k sinh trng, v (4) Cc bnh truyn
nhim do vi rut. Bn cc bnh truyn nhim
c sp xp theo trnh t bng ch ci trong
tng phn tng ng. Cc t ng ngha dng
cho cc bnh u c trnh by. Bn ca
mi bnh c i km vi mt bn m t cung
cp thng tin chnh v vi sinh vt gy bnh, s
lan truyn, thi gian bnh, biu hin lm sng,
phng trnh bnh, dch t, cc ngun thng tin
chnh ca bn , mt s hn ch ca d liu v
-Syndromes and synonyms: Other names by
ti liu tham kho. Cc mc chnh trong bn m
which the disease may be known or types of dist gm nhng thng tin nh sau:
eases caused by the agent.
-Cc hi chng v cc t ng ngha: Nhng tn
-Agent: The disease-causing pathogen(s) with
gi khc ca bnh hoc nhng dng bnh c
key characteristics.
gy ra bi cng vi sinh vt gy bnh.
-Reservoir: The main animal host or environ-Cc vi sinh vt gy bnh: Nhng cn nguyn
mental niche where the pathogen is predomigy bnh cng vi nhng c im chnh ca
nantly found and from where it can be transmitchng.
ted.
- cha: Cc vt ch chnh hoc nhng mi
-Vector: The living carrier that predominantly
trng m cc vi sinh vt gy bnh hay c tm
transmits the infectious agent to humans.
thy v t c th gy ly bnh.
-Transmission: The mechanism(s) by which the
-Vector: ng vt sng mang bnh, m n
pathogen is transmitted to humans
thng ly truyn cc vi sinh vt gy bnh sang
-Cycle: A summary of the lifecycle of the patho- cho con ngi.
gen.
-S ly truyn: C ch m vi sinh vt gy bnh
-Incubation period: Time period between the ex- ly nhim sang ngi
posure to the pathogen and disease onset.
-Chu k: Tm tt vng i ca vi sinh vt gy
-Clinical findings: Key symptoms of the bnh.
disease(s). A single pathogen may cause more
-Thi gian bnh: Thi gian t khi tip xc vi
than one disease syndrome.
vi sinh vt gy bnh cho n khi bnh khi pht.
-Diagnostic tests: Standard laboratory tests used
-Biu hin lm sng: Nhng triu chng chnh
to identify the infection.
ca bnh. Mt vi sinh vt gy bnh c th gy ra
-Epidemiology: Information on the determi- nhiu hn mt hi chng.
nants, distribution, and burden of the disease.
-Cc xt nghim chn on: Cc tiu chun xt
Groups at risk of disease are also identified in
nghim c dng chn on xc nh bnh.
this section.
The atlas is divided into four sections: (1) Associated factors, (2) Bacterial Infections, (3)
Parasitic Infections, and (4) Viral Infections.
Disease maps are ordered alphabetically within
their section. Synonyms for diseases are stated.
Each disease map is accompanied by a fact sheet
that provides key information on the pathogen,
disease transmission, incubation time, clinical
findings, prevention, and epidemiology, main
sources for the map, data limitations and key
references. The definitions of each heading in
the fact sheet are as follows:
-Map sources: Key sources used for the map are -Dch t: Thng tin v cc yu t nh hng, s
mentioned here.
phn b v gnh nng bnh tt. Nhng nhm
-Key references: Key references relating to the c nguy c mc bnh cng c trnh by trong
mc ny.
disease are listed here.
-Ngun d liu ca bn : Nhng ngun thng
tin chnh c dng xy dng bn c
cp y.
The fact sheets for the maps in Section 1 Infectious Disease Drivers have a different format
than those for the diseases. This section includes
maps that illustrate some of the principal driving forces of infectious disease distribution,
ranging from poverty and sanitation, to climate,
and land cover. We acknowledge that for some
factors shown in this section the relationship is
two-way, with the factor being both a cause and
a consequence of infection, e.g. poverty and undernutrition. The fact sheets in this section provide a definition, the trends and the relation to
infections. Also map sources and key references
are included in these fact sheets.
-Ti liu tham kho chnh: Nhng ti liu tham

kho chnh lin quan n mi bnh s c lit
k y.
Bn m t cho cc bn trong phn 1 Cc
yu t thc y bnh truyn nhim c trnh
by theo mt dn khc vi phn chi tit ca
tng nhm bnh. Phn ny bao gm cc biu
th hin mt s nhng yu t chnh nh hng
n s phn b ca cc bnh truyn nhim t
tnh trng ngho i, v sinh mi trng, cho
n kh hu v bao ph mt t. Chng ti
nhn thy rng vi mt s yu t, mi quan h
gia cc yu t ny vi bnh truyn nhim l
hai chiu, cc yu t ny va l nguyn nhn
v cng l mt hu qu ca bnh truyn nhim,
v d nh s ngho i v suy dinh dng. Cc
bn m t trong phn ny cung cp nh ngha,
xu hng v mi quan h vi cc bnh truyn
nhim. Ngoi ra, cc ngun d liu ca bn
v cc ti liu tham kho chnh cng c lit k
trong cc bn m t ny.
We have utilized many different sources to

compile this atlas, including Vietnamese surveillance data, review papers, primary research
papers, maps produced by others, key reference
texts such the Control of Communicable Diseases Manual (CCDM, 19th edition), the Atlas of
Human Infectious Diseases (Wiley-Blackwell,
2012) and the websites of the World Health Organization and Centers for Disease Control and
Prevention, USA.
The starting point for each map was to seek
surveillance data on the disease and to establish whether a map of disease distribution was
already available. Based on available information, the editorial team decided how the disease distribution should be visualized and with
what data source(s). Where high-quality maps
were already available we would use these unchanged (e.g. malaria maps) or modified and updated as needed, and permissions were obtained
when necessary. Where there was no existing
map or surveillance data available, a literature
search strategy was developed in order to gather
information on disease distribution. The mapping team prepared draft maps for review and
Chng ti s dng rt nhiu ngun thng tin

khc nhau bin son cun Atlas ny gm c
cc d liu gim st ti Vit Nam, cc bi bo
tng quan, cc bi bo nghin cu, cc bn
c xy dng bi nhng nhm nghin cu
khc, cc sch tham kho chnh nh sch Phng
chng cc bnh truyn nhim (Control of Communicable Diseases Manual, ti bn ln th 19),
cun Atlas cc bnh truyn nhim ngi ca
Wiley-Blackwell (Atlas of Human Infectious
Diseases, 2012) v trang thng tin in t ca T
chc y t th gii (WHO) v Trung tm Phng
chng bnh tt Hoa K (CDC, USA).
im xut pht ca mi bn l tm kim cc
thng tin kho st v xc nh xem bn phn
comment by the editors. Finally, the maps and b ca bnh tng c xy dng cha.
fact sheets were sent for external peer review to Da vo nhng thng tin thu c, nhm bin
check for accuracy and
tp quyt nh xem th hin s phn b ca bnh
nh th no v s dng ngun thng tin no.
DISCLAIMER
Vi nhng bn c cht lng tt c
Although extensive effort has been made to pro- xy dng sn t trc, chng ti c th s dng
duce accurate and up-to-date information, all nguyn gc (v d nh cc bn bnh st rt)
geographic information has limitations due to hoc thay i v cp nht thm nu cn thit .
the scale, resolution, date, and interpretation of Vi nhng trng hp khng c sn cc bn
the original source materials. The information cng nh cc d liu kho st, chng ti c cc
shown on our maps is compiled from numerous chin lc tm kim trong cc ti liu, ngun
sources and may not be complete. The authors thng tin thu c d liu v c im phn
are not responsible for any errors, omissions, b bnh. Nhm xy dng bn s chun b
or deficiencies in these maps. The maps are in- mt bn phc tho nhm bin tp nh gi
tended for illustrative and educational purposes. v tho lun. Cui cng, cc bn v cc bn
Medicine is a constantly changing field and huge m t s c gi n cho cc nh nghin cu,
amounts of new data emerge on a daily basis. cc bn ng nghip kim tra tnh chnh xc
Therefore, the contents of this work may not be v hon thin.
up-to-date and should not be used as a guide to
patient treatment, or as medical or travel advice. LU
Mc d nhm nghin cu dnh n lc rt
ln cp nht v a ra nhng thng tin chnh
xc, nhng cc thng tin v a l u khng
trnh khi nhng hn ch do phm vi, phn
gii, thi im v cch din t ca ti liu gc.
Cc thng tin c th hin trn bn ca
chng ti c son tho da trn nhiu ngun
d liu v c th cha hon chnh. Cc tc gi
khng chu trch nhim cho bt k li sai, b
st thng tin, hay s thiu st ca cc bn
ny. Cc bn ny ch nhm mc ch m t
v phc v cho vic ging dy v o to. Y
hc l mt ngnh khng ngng thay i v mi
ngy li c thm mt lng ln nhng thng
tin mi xut hin. Do , ni dung ca cun
sch ny c th khng c cp nht v khng
nn c s dng nh mt hng dn iu tr
cho bnh nhn, hay tham kho v mt y khoa
hay khi i du lch.
BAN BIN SON ATLAS CC BNH TRUYN NHIM VIT NAM
ATLAS OF COMMUNICABLE DISEASES IN VIETNAM, EDITORIAL BOARD
editors
Nguyn Vn Bnh, Cc Y t D phng Vit Nam (General Department of Preventive Medicine)
Nguyn Trn Hin, Vin V sinh Dch t Trung ng (National Institute of Hygiene and Epidemiology)
Babatunde Olowokure, T chc Y t th gii (World Health Organization)
Heiman Wertheim, n v nghin cu lm sng i hc Oxford (Oxford University Clinical Research
Unit)
Editorial group
n v nghin cu lm sng i hc Oxford

Oxford University Clinical Research Unit
Nguyn Th Thanh Thy

Peter Horby
Cc Y t D phng Vit Nam

General Department of Preventive Medicine
Trn
Vin V sinh Dch t Trung ng

National Institute of Hygiene and Epidemiology
Trn Nh Dng
Nguyn Thu Yn
V nh Thim
Nguyn Phan L Anh
Phm Quang Thi
Nguyn Thnh Chung
Lu Nguyn Th ng
Bnh vin Bnh nhit i Trung ng

National Hospital of Tropical Diseases
Nguyn Vn Knh
ng Hng Hi
Cc Phng chng HIV/AIDS

Vietnam Administration of HIV/AIDS control
Phan Th Thu Hng

V Hi Sn
Bnh vin St ret-KST-CT Trung ng

National Institute of Malariology Parasitology
and Entomology
Nguyn Mnh Hng

Nguyn Qu Anh
Bnh vin Phi Trung ng

National Lung Hospital
inh Ngc S
Nguyn Bnh H a
Bnh vin Da liu Trung ng

National Hospital of Dermatology
Trn Hu Khang
Nguyn Th Thanh Huyn
Bnh vin Bnh nhit i Tp.HCM

Hospital of Tropical Diseases, HCM city
Nguyn Vn Vnh Chu

V Minh Quang
Vin Pasteur Nha Trang

Pasteur Institute Nha Trang
Bi Trng Chin
Mnh Hng
Vin V sinh Dch t Ty Nguyn

Pasteur Institute Tay Nguyen
Phm Th Dc
ng Tun t
hu
Vin Pasteur H Ch Minh

Pasteur Institute Ho Chi Minh
Trn Ngc Hu
Trn Anh Tun
C Th Y Trung ng
Department of Animal Health
m Xun Thnh
Vn ng K
T chc Y t th gii
World Health Organization
Keith Sabin,
Nguyen Thi Phuc
Chng t i in hn thnh m n nhng ng i sau y ng g p rt ln ho vi y dng un Altas

Timothy Meinke (USAID), Guy Thwaites (OUCRU), Behzad Nadjm (OUCRU), Trn Tnh Hin (OUCRU),
ng Doortje Heemskerk (OUCRU), ng Dr Rogier van Doorn (OUCRU), TS Thy L (OUCRU), B s
Trung Dng (Vin St r t-K sinh trng-C n trng Trung ng), B s T Ng Thanh (C An ton th
ph m), Nguyn Ng Tin (C Th Y), B s Lin H (Bnh vin Bnh nhit i Trung ng), Sherine
Thomas (University of Liverpool), Tin s ng Vn (i h Y H N i) Chng t i ng mun g i l i
m n ti t h The Infe tious Disease esear h oundation, Netherlands v the Well ome Trust, K, trong
vi h tr nhng inh ph ngoi d tnh v nhng huyn gia gia u t un Atlas ny hon thnh
Acknowledgements:
We would like to thank the following people who have contributed in making this atlas: Timothy Meinke
(USAID), Guy Thwaites (OUCRU), Behzad Nadjm (OUCRU), Tran Tinh Hien (OUCRU), Dr Doortje
Heemskerk (OUCRU), and Dr Rogier van Doorn (OUCRU), Thuy Le (OUCRU), Dr Do Trung Dung (National
Institute of Malariology Parasitology and Entomology), Dr Ta Ngoc Thanh (Vietnam Food Administration),
Nguyen Ngoc Tien (Department of animal health), Dr Lien Ha (National Hospital of Tropical Diseases),
Sherine Thomas (University of Liverpool), Dr Dang Van De (Ha Noi Medical University). We would also like
to thank the Infectious Disease Research Foundation, Netherlands and the Wellcome Trust, UK, in co-funding
unforeseen costs and international experts to make this work possible.
MC LC/TABLE OF CONTENTS
Foreword
User's guide
Executive editorial committee and editorial group
Vietnam map
Communicable disease surveillance system in
Vietnam
13
Nam
ASSOCIATED FACTORS
CC YU T LIN QUAN
28
Anopheles mosquito
M A p e
29
Aedes mosquito
M Aedes
33
Climate
37
Connectivity
Diphtheria-Tetanus-Pertusis
vaccine coverage
r y
14
41
Food poisoning
Landcover
45
48
52
Natural disasters
R r
Pig density
60
Population distribution
63
Poverty rate
Poultry density
Undernutrition
56
66
70
Water and sanitation map

BACTERIAL DISEASES
CC B N
O I
Anthrax
Bacillary dysentery
73
77
U N
81
82
r r
87
Cholera
91
Diphtheria
95
Leprosy
Leptospirosis
99
ep
Melioidosis
Me
Meningitis syndrome
10
pr
103
107
111
Neonatal tetanus
115
Plague
Scrub typhus
120
S
125
Streptococcus suis
Trachoma in children
129
r e
133
Tuberculosis
137
Typhoid
142
Whooping cough
Ho g
146
PARASITIC DISEASES
CC B N
Amoebic dysentery
O SIN TRNG
A p
149
150
Clonorchiasis and Opisthorchiasis
Cysticercosis (Taenia solium)
Eosinophilic meningitis
Sn no
162
Fascioliasis
167
Lymphatic filariasis
Malaria Plasmodium vivax
S r
Plasmodium vivax
176
Malaria Plasmodium falciparum
S r
Plasmodium falciparum
179
Paragonimiasis
183
r y
CC B N
188
O IR T
A e
Chickenpox
192
193
197
Diarrhea
201
Hand, foot and mouth disease
HIV/AIDS
HIV/AIDS Penicillium marneffei
171
Adenovirus
Dengue
158
Soil transmitted helminths

VIRAL DISEASES
154
206
210
y
HIV/AIDS Penicillium marneffei
Influenza A/H5N1
Influenza illness and influenza subtypes
229
p
11
219
224
Japanese encephalitis vaccine coverage
214
235
Measles
239
Mumps
243
Rabies
Rubella
247
Rubella
SARS
Viral hepatitis
251
p
r
12
255
259
13
H THNG GIM ST BNH TRUYN NHIM TI VIT NAM

Gim st BTN thng xuyn c thc hin mi lc, mi ni trn phm vi c nc di s
ch o ca Cc Y t D phng-B Y T (theo Thng t 48 /2010/TT-BYTngy 31 thng 12 nm
2010). Tnh n 2013. C 28 bnh truyn nhim thuc din bt buc phi bo co (xem bng 1).
Danh sch ny do B Y T quyt nh v c th thay i ty vo tnh hnh thc t khi c cc bnh
dch mi ni, mi xut hin hoc mi c a vo chng trnh tim chng m rng (xem bng 2)
Bng 1: Danh sch cc bnh truyn nhim bt buc phi bo co:
A. C c b n h t r u y n nh i m p h i b o c o t he o t u n
TT
Tn bnh
Nhm*
M s
theo ICD-10
1.
A00
2.
Thng hn
A01
3.
St xut huyt
A90/A91
4.
Vim no vi rt
A83
5.
St rt
B50
6.
Tay - chn - ming
B08.4
7.
Vim mng no do no m cu
A39
8.
Si
B05
9.
Cm A(H5N1)
J09
10.
Vim ng h hp cp nng do vi rt
11.
Bnh truyn nhim nguy him mi pht sinh cha r tc nhn gy bnh
B. Cc b nh truyn nhim phi bo c o theo thng

TT
M s
T
Tn bnh
Nhm
theo ICD-10
1.
A00
2.
Thng hn
A01
3.
L trc trng
A03
4.
L amp
A06
5.
Tiu chy
A09
6.
Vim no vi rt
A83
7.
St xut huyt
A90/A91
8.
St rt
B50
9.
Vim gan vi rt
B15
10.
Bnh Di
A82
11.
Vim mng no do no m cu
A39
12.
Thu u
B01
13.
Bch hu
A36
14.
Ho g
A37
15.
Un vn s sinh
A33
16.
Un vn (khng phi un vn s sinh)
A35
14
17.
Lit mm cp nghi bi lit
A80
18.
Si
B05
19.
Quai b
B26
20.
Rubella (Rubeon)
B06
21.
Cm
J10,11
22.
Cm A(H5N1)
J09
23.
Bnh do vi rt Adeno
B30
24.
Dch hch
A20
25.
Than
A22
26.
Xon khun vng da (Leptospira)
A27
27.
Tay - chn - ming
B08.4
28.
Bnh do lin cu ln ngi
B95
* Cc bnh truyn nhim c chia lm 3 nhm: A, B, C. Nhm A: Bnh c bit nguy him, c
th lan truyn nhanh, rng v t l cht cao hoc khng r tc nhn gy bnh. Nhm B: Bnh nguy
him c th lan truyn nhanh v c th gy cht. Nhm C gm nhng bnh t nguy him v lan
truyn chm
Vic tin hnh thu thp d liu gim st v bo co tin hnh theo h thng qun l hnh chnh t
thn bn ti trung ng. Cac s liu gim st c bao cao thng qua bo co khn bng fax, in
thoi. S liu ca bo co tun v bo co hang thng c gi ln tuyn trn nh quy nh m t
trong bng 1. Cc n v phi thc hin bo co k c khi khng c ca bnh no. S liu bo co l
s mc, s cht cng s liu cng dn, kt qu gim st/can thip. Vi nhng v dch c bit, bo
co iu tra ca bnh v danh sch ca bnh cng c gi km theo, trong nhng trng hp khn
cp, bo co c th chuyn vt tuyn. Mc d phn ln ca bnh nht l cc ca bnh nng c ghi
nhn ti cc bnh vin ln, cc bnh vin v phng khm a khoa cng nh trm y t x ng vai tr
rt quan trng trong vic pht hin sm cc ca bnh. Khi cc v dch c xc nh, s c cnh bo t
tuyn trn xung tuyn di v tuyn c s c vai tr iu tra b sung cng nh tm kim ca bnh ti
cng ng. Ngoi ra, khi c ca bnh xc nh, cc trng hp lm sng sau c th c chn on
xc nh bng yu t dch t.
Nh trong s t chc ca h thng, c 2 lung d liu di chuyn, hng bo co v hng phn hi/
trao i (bao gm c cnh bo). S liu bo co ngy v tun c s dng cho p ng nhanh, thng
l dnh cho xc nh v dch v p ng dch. i phn ng nhanh ca cc tuyn c trch nhim phn
tch cc s liu ny v bo co tuyn trn cng nh phn hi cho tuyn di. S liu thng phn ln
c s dng cho bo co tng kt, tnh ton ngng dch v xy dng nin gim.
Tuy nhin, mt hn ch ca s liu gim st v bo co hu ht ch da trn kt qu chn on lm
sng m khng c kt qu xt nghim (xem nh ngha ca bnh di y). Nhng bnh cn chi tit
n phn tp ch yu c gim st thng qua cc d n gim st trng im. Vic ghi nhn v thng
k cc ca bnh ca mt s bnh truyn nhim cn cha mang tnh h thng v nh ngha ca bnh
cha c p dng nh mt chn on chnh thc ti cc c s khm cha bnh t y t c s n
bnh vin ln trn c nc. Cc s liu gim st cha thc s c quan tm nhiu v cht lng
15
tt c cc tuyn, c bit l tuyn x trong khi trm y t x l c s cung cp s liu nhiu loi
bnh. iu ny dn n nhng kh khn trong cng tc thng k, bo co v phng chng dch. Ch
t khi xut hin cc v dch, B Y t mi chnh thc yu cu p dng nh ngha ca bnh trong gim
st dch dn ti vic s liu b vnh gia cc nm hoc nhn nh tng t bin ca bnh ti mt thi
im nht nh do c s thay i v nhy ca h thng.
Mc d c nhng hn ch k trn, h thng gim st bnh truyn nhim ti Vit Nam vn l mt
knh chnh thc v quan trng trong nh gi tnh hnh bnh truyn nhim ti a phng. Trong
tng lai gn, h thng ny s c h tr bi cng ngh bo co trn nn web t tuyn huyn n
trung ng. Cho n thi im hin ti, ch cn mt vi n v cha vo h thng bo co ny. Cc
bo co in t s gii quyt vn chm tr trong bo co ca bnh ti cc tuyn ng thi gip
c quan chuyn mn v c quan iu hnh phn ng nhanh hn vi cc bnh truyn nhim ti a
phng.
Triu chng in hnh / nh ngha ca bnh gim st/bo co mt s bnh truyn nhim:
1. T
i ngoi phn lng nhiu ln
Phn c nh nc go
Nn (nhiu ln)
Nhanh chng mt nc, xanh, da nhn
2. Thng hn v ph thng hn
St cao 39-40oC, ko di 3-5 ngy
au u d di
To bn hoc tiu chy, phn ng thnh bng hoc n au
3. Hi chng l
i ngoi phn lng nhiu ln, phn c mu, nhy
4. Tiu chy
i ngoi phn lng 3 ln 1 ngy
Phn rt lng, thm ch ton nc
5. Vim no vi rt
St cao t ngt 39-40oC
au u
Ri lon vn ng: c ng bt thng, co git, lit (cng)
Ri lon tri gic: mt phng hng, l m, bt tnh
6. St dengue / st xut huyt dengue
St cao >38 oC, ko di 2-7 ngy
au u, au c, au khp, au mt
Xung huyt, pht ban
Du hiu xut huyt: nt, chm xut huyt, chy mu mi, li, i tiu / i ngoi / nn ra mu, kinh
nguyt ko di
16
Hi chng shock: mnh nhanh, yu, huyt p kt, da lnh m, vt v, l m

7. Vim gan vi rt
t ngt mt mi,
Chn n, bun nn, bng chng, au bng di snphi
Vng da, phn bc mu, nc tiu sm mu
8. Di
au vng thn kinh gn vt cn
D b kch thch
S nc, gi, nh sng, ting ng
Tng tit nc bt, kh nut, m sng, co git
Cht trong vng 5-7 ngy do suy h hp
9. Vim mng no do no m cu
St cao t ngt
au u d di
Bun nn, nn
C cng
C th c mng xut huyt
10. Thy u /varicella
St nh
Bt u vi chm / ban, sau vi gi thnh bng nc nng, sau 1-2 ngy thnh nt vng nt m
mu vang
Tn thng ri rc nhng thng nhiu u mt
Tn thng ng vy trong 3 - 4 ngy, thnh cc vy nhiu la tui trn na thn
Nga
Cc vy bong, sau 1 tun bin mt khng li so
11. Bch hu
au hu / hng, vim tuyn hnh nhn, hu hng, thanh qun, mi
Hng , nut au
C mng nhy bm hu hng, tuyn hnh nhn, thanh qun, mi
Mng trng xm dnh cht vo mng nhy, bc tch gy chy mu
12. Ho g
Ho dai dng trn 2 tun
Ho thnh cn d di, tr ho r ri khng km hm c, sau th rt vo nh g gy
Khc, nn ra nhiu nc bt, m ri,
Mt l sau mi cn ho, tot m hi, th nhanh
13. Un vn s sinh
Tr ra b bnh thng (c khc, b mt) trong vng 2 ngy u sau sinh
17
T ngy th 3 n ngy 28, b b (khng b mt c)

Co cng hoc co git khi b kch thch bi nh sng, ting ng hoc chm
Cc du hiu co tht / co git: cng hm, co git cnh tay, chn, cng li, n lng (opisthotonos)
Cht trong vng 7-14 ngy sau khi pht bnh
14. Un vn khc
au cng c mt, c, thn mnh
Cng bng
Co cng xy ra khi kch thch
T th in hnh co cng khi un vn l n lng v v mt nhn nh
15. Lit mm cp (LMC)
Lit mm (mm c, c yu, khng i c) t ngt xut hin trong vng 1 tun tr di 15 tui.
Bi lit xc nh: l LMC xc nh bi phn lp c vi rt bi lit hoang di
C th l bi lit: l LMC vi di chng lit, cht, mt theo di v khng ly c 2 mu phn
ng quy nh
16. Si
Nghi si:
St, pht ban km theo mt trong cc triu chng sau: ho, chy nc mi, vim kt mc (mt )
Si xc nh:
Si xc nh theo tiu chun phng th nghim:
Ca nghi si c IgM (+) si hoc phn lp c vi rt si
Si xc nh theo tiu chun dch t:
Ca nghi si c tip xc / lin quan, c tip xc trc tip vi ca si xc nh theo tiu chun phng
th nghim
Si xc nh theo tiu chun lm sng:
Ca nghi si khng ly c mu lm xt nghim v c biu hin lm sng ca si
Loi tr si:
Ca nghi si xt nghim IgM si (-) hoc c chn on xc nh bnh khc
17. Quai b
St, sng cng tuyn nc bt mang tai mt hoc hai bn
Ni sng da cng, da khng i mu
18. Cm
St cao t ngt 39-40oC

au u d di, au mnh, au c, khp
Chy nc mi, au hng, ho
19. Vim kt mc do Adenovirus
Vim kt mc (mt )
Vim hu hng
18
Sng hch bch huyt sau tai, di hm

20. Dch hch
St cao t ngt
au u, mt mi
Th hch: cc hch sng, , cng, thng bn, nch, c
Th phi: ho ra m, mu, au ngc, kh th
21. Bnh than
Th da: Bt u vi nga vng nhim khun, sau tn thng sn da, xung huyt, 2 - 6 ngy
thnh vt lot mu en. Xung quanh tn thng c ph n rng. Tin trin nh, hoc nng.
Th phi: Cc triu chng ban u ging vim nhim cp ng h hp vi st, ho, au ngc, kh
th, v 2 - 3 ngy shock v cht.
Th rut: Bun nn, nn chn n, au bng d di, km theo s, du hiu nhim trng huyt v
cht.
22. St vng da do Leptospira
St cao t ngt, au u, n lnh, mt mi, au c (nht l bp chn, i)
Trn dch kt mc
Thiu v niu
Ri lon nhp tim
Vng da
Ban (vm ming)
19
Bng 2. Chng trnh TCMR ti Vit Nam (xem thm bn bao ph vc xin)
Vc xin
i tng
Vng trin
khai
Vim no Nht Bn
12 thng; nhc sau 1-2 tun, nhc li 1 nm sau
Vng nguy c
Vc xin phng lao (BCG)
Lc sinh
Ton quc
Bi lit ung (OPV)
2,3,4 thng
Ton quc
Vim gan B
Trong vng 24h sau sinh, 2,3,4 thng
Ton quc
Si
9, 18 thng
Ton quc
Un vn
Ph n c thai; +1,+6 thng, +1 nm
Ton quc
Bch hu, Ho g, un vn (DPT)
2,3,4, thng
Ton quc
Thng hn
3-10 tui
Vng nguy c
Hib1
2,3,4 thng
Ton quc
1
Hin ti cha a Hib vo trong h thng gim st thng xuyn do nng lc chn on ca cc tuyn, Hib
vn l 1 trong cc nguyn nhn gy hi chng mng no (c trong gim st thng xuyn). NIHE khi ng h
thng gim st trng im Hib ti 3 bnh vin (Nhi trung ng, Nhi ng 1 v Nhi ng 2)
20
S t chc h thng thng tin, bo co bnh truyn nhim n B Y T
theo thng t s 48/2010/TT-BYT ca B Y T ngy 31/12/2010
B Y T
CC Y T D PHNG
Bnh vin
Vin
V sinh dch t
/Pasteur
Trung ng
Vin
SR-KST-CT
S
Y t
Trung tm
kim dch
Trung tm
YTDP tnh
Bnh vin
tnh, Bnh vin ca
B,ban, ngnh, Bnh
vin t nhn
Y t
n v y t c
quan/doanh nghip
Bnh vin huyn,

Phng khm a khoa
t nhn
Trung tm
Y t huyn
Trm y t x
Phng khm chuyn

khoa
Trung tm
PCSR tnh
Bo co/thng tin
trc tip
Y t thn, bn
Trao i, phn hi
thng tin
21
COMMUNICABLE DISEASE SURVEILLANCE SYSTEM IN VIETNAM
The Vietnamese communicable disease surveillance system is running nationwide under the responsibility of the General Department of Preventive Medicine - Ministry of Health (GDPM; Circular No 48 /2010/TT-BYT of Ministry of Health; 31st December 2010). In 2013 there are 28
communicable diseases under surveillance (see table 1). The list for disease surveillance is decided
by MOH and can be changed depending on new developments or emergence of communicable
diseases and the expanded program of immunization (EPI; table 2).
T a b l e 1 . Li s t of r e p or t a b l e c om m u n i ca b l e d i s e as e s:
A. L i s t of c om m u n i c ab l e d i s e as e s t h a t n e ed t o b e r e p o rt e d w eek l y
No
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Name of Disease
Group*
Code by ICD-10
Cholera
Typhoid
Dengue
Viral Encephalitis
Malaria
Hand, Foot, and Mouth disease
Meningococcal Meningitis
Measles
Influenza A(H5N1)
Severe respiratory infection caused by virus
Dangerous emerging disease with unknown
pathogen
A
B
B
B
B
B
B
B
A
A
A
A00
A01
A90/A91
A83
B50
B08.4
A39
B05
J09
B. L i s t of c om m u n i c ab l e d i s e as e s t h a t n e ed t o b e r e p o rt e d m on t h l y
No
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Name of Disease
Group*
Code by ICD-10
Cholera
Typhoid
Dysenteria
Amebiasis
Diarrhea
Viral Encephalitis
Dengue
Malaria
Viral hepatitis
Rabies
Meningitis syndrome
Varicella
Diphtheria
Pertussis
Neonatal tetanus
Other tetanus (not neonatal tetanus)
AFP- polio suspected case
Measles
Mumps
Rubella
Influenza (seasonal)
Influenza A(H5N1)
Adenovirus pharyngoconjunctivitis (APC)
Plague
Anthrax
Leptospirosis
Hand, foot and mouth disease
Streptococcosis suis
A
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
A
B
B
B
B
A
B
A
B
B
B
B
A00
A01
A03
A06
A09
A83
A90/A91
B50
B15
A82
A39
B01
A36
A37
A33
A35
A80
B05
B26
B06
J10,11
J09
B30
A20
A22
A27
B08.4
B95
22
*Communicable diseases are classified into three groups: A, B and C. Group A: Very dangerous,
can spread rapidly, and has a high mortality rate or is caused by an unknown pathogen. Group B
includes dangerous pathogens that can transmit quickly and can result in death. Group C includes
less dangerous pathogens with either low transmission or rarely leads to death.
All administrational levels (from commune to national) are responsible for collecting surveillance
data and writing reports. The reporting can be performed by fax, phone,or email.The data must
be submitted to the upper levelin weekly or monthly reports, depending on the type of disease
(see table 1). The surveillance reports include the following aggregated information per disease:
the number of new patients, the number of deaths, the cumulativecase and death and intervention
has been performed. In particularepidemics, case investigation reports can be submitted (eg: from
district to NIHE provincial PMC).Although the majority of communicable diseases are recorded
by the hospital system, the community network still plays an important role in early detection of
diseases and outbreaks. When a potential outbreak is detected of a reportable disease, an alert goes
out to the commune health centers (CHC) to raise awareness.
As shown in the figure of the reporting system, there are twodirections of reporting: reports and
information exchange (including disease alerts). Weekly reports will be used for rapid response,
usually for outbreak verification and disease control. Rapid response teams are in charge of data
analysis and reporting and to provide feedback to outbreak region. Monthly data is mostly used for
annual reporting, and to calculate a threshold for outbreak.
A weakness of the present surveillance system is identifying the different reportable diseases correctly, asmost are confirmed clinicallyusing case definitions(see list of case definitions below).
Without laboratoryconfirmation, the case definition is not systematically applied to the whole health
care system and is not standardized. Besides non-standard case definitions, also the quality of data
provided by communes is often poor due to data entry errors. Sentinel surveillance projects can
provide more accurate data of diseases like is done for influenza.Despite all the flaws, the surveillance system remains a crucial data source on the situation of communicable diseases in Vietnam. In
the near future, a web-based surveillance system will be launched in order to support and improve
surveillance activities.
List of case definitions of notifiable diseases.
1. Cholera
Multiple watery stools
Rice-water stool
Vomiting (frequent)
Signs of rapid dehydration
2. Typhoid and paratyphoid fever
High fever 39-40oC for 3-5 days
Severe headache
Constipation or diarrhea
Abdominal distension and tenderness
3. Dysentery syndrome
Abdominal cramp
23
Tenesmus
Multiple loose stools with blood and mucus
4. Diarrhoea
Loose stools 3 times per day
Very loose stools or watery stools
5. Viral meningitis
Sudden onset of high fever 39-40oC
Headache
Disorderly movement
Confusion
6. Dengue fever, haemorrhagic dengue fever
High fever above 38oC for 2-7 days
Headache, muscle and joint pain, periorbital pain
Congestion, skin rash
Signs of bleeding
Signs of shock
7. Viral hepatitis
Sudden onset of fatigue, malaise
Anorexia, nausea, abdominal discomfort, lower abdominal pain (upper right quadrant)
Jaundice, discolored stool, dark urine
8. Rabies
Pain along the nerve near the site of animal bite
Agitated
Afraid of water (hydrophobia), wind, light, noise
Increased salivation, difficulty to swallow, delirium, convulsion
Rapid progression and death
9. Meningococcal Meningitis
Sudden onset of high fever
Severe headache
Nausea and vomiting
Stiff neck
Possiblehaemorrhagiclesions
10. Chickenpox/varicella
Mild fever
Begins with red lesions/rash, after few hours developing to shallow blisters, after 1-2 days becoming yellow pustules.
Scattered lesions, predominantly on the scalp, different stages
Itching
11. Diphtheria
Sore throat/pharyngitis, inflammation of tonsil or larynx
24
Red throat, dysphagia

Pseudomembrane in pharynx, tonsil, larynx, nose
Greyish white cover attached to mucous membrane, cause bleeding when peeled off
12. Whooping cough
Persistent coughing more than 2 weeks
Paroxysmal cough, with episodes of cyanosis and ceasing breathing after a period of intense coughing
Whoop sound with sharp intake of breath after a coughing episode
Vomit after coughing
After each episode of coughing, the child is extremely tired, sweating and breathing rapidly
13. Neonatal tetanus
The newborn infant has normal breastfeeding (cry and suck) in the first 2 days after birth
From the 3rd-28th days, inability to nurse (cannot take suck breastfeeding)
Spasm or convulsion when stimulated with light, noise or touch
Signs of spasm/convulsion: stiff jaws, convulsion in arms and legs, tightened lips, bending back
(opisthotonos)
Death occurs after 7-14 days after acquired the disease
14. Other tetanus
Painful muscular contractions in the face, neck, trunk
Abdominal rigidity
Generalized spasm occurs when induced by sensory stimuli
Typical features of the tetanic spasm are the position of opisthotonos and the facial expression
known as risussardonicus
15. Acute Flaccid Paralysis (AFP)
Flaccid paralysis (flaccid muscles, muscle weakness or loss of movement ability) suddenly appear within 1
week in children of less than 15 years old.
- Confirmed poliomyelitis: is AFP with confirmed isolated wild polio virus
- Suspected poliomyelitis: is AFP but unable to obtain or test stool
16. Suspected measles

Fever, with at least one of the following symptoms: coughing, runny nose, conjunctivitis, rash
Confirmed measles diagnosis:
- Confirmed lab diagnosis: The suspected case has IgM (+) antibody or isolated measles virus
- Confirmed epidemiological diagnosis: The suspected case has epidemiological exposure with measles
cases with confirmed IgM (+) antibody during the incubation period of 7-14 days
Clinical diagnosis:no laboratory confirmation.

17. Mumps
Fever, swelling and tenderness in one or multiple salivary glands. The skin is not red.
18. Influenza
Sudden onset of fever:39-40oC
Severe headache, body, muscle and joint pain
Runny nose, sore throat, coughing
25
19. APC (Adenoviruspharyngoconjunctivitis)

Conjunctivitis (red eyes)
Pharyngitis
Lymphadenopathy behind parotis and below jaws
20. Plague
Sudden onset of high fever
Headache, malaise
Bubonic plague: swollen lymph nodes, which are inflamed, red, tender, and often occur in the inguinal or axillary areas, or neck (cervical)
Pneumonic plague: Coughing with pus and blood, chest pain, difficulty breathing
21. Anthrax
Cutaneous anthrax: initial itching of the affected site, followed by a lesion that becomes papular,
then vesicular, developing in 2-6 days into a depressed black eschar. Moderate to severe and very
extensive edema surrounds the eschar.
Inhalation anthrax: Initial symptoms are similar to acute respiratory inflammation with fever,
cough, chest pain, difficulty breathing, shock after 2-3 days leading to death.
Digestive/gastrointestinal anthrax: Nausea, vomit, anorexia, severe abdominal pain, accompanied with fever, followed by signs of septicemia and death.
22. Leptospirosis
Sudden onset of high fever, headache, chills, malaise, myalgia (specially in calves and thighs)
Conjunctivaleffusion
Renal failure
Arrhythmia
Jaundice
Rash
Table 2. Extended Immunization Program (EPI) in Vietnam (see also Vaccination coverage map)
Vaccine
Target population
Location
Japanese encephalitis (JE)
12 months; + 2 weeks; 2 years
High risk area
Bacille Calmette-Guerin vaccine (BCG)
birth
National
Oral polio vaccine (OPV)
2, 3, 4 months
National
Hepatitis B vaccine
birth
National
Measles vaccine
9,18 months
National
Tetanus toxoid
pregnant women; +1, +6 months; +1 year
National
Cholera
2-5 years
High risk area
Diphtheria, Tetanus and Pertussis (DTP)
2, 3, 4 months
National
Typhoid fever vaccine
3-10 years
High risk area
2, 3, 4 months
National
Haemophilus influenzae b (Hib)
26
Figure. Data flow of surveillance reporting of communicable diseases to Ministry of Health level.
Based on circular No 48 /2010/TT-BYT of Ministry of Health dated 31 December 2010
MINISTRY OF HEALTH
GENERAL DEPARTMENT
OF PREVENTIVE
MEDICINE
National
hospitals
Institutes /Pasteur
National institute of
malariology parasitology
and entomology
Health
service
Health
quarantine
centers
Provincial centre for

preventive medicine
Regional hospitals
Provincial centre for

malaria prevention.
Provincial hospitals
Private hospitals
organization/firm
medical care
District Hospitals,
Private clinics
District centre for

preventive medicine
Commune health
Centre
Local Clinics
Direct report
Local health centre
27
Exchange information
SECTION 1/ CHNG 1
Associated Factors/ Cac yu t lin quan
28
Subject: Anopheles mosquito
Ch : Mui Anophen
29
Ch : Mui Anophen
Definition:
Malaria is transmitted to humans by female
mosquitoes of the genus Anopheles. Vector
Anopheles is widely distributed and although
there are over 450 formally identified species,
only around 30-40 are considered important
in the transmission of malaria to humans.
The maps opposite show the distribution of
some important Anopheles species (or species
complexes) in Vietnam. The data are derived
from surveys undertaken in 23 sites in 15
provinces from October 2003 to November
2004 using cattle as bait. It is important to
note that the species distribution and density
of Anopheles is heterogeneous at relatively
small spatial scales and maps that attempt to
show species distribution at large scales are
necessarily an over-simplification.
nh ngha:
St rt ly truyn sang ngi do mui ci thuc
tc Anopheles. Anopheles phn b rng ri v
vi hn 450 loi c xc nh chnh thc, ch
c khong 30-40 c coi l c vai tr quan
trng trong vic truyn bnh st rt cho con
ngi. Cc bn ny biu din s phn b ca
mt s loi Anopheles quan trng Vit Nam
(hoc mt s nhm cn loi). S liu trn c
thu thp t 23 im gim st ca 15 tnh t
thng 10 nm 2003 n thng 11 nm 2004 s
dng sc vt nh l mi nh. iu lu quan
trng l phn b loi v mt ca Anopheles
l khng ng nht quy m nh, v cc bn
ny c gng m t s phn b loi quy m
rng ln hn nh l mt s n gin ho cn
thit.
Xu hng:
nhng vng m nguy c ly truyn l cn k
th cc yu t pht trin kinh t x hi, chng
hn nh iu kin nh c ci thin, khong
cch gia vt nui v ngi, thng l ct
b c s ly truyn. cc vng nguy c cao,
s pht trin kinh t v cc hot ng khng
ch st rt c th gim s ly truyn ng k
bnh st rt. Do vy, phm vi khng gian ca
ly truyn st rt Vit Nam gim xung
ng k trong vi thp k qua. Vic pht hin
khng thuc artemisinin Campuchia v bin
gii Thi Lan-Myanma c ch v ku
gi hnh ng loi tr st rt, v nhiu chng
trnh nhm thc hin vic loi tr cp
quc gia v khu vc. V tui th ca cc vector
v thi k bnh bn ngoi ca k sinh trng
st rt ph thuc vo yu t nhit , s thay
i nhit c nh hng ln ti nguy c ly
truyn st rt. Do vy, c nhiu tranh lun xung
quanh vic nh hng ca bin i kh hu i
vi nguy c ly nhim st rt. Mt s tc gi d
on rng st rt tng ln l kt qu ca bin i
kh hu, trong khi mt s th cho nh hng ca
bin i kh hu s gim s ly truyn nh l
kt qu t s pht trin kinh t x hi v nhng
n lc kim sot st rt.
Trends:
Where transmission potential is marginal,
general socio-economic development, such
as improvements in housing conditions and
reduced proximity of humans and animals,
is often sufficient to eliminate transmission
of malaria. In higher risk areas, economic
development combined with malaria control
activities can substantially reduce transmission.
Consequently, the spatial extent of malaria
transmission has contracted substantially in
Vietnam over recent decades. The detection of
artemisinin resistance in Cambodia and the ThaiMyanmar border have revived calls for malaria
elimination, and several initiatives are targeting
national or regional elimination. Since vector
longevity and the extrinsic incubation period
are both temperature dependent, changes in
temperature have a strong influence on malaria
transmission risk. There has therefore been a lot
of debate about the potential impact of climate
change on the distribution of malaria risk.
Some authors predict an increase in malaria as
a result of climate change, whilst others argue
that the effect of climate change will be entirely
30
Ch : Mui Anophen
Tm quan trng i vi bnh truyn nhim:
Cng truyn bnh st rt l mt hm s
ca: tnh nhy cm ca cc vector i vi k
sinh trng st rt, mt vc t; tui th vector,
thi gian bnh ca k sinh trng trong vector
(giai on bnh bn ngoi), t l nhim bnh
ngi, v tp tnh t ca vector. S ly truyn
bnh st rt cng cao ti nhng ni c
mt vc t ln c tnh nhy cm cao v a
thch t ngi (anthropophilic c ngha l a
ngi) v kh hu h tr cho thi gian bnh
bn ngoi ngn v tui th mui di. S hiu
bit v phn phi loi vector, v vai tr ca n
vi dch t hc st rt l rt quan trng kim
sot bnh st rt thnh cng v thi quen ht
mu v tr u ca cc loi khc nhau xc nh
s hiu qu tng i ca cc la chn kim
sot khc nhau. V d, mn tm thuc dit cn
trng (ITN) l hiu qu chng li cc loi mui
thch t trong nh (endophagic) v vo ban
m, trong khi cc thuc dit cn trng dng
phun tn lu trong nh (IRS) li hiu qu nht
phng chng cc loi mui c tp tnh ngh
ngi trong nh. Vng c tm cht chng cn
trng cng c hiu qu mt s vng, chng
hn nh vng Ty nguyn Vit Nam ni m
ngi dn i v ng trong rng ni c vector
st rt thch nghi sng rng r nh An. dirus.
Theo di khng ha cht dit cn trng trong
cc loi mui Anopheles cng l quan trng khi
m ITN v IRS c hin tng khng ha cht
chn lc, khng thuc dit cn trng c l l
mt yu t chnh lm tht bi ca cc chng
trnh phng v khng ch st rt trc y. S
c mt lin tc ca cc loi Anopheles c kh
nng truyn st rt khp Vit nam cho thy
rng s ti xut hin tr li ca k sinh trng st
rt c th to ra mt s ly nhim mi nhng
vng hin ti l khng c st rt.
offset by decreased transmission resulting

from socioeconomic development and malaria
control efforts.
Significance for infections:
The intensity of malaria transmission is a function
of: the susceptibility of the vector mosquito
to the malaria parasite; vector density; vector
longevity; the incubation time of the parasite
in the vector (extrinsic incubation period);
the prevalence of human infection; and vector
biting behaviour. Malaria transmission is most
intense where there is a high density of a highly
susceptible vector that likes to feed on humans
(anthropophilic) and a climate that supports
a short extrinsic incubation period and a long
mosquito life-span. An understanding of vector
species distribution and their contribution to
malaria epidemiology is critical for successful
malaria control since the preferred feeding and
resting behaviors of different species determine
the relative efficacy of different control options.
For instance, insecticide-treated mosquito nets
(ITN) are most effective against species that
like to bite indoors (endophagic) and at night,
whilst indoor residual insecticide spraying
(IRS) is most effective against species that
rest indoors (endophilic). Insecticide treated
hammocks may be helpful in areas, such as
the forested central highland areas of Vietnam,
where people work and sleep in forests that
contain forest adapted malaria vectors such as
An. dirus. Monitoring of insecticide resistance
amongst Anopheles species is also critical since
ITNs and IRS select for insecticide resistance,
and insecticide resistance was probably
a major factor in the failure of previous
control programs. The continued presence
of malaria competent Anopheline mosquito
species throughout Vietnam indicates that reintroduction of malaria parasites could result in
renewed transmission in areas that are currently
malaria free.
31
Ch : Mui Anophen
Map source:
Garros C, Van Nguyen C, Trung HD, Van Bortel
W, Coosemans M, Manguin S.
Distribution of Anopheles in Vietnam, with
particular attention to malaria vectors of the
Anopheles minimus complex. Malar J. 2008
Jan 11;7:11. doi: 10.1186/1475-2875-7-11.
A total of 23 sites in 15 provinces were
selected for mosquito collections in different
geographical areas of northern, central and
south-eastern Vietnam. Adult mosquitoes were
captured on cattle bait once, from October 2003
to November 2004, during a period ranging
from 3 to 10 nights.
Ngun bn :
Garros C, Van Nguyen C, Trung HD, Van Bortel
W, Coosemans M, Manguin S.
Distribution of Anopheles in Vietnam, with
particular attention to malaria vectors of the
Anopheles minimus complex. Malar J. 2008
Jan 11;7:11. doi: 10.1186/1475-2875-7-11.
Tng s 23 im ti 15 tnh thnh c chn
thu thp mui cc vng khc nhau ca
min Bc, min Trung v min ng Nam Vit
Nam. Mui trng thnh c bt trn gia sc
t thng 10 nm 2003 n thng 11 nm 2004
trong khong thi gian t 3 n 10 m.
Key references/Ti liu tham kho chnh:

- Cohuet A, et al. (2010) Evolutionary forces on Anopheles: what makes a malaria vector? Trends
Parasitol. 26(3):130-6.
- Gething PW, et al. (2010) Climate change and the global malaria recession. Nature.
20;465(7296):342-5.
- Hay SI, et al. (2010) Developing Global Maps of the Dominant Anopheles Vectors of Human
Malaria. PLoS Med;7(2):e1000209.
- Sinka ME, et al. The dominant Anopheles vectors of human malaria in the Asia-Pacific region:
occurrence data, distribution maps and bionomic prcis. Parasit Vectors. 2011 May 25;4:89. doi:
10.1186/1756-3305-4-89.
- Trung HD, et al. Malaria transmission and major malaria vectors in different geographical areas of
Southeast Asia. Trop Med Int Health. 2004 Feb;9(2):230-7.
- Kelly-Hope L, et al. (2008) Lessons from the past: managing insecticide resistance in malaria
control and eradication programmes. Lancet Infect Dis. 8(6):387-9.
- Pates H, et al. (2005) Mosquito behavior and vector control. Annu Rev Entomol. 50:53-70
- Wertheim H, Horby P, Woodall J (2012). Atlas of Infectious Diseases. Wiley-Blackwell, Oxford,
United Kingdom.
32
Subject: Aedes aegypti and aedes albopictus
Ch : Mui Aedes aegypti v aedes albopictus
33
Definition:
Aedes is a genus of mosquito (Order: Diptera;
Family: Culicidae) that includes over 900
species. The two most important species for
man, Aedes aegypti and Aedes albopictus
(Asian Tiger Mosquito), are members of
the subgenus Stegomyia andtransmit virus
infections to humans. Female Aedes require
blood meals to develop their eggs and feed
predominantly during the day. Aedes aegypti
feeds predominantly on humans and readily
feeds indoors, whereas Aedes albopictus
prefers humans but feeds on a wider range of
animals and usually outdoors. Female Aedes
aegypti and Aedes albopictus lay their eggsin
water-filled containers, preferably on rough,
damp surfaces just above the water line, and
the eggs hatch when submerged. The eggs may
survive desiccation for several months. In urban
areas Aedes use a wide range of water filled
containers, such as water storage containers,
plant pots, discarded tires, building sites, and
roof gutters. Natural sites where eggs may be
laid include trees holes, leaf axils, and pools
in riverbeds. Although Aedes species have a
global distribution, Aedes aegypti is a tropical
and sub-tropical species, and is uncommon in
areas where the average winter temperature
o
o
is 10 C or less (10 C winter isotherm) or at
altitudes above 1000 metres. Aedes albopictus
is also historically a tropical species, but strains
have evolved that are able to overwinter in
temperate climates and become established at
higher latitudes than Aedes aegypti.
nh ngha:
Aedes l mt chi mui (B: Diptera; H:
Culicide) bao gm trn 900 loi. C hai loi quan
trng nht i vi loi ngi l Aedes aegypti
v Aedes albopictus (hay cn gi l mui vn
chu ) l mt trong nhng thnh vin ca phn
chi Stegomyia v truyn vi rt cho ngi. Mui
ci Aedes cn c mu cho trng pht trin v
ht mu ch yu vo ban ngy. Aedes aegypti
ch yu ht mu ngi v thng trong nh
trong khi mui Aedes albopictus li thch t
ngi tuy nhin cng t cc ng vt khc
ngoi mi trng. Mui ci Aedes aegypti v
Aedes albopictus trng cc dng c cha
nc, c bit ni c b mt th nhm ngay
pha trn mp nc, v cc trng mui ny s
n khi chm xung nc. Trng c th sng st
trn cn trong vi thng. cc vng thnh th
Aedes trng cc dng c cha nc nh b
nc, thng phi vi, chum, chu cy cnh, lp
xe hng, ngi v, cng trng xy dng, v cc
mng ca mi nh. Cc im t nhin ni m
mui c th trng l cc hc cy, nch l v
cc vng nc gn sng. Mc d cc loi Aedes
phn b khp ton cu, nhng Aedes aegypti
l loi mui thch sng cc vng nhit i
v vng cn nhit i v him thy cc khu
o
vc c nhit ma xun l 10 C hoc di
o
10 C hoc cc cao trn 1000 mt so vi
mt nc bin. Loi Aedes albopictus c lch s
sng cc vng nhit i nhng mt s chng
tin ha v c kh nng sng st qua ma
ng cc khu vc n i v cng thch
nghi c cc khu vc c cao hn so vi
Aedes aegypti.
Trends:
Aedes aegypti originated in Africa and
subsequently spread to the Americas, Asia and
the Pacific, probably through shipping routes
during the 15th to 17th centuries. During the
20th Century Aedes aegypti has retreated from
southern Europe, North Africa, southern United
States, and parts of Australia. Yellow fever
eradication programs in South and Central
Xu hng:
Aedes aegypti c ngun gc chu Phi v sau
ly lan sang cc nc chu M, chu v
Thi Bnh Dng, thng qua tuyn ng vn
chuyn trong thi gian t th k 15 n th
k 17. Trong th k 20, Aedes aegypti b loi
khi min Nam chu u, Bc Phi, min Nam
Hoa K, v cc vng ca c. Cc chng trnh
34
America between the 1950s and 1970s saw

large declines in Aedes aegypti abundance and
even eradication in some countries, but Aedes
aegypti has subsequently re-invaded large parts
of Central and South America. Aedes albopictus
is native to Asia and is highly invasive. Since
1980 Aedes albopictus has spread extensively,
and is now established in many countries of
the Americas, Southern Europe, and in parts
of West Africa, possibly through international
trade in used tires. Whilst climate change might
increase the range of climate suitability for
Aedes aegypti and Aedes albopictus, the effects
are difficult to predict, but it seems likely that
temperate strains of Aedes albopictus will
continue to expand their geographic range.
thanh ton St vng Nam v Trung M gia

nhng nm 1950 v nm 1970 gp phn lm
gim ng k Aedes aegypti v thm ch loi b
hon ton mt s nc, nhng Aedes aegypti
sau li xut hin ti phn ln Trung v Nam
M. Aedes albopictus ngun gc Chu v
c s phn b rt rng. T nm 1980 Aedes
albopictus lan rng v hin nay xut hin
ti nhiu nc chu M, Nam u, v mt phn
ca Ty Phi. Bin i kh hu c th lm tng
phm vi kh hu thch hp cho Aedes aegypti v
Aedes albopictus, gy ra nhng tc ng kh
d on, d on trong tng lai, chng n i
ca Aedes albopictus s tip tc m rng phm
vi a l ca chng.
Aedes aegypti l vector chnh ca bnh st
vng da, st xut huyt v chikungunya. Aedes
albopictus l mt vector ca st xut huyt v
chikungunya, c bit l nhng khu vc m
loi ny chim u th. Aedes aegypti l vc t
mnh hn so vi Aedes albopictus, c kin
cho rng v tnh cht vt t v s thch chn
mi trng c tr, c kin li cp v s
nhy cm vn c ca mui vi vic nhim
v nhn ln ca virus. Mui Aedes aegypti
v Aedes albopictus trng thnh sng xung
quanh ni chng n, t khi bay xa hn 100m
(mc d c s liu ghi nhn ln n 800m).
Do , con ngi l nhn t quan trng trong
vic pht tn virus st xut huyt trong cng
ng, cng l yu t lm cho vect pht tn
rng ri v nhng thay i trong mi trng
sng ph hp thc y s m rng s phn b,
nguy c ly lan ca Arbovirus. Aedes aegypti
v Aedes albopictus c thc nghim
chng minh l c kh nng truyn c mt
lot cc Arboviruses khc, bao gm c vim
no Nht Bn, Virus ty sng Nile, Virus vim
no Eastern Equine, v virus La Crosse, nhng
chng khng c coi nh c ng vai tr quan
trng trong h sinh thi hoc truyn trc tip
nhng loi vi rt trn. Tuy nhin, qun th tc

Aedes aegypti is the main vector of yellow
fever, dengue and chikungunya. Aedes
albopictus is an important vector of dengue
and chikungunya, especially in areas where
this species predominates. Aedes aegypti is a
more efficient vector than Aedes albopictus
partly, it is thought, because of its biting and
habitat preferences, but also as a result of the
mosquitos inherent susceptibility to infection
and viral replication. Adult Aedes aegypti
and Aedes albopictus mosquitoes spend their
life in and around the place they emerged,
rarely flying further than 100m (although up
to 800m has been recorded). Thus it is largely
humans who are responsible for spreading
dengue virus within and between communities.
Anthropogenic transport of vectors over long
distance and changes in habitat suitability drive
the geographic expansion of arbovirus risk.
Aedes aegypti and Aedes albopictus have been
experimentally demonstrated to be potential
vectors for a wide range of other arboviruses,
including Japanese Encephalitis, West Nile
Virus, Eastern Equine Encephalitis, and La
Crosse virus, but they are not thought to play
an important role in the ecology or transmission
35
of any of these viruses. However, pathogen

and vector populations are not static, and
adaptations of either may see the emergence of
new arbovirus epidemiology associated with
Aedes aegypti and Aedes albopictus.
nhn gy bnh v vector khng phi l tnh, v

s thch nghi ca mt trong hai c th lm xut
hin dch Arbovirus mi lin quan ti Aedes
aegypti v Aedes albopictus.
Ngun bn :
Mt mui Aedes aegypti:
Vin V sinh dch t trung ng, Vin V sinh
dch t Ty Nguyn, Vin Pasteur Nha Trang,
Vin Pasteur H Ch Minh
Bn hin th mt mui Aedes aegypti,
vector chnh ca bnh st xut huyt ti Vit
Nam. Khng c s liu v mt mui Aedes
albopictus y trn ton quc.
T l tng i ca hai loi u trng Aedes:
Higa Y, et al. (2010) Geographic distribution
of Aedes aegypti v Aedes albopictus collected
from used tires in Vietnam.J Am Mosq Control
Assoc;26(1):1-9.
Map sources:
Aedes aegypti density index (DI):
National Institute of Hygiene and Epidemiology,
Pasteur Institute in Ho Chi Minh city, Pasteur
Institute in NhaTrang, Tay Nguyen Institute of
Hygiene and Epidemiology
The map shows only Aedes aegypti density
index which is the major vector of Dengue in
Vietnam. Aedes albopictus DI is not available
for the whole country.
Relative abundance of Larvae Aedes: Higa Y,
et al. (2010) Geographic distribution of Aedes
aegypti and Aedes albopictus collected from
used tires in Vietnam.J Am Mosq Control
Assoc;26(1):1-9.

- Benedict MQ, et al. (2007) Spread of the Tiger: Global Risk of Invasion by the Mosquito Aedes
albopictus. Vector Borne Zoonotic Dis; 7 (1): 7685.
- Higa Y, et al. (2010) Geographic distribution of Aedes aegypti and Aedes albopictus collected
from used tires in Vietnam.J Am Mosq Control Assoc;26(1):1-9.
- Jansen CC, et al. (2010) The dengue vector Aedes aegypti: what comes next. Microbes Infect 12
(4): 272-279.
- Lambrechts L,et al. (2010) Consequences of the expanding global distribution of Aedes albopictus
for dengue virus transmission.PLoSNegl Trop Dis 4 (5): e646.
- Rogers DJ, et al. (2006) The Global Distribution of Yellow Fever and Dengue. AdvParasitol 62:
182-220.
- Wertheim H, Horby P, Woodall J (2012). Atlas of Infectious Diseases.Wiley-Blackwell, Oxford,
United Kingdom.
36
Subject: Climate
Ch : Kh hu
37
Subject: Climate
Ch : Kh hu
Definition:
Climate can be considered to be the average
weather. The map opposite shows climate
zones based on the system developed by
Wladimir Koppen and Rudolf Geiger. The
system classifies land surface into five major
climate zones based on annual and monthly
mean temperature and precipitation. The data
used to derive the map cover the period 19502000. The three embedded graphs show the
monthly average temperature and rainfall in
the north, central, and southern regions in 2010
using data derived from weather stations.
nh ngha:
Kh hu c th c coi nh l thi tit vi
gi tr trung bnh. Trn bn cho thy vng
kh hu c da trn h thng pht trin bi
Wladimir Koppen v Rudolf Geiger. H thng
ny phn loi b mt t thnh nm vng kh
hu ch yu da trn nhit trung bnh hng
nm, hng thng v lng ma. Cc d liu
c s dng cho bn ly trong giai on
1950-2000. Ba th th hin nhit trung
bnh hng thng v lng ma min Bc,
Trung v khu vc pha Nam trong nm 2010.
D liu thu c t cc trm d bo thi tit.
Trends:
Vietnam is a long country and the climate
shows more annual variability (seasonality) in
the north and at higher altitudes in the central
highlands than in the south and the low lying
central regions. The map opposite is based
on annual and monthly climate data over a
50-year period and does not consider long
term non-seasonal trends in climate. Climate
change is a controversial subject and despite
general consensus about the existence of
global warming, future trends and impacts
on local climate and weather is less easily
agreed. However, attempts to model the effect
of global warming on climate using the Koppen
classification have estimated a shift between
major climate classes of around 3% during the
21st Century. Prediction of how these changes
might affect infectious diseases is also difficult,
as discussed below.
Xu hng:
Vit Nam l t nc tri di v kh hu th
hin s thay i hng nm (theo ma) khu
vc pha bc v theo cao nh Ty Nguyn
so vi min Nam v vng thp min Trung.
Bn da trn d liu kh hu hng nm v
hng thng trong khong thi gian 50 nm v
b qua nhng xu hng khng c tnh ma v
trong thi gian di. Bin i kh hu l mt ch
gy tranh ci v mc d c khng nh s tn
ti ca khi nim nng ln ton cu, xu hng
lu di v nhng tc ng i vi kh hu a
phng v thi tit khng d dng thng nht
c. Tuy nhin, s c gng m hnh ha
th hin tc ng ca vic nng ln ton cu ln
kh hu bng cch s dng phn loi Koppen
c tnh s thay i gia cc lp kh hu chnh
khong 3% trong th k 21. Vic d bo nhng
thay i ny c th nh hng nh th no n
cc bnh truyn nhim l rt kh khn v s
c trnh by chi tit di y.

Climate has a major influence on infectious
disease epidemiology that is both spatial
- affecting the geographic distribution of
disease; and temporal - affecting the timing
of transmission peaks. Temporal patterns are
typically seasonal but longer, non-annual,
climate cycles, such as the El Nio Southern

Kh hu c nh hng ln v dch t hc bnh
truyn nhim 2 yu t gm khng gian - nh
hng n s phn b a l ca bnh, v thi
gian - nh hng n thi gian ca cc nh
dch. M hnh thi gian thng theo ma nhng
ko di, khng thng nin, chu k kh hu,
38
Subject: Climate
Ch : Kh hu
Oscillation (ENSO), may also influence

infectious disease epidemiology. ENSO has
been linked to dengue, malaria, and cholera
epidemiology. The effect of climate may
be mediated by climate dependent vector
competence (e.g. malaria and dengue), climate
dependent pathogen survival, or by climatically
determined habitat suitability for environmental
pathogens (e.g. Burkholderia pseudomallei,
Coccidioides immitis), their vectors (e.g.
mosquitoes, ticks, flies) or animal reservoirs
(e.g. bats). In general, human pathogen diversity
is associated with latitude, being maximum
at the equator and decreasing with distance
from the equator. Climate is also associated
with temporal changes in social behaviours,
such as the mixing of children during school
terms, which influence disease epidemiology.
Temperature, humidity, and perhaps sunlight
may also directly affect individual susceptibility
to infection by altering mucosal integrity or
innate immunity. However, despite very clear
spatial and seasonal patterns of many infections,
the precise mechanism or interactions are
rarely disentangled and usually remain a
matter of speculation. Longer-term trends in
climate and the effect on the distribution and
prevalence of infectious diseases are even less
easily identified and this remains an area of
controversy, particularly since trends in disease
epidemiology may be confounded by many
other concomitant changes, such as land use,
disease control programs, and socioeconomic
development.
chng hn nh hin tng El Nino (ENSO),

cng c th nh hng n dch t hc bnh
truyn nhim. ENSO c lin quan n bnh st
xut huyt, st rt, dch t. Bin i kh hu c
th gy ra nh hng gin tip thng qua cc
vector ph thuc kh hu (bnh st rt v st
xut huyt), s sng st ca cc tc nhn gy
ph thuc kh hu, hoc bi cc yu t kh hu
quyt nh cho mi trng sng ph hp vi cc
mm bnh mi trng (v d nh Burkholderia
pseudomallei, Coccidioides immitis), vector
cc bnh (v d nh mui, ve, rui) hoc ng
vt lm cha (v d nh loi di). Nhn chung,
a dng mm bnh ca con ngi lin quan n
v , t c ti a ti ng xch o v
gim dn theo khong cch t ng xch o.
Kh hu cng c lin quan vi nhng thay i
v thi gian trong hnh vi x hi, chng hn nh
s tp trung tr em trong ma tu trng, chng
nh hng n dch t hc ca bnh. Nhit ,
m, v c th c nh sng mt tri c l cng
trc tip nh hng n tnh nhy cm ca c
nhn vi nhim trng bng vic thay i tnh
ton vn ca nim mc hoc min dch bm
sinh. Tuy nhin, mc d m hnh khng gian
v theo ma ca nhiu bnh nhim trng rt r
rng, c ch hoc tng tc chnh xc him khi
c phn nh r v thng vn l mt vn
gy tranh ci. Xu hng di hn v kh hu v
tc ng i vi vic phn phi v ph bin ca
cc bnh truyn nhim cn t c xc nh d
dng v iu ny vn cn l mt ti gy tranh
ci, c bit l khi xu hng dch t hc bnh
c th b o ln bi nhiu thay i khc, chng
hn nh vic s dng t, chng trnh kim
sot dch bnh, v pht trin kinh t x hi.
Map sources:
The Climate map was made by using climate
data obtained from WorldClim Global Climate
Data (1950-2000),
available at: www.worldclim.org.
Ngun bn :
Bn kh hu c da trn d liu kh hu
t ngun WorldClim Global Climate Data
(1950-2000)
www.worldclim.org.
39
Subject: Climate
Ch : Kh hu
Key references/Tham kho chnh:

- Dunn RR, et al. (2010) Global drivers of human pathogen richness and prevalence. Proc R Soc
B: doi:10.1098.
- Guernier V, et al. (2004) Ecology Drives the Worldwide Distribution of Human Diseases. PloS
Biol 2(6): e141.
- Hijmans RJ, et al. (2005) Very high resolution interpolated climate surfaces for global land areas.
Int J Climat 25: 1965-1978.
- Lafferty KD. (2009). The ecology of climate change and infectious diseases. Ecology 90 (4):
888900.
- Rubel F, et al. (2010) Observed and projected climate shifts 1901-2100 depicted by world maps
of the Kppen-Geiger climate classification. Meteorol Z 19: 135-141.
United Kingdom.
40
Subject: Connectivity
Ch : Kt ni giao thng
41
Definition:
Globalization has been defined as a change in
the nature of human interactions across a wide
range of spheres including the economic, social, political, technological and environmental. Increased connectedness of people in space
and time is one dimension of globalization that
is especially relevant for infectious diseases.
The connectivity map shows the major roads,
railroad, terrain (elevation) and major airline
routes with number of passengers in 2010.
nh ngha:
Ton cu ha c nh ngha l s thay i
v bn cht ca s tng tc gia con ngi
vi con ngi trong nhiu lnh vc nh kinh t,
x hi, chnh tr, k thut v mi trng. Tng
cng s kt ni ca con ngi v c khng
gian v thi gian l mt kha cnh ca ton
cu ha, m n c bit lin quan ti cc bnh
truyn nhim. Bn kt ni th hin cc tuyn
ng chnh, ng st, a hnh ( cao) v
cc ng bay chnh cng vi s lng hnh
khch trong nm 2010.
Trends:
Human interactions on a physical and intellectual level have been increasing for centuries
but we are now more connected than ever. The
dominant force behind this increasing connectedness has been economic, with individuals,
corporations and nations seeking ever-greater
opportunities to exploit resources and new markets. Since the market reforms, Vietnam has
made spectacular progress in GDP growth and
poverty reduction. Annual per capita growth
has averaged 5.9 percent.
A critical part of this success has been a high
level of investment in infrastructure. Around
9-10 percent of GDP has been invested in transport, telecommunications, energy, water, and
sanitation in recent years, a high level of infrastructure investment by international standards.
The Vietnamese railway network has a total
length of 2,600 km, dominated by the 1,726 km
single track running between Hanoi and Ho Chi
Minh City. Two railways connect Vietnam to
the Peoples Republic of China. There are currently no railway connections between Vietnam
and Cambodia or Laos.
Viet Nams road system includes: national roads
(quc l) administered by the central government; provincial roads (tnh l or ng tnh)
managed by provinces; district roads (huyn l
or ng huyn) managed by districts; urban
roads managed by cities and towns; and commune roads managed by communes. The total
length of the Viet Nam road system is about
222,179 km with 19.0% paved (source: Vietnam Road Administration, 2004).
Xu hng:
S tng tc gia con ngi mc vt cht
v tr tu ang tng ln trong nhng th k qua,
v chng ta hin ang kt ni vi nhau nhiu
hn bao gi ht. Yu t chnh ng sau s kt
ni ang khng ngng tng chnh l kinh t
vi nhng c nhn, tp on v quc gia ang
tm kim nhng c hi ln hn bao gi ht
khai thc cc ngun lc v nhng th trng
mi. K t khi nn kinh t th trng c hnh
thnh, Vit Nam t nhng bc tin vt
bc v tng trng GDP v xa i gim ngho.
Tc tng trng bnh qun hng nm vo
khong 5,9%.
Mt phn quan trng ng gp vo thnh cng
ny l s mnh dn u t vo c s h tng.
Trong nhng nm gn y, khong 9-10 phn
trm ca GDP c u t vo phng tin
giao thng, thng tin lin lc, nng lng, nc
v v sinh mi trng.
Mng li ng st ca Vit Nam c tng
chiu di l 2.600 km, trong ch yu l
tuyn ng st t H Ni n thnh ph H
Ch Minh vi chiu di 1.726 km. C hai tuyn
ng st chy t Vit Nam n Trung Quc.
Hin nay, cha c tuyn ng st no ni gia
Vit Nam vi Campuchia hay Lo.
H thng ng b ca Vit Nam gm c: quc
l c qun l bi c quan cp Trung ng;
tnh l hay ng tnh c qun l bi cp
Tnh; huyn l hay ng huyn thuc quyn
qun l ca cc qun; h thng ng th
c qun l bi thnh ph; v ng cc
x phng chu s qun l ca cc x phng.
Tng chiu di ca cc tuyn ng b Vit
42
Vietnam operates 37 civil airports, including

three international: Noi Bai in Hanoi, Da Nang
in central Vietnam, and Tan Son Nhat in HCMC.
Tan Son Nhat is the largest, handling 75 percent of international passenger traffic. Vietnam
is connected to major airports across the world
and this number is increasing. In 2010 the aviation industry showed double digit growth and
cargo increased by 30%.
Nam vo khong 222.179km vi khong 19,0%

c tri nha (Ngun: Cc Qun l ng b
Vit Nam, 2004).
Vit Nam hin c 37 sn bay dn s ang hot
ng, trong c 3 sn bay quc t: Ni Bi
H Ni, Nng min Trung Vit Nam, v
Tn Sn Nht thnh ph H Ch Minh. Tn
Sn Nht l sn bay ln nht, iu phi khong
75% cc chuyn bay quc t. Vit Nam hin
kt ni vi phn ln cc sn bay trn th gii
v con s ny ang ngy cng tng ln. Trong
nm 2010, ngnh cng nghip hng khng cho
thy ch s tng trng tng gp i v s lng
hng ha c vn chuyn tng 30%.

Globalization has both positive and negative
consequences for health. Increased accessibility to information, diagnosis and care, and preventive health services, such as immunization,
have a very positive impact on health, as does
access to education and, most importantly, the
economic benefits of global integration. On the
other hand, people and goods carry diseases and
there are sobering historic examples of the devastating effect of the introduction of new diseases to vulnerable populations. Severe Acute
Respiratory Syndrome (SARS) is perhaps the
most dramatic modern equivalent, where air
travel rapidly disseminated a highly virulent
infection. More recently, a novel influenza A/
H1N1 subtype emerged in Central America
in 2009 and rapidly spread around the globe.
However, the immediate and frightening impact of globally transmitted epidemic diseases
such as SARS and influenza perhaps diverts attention from the importance of more insidious
infections. The spread of HIV has been less rapid but far more damaging than any other contemporary epidemic and has undoubtedly been
expedited by globalization, with HIV transmission associated with economic migrants, the
commercial sex trade and changes in sexual
behaviors. Dengue is another globalizing disease: the precise reasons for the geographic expansion of dengue over the past 50 years are
not clear but factors may include the dissemination of vectors through global trade and the
movement of viruses by infected travelers. This
demonstrates how increased connectivity links
previously separated ecological systems and offers new opportunities for pathogens to extend
beyond their traditional niche.

Ton cu ha gy c nhng nh hng tch cc
v tiu cc n ngnh Y t. Tng cng tip cn
vi thng tin, chn on v chm sc, cc dch
v y t d phng, nh min dch c tc ng
tch cc ln sc khe, ng thi vi vic tip
cn vi gio dc, v quan trng nht l cc li
ch kinh t ca vic hi nhp quc t. Mt khc,
ngi v hng ha l nhng i tng mang
bnh v c nhng v d nht nh trong
lch s v nhng hu qu nng n ca vic ly
truyn nhng bnh mi cho nhng cng ng
d b nh hng. Hi chng vim ng h hp
cp (SARS), c l l mt v d su sc nht ca
thi i ny, khi m vic di chuyn bng ng
hng khng nhanh chng pht tn mt bnh
truyn nhim cc k nguy him. Gn y, mt
kiu tup l ca virus cm A/H1N1 xut
hin Trung M nm 2009 v nhanh chng lan
ra ton cu. Tuy nhin, nhng nh hng tc
th v ng s ca nhng bnh dch lan truyn
khp ton cu nh SARS hay cm c l lm
lc hng s ch khi nhng cn bnh truyn
nhim m thm khc. Tc ly lan ca HIV
gim i nhng n vn gy nhng thit hi
nng n hn so vi nhng dch bnh ng thi
v chc chn chu s tc ng ca ton cu
ha vi mi lin quan gia s ly lan ca HIV
v nhng ngi di c v mc ch kinh t, mi
dm v nhng thay i trong hnh vi sinh hot
tnh dc. Dengue cng l mt bnh mang tnh
ton cu khc: nhng nguyn nhn chnh xc
43
ca s lan rng v mt a l ca dengue trong

sut 50 nm qua vn cha c lm r, nhng
nhng yu t nh hng c th gm c s pht
tn ca cc vector thng qua cc hot ng giao
dch ton cu, v s di chuyn ca virus do cc
du khch nhim bnh. iu ny cho thy s gia
tng ca cc ng kt ni trc y b tch
bit vi h thng sinh thi hc nh th no v
n m ra nhng c hi mi cho cc tc nhn
gy bnh vt ra ngoi nhng phm vi truyn
thng ca chng.
- Dollar D. (2001) Is globalization good for your health. WHO Bulletin 79 (9).
- Hufnagel L, et al. (2004) Forecast and control of epidemics in a globalized world. PNAS 101
(42).
- Lee K. (2003) Globalization and health, an introduction. London, Palgrave Macmillan.
- Saker L, et al. (2004) Globalization and Infectious Diseases: a review of the linkages. UNICEF/
UNDP/World Bank/WHO.
- Tatem AJ, et al. (2006) Global traffic and disease vector dispersal. PNAS 103 (16).
- World Bank. (2009) World Development Report 2009 Reshaping Economic Geography.
44
Subject: Diphtheria-Tetanus-Pertussis vaccine coverage
Ch : T l tim phng vc xin bch hu-ho g-un vn
45
Definition:
The map shows the estimated coverage with
three doses of the combined diphtheria, tetanus
and pertussis vaccine (DTP3) in infants (aged
< 1 year). It is a 3 in 1 vaccine that is given
three times during the first year. This vaccine
is cheap, readily available and has been part
of WHO recommended infant immunization
schedule since the Expanded Program on
Immunization (EPI) began in 1974. Therefore
DTP3 coverage is often used to monitor the
overall performance of national immunization
programs. The EPI program was introduced in
Vietnam in 1981 and DTP was introduced in
1985.
nh ngha:
Bn th hin phm vi bao ph vi ba liu
ca vc xin kt hp bch hu, un vn v ho
g - (DTP3) tr s sinh (tui <1 nm). N l
vc xin 3 trong 1 c tim 3 ln trong nm u
tin. Vc xin ny gi r, sn c v l mt phn
ca lch tim chng tr em c WHO khuyn
co k t khi Chng trnh Tim chng M
rng (EPI) bt u vo nm 1974. V vy s bao
ph ca DTP3 thng c s dng gim st
hiu sut tng th ca chng trnh tim chng
quc gia. Cc chng trnh tim chng m rng
c p dng ti Vit Nam vo nm 1981 v
DTP c s dng vo nm 1985.
Xu hng:
Ti Vit Nam c mc gia tng nhanh mc
bao ph ca cc vc xin theo lch TCMR t nm
1986 n nm 1990, vi DTP3 tng t 43% n
87%: DTP3 vt qu 90% k t nm 2003.
Cho n gn y Vit Nam sn xut c
DTP trong nc, nhng t nm 2010 chuyn
sang vc xin 5 trong 1 kt hp DTP vim gan
B-Hib. Mc bao ph tim chng Vit Nam
vn cn rt cao v chng minh cho sc mnh
ca h thng y t cng cng trong vic tip cn
phn ln cc qun th ch. Tuy nhin bn
cho thy nhng thch thc trong vic duy tr
mc bao ph cao ca vc xin ti nhng khu
vc nng thn kh tip cn. Nhng thch thc
khc cho chng trnh tim chng quc gia bao
gm cc tc ng ca cc tc dng ph, nhn
thc v an ton vc xin v vai tr ngy cng
tng ca khu vc y t t nhn.
Trends:
In Vietnam, there were sharp increases in
routine vaccination coverage between 1986 and
1990, with DTP3 coverage rising from 43% to
87%: DTP3 coverage has exceeded 90% since
2003. Until recently Vietnam has been using
domestically produced DTP, but since 2010 has
been rolling-out a commerically available DTPHepB-Hib pentavalent vaccine. Immunization
coverage in Vietnam remains very high and
testifies to the strength of the public health
system in reaching the vast majority of the
target population. However the map shows the
challenge of maintaining high vaccine coverage
in hard to reach rural areas. Other challenges
for the national immunization program include
the impact of adverse events on perceptions of
vaccine safety and the increasing role of the
private healthcare sector.

Th gii vn cn gp rc ri bi s bt bnh
ng trong chm sc sc khe v phc v
nhm ngho kh, tr em khng c chm sc
trn th gii, cc bnh truyn nhim do l
nguyn nhn t vong ln nht v gnh nng y
t ln nht. Khong 9 triu tr em di 5 tui
t vong mi nm, ch yu l cc nc ang
pht trin. Tim chng l mt trong nhng bin

The world remains troubled by significant
health inequalities and for the impoverished,
under-served children of the world, infectious
diseases are the biggest killer and the biggest
health burden. Around 9 million children
under 5 die each year, mostly in developing
countries. Immunization is one of the most
46
effective life-saving interventions available

to these children and is an essential tool for
improving childhood survival. Every year
vaccines prevent an estimated 2.5 million child
deaths and an enormous burden of ill health,
leading to strengthened human resources,
greater economic productivity, improved
socioeconomic development, and healthier and
happier communities. Vaccination coverage is
typically low in remote rural areas, deprived
urban settings, mobile populations, and in
regions affected by conflict or instability. In
2008 around 24 million children aged 1 year
had not received 3 doses of DTP; 70% of these
children lived in ten countries: Chad, China,
Democratic Republic of the Congo, Ethiopia,
India, Indonesia, Iraq, Nigeria, Pakistan, and
Uganda. Whilst reaching these vulnerable
children is not simple, better coverage with
existing vaccines could prevent an additional 2
million deaths each year in children under 5.
php can thip cu sng tnh mng hiu qu

nht cho nhng tr em v l mt cng c
cn thit ci thin s sng st cn tr em. Tt
c cc loi vc xin ngn nga khong 2,5 triu
tr em t vong/nm v gim mt gnh nng rt
ln ca sc khe, dn n ngun nhn lc c
tng cng, tng nng sut kinh t, ci thin
pht trin kinh t x hi v lm cho cng ng
khe mnh hn v hnh phc hn. Mc bao
ph ca tim chng thng thp cc vng
nng thn xa xi, khu vc th ngho, dn di
bin ng, v trong cc khu vc b nh hng
bi xung t hay bt n. Nm 2008 khong 24
triu tr em 1 tui khng nhn c 3 liu
DTP, c 70% nhng a tr sng trong mi
quc gia: Chad, Trung Quc, Cng ha Dn
ch Congo, Ethiopia, n , Indonesia, Iraq,
Nigeria, Pakistan, v Uganda. Vic tim chng
vi nhm tr em d b tn thng ny l khng
n gin, mc bao ph tt hn vi cc loi
vc-xin hin nay c th ngn chn thm 2 triu
ca t vong mi nm tr em di 5 tui.
Map sources:
Data for the Vaccination Coverage DTP3 map
were obtained from Expanded Program on
Immunization, National Institute of Hygiene
and Epidemiology (NIHE).
Ngun bn :
D liu v mc bao ph ca ca bn DTP3
t chng trnh tim chng m rng quc gia,
Vin v sinh dch t trung ng (NIHE).
Key references/Tham kho chnh:

- Review of Expanded Program of Immunization Vietnam 2009. UNICEF and NIHE.
- Andre FE. (2008) Vaccination greatly reduces disease, disability, death and inequity worldwide.
Bull World Health Organ 86 (2): 140-146.
- Lim SS, et al. (2009) Tracking progress towards universal childhood immunisation and the
impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis
immunisation coverage. Lancet 372: 20312046.
- WHO, UNICEF, World Bank. (2009) State of the worlds vaccines and immunization, 3rd ed.
Geneva, World Health Organization.
United Kingdom.
47
Subject: Food poisoning
Ch : Ng c thc phm
48
Ch : Ng c thc phm
nh ngha:
Bnh truyn qua thc phm l tnh trng bnh
l xut hin do vic tiu ho thc phm b
nhim bn bi vi rt, vi khun, k sinh trng
hoc c cha c cht. Cc tc nhn gy bnh
rt a dng, bao gm cc loi vi rt nh noro
vi rt, rota vi rt, v hepatitis A; Vi khun
nh Camplylobacter, Salmonella, Shigella,
Clostridium perfringens, Vibrio cholera, E.
coli, v Listeria; K sinh trng gm c Giardia
v Cryptosporidium. Vit Nam, vi khun
Streptococcus suis (lin cu ln), gy vim
mng no v nhim khun huyt, n lin quan
ti vic n cc mn t ln sng hoc cc mn t
ln nu cha chn. c cht t nhin cng gy
ra ng c thc phm. Chng bao gm c cht
ca botulinum , cht c ca Bacillus cereus,
c t rut ca Staphylococcus aureus, nm
c, v c cc c cht t hi sn nh (c nc,
mt s loi s).
Definition:
Foodborne illness refers to any illness that arises
from the ingestion of food that is contaminated
with viruses, bacteria, or parasites, or contains
toxins. An extremely large number of pathogens
may cause foodborne illness, including virus
such as norovirus, rotavirus, and hepatitis A;
bacteria such as Camplylobacter, Salmonella,
Shigella, Clostridium perfringens, Vibrio
cholera, E. coli, and Listeria; and parasites
such as Giardia and Cryptosporidium. In
Vietnam the bacterium Streptococcus suis,
which can cause meningitis and septicaemia,
is associated with the consumption of undercooked pork products. Natural toxins may also
cause food poisoning. These include botulinum
toxin (causing botulism), Bacillus cereus toxin,
Staphylococcus aureus enterotoxin, poisonous
mushrooms, and a variety of marine toxins
(puffer fish toxin, ciguatera toxin, scrombotoxin,
and paralytic shellfish poisoning).
ng ly truyn:
Theo nh ngha, bnh truyn qua thc phm
gy ra bi vic tiu ho thc phm b nhim bn.
Tuy vy, cc tc nhn gy bnh ng tiu ha
c th thng qua nhiu con ng khc nhau
v d nh thng qua nc ung, ly truyn t
ngi sang ngi qua ng phn ming hoc
qua ngun nc sinh hot hng ngy b nhim
bn. V th , xc nh mt thc phm c th l
nguyn nhn gy ra nhim khun hay v ng
c ln thng rt kh khn.
Transmission route:
By definition foodborne illnesses are transmitted
through the ingestion of contaminated
foods. However, many pathogens that cause
gastrointestinal illness can be transmitted by a
variety of routes e.g. from contaminated food
but also from drinking water, from personto-person via the fecal-oral route, or from
contaminated water sources. As such, it is often
difficult to identify a particular food as the
source of infections and outbreaks.
Thi gian bnh:

a dng. Thi gian bnh c th ngn i vi
nhng trng hp ng c bi tin c t.
Incubation Period:
Various. May be very short if the illness is
caused by a pre-formed toxin.
Cc pht hin lm sng:

Theo nh ngha, cc cn nguyn gy bnh
thm nhp c th thng qua ng tiu ha nn
nhng triu chng c trng ca bnh th hin
l triu chng v tiu ha nh bun nn, nn,
au bng hoc tiu chy. Tuy nhin, cc triu
chng ca mt s bnh truyn qua thc phm
c nhng du hiu ni tri khc ngoi ng
Clinical Findings:
Since by definition the pathogens that cause
foodborne illness enter via the gastointestinal
tract, the majority of foodborne illnesses are
characterised by gastrointestinal symptoms,
such as nausea, vomiting, abdominal pain,
or diarrhoea. However, the symptoms of
49
Ch : Ng c thc phm
some foodborne illnesses are predominantly

outside the gastointestinal tract. This is most
often the case for toxic food poisoning, where
neurological or allergic type symptoms may
predominate e.g. botulism, marine toxins, some
poisonous mushrooms.
tiu ha. Thng l nhng trng hp nhim

c thc phm gy triu chng v thn kinh
hoc d ng, thng do c cht c cht ca
botulinum, c ca c nc hoc mt s loi
nm c.
Xt nghim chn on:
C rt nhiu loi xt nghim dng chn on
nhng ng c do yu t sinh vt thng kh
chn on bi bnh nhn thng khng n
c s y t hoc ch c iu tr triu chng m
khng iu tr cn nguyn. Mt s cn nguyn
sinh vt gy nn nhng triu chng lm sng
in hnh c th c chn on lm sng hoc
chn on xc nh nh pht hin phn lng
mu nc go trong nhim khun t.
Diagnostic Tests:
A variety of diagnostic tests are available but the
organism causing foodborne illness is usually
undiagnosed since most people will not seek
medical care, and those that do seek medical
care are treated for the symptoms regardless
of the causative organism. Certain organisms
cause a characteristic clinical syndrome and
are more likely to be diagnosed clinically or in
the laboratory e.g. rice water stools caused by
Vibrio cholera infection.
Phng bnh:
Phn ln cn nguyn gy ra bnh truyn qua
thc phm, c rt nhiu trong t nhin, trong
ng rut ca c ngi v ng vt hoc sn
c trong mi trng. Vic loi b hon ton cc
cn nguyn gy bnh l bt kh thi. Bin php
d phng hiu qu nht l da trn c s v
sinh an ton thc phm mt cch ton din theo
chui cung ng t ni sn xut n tn bn n
Prevention:
The large number of pathogens causing
foodborne illness, and the ubiquitous nature
of some of the commonest causes in the
intestinal tract of animals and humans and in
the environment means that eradicating the
source is impossible. Prevention is focused on
improving food safety at different stages of the
food chain from farm to fork.
Dch t hc:
Bnh truyn qua thc phm rt ph bin, hu
ht cc ca mc u khng c gim st v
cc v dch cng khng c ghi nhn. Nhng
nhm c nguy c cao nh ngi gi v ph n
c thai, v c h min dch yu chu nhiu nguy
c v v cc bnh nng do nhim trng truyn
qua thc phm. Thc phm sng l nguyn
nhn ph bin nht gy ra tnh trng bnh l,
gm tht sng, trng sng, rau sng, hoa qu c
cha tc nhn sinh hc hoc nhim phn ngi.
Gia tng sn xut thc phm, i i vi m
rng h thng phn phi ton cu cng lm gia
tng nguy c bng pht nhng v dch ln v
khin cho cng tc iu tra v kim sot thm
phn kh khn.
Epidemiology:
Foodborne illness is extremely common and
most cases are not identified through surveillance
and will not be recognised as outbreaks.
Certain groups, particular pregnant women,
the elderly, and the immunocompromised,
are at particular risk of severe illness due to
foodborne infections. Raw foods are the most
likely foods to cause illness e.g raw meats, raw
eggs, raw shellfish, or raw vegetables and fruits
that are contaminated with organisms from
animal or human faeces. Intensification of food
production and manufacturing, couple with
expanded distribution networks, increases the
risk of large scale outbreaks that are difficult to
detect and control.
50
Ch : Ng c thc phm
Map sources:
Food poisoning outbreaks report from Vietnam
Food Administration in 2011.
All commune health centers and district
health centers will report food poisoning
outbreaks to Department of health twice a
year in July and January. Reports will be in
form, including time, place, number of food
intake, number of infected people, number of
deaths, reason and diagnostic. Department of
health will summarize and report to Vietnam
Food Administration twice a year in July and
January.
Ngun bn :
Bo co ng c thc phm t Cc An ton
thc phm, B Y t nm 2011.
Cc trung tm y t x, huyn hng nm bo co
cc v ng c thc phm ln S y t tnh hai
ln vo thng 7 v thng 1 nm sau. Bo co
di dng vn bn bao gm cc thng tin v
a im xy ra ng c, thi gian, thc n, s
ngi b nhim, s ca t vong, nguyn nhn v
triu chng. S y t s tng hp v bo co s
liu ln Cc An ton thc phm v b Y t hai
ln trong nm vo thng 7 v thng 1 nm sau.
Key references/Ngun tham kho chnh:

- OBrien SJ (2012). The public health impact of food-related illness. .Curr Opin Infect Dis.
Oct;25(5):537-45.
- Tauxe RV, et al (2010). Evolving public health approaches to the global challenge of foodborne
infections. Int J Food Microbiol. May 30;139 Suppl 1:S16-28.
United Kingdom.
51
Subject: Landcover
Ch : Lp t b mt
52
Subject: Landcover
Ch : Lp t b mt
Trends:
The Vietnam General Statistics Office reported
that on January 1st 2011 approximately 30% of
Vietnams land area is agricultural production
land and 46% is forestry land. The 2010 FAO
Forest Resource Assessment reported that 74%
of forest in Vietnam is naturally regenerated
forest, 25% is planted forest, and 1% is primary
forest. Vietnam has followed a policy of active
reforestation since the early 1990s with the
area of forest having increased from 9,363
thousand hectares in 1990 to 13,797 thousand
hectares in 2010: an increase of 47%. However,
this increase is the result of planted forests and
natural regeneration, with the area of primary
forest having declined from 384 thousand
hectares in 1990 to 80 thousand hectares in
2010.
Xu hng:
Theo bo co ca Tng cc thng k vo ngy
01/01/2011, khong 30% din tch t ti VN
l t sn xut nng nghip, 46% l t rng.
Theo bo co nh gi v ti nguyn rng ca
T chc nng lng lin hp quc (FAO) 2010,
74% din tch rng ca VN l rng ti sinh t
nhin, 25% l rng trng v ch c 1% l rng
nguyn sinh. Vit Nam thc hin chnh sch
khuyn khch trng rng t u nhng nm
1990, kt qu l din tch rng tng ln 47% t
9.363.000 ha nm 1990 ln 13.797.000 ha nm
2010. Tuy nhin, s tng ln l kt qu rng
trng v rng ti sinh t nhin, din tch rng
nguyn sinh li ang gim xung t 384.000 ha
nm 1990 xung khong 80.000 ha nm 2010.
Rng l ni sinh sng ca rt nhiu ng vt (
cha t nhin) v vec t ca nhiu bnh truyn
nhim m c th truyn bnh mang tnh cht c
hi (cng sinh) hoc nh l mt phn vng i
(chu k) t nhin ca mm bnh. Nhng bnh
truyn nhim m ngi l vt ch chnh c lin
quan n rng l him nhng ng ch bao
gm bnh st rt c ly truyn bi cc loi
mui Anopheles lin quan ti rng. Ph bin
hn, cc bnh truyn nhim lin quan ti mi
trng rng l nhim trng c hi c ngun
gc t ng vt bi ngi thng khng phi
mt mt xch trong vng i t nhin ca mm
bnh. Nhng nhim trng c hi ny c th l
qua vc t (Kyasanur vi rut, Semliki vi rut, v
Plasmodium knowlesi),ly qua ng tiu ha
do n tht th rng (VD. Ebola, monkeypox),
hoc chnh do cc tc nhn mi trng t nhin
(Cryptococcus gattii). i lc, c th c nhng
ly truyn gii hn trc tip t ngi sang
ngi thng l khng bn vng v d dng
khng ch (monkey pox, Ebola v Marburg
virus, Nipah vi rut). i khi, nhng hin tng
ly truyn ca nhim trng c hi ny xy ra

Forests are habitats for animal reservoirs and
vectors of a wide range of infectious diseases
that may infect humans either opportunistically
or as part of the pathogens natural life
cycle. Forest associated infections where
humans are the definitive host are rare but
notably include malaria transmitted by forest
associated anopheles species. More commonly,
forest associated infections of humans are
opportunistic zoonoses where humans are not
part of the natural pathogen life-cycle. These
opportunistic infections may be vector-borne
(e.g. Kyasanur forest virus, Semliki forest
virus, and Plasmodium knowlesi), the result
of human predation on animals (e.g. Ebola,
monkeypox), or from environmental sources
(e.g. Cryptococcus gattii). Sometimes there may
be limited human-to-human transmission that
is either not sustained or is readily controlled
(e.g. monkey pox, Ebola and Marburg viruses,
Nipah virus). Occasionally these opportunistic
transmission events are highly successful and
53
Subject: Landcover
Ch : Lp t b mt
the pathogen becomes fully adapted to the new

host. It is likely that a large proportion of current
human pathogens originated from animal
pathogens: the best known of these is HIV,
which probably originated from chimpanzees
sometime prior to 1940.
thnh cng v tc nhn tr ln thch nghi vi

c th vt ch mi. Dng nh mt phn ln
nhng tc nhn gy bnh trn ngi hin nay
u c ngun gc t ng vt, ni ting nht
trong s l HIV c ngun gc t loi Tinh
tinh khong trc nm 1940.
Human activities have had an enormous impact

on forests and will continue to do so as long
as demand continues for hard wood, fire wood,
pulp, agricultural and grazing land, living space,
roads, minerals and power. Deforestation can
involve clearance or selected logging of high
value trees. Selected logging will bring workers
into greater contact with zoonotic reservoirs
and vectors whereas clearance may increase
or decrease contact with pathogens as the
local ecology is disrupted. Transient outbreaks
have occurred when deforestation activities
have bought humans into close contact with
animal reservoirs and vectors e.g. Venezuelan
hemorrhagic fever or when deforested areas
have been colonised by pathogen carrying
vectors e.g. black flies and onchocerciasis.).
The effects of deforestation and anthropogenic
changes of ecology are not however easy to
predict and may increase or decrease risks. An
indirect effect of deforestation was observed
when haze from forest clearance fires reduced
fruit production, forcing fruit bats to encroach
on domestic fruit orchards close to pig rearing
areas, leading to an outbreak of Nipah virus; thus
demonstrating the complex interconnectedness
of human activities, ecosystems and infectious
diseases threats.
Rice field in the lowland are associated with
occurence of Meliodosis in particular farmer
(see Meliodosis map)
Cc hot ng ca con ngi gy ra nhng tc

ng ln i vi rng v nhng nh hng ny
chc chn s cn gia tng bi nhng nhu cu
lun gia tng ca con ngi nh khai thc g,
ci, t nng nghip v chn th, khng gian
sng, ng x, khai khong v nng lng.
Cc hot ng khai thc rng lin quan n vic
pht quang, khai thc chn lc nhng cy c gi
tr kinh t cao. Vic khai thc t ngi cng
nhn vo mi tip xc cht vi nhng cha
thin nhin v cc vc t, trong khi vic pht
quang c th lm tng hoc gim vic tip xc
vi mm bnh do ph v chu k sinh thi t
nhin trong khu vc. Cc v dch ngn xy ra l
kt qu ca hot ng khai thc rng, do ngi
lao ng tip xc qu gn vi cc ng vt l
cha t nhin v vc t (VD st xut huyt
Venezuela hoc khu vc rng sau khi b ph b
xm chim bi cc vc t mang theo mm bnh
(Rui en v bnh do rui truyn). Tc ng
ca khai thc rng v nhng thay i sinh thi
gy ra bi con ngi l rt kh d on, v c
th c tnh tch cc hoc tiu cc. Mt tc ng
khng trc tip ca khai thc rng c nghi
nhn khi khi t la do t rng lm ry lm
gim sn lng hoa qu, khin cho nhng con
di n hoa qu bay vo vn hoa qu ca dn
c gn vi khu chn nui ln, dn n v dch
Nipad vi rut, iu ny minh ha r rt cho mi
quan h phc tp gia hot ng ca con ngi,
h sinh thi v cc mi nguy c v bnh truyn
nhim. Rung la cc vng trng c mi lin
quan n s xut hin ca bnh Meliodosis,
c bit nhng ngi nng dn (xem bn
Meliodosis)
54
Subject: Landcover
Ch : Lp t b mt
Data sources:
http://www.fao.org/geonetwork/srv/en/main.
home
Vietnam land cover data set is derived from the
original raster based Globcover global archive,
made by International Food Policy Research
Institute IFPRI. The map takes in consideration
occurrence of cropland, pasture, forest and
others.
Ngun bn :
http://www.fao.org/geonetwork/srv/en/main.
home
B d liu t b mt Vit Nam c ngun gc
t kho lu tr ton cu bn nh ct lp
Globcover, c thc hin bi Vin nghin cu
chnh sch lng thc quc t (International
Food Policy Research Institute IFPRI). Bn
ny tnh ton da trn s hin din ca t
trng cy, t trng c, t rng v mt s loi
t khc.

- Food and Agriculture Organization, Global Forest Resources Assessment 2010 (FRA 2010). http://
www.fao.org/forestry/fra/fra2010/en/
- Looi L.M. et al. (2007) Lessons from the Nipah virus outbreak in Malaysia.
Malays J Pathol. Dec;29(2):63-7.
- Teixeira A.R. et al. (2001) Emerging Chagas disease: trophic network and cycle of transmission
of Trypanosoma cruzi from palm trees in the Amazon.
Emerg Infect Dis. Jan-Feb;7(1):100-12.
- Tesh RB. (1994) The emerging epidemiology of Venezuelan hemorrhagic fever and Oropouche
fever in tropical South America. In: Wilson ME et al, Disease in evolution: global changes and
emergence of infectious diseases, New York, New York Academy of Sciences, 1994.
- Walsh J.F. et al. (1993 ) Deforestation: effects on vector-borne disease. Parasitology. 106
Suppl:S55-75.
- Wolfe N.D. et al. (2005) Bushmeat hunting, deforestation, and prediction of zoonoses emergence.
Emerg Infect Dis. Dec;11(12):1822-7.
- Wilson M.D. et al. (2002) Deforestation and the spatio-temporal distribution of savannah and
forest members of the Simulium damnosum complex in southern Ghana and south-western Togo.
Trans R Soc Trop Med Hyg. Nov-Dec;96(6):632-9.
United Kingdom.
55
Subject: Natural hazard risk
Ch : Ri ro thm ha thin nhin
56
Definition:
The table embedded in the map lists the major
natural hazards that may be encountered in the
various geographical regions of Vietnam, which
are shown in different colours. In addition, the
areas shaded in blue and their associated dashed
lines show where there is a 10% probability of
a tropical storm of this intensity striking in the
next 10 years (as of 1st March 2011). The zones
are based on the Saffir-Simpson Hurricane
Wind Scale of sustained wind-speeds, with the
highest category (category 5 Hurricane; 250
KMH +) omitted since it is not predicted to
occur in Vietnam. The dashed line indicates the
area of coast line that is susceptible to storm
surges Storm surges are often responsible for
the greatest loss of life along coast lines affected
by storms.
nh ngha:
Bng biu theo bn lit k ra nhng him
ha thin tai chnh c th xy ra trn cc vng
a l khc nhau ca Vit Nam v c biu
din theo nhng mu sc khc nhau. Ngoi ra,
nhng khu vc mu xanh v nhng ng t
nt th hin nhng ch m c khong 10% nguy
c xy ra nhng trn bo nhit i ln trong 10
nm ti (tnh t 01/03/2011). Nhng vng m
theo Thang gi bo Saffir-Simpson, vi mc
phn loi cao nht (bo s 5; trn 250 Km/h)
c loi tr do khng c kh nng s xy ra
ti Vit Nam. ng t nt m t ng b
bin d b bo tn cng. Bo thng l nguyn
nhn gy nn nhng thit hi ln v ngi ti
khu vc b bin.
Xu hng:
Nm trong khu vc Nhit i gi ma m, Vit
Nam thng xuyn phi hng chu nhng cn
bo ln, v d nh bo Ketsana v Mirinae xy
ra nm 2009. Dn c tp trung cao v s pht
trin kinh t ti cc vng t ven bin lm gia
tng nguy c xy ra thit hi v ngi nu xy
ra cc cn bo, nc bin dng hoc l lt.
th ha ti khu vc ng bng sng Hng v
sng M kng khin tnh trng lt th, mt
mi nguy thin tai phc tp hn v tn km
hn. Tuy nhin, Vit Nam l quc gia c b dy
kinh nghim trong vic i ph vi thin tai.
Vit Nam thc hin rt nhiu bin php d
phng, k hoch khc phc thit hi, bao gm
nng cp c s h tng (v d: Ci thin iu,
tng cng an ton khu bn cng, ci thin h
thng cp thot nc), cng ng v tng cng
th ch. Bin i kh hu ton cu c coi l
nguyn nhn su xa ca s gia tng c v tn
sut ln qui m ca nhng hin tng thi tit
cc oan; nu mc nc bin tng cao s dn
n nguy c cao v l lt v tc ng ti nc
bin dng. ng t cng l mt mi nguy c
i vi khu vc min Bc.
Patterns and trends:

Located in the tropical monsoon zone, Vietnam
is particularly vulnerable to the effects of
typhoons, as demonstrated in 2009 by typhoons
Ketsana and Mirinae. The high concentration of
people and economic activity in coastal plains
of Vietnam means that high numbers of people
are at risk of the effects of storms, storm-surges,
and flooding. Increasing urbanization in the
Red River and Mekong Deltas has made urban
flooding a more costly and complex hazard.
However Vietnam has extensive experience
of dealing with these natural disasters and has
implemented a wide range of prevention and
mitigation strategies including infrastructure
improvements (e.g. safe harbors, strengthened
river and sea dykes, improved drainage systems
and river flows) and community and institutional
strengthening. The frequency and magnitude of
extreme weather events may increase as a result
of climate change, whilst sea level rises (if they
occur) would increase the risk of flooding and
the impact of storm surges. Northern Vietnam
also has some vulnerability to earthquakes.
57
Significance for infectious diseases:

Non-epidemic risks: tetanus and wound
infections are a concern for individual survivors
with traumatic injuries. The pathogens
responsible for wound infections will depend
on the local microbial epidemiology and the
nature of the disaster. Flooding increases the
risk of skin infections, conjunctivitis, ear, nose
and throat infections, and aspiration pneumonia.
Workers handling corpses need to protect
themselves against the risk of blood-borne
viruses, enteric pathogens and tuberculosis.
Epidemic risks: Large infectious disease
outbreaks following natural disasters are
uncommon, although leptospirosis cases
may increase as a result of direct exposure to
contaminated flood-waters. When outbreaks do
occur they are usually in displaced populations
living in crowded, temporary shelter with
inadequate infrastructure and health care.
Contaminated drinking water and a lack of
sanitation facilities can lead to epidemics
of water-borne infections such as cholera.
Overcrowding and poor living conditions
result in a significant increase in morbidity
and mortality from acute respiratory infections
and, if vaccination coverage is low, vaccine
preventable diseases such as measles. Disasters
may also lead to an increase in suitable vector
habitats, resulting in vector borne disease
outbreaks. Malaria outbreaks following
flooding in endemic areas are well recognized
and occur after a lag of six to eight weeks.
In the immediate aftermath of a natural disaster
there is often great concern about the epidemic
risk posed by dead bodies. There is however
no evidence that dead bodies arising from
natural disasters pose an epidemic risk. Most
people who die as an immediate consequence
of a natural disaster are killed by trauma or
drowning (and in the case of urban flooding,
electrocution). Since most are not suffering
from a communicable disease at the time of
their death and pathogens do not survive long

Nhng yu t nguy c khng gy dch: Un
vn v nhng nhim trng vt thng thng
l mi quan ngi cho cc nn nhn sng st
vi vt thng do chn thng. Cn nguyn
ca cc nhim trng vt thng ph thuc vo
dch t hc vi sinh vt ca khu vc v bn cht
ca thin tai. L lt thng lm gia tng nguy
c nhim trng da, vim kt mc, nhim trng
tai mi hng, vim phi. Ngi tham gia chn
hoc thiu hy xc cht cn c bo h trnh
cc vi rt truyn qua mu, mm bnh ng
rut v lao phi.
Nhng yu t nguy c gy dch: nhng i
dch ln sau thin tai khng thng xuyn xy
ra. Tuy nhin nhim nc sau l c th gia
tng s ca mc leptospirosis (xon trng). Dch
thng xy ra nhng khu di tn tp trung ng
ngi, c s vt cht thiu thn v khng c h
thng chm sc y t y . nhim nc sinh
hot v dng sinh hot thiu v sinh c th
gy ra dch bnh truyn qua nc nh bnh t.
Tp trung ng ngi v iu kin sinh hot
thiu thn lm gia tng ng k t l mc v t
l t vong do cc bnh l ng h hp. Nu
bao ph ca vc xin thp c th khin nhng
bnh c th phng trnh bng vc xin nh si
c nguy c bng pht. Thin tai cng lm gia
tng mi trng sng thun li cho cc vc t,
dch bnh do vc t truyn. Dch st rt theo
sau l lt ti nhng vng dch t c ghi
nhn v xy ra t 6-8 tun sau l.
Trong nhng hu qu ngay lp tc ca thin tai
c mt mi quan ngi thng xuyn v nguy
c bnh dch gy ra bi cc xc ngi cht.Tuy
nhin, cha c bng chng khng nh rng s
tng xc ngi cht t cc thm ho thin nhin
l mt nguy c dch bnh. Nguyn nhn t vong
thng nh l mt hu qu ngay lp tc ca cc
thm ho thin nhin l do chn thng, cht
ui (v trong trng hp lt th, git in).
Do phn ln h khng phi hng chu mt bnh
truyn nhim ti thi im h t vong v nhng
mm bnh nhim trng thng cng khng tn
58
in the body after death, they do not pose an

epidemic risk.
ti lu trong xc ngi sau cht, nhng t thi

ny khng gy ln mt nguy c dch bnh.
Map sources:
United Nations Office for the Coordination of
Humanitarian Affairs
http://ochaonline.un.org/roap/MapCentre/
HazardMaps/tabid/3725/language/fr-FR/
Default.aspx
http://www.desinventar.net/definitions_2.html
Ngun bn :
Vn phng Lin hp quc iu phi cc vn
nhn o (United Nations Office for the
Coordination of Humanitarian Affairs - OCHA)
http://ochaonline.un.org/roap/MapCentre/
HazardMaps/tabid/3725/language/fr-FR/
Default.aspx
http://www.desinventar.net/definitions_2.html

- Communicable disease control in emergencies: a field manual edited by M. A. Connolly. (2005)
World Health Organization.
- Flooding and communicable diseases fact sheet. (2005) WER No. 3, 80, 2128
- Morgan O. Infectious disease risks from dead bodies following natural disasters. (2004) Pan
American Journal of Public Health, 15(5):307312.
United Kingdom.
59
Subject: Pig density
Ch : Mt ln
60
Ch : Mt ln
Definition:
The maps opposite show the national distribution
of domesticated pigs per km2 in 2006.
nh ngha:
Bn th hin phn b ca ln theo din tch
trn ton quc vo nm 2006.
Trends:
Due to the increase in global human population
and economic development, demand for
livestock products has risen dramatically
over the last 50 years, with the per capita
consumption of meat in developing countries
more than tripling since the early 1960s and egg
consumption increasing fivefold. The increased
demand for meat has been met by more intensive
and geographically concentrated production of
livestock, especially pigs and poultry. Vietnam
has seen strong growths in the demand for
pork, with pig production more than doubling
between 1996 and 2006. The demand for pork
has been driven by growing household incomes
and population growth, and it is forecast that
per capita consumption of pork will continue
to increase. The highest density of pig farming
is in the Red River Delta, followed by the areas
around Ho Chi Minh City. The pig density is
strongly associated with human population (see
population density map). There are on average
2.8 pigs per household. The pig raising sector
is still highly dependent on household suppliers
but increased demands for pork in the future
is likely to be met by increasing productivity,
increasing numbers of commercial pig farms,
and the importation of pork products.
Xu hng:
Dn s ton cu gia tng v s pht trin kinh t
l nguyn nhn dn n s gia tng ng k v
nhu cu i vi cc sn phm ca ngnh chn
nui gia sc trong 50 nm qua. c tnh ti cc
quc gia ang pht trin, mc tiu th bnh qun
i vi tht ln tng gp 3 ln v i vi trng
tng gp 5 ln so vi u nhng nm 1960.
p ng nhu cu ny cc quc gia phi tng
nng sut chn nui v c hnh thnh nhng khu
chn nui tp trung. Nhu cu tiu th tht ln
Vit Nam l rt ln, do vy m sn phm tht
tng gp i t nm 1996 n 2006. Cng vi
gia tng dn s v s pht trin kinh t h gia
nh th nhu cu tht ln c d on l s cn
tip tc tng. Mt nui ln cao nht l khu
vc ng bng sng hng v tip n l khu vc
xung quanh thnh ph H Ch Minh. Mt ln
c mi lin quan cht ch i vi dn s (Xem
trong bn Mt ln). Trung bnh c khong
2.8 con ln/h gia nh. Ngnh chn nui ln
c tnh cht chn nui h gia nh. Tuy nhin,
cng vi nhu cu tht ln ngy cng tng th tng
nng sut, tng s lng cc nng tri nui cng
nghip v nhp khu cc sn phm tht ln
bt u tng ln.

Ln l ngun gc ca nhiu bnh nhim trng c
ngun gc t ng vt, bao gm c thng hn,
campylobacter, brucellosis, dch hch (yersinia
enterocolitica) leptospirosis, trichinellosis
(trichinella spiralis), fasciolopsiasis (fasciolopsis
buski), sn dy v bnh giun sn (taenia solium),
lin cu ln, v vim gan E. Ln cng l cha
cho vi rt vim no Nht Bn v vi rt Nipah
nhn ln. Ln c th b nhim vi rt cm m
sau ly nhim cho cc loi chim v chng
cng thng ly nhim cho ngi. Do vy, ln
c th l ni vi rt c ngun gc t ngi v
chim ti t hp thnh mt chng vi rt cm mi.
V d nh nm 2009, cm A/H1N1 i dch c
ngun gc t ln. Lin cu ln (Streptococcus

Pigs can be the source of several zoonotic
infections, including salmonella, campylobacter,
Brucellosis, Yersiniosis (Yersinia enterocolitica)
Leptospirosis,
Trichinellosis
(Trichinella
spiralis), Fasciolopsiasis (Fasciolopsis buski),
taeniasis and cysticercosis (Taenia solium),
Streptococus suis, and hepatitis E. Pigs are
also important as amplifying hosts of Japanese
Encephalitis and Nipah virus. Pigs can be
infected by influenza viruses that usually
infect birds and also those that normally infect
humans, this means that they can acting as
a mixing-vessel to produce new influenza
61
Ch : Mt ln
suis) nguyn nhn quan trng nht ca bnh
vim mng no do vi khun Vit Nam. Cc
ca nhim bnh thng c lin quan ti vic n
cc mn n cha nu chn hoc tht ln ti hoc
c phi nhim ngh nghip vi ln v cc sn
phm t ln, v ch bin tht ln khi c cc tn
thng ngoi da. Trong nm 2010 xy ra s
bng pht dch vi rt gy hi chng sinh sn v
h hp (PRRS, bnh tai xanh) v c bo co
t 49 tnh/TP ca Vit Nam. Nhng v dch ny
c lin quan vi vic tng t l ca nhim trng
lin cu ln h thng c ng nhim vi vi
rt PRRS. iu gi rng nguy c ly lan
bnh lin cu ln c ngun gc t ng vt sang
ngi c th tng cao trong thi gian bng pht
dch ln tai xanh. Vic kim sot cc bnh nhim
c ngun gc t ng vt lin quan ti ln yu
cu nhng s ci thin trong vic cch ly n ln
nui khi cc ng vt nui khc v ng vt
hoang d trong qu trnh git m v bun bn;
vic gim st dch bnh ln, tng cng cc
hot ng kim sot trong thi gian dch, thc
hnh git m an ton, kim tra cht lng tht,
cht lng bo qun v tuyn truyn n chn cc
sn phm t tht ln.
viruses that are a mixture of avian and human

viruses. The 2009 pandemic influenza virus
H1N1 originated from pigs. Streptococcus
suis is the most important cause of bacterial
meningitis in Vietnam and is associated with
eating under-cooked or raw pork dishes,
occupational exposure to pigs and pig products,
and the preparation of pork in the presence
of skin lesions. In 2010 outbreaks of Porcine
Reproductive and Respiratory Syndrome Virus
(PRRSV or blue ear disease) were reported
from 49 provinces of Vietnam. These outbreaks
were associated with increased prevalence of
systemic Streptococus suis infection in pigs
co-infected with PRRSV and suggest there
may be an increased risk for potential zoonotic
transmission of Streptococus suis to humans
during outbreaks of PRRS in swine. The control
of zoonotic infections associated with pigs
requires improvements in the separation of pigs
from other domestic and wild animals during
pig production and marketing; monitoring of
pig diseases and the enforcement of movement
controls during epidemics; safe slaughtering
practices; the inspection of meat quality; the
safe handling of raw pork; and the thorough
cooking of all pork products prior to eating.
Map sources: Total number of pig per district
was collected from 01 April 2006 and 01
October 2006 census, General Statistics Office
Pig data was added to points which are
centroid at each district and used for Krigging
Interpolation method to depict the estimated
number of pigs per square kilometer.
Ngun bn :
S liu s lng ln trn mi qun, huyn c
thu thp t tng iu tra theo phng php iu
tra ton b vo thi im 01 thng 04 v 01 thng
10 nm 2006 ca Tng Cc Thng K.
S liu ny c gn vo cc im trn bn
ti mi qun, huyn v s dng phng php ni
suy Krigging suy ra ra mt ln c tnh
trn mt km2

- Tisdell, C. (2008). Structural Transformation in the Pig Sector in an adjusting Vietnam Market:
A preliminary Investigation of Supply-side Changes, Economic, Theory, Applications and Issues.
Working Paper, No. 50, School of Economics, The University of Queensland, Brisbane, 4072,
Australia.
- Nghia HD, et al. (2011) Risk factors of Streptococcus suis infection in Vietnam. A case-control
study. PLoS One. 2011 Mar 8;6(3):e17604.
- Hoa NT, et al. (2013) Streptococcus suis and porcine reproductive and respiratory syndrome,
Vietnam. Emerg Infect Dis. 2013 Feb;19(2):331-3.
United Kingdom.
62
Subject: Population distribution
Ch : Phn b dn c
63
Ch : Phn b dn c
Definition:
The map shows the population distribution in
Vietnam in 2009, data from General Statistics
Office
nh ngha:
Bn th hin s phn b dn c Vit Nam
nm 2009, ly t Tng iu tra dn s va nha
nm 2009, Tng cc thng k
Trends:
The Vietnam Population and Housing Census
enumerated a population of 85,789,573 on 1st
April 2009, making Vietnam the third most
populous country in Southeast Asia, after
Indonesia and the Philippines, and the thirteenth
most populous country in the world. Population
density in Vietnam is high at 259 persons/
km2 and is the third highest in Southeast Asia
(after the Philippines and Singapore). There
is however great variation in the distribution
of persons, with a concentration of persons in
the Red River and Mekong River deltas, where
43% of the population lives.
Population growth rate is closely linked to the
level of economic development, with growth
rates in the poorest countries being twice that of
the developed world. In the period between the
1999 and 2009 Vietnam Population Censuses
the population growth rate was 1.2% per year
(an average of 947,000 persons per year),
making this period the decade experiencing
the lowest population growth rate in the past
30 years. This declining fertility coupled with
an increase in life expectancy has led to an
aging population, with a smaller proportion of
the population in the younger age groups. The
share of the population below 15 years of age
has declined from 33% in 1999 to 25% in 2009.
As well as an ageing population, Vietnams
population is also urbanizing. During the period
19992009, the average annual population
growth in urban areas was 3.4%, compared to
0.4% in rural areas. Of the population increase
of 9.47 million persons occurring between 19992009, 77% was accounted for by increases in
urban areas. However, the population remains
mostly rural, with 30% of the population living
in urban areas in 2009.
Xu hng:
Theo kt qu Tng iu tra dn s v nh
, dn s Vit Nam n thi im 1 thng
4 nm 2009 l 85,789,573 ngi, l quc gia
ng dn th 3 trong khu vc ng Nam
ch sau Indonesia, Philippines v l quc gia
ng dn th 13 th gii. Mt dn c l 259
ngi/km2, ng th 3 ng Nam (ch sau
Philippines v Singapore). Tuy vy s phn b
dn c li rt a dng vi t l 43% dn s sinh
sng ti khu vc ng bng sng Hng v sng
M Kng.
T l gia tng dn s phn no th hin s pht
trin kinh t ca quc gia, t l tng dn s ti
nhng nc ngho l gp i so vi nhng nc
pht trin. Trong giai on t 1999 n 2009,
t l tng dn s trung bnh ca Vit Nam vo
khong 1,2% mi nm (trung bnh 947 nghn
ngi mi nm) v y l giai on c t l tng
dn s thp nht trong 30 nm. iu ny cng
vi tui th trung bnh gia tng dn n cu
trc dn s gi, ch c mt phn nh dn s tr.
Trong , nhm dn c di 15 tui gim t
33% nm 1999 xung 25% vo nm 2009.
Cng vi tui th dn s gia tng, Vit Nam
cng phi i mt vi tnh trng gia tng dn
c khu vc th. Cng trong giai on 1999
2009, s gia tng dn c th trung bnh hng
nm l 3.4% so vi 0.4% ca khu vc nng
thn. Trong 10 nm, dn c tng thm 9.47
triu ngi, c n 77% ghi nhn ti khu vc
th. Tuy vy, phn ln dn c vn tp trung ti
khu vc nng thn v ch c 30% dn s sinh
sng ti cc khu vc th (s liu nm 2009).
Nhiu kin a ra rng nu dn s gia tng
qu kh nng cung cp ca ti nguyn thin
nhin s chc chn dn n hu qu l chin
64
Ch : Phn b dn c
Significance for infectious diseases:

It has long been argued that war, famine and
disease are an inevitable consequence when
population density exceeds the natural carrying
capacity of the ecosystem. However there is
the ability of technological, commercial and
social advances to sustain ever-increasing
population densities. Although the size and
demographic profile of populations influence
the infectious diseases that thrive, densely
populated countries can be healthy. For health
policy makers, a distinction is needed between
the risk of infection, which may be greatest in
poor rural areas, and the overall burden, which
may be greatest in densely populated areas.
tranh, i ngho v bnh tt. Tuy nhin s tin

b trong khoa hc k thut, x hi v thng
mi vn c th m bo s cn bng vi tc
gia tng khng ngng ca dn s v mt dn
s. Bt chp cu trc v tnh cht nhn khu
hc ca dn s nh hng ti cc bnh truyn
nhim, tnh trng sc kho ca cc quc gia
ng dn c c th tt. Vi nhng ngi lm
chnh sch y t, cn c ci nhn su sc v c
th nhm phn bit r gia nhng nguy c v
bnh truyn nhim ti khu vc nng thn kh
khn v gnh nng chung ti nhng khu vc c
mt dn c cao.
Ngun bn :
S liu ca cuc tng iu tra dn s nm 2009,
Tng cc thng k. S liu c thu thp t
phiu iu tra dn s v nh ti tng h gia
nh thng 4 nm 2009.
Map sources:
The final results of the 2009 Vietnam Population
and Housing Census. Vietnam General Statistics
Office, Hanoi, 2010. The data was collected by
population and housing census questionnaire in
each household in April 2009.

- The 2009 Vietnam Population and Housing Census. Final Results. Vietnam General Statistics
Office, Hanoi, 2010.
- United Nations, Department of Economic and Social Affairs, Population Division: World
Population Prospects: The 2008 Revision. New York, 2008.
- United Nations, Department of Economic and Social Affairs, Population Division:
World Urbanization Prospects, the 2009 Revision: Highlights. New York, 2010
United Kingdom
65
Subject: Poverty rate
Ch : T l h ngho
66
Ch : T l h ngho
Definition:
The map opposite shows the proportion of
the population estimated to live in poverty by
district in 2009. Poverty is derived using data
from the 2009 Population and Housing Census
and the 2010 Vietnam Household Living
Standard Survey.
nh ngha:
Bn th hin t l h ngho theo khu vc
trong nm 2009. Tnh trng ngho c ly t
Tng iu tra dn s v nh nm 2009 v
iu tra mc sng h gia nh nm 2010.
Xu hng:
Vit Nam c nhng nhiu tin b trong vic
gim ngho, tr thnh mt quc gia c thu nhp
trung bnh thp vi thu nhp bnh qun u
ngi t mc 1,130$ vo cui nm 2010, v
hon thnh mc tiu thin nin k s 1 (xa i
gim ngho) trc thi hn 2015. T l ngho
ca quc gia gim 75%, t mc 58,1% nm
1993 xung ch cn 14,5% nm 2008. Nhng
chnh sch xa i gim ngho ca Vit Nam
c nh gi rt cao v Vit Nam thnh
cng hn rt nhiu nc khc trong vic t
c s pht trin cng bng. Tuy vy, khng
phi tt c mi ngi c hng li ngang
nhau t nhng pht trin kinh t. Tnh trng
ngho i Vit Nam vn cn mang nng tnh
vng min, nhng khu vc vng ni xa xi pha
Bc hoc Ty Nguyn l khu vc c t l ngho
i cao nht trong khi khu vc ng bng sng
Hng v sng M Kng l thnh vng hn.
Tuy vy, mt dn c ti khu vc ng bng
sng Hng v sng M Kng li rt cao, do
vn c mt t l cao dn c sng trong tnh
trng ngho tp trung ti cc khu vc ng bng
ny. Cng ng dn tc thiu s sng ti nhng
khu vc nng thn xa xi ni c mc sng thp
nht; ngay c trong khu vc ngho ny, cc h
gia nh dn tc thiu s vn c mc sng thp
hn so vi h gia nh ngi Kinh hoc ngi
Hoa. Trong nm 2008, 50% s ngi dn tc
thiu s vn sng di mc ngho v trn 31%
chu cnh thiu i.
Trends:
Vietnam has been highly successful in reducing
poverty, becoming a lower middle-income
country with per capita income of $1,130 by
the end of 2010, and achieving Millenium
Development Goal 1 (Eradicate Extreme
Poverty and Hunger) ahead of the 2015
deadline. From a poverty rate of 58.1 percent in
1993, Viet Nam successfully reduced poverty
to an estimated rate of 14.5 percent in 2008
a reduction of 75 percent. Vietnams poverty
alleviation policies have been widely praised
and Vietnam has been more successful than most
countries in achieving equitable development.
Nevertheless, economic development has
not benefited everyone equally. Poverty in
Vietnam is highly geographical, with the
remote mountainous regions of the North and
Central Highlands being the poorest areas, and
the Red River Delta and Mekong Delta are
more prosperous. However, because population
density is far higher in the Red River and
Mekong Deltas, a large proportion of all the
poor people in Vietnam live in the deltas.
Ethnic minority populations are concentrated
in the remote rural areas where poverty is
greatest, and within these poor areas poverty is
more common in ethnic minority households
compared to Kinh and Hoa households. As of
2008, 50 percent of ethnic minorities were still
living below the general poverty line, and up to
31 percent suffered from food poverty.

Ngho i l tc nhn quyt nh ton cu quan
trng nht ca nguy c bnh truyn nhim.
Ngho i l mt nhn t ca mt chm du

Poverty is the single most important global
67
Ch : T l h ngho
determinant of infectious disease risk. Poverty

is a marker of a constellation of vulnerabilities
that
includes
environmental,
sanitary,
nutritional, behavioral and health care access
components. But poverty is also both the result
and a cause of poor governance structures,
a condition which is accompanied by weak
preventive and curative health systems, food
insecurity and internal social disruption. In
general, infectious diseases remain a significant
health problem in countries with low GDP,
where as non-communicable diseases dominate
the illness landscape of richer nations. The
epidemiological transition, from infectious
diseases to non-communicable diseases, is not
however always smooth and many countries
experience a period of a double-burden where
infectious diseases predominate in certain risk
groups whilst non-communicable diseases
begin to burden more affluent sectors of society.
Achieving continued reductions in poverty
is probably the most effective intervention to
reduce the global burden of infectious diseases.
hiu cho tnh trng d b tn thng bao gm

mi trng, tnh trng v sinh, ch dinh
dng, thi v tip cn cc dch v chm
sc sc khe. Ngho i va l nguyn nhn
li va l kt qu ca nhng cu trc qun l
yu, mt tnh trng m trong ng hnh
cng vi nhng h thng y t d phng v cha
tr km, mt an ninh lng thc v c nhng
phn ha trong lng x hi. Nhn chung, bnh
truyn nhim vn l vn y t ln i vi
nhng quc gia c GDP thp, trong khi bnh
khng truyn nhim chim ch o trong bi
cnh bnh ca nhng quc gia giu c hn. S
chuyn giao v mt dch t hc, t nhng bnh
truyn nhim sang nhng bnh khng ly, tuy
nhin, thng khng d dng, nhiu quc gia
tri qua mt khong thi gian ca mt gnh
nng kp, khi m nhng bnh truyn nhim
vn chim u th mt nhm nguy c nht
nh trong khi nhng bnh khng ly cng
bt u tr thnh gnh nng vi tng lp giu
c hn ca x hi. Kt lun li, duy tr nhng
thnh tch t c trong xa i gim ngho
chnh l bin php hiu qu nht gim gnh
nng bnh truyn nhim ton cu.
Map sources:
Lanjouw, Peter & Marra, Marleen & Nguyen,
Cuong, 2013. Vietnams evolving poverty
map: patterns and implications for policy,
Policy Research Working Paper Series 6355,
The World Bank
This study uses two data sets. The first is the
15-percent sample of the Vietnam Population
and Housing Census (VPHC). The 2009 VPHC
was conducted by the General Statistics Office
of Vietnam in April 2009
The second dataset is the 2010 Vietnam
Household Living Standard Survey (VHLSS).
The 2010 VHLSS was also conducted by GSO
with technical support from the World Bank in
Vietnam.
Ngun bn :
Lanjouw, Peter & Marra, Marleen & Nguyen,
Cuong, 2013. Vietnams evolving poverty
map: patterns and implications for policy,
Policy Research Working Paper Series 6355,
The World Bank
Nghin cu trong bi bo s dng hai ngun
s liu. Ngun th nht bao gm 15% mu ca
Tng iu tra dn s v nh nm 2009 c
tin hnh bi Tng cc thng k vo thng t
nm 2009. Ngun s liu th hai t Kho st
tiu chun mc sng ca cc h gia nh do
Tng cc thng k v Ngn hng th gii ti
Vit Nam.
68
Ch : T l h ngho

- Rural Poverty and Inequality Maps in Vietnam: Estimation using Vietnam Household Living
Standard Survey 2006 and Rural Agriculture and Fishery Census 2006. MPRA Paper No. 36378.
Online at http://mpra.ub.uni-muenchen.de/36378/
- World Development Indicators. World Bank 2010. ISBN 978-0-8213-8232-5
- Human Development Report 2009. Overcoming barriers: Human mobility and development.
UNDP 2009. ISBN 978-0-230-23904-3
- Lanjouw, Peter & Marra, Marleen & Nguyen, Cuong, 2013. Vietnams evolving poverty map :
patterns and implications for policy, Policy Research Working Paper Series 6355, The World Bank
United Kingdom.
69
Subject: Poultry density
Ch : Mt gia cm
70
Ch : Mt gia cm
Definition:
The maps show the distribution and density of domestic poultry.
nh ngha:
Nhng bn ny th hin s phn b v mt
gia cm.
Trends:
Due to the increase in global human population
and economic development, demand for livestock
products has risen dramatically over the last 50
years, with the per capita consumption of meat
in developing countries more than tripling since
the early 1960s and egg consumption increasing fivefold. The increased demand for meat has
been met by more intensive and geographically
concentrated production of livestock, especially
pigs and poultry. In Vietnam, the highest proportion of households engaged in animal husbandry
are located in the mountainous areas. In the Red
River and Mekong River deltas, the percentage
of rural households with animal husbandry are
generally below 10%. Small scale farmers are being replaced by larger industrial farms (particular
pig and poultry). In southern Vietnam the households are typically engaged with large-scale animal husbandry, mainly poultry. In the north, more
households are raising pigs: 70-80% of rural
households as compared to 20-30% in southern
Vietnam. In Vietnam about 84% of rural households hold poultry: in north 70-80% and in south
40-60%. In the north most rural households keep
small numbers of poultry for domestic use. In the
south the poultry keeping households are often
more industrial large scale farms. Like pigs, poultry follows the human population distribution.
Highest number of poultry is found in southern
Vietnam.
Xu hng:
Dn s ton cu gia tng v s pht trin kinh t l
nguyn nhn dn n s gia tng ng k v nhu
cu i vi cc sn phm ca ngnh chn nui gia
sc trong 50 nm qua. c tnh ti cc quc gia
ang pht trin, mc tiu th bnh qun i vi
tht ln tng gp 3 ln v i vi trng tng gp
5 ln so vi u nhng nm 1960. p ng
nhu cu ny cc quc gia phi tng nng sut
chn nui v c hnh thnh nhng khu chn nui
tp trung, c bit i vi ln v gia cm. Vit
Nam, t l chn nui quy m gia nh nh l ch
yu tp trung cc vng min ni. ng bng
sng Hng v ng bng sng Cu Long, t l
ca cc h gia nh vi chn nui thng l thp
hn 10%. Cc nng h quy m nh ang c
thay th bi cc trang tri cng nghip quy m
ln (c bit l ln v gia cm). min nam cc
h gia nh thng c xu hng u t vi quy
m ln, ch yu l chn nui gia cm. min
bc t l h gia nh chn nui ln c xu hng
tng cao; 70-80% ca nng h so vi ch 20-30%
ca khu vc min Nam. nng thn Vit Nam
c 84% h gia nh chn nui gia cm; min Bc
70-80% v min nam l 40-60%. min bc cc
nng h nui gia cm quy m nh ch yu cung
cp th trng ni a. min Nam cc nng h
chn nui gia cm thng l quy m trang tri
cng nghip ln. Tng t nh chn nui ln, gia
cm c chn nui cng ph thuc vo phn b
dn s. S lng gia cm ln nht l khu vc
min Nam.

Though this map only depicts poultry livestock,
we will provide some brief information on the
significance of livestock in general for infections.
It has been proposed that the domestication of
livestock around 10,000 years ago was a major
factor behind the adaptation and emergence of
many infections that are now well established in
humans, like measles. Today, livestock can be
the source of a wide range of zoonotic infections.
High-density monoculture of domestic animals is

Trn bn , bn cnh thng tin v n gia cm
cn c nhng thng tin c bn v mi lin quan
gia n gia cm ni chung vi cc bnh truyn
nhim. C gi thuyt cho rng phng thc chn
nui gia sc khong 10 ngn nm trc y l
mt yu t chnh ca vic thch ng v ly lan
ca cc tc nhn nhim trng hnh thnh t
lu qun th ngi, nh bnh si. Ngy nay,
chn nui gia sc l ngun ca cc bnh truyn
71
Ch : Mt gia cm
a form of low biodiversity that poses a particular

threat for the spread of infectious diseases from
farmed animals to humans. Where domesticated
animals are a conduit of spread from wild animals
to humans, high density livestock production may
promote spread of zoonotic diseases. Genetic diversity within an individual host species is important since genetic diversity limits the potential for
devastating epidemics. The best known example
of zoonotic infections from poultry in Vietnam is
avian influenza (influenza A/H5N1, see avian influenza map).. Influenza is interesting since wild
birds are the natural reservoir and it is also endemic in human populations, with livestock (pigs
and poultry) acting as intermediary hosts and
mixing vessels. Other examples of infectious
diseases from poultry is campylobacteriosis by
eating undercooked poultry meat or salmonellosis
(inadequately heated eggs or other contaminated
food stuffs). The widespread use of antimicrobials
in animal production for prevention and treatment
of infection, and for growth promotion, presents
a risk of the development and transfer of antimicrobial resistance. The intensification of livestock
production systems can improve food safety but
can also introduce new risks by increasing the
interaction between livestock and wild animal
reservoirs, whilst sophisticated production and
distribution chains can increase opportunities for
rapid dispersal of pathogens.
nhim khc nhau c ngun gc t ng vt.Hnh

thc c canh mc cao i vi mt s loi
ng vt dn n mc a dng sinh hc thp v l
mi e da lan truyn bnh truyn nhim t ng
vt sang ngi. Ti nhng ni gia sc l trung
gian ly truyn bnh t ng vt hoang d sang
ngi, mt chn nui gia sc cao lm tng s
ly truyn ca cc bnh c ngun gc ng vt.
Tnh a dng sinh hc v ngun gen ca nhng
loi vt ch c th rt quan trng bi l tnh a
dng lm gii hn nguy c pht tn dch bnh.
V d sinh ng nht v bnh ly truyn qua gia
sc ti Vit Nam l Cm gia cm (cm A/H5N1,
trong bn cm gia cm). Vi rt cm ang c
quan tm do cc loi chim hoang d l cha
t nhin v n cng l bnh dch trong qun th
ngi, vi gia sc (ln v g) ng vai tr vt
ch trung gian v bnh trn. V d khc l bnh
vim d dy vi khun campylobacter do n tht
gia cm cha nu chn hoc nhim Salmonella
(Trng cha chn k hoc cc loi thc n nhim
khun). Vic s dng khng sinh phng v iu
tr cc bnh nhim khun n gia sc cng nh
thuc tng trng l mt nguy c ca vic pht
trin v truyn vic khng thuc khng sinh. Vic
y mnh h thng chn nui c th ci thin an
ton thc phm nhng cng c th to ln nhng
nguy c mi bi tng s tng tc gia ng vt
nui v cc cha ng vt hoang d, trong khi
nhng chui sn xut v cung ng thc phm
ngu bin c th tng nhng c hi cho vic ly
lan nhanh chng cc tc nhn.
Map sources:
Poultry data is from 2005 census, Department of
Animal Health- Ministry of Agriculture and Rural
Development and General Statistics Office. The
data was collectednthrough household and farm
surveys between April 2005 an1 October 2005.
Ngun bn :
D liu v gia cm t Tng iu tra 2005, Cc
Th Y, B Nng nghip v pht trin nng thn v
Tng Cc Thng k. S liu c thu thp t
iu tra cc h gia nh v trang tri vo 04/2005
n 10/2005

- Food and Agriculture Organization. (2009) The state of food and agriculture livestock in the balance.
FAO Report.
- Epprecht M and Robinson T (Eds). (2007) Agricultural atlas of Vietnam.Cartographic Publishing
House.
- Wint GRW,et al. (2007) Gridded livestock of the world 2007. FAO Report.
United Kingdom.
72
Subject: Undernutrition
Ch : Tnh trng suy dinh dng
73
Definitions:
A person has under nutrition if their diet does
not contain sufficient protein and calories for
growth or maintenance, or if they are not able to
absorb sufficient protein and calories because
of ill health. Under-nutrition manifests as low
weight for age (underweight), low weight for
height (wasted), or low height for age (stunted).
The prevalence of stunting is a good measure
of chronic undernutrition and the damage
stunting causes to a childs development is
permanent. A person has overnutrition if their
diet supplies more calories and protein than
they require, leading to unhealthy weight gain.
The term malnutrition encompasses both undernutrition and over-nutrition. The map shows
the prevalence of moderate and severe stunting,
underweight and wasting in children less than 5
years of age in 2010 from Nutrition surveillance
survey (National Institute of Nutriton) and
sentinel survey (General Statistic Office).
nh ngha:
Suy dinh dng l tnh trng m ch n ca
mt ngi khng cung cp y cht m
(protein) v nng lng (calo) cho s sng v
pht trin, hoc ngi khng c kh nng
hp thu cht m v nng lng cn thit do
tnh trng bnh l. Suy dinh dng th hin
tnh trng: Nh cn so vi tui (Nh cn), nh
cn so vi chiu cao (Gy cm) hoc thp b
hn so vi tui (Thp ci). T l nh cn so
vi chiu cao (Thp ci) l mt ch s v tnh
trng suy dinh dng mn tnh c nh hng
lu di n s pht trin th lc v tr tu ca
tr. Tha dinh dng l tnh trng nu ch n
ca ngi cung cp qu nhu cu protein v
calo, dn n qu cn. Thut ng ri lon dinh
dng bao gm c suy dinh dng v tha dinh
dng. Bn cho thy t l suy dinh dng
cn nng theo tui, chiu cao theo tui v cn
nng theo chiu cao ca tr di 5 tui theo
iu tra gim st dinh dng (ca Vin Dinh
dng Quc gia) v iu tra im (Tng Cc
Thng K) nm 2010.
Trends:
In the past, the Vietnamese people had very high
rates of undernutrition but Vietnam has made
substantial progress in improving the nutritional
status of children over the past decade. The
prevalence of underweight in children under 5
has reduced on average by 1.5% annually, from
31.9% in 2001, to 25.2% in 2005, and 17.5%
in 2010. The prevalence of stunting in children
under 5 has also been reduced, from 43.3% in
2000 to 29.3% in 2010. However, Vietnam
remains among the 36 countries with the highest
stunting rates in the world, with the prevalence
of stunting being 30% in 33 provinces, and 1
in 3 Vietnamese children failing to reach their
full height potential. The highest prevalence
of undernutrition is in the remote and hard
to reach Northern Mountainous Area and
the Central Highlands. In these areas, undernutrition is concentrated in ethnic minority
populations. The rate of overweight and obesity
among children aged under 5 years is 5.6%
and is 6 times higher than the rate in 2000. In
Xu hng:
Trc y, t l ngi dn Vit Nam b suy dinh
dng l rt cao tuy nhin nh nhng thnh tu
quan trng c thc hin trong sut hng chc
nm qua, tnh trng dinh dng ca tr em
c ci thin r rt. T l tr suy dinh dng
di 5 tui gim trung bnh 1,5% hng nm,
t 31,9% nm 2001 xung 25,2% nm 2005 v
17,5% nm 2010. T l tr thp b di 5 tui
cng gim t 43,3% nm 2000 xung 29,3%
nm 2010. Tuy nhin, Vit Nam vn trong
nhm 36 quc gia c t l tr thp ci cao nht,
t l trn 30% trong tng s 33 tnh/TP v c 1
trn 3 tr em khng t c chiu cao ti
a. T l suy dinh dng ph bin vng xa xi
v ho lnh khu vc min ni pha Bc v Ty
Nguyn. nhng khu vc ny, suy dinh dng
tp trung nhm dn tc thiu s. T l tha
cn bo ph tr di 5 tui l 5,6%, cao gp 6
ln t l nm 2000. Ti TP H Ch Minh v H
74
Ho Chi Minh city and Hanoi this rises to 1215%. The Government has launched a 20112020 National Nutrition Strategy to tackle the
remaining challenges of undernutrition and the
emerging challenge of overnutrition.
Ni, t l ny ln ti 12-15%. Chin lc dinh

dng quc gia giai on 2011-2020 c
trin khai nhm i ph vi nhng thch thc
hin c do suy dinh dng cng nh nhng
thch thc mi ni ca tnh trng tha cn.

Undernutrition,
including
micro-nutrient
deficiency (such as vitamin A and zinc),
compromises mucosal integrity and impairs
both innate and acquired immunity. This
leads to both an increased risk of infection
and an increased risk of severe disease and
death. Common infections recognized to
be associated with under nutrition include
diarrhea, pneumonia, measles, malaria, and
TB. Since these infections are widespread in
less developed countries, the impact of under
nutrition on childhood deaths from infection
is large and under-nutrition is estimated to
contribute to one third of all deaths in children
under the age of 5 years.
Conversely, infection itself can increase
macro and micro nutrient requirements impair
nutrient uptake and increases loses. Intestinal
parasites in particular have a large impact
on childhood nutrition as a result of loss of
appetite, malabsorption, and chronic blood loss,
which in turn leads to physical and intellectual
growth retardation. Pneumonia, diarrhea,
malaria and HIV/AIDS are all recognized as
direct causes of undernutrition. Undernutrition
and infection are therefore a deadly coalition,
whereby undernutrition increases susceptibility
to infection and infection exacerbates under
nutrition.

Suy dinh dng bao gm thiu vi cht dinh
dng (vitamin A, zinc), gim s ton vn ca
nim mc, suy gim c h min dch t nhin
v thu c. iu ny lm tng nguy c i
vi c nhim trng, cc bnh nguy him v
k c t vong. Nhng bnh nhim trng ph
bin c lin quan n dinh dng bao gm c
tiu chy, vim phi, si, st rt v lao. Nhng
bnh nhim trng trn rt ph bin ti nhng
quc gia ang pht trin, tc ng ca suy dinh
dng ln t l cht tr em do nhim trng l
rt ln v n c c tnh l gp phn n mt
phn ba s tr em cht di 5 tui.
Mt khc, nhim trng lm tng nhu cu v
vi cht v dng cht, lm gim hp thu dinh
dng v tng o thi. Cc k sinh trng
ng rut c bit c tc ng ln dinh dng
tr em, gy ra chn n, km hp thu, thiu mu
mn tnh...dn n chm pht trin th cht, tr
tu. Vim phi, tiu chy, st rt v HIV/AIDS
l nhng nguyn nhn trc tip gy ra suy dinh
dng. S phi hp gia suy dinh dng v
nhim trng tr nn c bit nguy him, suy
dinh dng gia tng kh nng nhim trng v
nhim trng l trm trng thm tnh trng suy
dinh dng.
Ngun bn :
Tng iu tra dinh dng nm 2009. iu tra
gim st dinh dng -Vin Dinh dng) v iu
tra im 2010-Tng cc Thng k.
Phng php chn mu: iu tra chn mu
chm theo tnh
Phng php thu thp s liu: cn o nhn trc
v iu tra phng vn.
Map sources:
A review of the nutrition situation in Vietnam
2009-2010, National Institude of Nutrition-Unicef
General nutrition survey (National institute of
Nutrition) and sentinel survey (general statistics
office)
Sample: cluster survey by province
Method of measurement: anthropometric and
interviews.
75
Key references /Ti liu tham kho chnh:

- A review of the nutrition situation in Vietnam, 2009-2010. National Institute of Nutrition and
United Nations Childrens Fund, Hanoi, 2011. Available at: http://www.unicef.org/vietnam/
resources_18459.html
- National Nutrition Strategy for 2011-2012, with a vision toward 2030. Hanoi, 2012. Available at:
http://www.unicef.org/vietnam/resources_18460.html
- Black R.E. et al. (2008) Maternal and child undernutrition: global and regional exposures and
health consequences.Lancet. Jan 19;371(9608):243-60.
- Katona P et al. (2008) The interaction between nutrition and infection
Clin Infect Dis. May 15;46(10):1582-8.
- Schaible UE, Kaufmann SH. (2007) Malnutrition and infection: complex mechanisms and global
impacts. PLoS Med. May;4(5):e115.
United Kingdom.
76
Subject: Water and sanitation
Ch : Ngun nc v h thng v sinh
77

nh ngha:
Theo Mc tiu Pht trin Thin nin k 7, Mc
tiu 7c l Trc nm 2015, gim mt na t l
ngi dn khng c tip cn vi nc ung
an ton v v sinh c bn. Hai ch s gim
st nh gi tin t c mc tiu ny
l t l dn s s dng ngun nc c ci
thin v t l dn s s dng mt c s trang
thit b v sinh mi trng c ci thin. Mt
ngun nc ung ci thin c nh ngha l
ngun nc c bo v khng b nhim bn
bn ngoi, c bit l khng b nhim bn do
phn. Mt c s v sinh mi trng c ci
thin c xc nh l nh v sinh phn tch
phn vi ngi tip xc. Hai bn hin th
t l h gia nh c nc v nh tiu hp v
sinh lm sch trong tng iu tra dn s v nh
nm 2009. Trng hp mt nh tiu hp v
sinh c nh ngha l mt nh tiu thm di
hoc bn thm di, v mt ngun nc an ton
c nh ngha l nc my, nc ma, ging
khoan hoc ging o c bo v.
Definition:
Millennium Development Goal 7, target 7c is
to Halve, by 2015, the proportion of people
without sustainable access to safe drinkingwater and basic sanitation. The two monitoring
indicators to assess progress towards achieving
this goal are: the proportion of population
using an improved drinking water source and
proportion of population using an improved
sanitation facility. An improved drinkingwater source is defined as one that is protected
from outside contamination, in particular
from contamination with faecal matter. An
improved sanitation facility is defined as one
that hygienically separates human excreta from
human contact. The two maps opposite show
the proportion of households with access to
clean water and hygienic toilet facilities as
assessed in the 2009 population and housing
census; where a hygienic toilet is defined as
a flush or semi-flush toilet, and a safe water
source is defined as piped water, rain water, a
bore well, or a protected hand-dug well.
Xu hng:
T nm 1999 n nm 2009, t l h gia nh
s dng nh v sinh hp v sinh tng hn gp
ba ln, t 16,4% n 54%. T l h gia nh
thnh th s dng nh v sinh hp v sinh
tng t 54,3% nm 1999 ln 87,8% trong nm
2009. Trong khu vc nng thn, s gia tng cn
cao hn, t 4,4% nm 1999 ln 39,0% trong
nm 2009. D liu ny chng minh s ci thin
n tng trong iu kin v sinh t nm 1999
n nm 2009. Mc d c s chnh lch gia
cc h gia nh thnh th v nng thn gim,
60% s h nng thn vn khng c mt nh
v sinh theo ng nh ngha. Trong nm 2009
86,7% h gia nh c tip cn vi ngun
nc sch, tng 9 phn trm so vi nm 1999.
Mc tng t tng ng trong khu vc th
v nng thn, t 91,8% n 96,3% thnh th
v t 73,7% n 82,5% khu vc nng thn.
Mc d t l h s dng nc sch tng ln,
ton quc vn ch c 25,5% h gia nh c s
dng nc my t nh my x l nc v trong
Trends:
Between 1999 and 2009 the proportion of
households using a sanitary toilet more than
tripled, from 16.4% to 54%. The proportion
of urban households using a sanitary toilet
has increased from 54.3% in 1999 to 87.8% in
2009. In rural areas, the growth is even greater,
from 4.4% in 1999 to 39.0% in 2009. These
data demonstrate impressive improvements in
sanitation between 1999 and 2009. Although the
difference between urban and rural households
has reduced, 60% of rural households still do not
have access to a sanitary toilet. In 2009 86.7% of
households had access to a clean water source,
an increase of 9 percentage points compared to
1999. The increase has been roughly equal in
urban and rural areas, from 91.8% to 96.3% in
urban areas and from 73.7% to 82.5% in rural
areas. Although the proportion of households
using clean water has increased, nationally still
only 25.5% of households have access to piped
78
water from a water treatment plants and in rural

areas this piped-water accounts for only 8.6%
of the total.
khu vc nng thn nc my ch chim 8,6%

tng s.
c tnh mi nm trn ton cu khong 2,4
triu ca t vong c th ngn nga nu tt c
mi ngi c tip cn vi nc sch, v sinh
v thc hnh tt v sinh chung. Hu ht cc
trng hp t vong l tr nh ti cc nc
ang pht trin v l do tiu chy hoc do ri
lon dinh dng lin quan n tiu chy. Nhim
trng lin quan ti cht lng nc km thiu
th tch nc c th c phn loi gm nhim
trng truyn qua ng nc (nhim trng nc
bn), nhim trng da trn ngun nc (cn
nguyn sng trong nc hoc c vng i trong
nc) v nhim trng nc ra (nhim trng
do thiu nc sinh hot). Nhim trng truyn
qua nc gm cc bnh amip, thng hn, t,
vim gan A v E, Campylobacter, rotavirus, E.
coli, nhim giardia, cryptosporidiosis. Nhim
trng nc da trn ngun nc gm cc bnh
dracunculiasis v bnh sn mng. Nhim trng
nc ra l cc bnh khi m tip cn vi nc
v sinh c bn km s gia tng nguy c nhim
trng chng hn nh au mt ht v gh. c
tnh c trn th gii c 1/5 s ngi i v sinh
ngoi tri lm tng cc truyn nhim ng
phn-ming c cp trn, tip xc vi
phn cng gy ra hu qu nhim trng nhim
giun ng rut (giun a, Trichuriasis, v
bnh giun mc). Cc k sinh trng ng rut
lm gim dinh dng, s pht trin v chc
nng nhn thc.
S phn bit nhim trng truyn qua nc v
nhim trng nc ra, v gia cc bnh nhim
trng lin quan n nc v nhim trng lin
quan n v sinh thng khng mang tnh cht
t nhin bi v qu trnh truyn cc bnh nhim
trng ng phn-ming lin quan n tiu hy
phn khng an ton v phng tin truyn cc
bnh nhim trng c th l nc bn, bn tay
bn hoc thc phm b nhim. iu kin nc
v v sinh ngho nn gp phn vo gnh nng
ca cc bnh l khc ngoi tiu chy m c

It is estimated that globally around 2.4 million
deaths could be prevented each year if everyone
had access to good water and sanitation and
practised good hygiene. Most of these deaths
occur in young children in developing countries
from diarrhoea or as a consequence of under
nutrition related to diarrhoea. Infections
associated with poor quality or volume of water
can be categorised in to water-borne, waterbased, and water-washed infections. Waterborne infections include: amoebiases, typhoid,
cholera, hepatitis A and E, campylobacter,
rotavirus, E. coli, giardiasis, cryptosporidiosis.
Water-based infections include dracunculiasis
and schistosomiasis. Water-washed infections
are those, such as trachoma and scabies, where
poor access to water for basic hygiene increases
the risk of infection. Around 1 in 5 people in
the world defecate in the open and in addition
to the feco-orally transmitted infections already
mentioned above, exposure to feces also results
in a cycle of infection with intestinal nematode
infections (Ascariasis, Trichuriasis, and
hookworm disease). These intestinal parasites
impair nutrition, growth and cognitive function.
The distinction between water-borne or
water-washed infections, and between water
or sanitation related infections, is however
somewhat artificial since the process of
transmission of feco-oral infections involves
unsafe disposal of feces and the vehicle for
transmission may be unclean water, unclean
hands or contaminated food. Poor water and
sanitation also contribute to the burden of nondiarrhoeal diseases, particularly respiratory
infections. There are two main mechanisms for
this: first, enteric disease increases susceptibility
to non-enteric diseases such as pneumonia, and
second, the risk of respiratory infections can be
reduced by hand washing with soap and water.
79
It is estimated that 19% of deaths in children

are associated with inadequate hygiene, water
or sanitation. This terrible burden could be
substantially reduced by the implementation
of proven and cost-effective interventions to
improve accessibility, quality and reliability
of basic water and sanitation services, and to
improve hygiene practices.
bit l nhim trng ng h hp. C hai c ch

chnh ca vic ny: th nht, bnh ng rut
tng nhy cm vi cc bnh ngoi ng rut
nh vim phi, v th hai, nguy c nhim trng
ng h hp c th c gim bng cch ra
tay vi x phng v nc.
Ngi ta c tnh rng 19% cc ca t vong tr
em c lin quan n v sinh c nhn km, thiu
nc hoc mt v sinh. Gnh nng bnh tt to
ln ny c th c gim ng k nh vic thc
hin cc bin php can thip c chng
minh v hiu qu nhm ci thin kh nng tip
cn, cht lng v tin cy ca ngun nc,
dch v v sinh c bn v ci thin thi quen v
sinh.
Map source:
The final results of 2009 Vietnam Population
and Housing Census. Vietnam General Statistics
Office, Hanoi, 2010. The data was collected by
population and housing census questionnaire in
each household in April 2009.
Ngun bn :
Tng iu tra dn s v nh nm 2009, Tng
cc thng k. S liu c thu thp t phiu
iu tra dn s v nh ti tng h gia nh vo
thng 4 nm 2009.
- The 2009 Vietnam Population and Housing Census. Final Results. Vietnam General Statistics
Office, Hanoi, 2010.
- Bartram J, Cairncross S (2010). Hygiene, Sanitation, and Water: Forgotten Foundations of Health.
PLoS Med 7(11): e1000367. doi:10.1371/journal.pmed.1000367
- Hunter PR, et al (2010) Water Supply and Health. PLoS Med 7(11): e1000361. doi:10.1371/
journal.pmed.1000361
- Mara D, et al (2010) Sanitation and Health. PLoS Med 7(11): e1000363. doi:10.1371/journal.
pmed.1000363
- Prss-stn A, et al (2008). Safer water, better health: costs, benefits and sustainability of
interventions to protect and promote health. World Health Organization: Geneva.
- WHO and UNICEF (2010). Progress on Sanitation and Drinking Water; 2010 update. Joint
Monitoring Programme for Water Supply and Sanitation.
United Kingdom.
80
SECTION 2/ CHNG 2
Bacterial Diseases/Cac bnh do vi khun
81
Subject: Anthrax
Ch : Bnh than
82
Subject: Anthrax
Ch : Bnh than
Classification:
ICD-9 022; ICD-10 A22
Phn loi:
ICD-9 022; ICD-10 A22
Clinical Syndromes and Synonyms:

Clinically can present with cutaneous
ulceration, gastrointestinal symptoms, or
inhalational anthrax. The disease is also known
as charbon, malignant pustule, malignant
oedema, woolsorter disease, tanner disease,
ragpicker disease.
Hi chng lm sng v ng ngha:

lm sng c th biu hin vim lot da, cc triu
chng tiu ha, bnh than ng h hp. Cn
bnh ny cn c gi nh mn m charbon
c tnh, c tnh ph, bnh woolsorter, bnh th
thuc da, bnh ragpicker.
Tc nhn:
Nha bo ca Bacillus anthracis, gram dng,
c v bc, khng lng. Cc nha bo c kh
nng chu kh hn, nhit khc nghit, PH
v bc x tia cc tm, v nhiu cht kh trng,
v c th sng st trong 60 nm. N c coi l
mt tc nhn chin tranh sinh hc.
Agent:
Spores of Bacillus anthracis, a Gram-positive,
encapsulated, non-motile rod. The spores
are resistant to desiccation, extremes of
temperature and pH, ultraviolet radiation and
many disinfectants, and can remain viable for
60 years. It is considered a biological warfare
agent.
cha:
t c tnh cht kim, c hm lng canxi cao
v lng ng vt, len hoc da, c bit l da d
b nhim vi t. Bo t c th pht trin
(thnh th hot ng) bn ngoi c th ng vt
trong iu kin thch hp.
Reservoir:
Alkaline soil with high calcium content and
animal hair, wool or hides, particularly goat
skins that has been contaminated with soil.
Spores can germinate outside an animal under
appropriate conditions.
Vector:
Rui Tabanid v Stomoxys v mui c
chng minh l vt truyn nhim, nhng
khng phi l vct truyn sang ngi. Rui
(Calliphoridae) c th ly lan vi khun cho
ng vt n c bng cch n xc cht v sau
i ngoi trn l cy v bi cy gn .
Vector:
Tabanid and Stomoxys flies and mosquitoes have
been shown to transmit infection, but are not
epizootic vectors. Blow-flies (Calliphoridae)
can spread the bacteria to grazing animals by
feeding on carcases and then defecating on
leaves of nearby trees and shrubs.
Ly truyn
C tip xc vi m ng vt b nhim bnh:
1. Bnh than th da: da tip xc trc tip trong
qu trnh ch bin da ng vt b nhim, tc,
len, hoc cc sn phm da ng vt khc.
2. Bnh than th ng rut: tiu th tht t gia
sc b nhim bnh.
3. Bnh than qua th h hp: ht phi bo t
bnh than bng cch thuc da/xn lng cu
hoc x l lng b nhim bn/len hay c trong
mt cuc tn cng khng b sinh hc.
Transmission:
Contact with infected animal tissue:
1. Cutaneous anthrax: direct skin inoculation
during processing of contaminated animal
hides, hair, wool, or animal hide products.
2. Gastro-intestinal anthrax: consuming meat
from infected livestock.
3. Inhalation anthrax: inhalation of anthrax
spores by tanning/shearing sheep or processing
83
Subject: Anthrax
Ch : Bnh than
contaminated hair/wool or intentional during a

bioterrorist attack.
Cases have also been reported in intra-venous
drug users (IDU) from contaminated heroin.
There is no evidence of direct person -to-person
transmission.
Mt s ca c bo co ngi s dng ma
ty tim tnh mch (IDU) t heroin b nhim
bn. Khng c bng chng ly truyn trc tip
t ngi sang ngi.
Chu k:
ng vt n c b nhim bnh khi chng n
cc nha bo trong qu trnh chn th trn t
b nhim. Khi con vt cht, mt t cng b
nhim bi cc nha bo vi khun. ng vt n
tp v ng vt n tht b nhim do n phi con
mi b nhim bnh hoc xc ng vt. ng vt
n tht v con ngi l cha ngu nhin.
Cycle:
Herbivores become infected when they ingest
spores during grazing on contaminated soil.
When the animal dies, the ground under the
carcase is contaminated by bacterial spores.
Omnivores and carnivores are infected by
feeding on infected prey or carcases. Carnivores
and humans are incidental hosts.
Thi gian bnh:

1-7 ngy, c th ln n 60 ngy trong trng
hp phi nhim do ht phi.
Incubation period:
1-7 days; can be up to 60 days in the case of low
inhaled exposures.
Biu hin lm sng:

C 3 th bnh biu hin ph thuc vo ng
xm nhp:
1. Th da: tn thng da l mt vay en c
bao quanh bi ph n, thng l trn u, cnh
tay hoc bn tay, i km vi tnh trng mt mi
v st, 80% cc trng hp mt i mt cch t
nhin sau 7-10 ngy, nhng nu khng cha tr,
n c th pht trin thnh nhim trng huyt v
vim mng no gy t vong.
2. Th ng rut: bun nn, nn, chn n, au
bng, st, nn ra mu, tiu chy i khi ln mu
v thng gy t vong nhim trng huyt v
sc.
3. Th h hp: tin trin nhanh chng v bt u
vi st, kh chu v ho nh v au ngc, pht
trin suy h hp cp tnh, du hiu gin trung
tht trn X quang, tm ti v sc.
Bnh than da khng c iu tr c t l t
vong 5-20% (<1% vi iu tr), bnh than
ng rut 25-60%, v bnh than qua ng
h hp 100% (75% vi iu tr).
Clinical findings:
There are 3 types of disease presentation
depending on the portal of entry:
1. Cutaneous: the skin lesion is a characteristic
black eschar surrounded by oedema, usually on
the head, forearms or hands, accompanied by
malaise and fever, in 80% of cases resolving
spontaneously after 7-10 days, but if left
untreated it may evolve into fatal septicemia
and meningitis.
2. Gastro-intestinal: produces nausea, vomiting,
anorexia, abdominal pain, fever, hematemesis,
occasionally bloody diarrhea and often fatal
septicemia and shock.
3. Inhalation anthrax: rapidly progressive and
starts with fever, malaise and mild cough and
chest pain, evolving to acute respiratory distress,
diagnostic mediastinal widening, cyanosis and
shock.
Untreated cutaneous anthrax has a case fatality
rate of 5-20% (<1% with treatment), GI anthrax
25-60%, and inhalation anthrax 100% (75%
with treatment).
Xt nghim chn on:

Soi knh hin vi (nhum MFadyan) tn thng,
dch no ty, hoc mu; nui cy vi khun
84
Subject: Anthrax
Ch : Bnh than
Diagnostic tests:
Microscopy (MFadyan stain) of lesion, CSF
or blood; bacterial culture of lesion, blood or
respiratory specimen; PCR; ELISA.
t mu, cc tn thng, mu bnh phm ca

ng h hp; PCR; ELISA.
Phng nga:
Vc xin cho vt nui v con ngi vi ngh
nghip c nguy c trong vng lu hnh dch.
iu tr khng sinh d phng khi tip xc v
vc xin trong trng hp ca bnh than qua
ng h hp. Xc cht ng vt nhim bnh
nn c t chy hoc chn su, tt nht ti
ni cht (ngn nga nhim mi trng).
Prevention:
Vaccination of livestock and humans with
occupational risk in endemic areas. Antibiotic
prohylaxis when exposed and vaccination in
case of inhalation anthrax. Infected animal
carcases should be burned or deeply buried,
preferably at the site of death (prevent
environmental contamination).
Dch t hc:
Bnh than phn b trn ton th gii. Tim
phng cho ng vt, iu tr khng sinh, v cc
quy nh kim dch dn n gim mnh trong
nhim trng bnh than cc trang tri. Bnh
than xy ra ch yu khu vc nng thn ti
nhng nc ni khng c tim chng cho ng
vt tt v kim sot th y vi git m gia sc
km. C mt bin ng theo ma ca bnh
ng vt vi s gia cc ca bnh trong thi tit
kh, nng. C th mi trng ny lm gim
kh nng min dch ca ng vt v lm cho
chng d nhy cm hn. iu kin thi tit
cng c th nh hng n cch ng vt tip
xc vi t b nhim. Nguy c mc bnh cao
cho nhng ngi c ngh nghip lin quan n
x l da ng vt, tc, len hoc xng. Bnh
than tiu ha xy ra khi n phi m b nhim vi
khun than.
Bnh than ng vt l dch nh lu hnh
Vit Nam i khi dn n bng pht cc cc
dch trn qun th ngi m c lin quan nhng
ng vt nhim bnh. Trong nm 2011, mt
t bng pht ca bnh than trn a bn tnh
Lai Chu c bo co 25 - 30 ngi b
nh hng, v ngay sau khi cc trng hp ny
c bo co, cc tnh khc nh in Bin, H
Giang cng c bo co ca bnh. Cc trng hp
bt ngun t n v x l tht t gia sc b bnh.
Trc , mt t bng pht ng c thc phm
khu vc min ni pha Bc ca tnh H Giang
cng c bo co trong nm 2008. V dch
Epidemiology:
Anthrax has a worldwide distribution.
Livestock vaccination, antibiotic treatment, and
quarantaine regulations lead to a strong decline
in anthrax infections in domestic lifestock.
Anthrax occurs mainly in rural areas in countries
where there is no livestock vaccination and no
veterinary control of slaughtered animals.There
is a seasonal variation in animal disease with an
increase in cases during hot dry weather, which
reduces the immunity of animals and making
them more susceptible. Weather conditions may
also influence how the animal come in contact
with potentially contaminated soil. Anthrax is
an occupational hazard for people who process
animal hides, hair, wool or bones. GI anthrax
occurs when infected tissue is ingested.
Anthrax in animals is endemic in Vietnam,
and this has lead to occasional outbreaks in
the human populations associated with these
animals. In 2011, an outbreak of anthrax in Lai
Chau province was reported. 25 30 people
were effected in this outbreak, and shortly after
this cases were reported from other provinces
like Dien Bien and Ha Giang. The cases were
all traced back to eating and handling meat
from sick cattle. Prior to this, an outbreak of
food poisoning in the northern mountainous
region of Ha Giang was also reported in 2008.
This was thought to be due to anthrax.
85
Subject: Anthrax
Ch : Bnh than
Map sources:
Communicable disease year book from 2007
to 2011, General Department of Preventive
Medicine.
ny c cho l do vi khun than.

Ngun bn :
Nin gim thng k bnh truyn nhim t nm
2007 n nm 2011, Cc Y t d phng.

- Turnbull PCB, et al. (1998) Guidelines for the Surveillance and Control of Anthrax in
Human and Animals. 3rd edition. WHO report WHO/EMC/ZDI/98.6.
- Dixon TC, et al. (1999) Anthrax. N Engl J Med; 341 (11): 815-826.
- Swartz MN. (2001) Recognition and Management of Anthrax - An Update. N Engl J Med; 345:
1621-1626.
- Hugh-Jones ME, et al. (2009) The ecology of Bacillus anthracis. Mol Aspects Med; 30(6):356-67.
United Kingdom.
86
Subject: Bacillary dysentery
Ch : L trc trng
87
Ch : L trc trng
Classification:
ICD-9 004; ICD-10 A03.9
Phn loai:
ICD-9 004; ICD-10 A03.9

Shigellosis, dysentery, Marlow syndrome
Hi chng lm sang va ng ngha:

Ly, bnh kit ly, Hi chng Marlow
Agent:
Three species of the gram negative bacteria
Shigella are associated with bacillary
dysentery: Shigella sonnei, S. flexneri and
S.dysenteriae. Less commonly, salmonellosis
caused by salmonella enterica can be referred
to as bacillary dysentery, but usually the term is
restricted to shigellosis.
Tac nhn:
Co 3 loi vi khun Shigella gram m co lin
quan n hi chng ly trc khun: Shigella
sonnei, S. flexneri va S. dysenteriae. It ph
bin hn, thng han m gy ra bi vi khun
Salmonella enterica c th xem xp vo hi
chng l trc trng, tuy nhin thut ng l trc
trng ny ch yu ni n gy ra do vi khun l.
Reservoir:
Humans
cha:
ngi
Vector:
Main transmission is via the faecal-oral route
but mechanical vectors like houseflies have
been implicated in spread of infection.
Vector:
C ch ly truyn chnh l ng t phn qua
ming nhng cc trung gian truyn bnh nh
rui nh c vai tr trong vic ly truyn bnh.
Transmission:
Via the faecal-oral route. The usual mode of
transmission is directly person-to-person handto-mouth, and the infectious dose can be as
small as 10 to 200 organisms.
Ly truyn:
Qua ng phn ming. Kiu ly truyn thng
thng l trc tip t ngi qua ngi, t tay
qua ming, mt liu nh t 10 n 200 vi khun
l c th gy bnh.
Incubation Period:
12 to 96 hours, but usually closer to 24hrs, and
recovery takes 5 to 7 days.
Thi k bnh:
12 n 96 gi, nhng thng l khong 24 gi,
v hi phc sau 5 n 7 ngy.
Clinical Findings:
Symptoms can range from mild abdominal
pains to full-blown dysentery characterised by
abdominal cramps, fever, diarrhoea, vomiting
and blood, pus, or mucus in stools. Tenesmus
is commonly described with this infection.
Complications of infection include rectal
bleeding due to mucosal inflammation and/
or ulceration, and severe dehydration. Other
possible sequalae associated with this infection
include haemolytic ureamic syndrome and
Reiters syndrome.
Biu hin lm sng:

Cc triu chng c th t au bng nh n
nng, au qun bng, st, tiu chy, nn ma
v c mu, hoc km vi m, hoc cht nhy
trong phn. Cm gic but mt rn thng
c m t vi nhim trng ny. Cc bin
chng ca nhim trng bao gm chy mu trc
trng do vim nim mc v/hoc lot, v mt
nc nghim trng. Cc bin chng khc c
th c lin quan n nhim trng ny bao gm
hi chng tan mu, tng ure huyt v hi chng
Reiters.
88
Ch : L trc trng
Diagnostic Tests:
Stool culture on deoxycholate Agar (DCA)
or MacConkey Agar. Further serological
investigations with species-specific sera can
help to confirm characteristic bacterial colonies.
Xt nghim chn on:

Nui cy phn trn thch Agar (DCA) hoc
MacConkey Agar. Cc xt nghim huyt thanh
c hiu theo chng huyt thanh c th gip
khng nh li c tnh ca khun lc.
Prevention:
Simple basic hygiene precautions like washing
hands before handling food and making sure
that all food is thoroughly cooked before eating
can help to prevent getting shigellosis. There
is currently no available licensed vaccine to
prevent this infection.
Phng bnh:
V sinh c nhn n gin nh ra tay trc khi
ch bin thc n hoc m bo cc thc phm
c nu chn c th trnh c bnh l. Hin
nay cha c vc xin phng l no c cp
php.
Dch t hc:
Bnh lu hnh khp ni trn th gii v c
cho l nguyn nhn gy ra khong 120 nghn ca
bnh l nng. Hu ht cc trng hp bnh xy
ra cc nc ang pht trin v lin quan n
tr em di 5 tui. Hng nm c khong 1.1
triu ca t vong do Shigella trong 60% l tr
em di nm tui.
Vit Nam, bnh l trc trng tip tc l mi
quan ngi v y t cng cng. T 1991 n 2001,
435.037 trng hp bnh l trc trng c bo
co trn ton quc. Cc con s cao nht c
ghi nhn vng ng bng sng Cu Long
(28,2%), duyn hi Nam Trung B (15,9%), v
Ty Nguyn (14,7%). Trong khong thi gian
ny, H Ni ghi nhn t l mc thp nht. Cc
bo co cng lu rng c mt s thay i
trong cc chng vi khun gy bnh Vit Nam,
t S. flexneri S. sonnei, vi mt s thay i lin
quan vi s nhy cm khng sinh ca cc chng
ny.
Epidemiology:
Shigellosis is endemic throughout the world,
and it is thought to be responsible for about
120 million cases of severe dysentery. The
overwhelming majority of infection occurs in
developing countries and involves children less
than five years of age. About 1.1 million people
were estimated to die from Shigella each year
and 60% of those that die are thought to be
under the age of five years.
In Vietnam, bacillary dysentery continues to
raise public health concerns. From 1991 to
2001, 435037 cases of bacillary dysentery
were reported nationally. The highest numbers
appear to have been recorded in the Mekong
river delta (28.2%), south central coast (15.9%),
and central highlands (14.7%). Over this time
period Ha Noi recorded the lowest rates of
infection. It has also been noted that over time
there has been a shift in the dominant species
causing infection in Vietnam, from S. flexneri
to S. sonnei, with an associated change in the
antibiotic sensitivities of these species.
Ngun bn :
Nim gim thng k 26 bnh truyn nhim t
nm 2007 n 2011, Cc Y t d phng
Map sources:
Communicable diseases year book from 2007
Medicine.
89
Ch : L trc trng

- Kelly-Hope LA et al. (2007) Geographical distribution and risk factors associated with
enteric diseases in Vietnam. Am J Trop Med Hyg. 2007 Apr;76(4):706-12.
-World Health Organisation (2009) Diarrhoeal diseases http://www.who.int/vaccine_research/
diseases/diarrhoeal/en/index6.html
- Vinh H et al (2009) A changing picture of shigellosis in southern Vietnam: shifting species
dominance, antimicrobial susceptibility and clinical presentation. BMC Infect Dis. Dec
15;9:204.
- Wertheim H, Horby P, Woodall J (2012). Atlas of Infectious Diseases. Wiley-Blackwell,
Oxford, United Kingdom.
90
Subject: Cholera
Ch : T
91
Subject: Cholera
Ch : T
Classification:
ICD-9 001; ICD-10 A00
Phn loi:
ICD-9 001; ICD-10 A00

Summer diarrhoea, acute diarrhoea.

Tiu chy ma h, tiu chy cp tnh.
Agent:
Enterotoxin-producing Vibrio cholerae 01 and
0139 Bengal. Serogroup 01 has two biotypes,
classical and El Tor, each with 3 serotypes:
Inaba, Ogawa and the rarer Hikojima.
Tc nhn:
Vi khun t Vibrio cholerae 01 v 0139 Bengal
sinh c t rut. Phn nhm huyt thanh 01
c 2 tp sinh hc, c in v El Tor, mi mt
tp sinh hc c 3 phn tp huyt thanh: Inaba,
Ogawa v Hikojima t gp.
Reservoir:
Principally humans; also warm-water marine
and estuarine copepods, other zooplankton.
Crabs, shrimps and shellfish carry the vibrio on
their carapaces and shells.
cha:
Ch yu l ngi, cc sinh vt vng ca sng
nc m v cc ng vt phu du khc. Cc loi
cua, tm v s hoc hn mang vi khun trn mai
v v ca chng.
Vector:
Main transmission is fecal-oral, but houseflies
act as supplementary vectors by contaminating
food after feeding on exposed human faeces.
Vector:
ng ly truyn ch yu l phn-ming,
nhng rui nh l tc nhn ng vai tr vector
ph gy nhim khun thc phm sau khi tip
xc vi ngun phn ngi c nhim khun.
Transmission:
Consuming faecally contaminated food or water,
raw or undercooked contaminated shellfish.
Person-to-person transmission through indirect
fecal-oral transmission occurs. The role of
bacteriophages needs further elucidation.
Ly truyn:
n ung cc thc n, cc thc phm sng hoc
nc b nhim bn t phn, hi sn nhim bn
cha chn. Ly truyn t ngi sang ngi gin
tip thng qua ng phn- ming cng xy ra.
Vai tr ca th thc khun th (bacteriophages)
cn c nghin cu thm.
Incubation period:
A few hours to 5 days; usually 2-3 days. The
incubation period is short and infection is
usually less than two weeks.
Thi gian bnh:

Mt vi gi cho n 5 ngy; thng thng 2-3
ngy. Thi k bnh ngn v nhim khun
thng t hn 2 tun.
Clinical findings:
Among those infected, about 20% develop acute
watery diarrhoea, of which 10-20% develop
severe watery diarrhoea with vomiting, leading
to severe dehydration which may be lethal if
not treated. The case fatality rate is typically
below 5%, but in crowded refugee camps it can
run as high as 50%.
Biu hin lm sng:

Khong 20% s ngi nhim khun c a chy
cp tnh, trong s c 10-20% a chy nng
92
Subject: Cholera
Ch : T
Diagnostic tests:
Dipstick tests can be used for rapid diagnosis,
and maybe more useful in an outbreak setting,
but they do not yield isolates for subtyping and
sensitivities. Dark-field or phase microscopy on
fecal or rectal swab smears can be useful, but
infection is usually confirmed through culture
from a stool sample or rectal swab.
km theo nn v dn n mt nc nng c th
gy t vong nu khng c iu tr kp thi.
T l t vong khong 5%, tuy nhin trong cc
tri t nn t l ny c th ln n 50%.
Xt nghim chn on:
Dng cc xt nghim test nhanh cho vic chun
on nhanh l rt c ngha trong vic pht
hin sm v dch, tuy nhin test nhanh khng
th t c phn tp v nhy cm khng
sinh ca vi khun c. Soi ti bng kinh hin
vi nn en cc bnh phm nh phn hoc tm
bng trc trng c th c s dng, tuy nhin
chn on xc nh thng phi dng n k
thut nui cy v phn lp.
Prevention:
Hygiene and access to clean water and sanitation
are paramount in preventing this infection. An
oral cholera vaccine is available which is safe
and provides sustained protection of >50% that
lasts for 2 years in endemic populations. The
vaccine does not protect against infections with
O139 strains. Chemoprophylaxis for contacts
may consist of tetracycline or doxycycline, and
breast-feeding protects infants. Infection results
in limited protection against homologous
strains, but there is no cross-protection. Cholera
must be reported to national health authorities
as small local outbreaks may become large
epidemics.
Phng bnh:
V sinh c nhn, s dng ngun nc sch,
v v sinh mi trng ng vai tr quan trng
trong phng chng bnh t. Vc xin t ng
ung cng sn c vi mc bo v ln n
50% v ko di thi gian bo v cho ngi
dng t nht 2 nm trong cc vng lu hnh
dch. Vc xin ny khng bo v chng li nhim
khun vi chng O139. Liu php iu tr bng
thuc cho ngi tip xc ngun ly c th dng
tetracycline hoc doxycycline, v nui con
bng sa m cng l yu t bo v tr nh. Mc
hoc nhim bnh t c th to ra hiu qu bo
v i vi nhim cng chng ln sau, tuy nhin
khng c bo v cho. Bnh t l bnh bt buc
phi thng bo cho c quan y t quc gia v mt
v dch nh ti a phng c th ly lan thnh
v dch ln trong thi gian ngn.
Epidemiology:
Cholera is a common cause of epidemic
diarrhoea and there are an estimated 3 to 5
million cholera cases and 100,000 to 130,000
deaths due to cholera each year. The disease is
endemic in south-east Asia. It has a seasonal
pattern with one or two peaks corresponding to
the warm season. Areas with overcrowding and
poor sanitation such as slums, refugee camps
and regions with political conflicts are at high
risk for cholera outbreaks. Natural disasters
(e.g. flooding) can be followed by cholera
outbreaks due to disruption of the sanitation
system (Natural Disasters map).
In 1964, in Vietnam, an outbreak of cholera
was identified, and the infection was due to
serogroup 01 biotype El Tor, however in 1992,
serotype 0139 emerged as cauing the majority
Dch t hc:
Bnh t l mt nguyn nhn thng gp gy ra
dch a chy v theo c tnh c khong 3 n
5 triu ca mc v 100,000 n 130,000 ca t
vong hng nm. Bnh t dch lu hnh khu
vc ng Nam . Bnh dch ny c tnh cht
93
Subject: Cholera
Ch : T
of infection. More recently in 2007 and 2008,

serogroup 01 Ogawa had been found to have
caused a significant number of cases during
that time period in Vietnam. Between 2007 and
2010, isolated strains have shown phenotypic
traits of both 01 Ogawa and El Tor serogroups.
ma vi mt hoc hai nh dch tng ng vi

thi tit m. Cc khu vc ng dn c v tnh
trng v sinh km nh cc khu nh chut, cc
trai t nn v cc khu vc c xung t chnh tr,
tn gio, chin tranh l nhng khu vc c nguy
c bng pht dch cao. Cc thm ha t nhin
(v d nh bo, lt...) c th km theo cc v
dich t sau do tnh trng v sinh km.
Nm 1964, Vit nam, mt v dch t c
bo co v tc nhn gy dich l phn tp huyt
thanh 01 phn tp sinh hc El Tor. Tuy nhin,
nm 1992, phn tp huyt thanh O139 ni ln
nh tc nhn chnh gy dch. Gn y, nm
2007 v 2008, phn tup huyt thanh 01 Ogawa
c xc nh l nguyn nhn gy ra nhiu v
dch. Gia nm 2007 v 2010, chng vi khun
t phn lp c mang c tnh ca 2 phn tp
01 Ogawa v El Tor.
Map sources:
Data from National Hospital of Tropical
Diseases and 26 communicable diseases year
book from 2000 to 2011, General Department
of Preventive Medicine.
Ngun bn :
S liu ca Bnh vin Bnh nhit i trung
ng, 2007-2010 v Cun nin gim thng k
26 bnh truyn nhim 2000-2011, Cc y t d
phng.
- Tran HD. Et al. (2012) Multi-drug resistant Vibrio cholerae O1 variant El Tor isolated in northern
Vietnam between 2007 and 2010. J Med Microbiol. 2012 Mar;61(Pt 3):431-7.
- World Health Organisation: Global Task Force on Cholera Control - Cholera country profile:
VIETNAM http://www.who.int/cholera/countries/VietNamCountryProfile2008.pdf
- Emch M, et al. (2008) Seasonality of cholera from 1974 to 2005: a review of global patterns. Int
J Health Geogr 7: 31.
- Nelson EJ, et al. (2009) Cholera transmission: the host, pathogen and bacteriophage dynamic. Nat
Rev Microbiol 7 (10): 693-702.
- Reidl J, et al. (2002) Vibrio cholerae and cholera: out of the water and into the host.
FEMS Microbiol Rev 26 (2): 125-139.
United Kingdom.
94
Subject: Diphtheria
Ch : Bch hu
95
Subject: Diphtheria
Ch : Bch hu
Classification:
ICD-9 032; ICD-10 A36.
Phn loi:
ICD-9 032; ICD-10 A36.
Syndromes and Synonyms:

Veldt sore (cutaneous diphtheria).
Hi chng v ng ngha:
au Veldt (bch hu da).
Agent:
Corynebacterium diphtheriae is a gram
positive, aerobic rod that is classified into three
potentially toxigenic biotypes, intermedius,
mitis, and gravis. Toxin producing strains of
C. diphtheriae carry a bacteriophage derived
toxgene. Toxin producing strains of C. ulcerans
may also cause respiratory diphtheria.
Tc nhn:
Corynebacterium diphtheria l mt vi khun
hnh que hiu kh gram dng c phn thnh
ba sinh type c kh nng sinh c t bao gm,
intermedius, mitis, v gravis. Chng vi khun
sinh c t C. diphtheria mang mt th thc
khun c gen tox. Cc chng C. ulcerans sinh
c t cng c th gy bnh bch hu th h
hp.
Reservoir:
Humans. Cattle and other livestock may harbour
C. ulcerans.
cha:
Con ngi. Gia sc v c vt nui khc c th
cha C. ulcerans.
Transmission:
Respiratory droplets from people with
respiratory diphtheria, or from asymptomatic
throat or nasal carriers or direct contact with
discharge from the skin of cutaneous diphtheria
cases. People recovering from diphtheria may
carrier the organism in the nasopharynx for
weeks. Infection is rarely from contaminated
items.
Truyn nhim:
Nhng git nh c ngun gc t h h hp ca
nhng ngi c bnh bch hu th h hp, hoc
t c hng, ng mi ca ngi mc bnh m
khng c triu chng. Tip xc trc tip vi
dch tit ra t da ca cc trng hp bch hu
th da. Ngi hi phc t bnh bch hu c th
mang cc sinh vt trong mi hng trong nhiu
tun. Him khi ly nhim qua b mt vt dng.
Incubation period:
Usually 2-5 days (range 1-10 days).
Thi gian bnh:

Thng l 2-5 ngy (t 1-10 ngy).
Clinical findings:
Respiratory diphtheria is classically associated
with fever, inflammation of the pharynx
or larynx, pseudomembrane formation,
lymphadenopathy and oedema of the soft
tissues of the neck. However, most cases
are mild and may resemble streptococcal
pharyngitis and the pseudomembrane may be
absent. The exotoxin of C. diphtheriae can
cause a polyneuritis and myocarditis. Nasal
diphtheria is usually mild and chronic with nasal
discharge and ulceration. Cutaneous diphtheria
Biu hin lm sng:

Bch hu h hp theo nh y vn kinh in lin
quan ti st, vim hng hoc thanh qun, hnh
thnh mng gi, hch to v ph n ca cc m
mm ca c. Tuy nhin, hu ht cc trng hp
u nh v c th tng t nh vim hng do
lin cu v c th khng hnh thnh mng gi.
Cc exotoxin ca C. diphtheria c th gy ra
vim thn kinh v vim c tim. Bch hu mi
thng nh v mn tnh gm c chy nc mi
v vim lot. Bch hu da thng mn tnh, lot
96
Subject: Diphtheria
Ch : Bch hu
is characterized by chronic, sharply demarcated

ulcers with an adherent gray pseudomembrane.
It is usually associated with skin infections
caused by Staphylococcus aureus and group A
streptococci.
phn nh r rt vi mng gi mu xm bm
cht. Thng c kt hp vi nhim trng da
do t cu (Staphylococcus aureus) v cc nhm
lin cu A (Streptococcus).
Xt nghim chn on:
Nui cy phn lp C. diphtheria v C. ulcerans
ca cc mu bnh phm lm sng v xt nghm
toxigenicity t chng nui cy ti phng th
nghim tham chiu.
Diagnostic tests:
Isolation of C. diphtheriae and C. ulcerans by
culture of clinical specimens and toxigenicity
testing of cultured strains at reference
laboratories.
Phng nga:
Tim chng vi c t bch hu (c t bt
hot), thng c kt hp trong mt mi vc
xin a gi cng vi c t un vn v cc thnh
phn v bo hoc ton b t bo ca ho g (xem
bn DTP3). Lch tim khuyn ngh l t
tim u gm ba liu trong bn thng u i
v mt hoc hai mi nhc li t 18 thng n 5
tui . Bin php phng nga khc bao gm iu
tr cc trng hp mc v ngi mang trung
bng thuc khng sinh tiu dit cc sinh vt
v ngn chn s ly truyn.
Prevention:
Immunization
with
diphtheria
toxoid
(inactivated toxin), usually formulated in a
multi-valent vaccine with tetanus toxoid and
a cellular or whole-cell pertussis components
(see DTP3 map). Recommended schedule
is a primary course of three doses in the first
four months of life and one or two boosters
between 18 months 5 years. Other preventive
measures include treatment of cases and carriers
with antibiotics to eradicate the organism and
prevent further transmission.
Dch t hc:
Trong u th k 20 bnh bch hu l nguyn
nhn t vong hng u tr em t 4-10 tui
chu u v nhiu quc gia tng tri qua dch
bnh bch hu ln trong Th chin II. Tim
chng tr em hu nh loi tr bch hu
vn tn ti nh mt vn y t cng cng ti
cc quc gia pht trin, v cc trng hp bch
hu bo co ti WHO gim gn 93% t nm
1980 n nm 2008. WHO c tnh khong
5.000 ca t vong do bnh bch hu xy ra trong
nm 2004, vi 4.000 trong s ny tr em di
05 tui. T nm 1990, dch bnh bch hu
xy ra chu Phi, Trung ng, chu v Nam
M. Nu khng c min dch nhc li nh k
thng qua tim phng hoc tip xc t nhin vi
cc chng sinh c t ca C.diphtheriae, ngi
ln c th tr nn d b nhim trng. Dch bnh
sau c th xy ra v tr nn trm trng nu
c kt hp vi iu kin sng km hoc s xut
Epidemiology:
In the early 20th century diphtheria was the
leading cause of death in children aged 4-10
years in Europe and many countries experienced
large diphtheria outbreaks during World War
II. Childhood vaccination has now virtually
eliminated diphtheria as a public health problem
in most developed countries and diphtheria
cases reported to WHO have fallen by almost
93% between 1980 and 2008. The WHO has
estimated around 5000 deaths from diphtheria
occurred in 2004, with 4000 of these in children
less than five years of age. Since 1990, diphtheria
outbreaks have occurred in Africa, the Middle
East, Asia, and South America. Without
periodic immunological boosting through
vaccination or natural exposure to toxigenic
strains of C. diphtheriae, adults may become
susceptible to infection. Epidemics may then
97
Subject: Diphtheria
Ch : Bch hu
occur, exacerbated by poor living conditions or

the emergence of new toxigenic variants. This
has led to the introduction of booster doses of
toxoid in some non-endemic countries.
In Vietnam 181 cases were reported in 2001 and
declined to 13 cases in 2011 due to improved
vaccination coverage. Still some provinces have
poor immunization coverage. The majority of
cases are reported from HCMC. From 1999 to
2004, HCMC reported 401 clinically suspected
and 90 laboratory-confirmed diphtheria cases.
No DPT/DT immunization (odds ratio, 9.9
[95% CI, 1.9-52.3]) and bathing only once a
day or less (OR 1.7 [95% CI, 1.0-2.9]) were
associated with diphtheria incidence. Estimated
vaccine efficacy of three or more DPT/DT doses
was 88%. Since 2000 the number of cases has
reduced
hin ca bin th sinh c t mi. Do vy, mt

liu vc xin tng cng c khuyn ngh cc
nc khng c lu hnh dch a phng.
Vit Nam 181 trng hp c bo co trong
nm 2001 v gim xung ch cn 13 trng hp
trong nm 2011 do s ci thin mc bao ph
tim chng. Vn cn mt s tnh c mc bao
ph tim chng thp. Phn ln cc trng hp
c bo co t TP H Ch Minh.T nm 1999
n nm 2004, TP H Ch Minh bo co 401
trng hp bnh nghi bch hu lm sng v 90
ca xc nhn bng kt qu xt nghim. Khng
tim chng (OR, 9.9 [95% CI, 1,9-52,3]) v
tm ch mt ln mt ngy hoc t hn (OR 1.7
[95% CI, 1,0-2,9]) c lin quan vi t l mc
bnh bch hu. Hiu qu c tnh ca ba hoc
nhiu hn ba liu vc xin DPT / DT c tnh
l 88%.T nm 2000, s trng hp gim
ng k.
Map sources:
Medicine.
Ngun bn :
Nin gim bnh truyn nhim t 2007 ti 2011,
Cc Y t d phng.

- Galazka A. (2000) The Changing Epidemiology of Diphtheria in the Vaccine Era. JID 181 (Suppl
1): S29.
- Mokrousov I. (2009) Corynebacteriumdiphtheriae: Genome diversity, population structure and
genotyping perspectives. Infection, Genetics and Evolution 9: 115
- Murakami H, et al. (2010) Endemic diphtheria in Ho Chi Minh City; Viet Nam: a matched
case-control study to identify risk factors of incidence. Vaccine;28(51):8141-6. doi:10.1016/j.
vaccine.2010.09.088.
- World Health Organization. (2009) State of the worlds vaccines and immunization, 3rd ed.
Geneva, WHO, UNICEF, World Bank. Report.
- World Health Organization. (2009) WHO vaccine-preventable diseases: monitoring system. 2009
Global Summary.Immunization, Vaccines and Biologicals.
United Kingdom.
98
Subject: Leprosy
Ch : Bnh phong
99
Subject: Leprosy
Ch : Bnh phong
Classification:
ICD-9 030; ICD-10 A30
Phn loi:
ICD-9 030; ICD-10 A30

Multibacillary leprosy, paucibacillary leprosy,
lepromatous leprosy, tuberculoid leprosy. This
disease is also referred to as Hansens disease.

Bnh phong, bnh phong t trc khun, bnh
phong nhiu trc khun, bnh phong ci. Bnh
ny cng c gi l bnh Hansen.
Agent:
Mycobacterium leprae, a slow-growing, acidfast, intracellular bacterium. It grows best at
2730C, which explains the main target
organs of M. leprae: skin, peripheral nerves,
nasal mucosa, upper respiratory tract, and eyes.
Tc nhn:
Mycobacterium leprae l mt vi khun k sinh
ni bo, a acid, pht trin chm. Vi khun pht
trin tt nht mc 27 -30 C, iu ny gii
thch cc c quan ch chnh ca M. leprae l
: da, dy thn kinh ngoi bin, nim mc mi,
ng h hp trn, v i mt.
Reservoir:
Humans are the main reservoir. Subclinical
infection is likely common in endemic areas,
as M. leprae DNA can be found in nasal
swabs in up to 5% of healthy individuals in
Asian endemic regions. Subclinical infection
generally does not develop into clinical disease.
Natural infection occurs in armadillos and
several primates.
Transmission:
The precise mechanism is unclear: probably
by aerosol spread of nasal secretions from a
case to the nasal or respiratory mucosa of close
contacts. There is no evidence that the infection
is spread by direct contact, as M. leprae can not
cross intact skin. The relative risk for leprosy
disease in household contacts is 8 to 10 for
multibacillary (lepromatous) leprosy and 2 to 4
for paucibacillary (tuberculoid) leprosy.
Incubation period:
3 to 5 years, but can be as short as 9 months
ranging to greater than 20 years.
Clinical findings:
The disease mainly affects the skin, peripheral
nerves, mucosa of the upper respiratory tract
and the eyes. In the early stages of disease,
it can manifest with patches of hyper or
cha:
Con ngi l cha chnh. Nhim khun khng
triu chng l ph bin trong vng lu hnh
dch, ADN ca M. leprae c th tm thy trong
dch mi ngi lnh ln n 5% trong khu vc
chu c lu hnh dch. Nhim trng khng
triu chng thng khng pht trin thnh bnh
cnh lm sng. Nhim trng t nhin xy ra
trong b th c mai v mt s loi linh trng.
Ly truyn:
Cha r rng c ch ly bnh: c th l do ly
lan quan cc ht nh t ngun cht tit nim
mc mi hoc t ng h hp ca ngi tip
xc gn. Khng c bng chng cho rng nhim
trng ly qua tip xc trc tip, M. leprae khng
th vt qua hng ro da khi da cn nguyn
vn. Nguy c tng i cho bnh phong ci cho
nhng tip xc trc tip trong h gia nh l 8
n 10 i vi bnh phong nhiu trc khun
(multibacillary lepromatous) v 2 n 4 i
vi bnh phong t trc khun (paucibacillary
tuberculoid) .
Thi gian bnh:
T 3 n 5 nm, nhng c th ngn nht l 9
thng v c th ln hn 20 nm.
100
Subject: Leprosy
hypo pigmented skin and/or peripheral nerve
enlargement with loss of sensation, sometimes
leading to paralysis, muscle wasting and
trophic ulcers. Patients are classified as having
either paucibacillary or multibacillary leprosy.
Paucibacillary leprosy is milder and clinically
characterized by less than five skin patches
or lesions, whereas multibacillary leprosy is
clinically characterized as five or more skin
patches or lesions. Other lesions described
include the presence of nodules, plaques,
thickened dermis, and frequent involvement of
the nasal mucosa resulting in nasal congestion
and epistaxis. Paucibacillary and multibacillary
disease describe two ends of a spectrum of
possible presentations of this disease. In the
later stages of disease, reduced sensation of
fingers and toes may lead to loss of digits due to
trauma or burns. Up to 10% of cases with early
lesions may resolve spontaneously.
Diagnostic tests:
According to the WHO operational leprosy
case definition, a case has at least one of the
following: (1) hypopigmented or reddish skin
lesion (s) with loss of sensation, (2) thickening
of the peripheral nerves with loss of senation,
and (3) acid fast bacilli in skin smear. Histology
is the gold standard. M.leprae can not be
cultured in vitro.
Prevention:
Leprosy control is achieved by timely detection
and treatment of new cases. Treatment is free
of charge. BCG vaccination provides variable
protection: from 34% to 80%. Patients under
treatment should be permitted to attend school
and work. Chemoprophylaxis and quarantine
are not recommended. M. leprae bacilli remain
viable for 9 days in dried nasal secretions and
about 6 weeks in moist soil.
Epidemiology:
The disease is thought to have originated in the
tropics and subtropics of Africa and Asia. WHO
Ch : Bnh phong
Biu hin lm sng:
Bnh ch yu nh hng n da, dy thn kinh
ngoi bin, nim mc ca ng h hp trn v
mt. Trong giai on u ca bnh, n c th
biu hin vi cc mng sc t m hoc nht
v/hoc ri lon dy thn kinh ngoi bin lan
rng dn nh mt cm gic, i khi dn n lit,
nho c v lot thiu dng. Bnh nhn c
phn loi l c bnh phong th t trc khun
(paucibacillary) hoc th nhiu trc khun
(multibacillary). Paucibacillary l bnh phng
nh hn v v lm sng c trng bi t hn 05
mng ri lon sc t da, trong khi bnh phong
multibacillary v lm sng c m t c nhiu
hn 05 ri lon sc t da hoc tn thng da.
Cc tn thng khc c m t bao gm s
hin din ca cc hnh ngoi vi, mng bm, h
b dy ln, v thng xuyn chy mi dn n
nght mi v chy mu cam. Th paucibacillary
v multibacillary thc ra l m t hai u ca
mt qu trnh biu hin ca bnh ny. Trong giai
on cui ca bnh, gim cm gic cc ngn tay
v ngn chn c th dn n mt cc ngn do
chn thng hoc bng.
Xt nghim chn on:
Theo nh ngha ca WHO, mt trng hp b
phong c t nht c mt trong cc triu chng
sau: (1) tn thng gim sc t hoc hi ca
da, vi mt cm gic, (2) t b ca cc thn kinh
ngoi bin vi mt cm gic, v (3) trc khun
khng cn ton trn tiu bn nhum soi da. M
bnh hc l tiu chun vng. M. leprae khng
th nui cy in vitro.
Phng nga:
Kim sot bnh phong t c bng cch pht
hin sm v iu tr kp thi cc trng hp
mi. iu tr phng l iu tr min ph. Tim
chng BCG c th to s bo v t bt nh:
t 34% n 80%. Nn cho php bnh nhn i
hc v lm vic khi ang c iu tr. iu tr
d phng v kim dch khng nn dng. Trc
khun M. leprae vn sng st 9 ngy trong cc
cht tit mi kh v khong 6 tun trong t m.
101
Subject: Leprosy
Ch : Bnh phong
reported 181,941 leprosy cases at the beginning

of 2011. Although the worldwide prevalence has
declined in the last two decades, the incidence has
remained the same. India had the most new cases
in 2008 (134,000), followed by Brazil (39,000)
and Indonesia (17,000). Males are generally
affected more than females with a ratio of 2:1;
young children are rarely infected. Epicurves
for paucibacillary leprosy show a peak at age 15
followed by a trough at age 20; in multibacillary
leprosy the peak comes a little later. Poverty and
crowded dwellings are important risk factors.
WHO data from 1983 to 2006 for Vietnam,
suggested that the annual number of newly
detected cases had dropped and that the
prevalence of this disease had dropped
significantly, from 6.76 cases/10 000 in 1983
to 0.04/10 000 in 2011. Since 1995, it appears
that the proportion of females in the new cases
identified has increased by 35-38%. The cure
rates reported from Vietnam for paucibacillary
and multibacillary leprosy in 2008 and 2009
were 99 and 100% respectively. However,many
patients will continue to have attacks of
neuritis, erythema nodosum leprosum and other
debilitating immunological reactions for many
years after bacteriological cure
Map sources:
National Leprosy Control Programme, National
Hospital of Dermatology and Venereology from
2007 to 2011.
Dch t hc:
Cn bnh ny c cho l c ngun gc
vng nhit i v cn nhit i ca chu Phi v
chu . u nm 2011, WHO bo co 181.941
trng hp bnh phong. Mc d t l hin mc
trn ton th gii gim trong hai thp k qua,
nhng t l mc mi vn khng thay i. n
c nhng trng hp mi mc nht trong
nm 2008 (134.000), tip theo l Brazil (39.000)
v In--n-xi-a (17.000). Nam gii thng b
nh hng nhiu hn n vi t l 2:1; tr em
him khi b nhim loi trc khun ny. ng
cong dch cho bnh phong (paucibacillary)
c nh tui 15 theo sau bi mt vng lm
tui 20, trong bnh phong (multibacillary)
nh n mun hn mt cht so vi bnh phong
(paucibacillary). Ngho v nh ng c l
nhng yu t nguy c quan trng ca bnh ny.
S liu ca T chc Y t Th gii Vit Nam
t 1983 n 2006, cho rng s lng cc trng
hp mi c pht hin hng nm gim
xung v s ph bin ca bnh ny gim
ng k, t 6,76 ca/10000 vo nm 1983 n
0.10/10 000 trong nm 2006. T nm 1995, t l
ph n trong cc trng hp mi c xc nh
tng 35-38%. Cc bo co t Vit Nam cho
bit t l cha khi bnh phong paucibacillary
v multibacillary nm 2008 v 2009 l 99 v
100%. Tuy nhin rt nhiu bnh nhn vn tip
tc b vim dy thn kinh, ban nodosum
leprosum v suy nhc phn ng min dch
nhiu nm khi cha tr.
Ngun bn :
D n phng chng bnh phong quc gia, Vin
da liu trung ng t nm 2007 n nm 2011.

- Britton WJ, et al. (2004) Leprosy. Lancet 363: 1209-1219.
- Scollard DM, et al. (2008) The continuing challenges of leprosy. Clin Microbiol Rev 19 (2): 338381.
- World Health Organization. (2009) Global leprosy situation, 2009. Weekly Epidemiological Record
33 (84): 333-340.
United Kingdom.
102
Subject: Leptospirosis
Ch : Bnh leptospira
103
Ch : Bnh leptospira
Classification:
ICD-9 100; ICD-10 A27
Phn loi:
ICD-9 100; ICD-10 A27

Weils disease, swamp fever, cane cutters disease,
hemorrhagic jaundice, swineherd disease.
Hi chng lm sng v cc tn gi:

Bnh Weil, st m ly, bnh ct ma, xut huyt
vng da, bnh chn ln.
Agent:
Multiple species of the spirochetal genus,
including Leptospira interrogans, which is the
species associated with most severe disease. There
are currently 8 species found to be pathogenic for
humans, associated with >250 serovars belonging
to the pathogenic species. Antigenically related
serovars are grouped into 24 serogroups. A
single serovar may belong to different Leptospira
species.
Tc nhn:
Mt s loi thuc chi spirochetal, bao gm c
Leptospira interrogans, l tc nhn gy bnh
nghim trng nht. Hin ti tm thy 8 loi c
th gy bnh cho con ngi, v trn 250 bin th
huyt thanh khc c nguy c gy bnh. Cc khng
nguyn lin quan ti cc bin th huyt thnh
c phn chia thnh 24 nhm huyt thanh. Mt
bin th huyt thnh duy nht c th thuc nhiu
loi Leptospira khc nhau.
Reservoir:
Rats and other rodents, dogs, cattle and pigs are
the most important zoonotic reservoirs of human
infection. Many serovars are adapted to specific
reservoir mammals: pigs (Pomona, Tarassovi),
cattle (Hardjo, Pomona), horses (Bratislava),
dogs (Canicola), sheep (Hardjo), racoon
(Grippotyphosa), rats (Icterohaemorrhagiae,
Copenhageni), mice (Ballum, Arborea, Bim),
marsupials (Grippotyphosa), and bats (Cynopteri,
Wolffi).
cha:
Chut, cc loi gm nhm, ch, gia sc v ln l
nhng cha ng vt chnh. Nhiu bin th huyt
thanh ch tn ti trn nhng cha ng vt nht
nh: Ln (Pomona, Tarassovi), Gia sc (Hardjo,
Pomona), nga (Bratislava), ch (Canicola),
cu (Hardjo), gu trc (Grippotyphosa), loi
gm nhm ngoi chut (Icterohaemorrhagiae,
Copenhageni), chut (Ballum, Arborea, Bim), th
c ti (Grippotyphosa), v di (Cynopteri, Wolffi).
Transmission:
Direct contact of abraded skin or conjunctival
mucosa to urine of infected animals or exposure
to environmental sources where urine is deposited
such as fresh water ponds, rice paddies, and soil.
Infection via ingestion is uncommon.
Cycle:
Leptospira chronically colonize the proximal
renal tubules of large variety of animals and are
excreted in the urine into the environment. Animals
can shed Leptospira into the environment for
prolonged periods without any signs of disease.
Ly truyn:
Tip xc trc tip trn da tn thng hoc nim
mc kt mc c dnh nc tiu ca ng vt nhim
bnh hoc phi nhim vi yu t mi trng cha
nc tiu ng vt nhim bnh (nc ao h, la
non, t). Ly nhim qua ng tiu ha khng
ph bin.
Chu k:
Xon khun Leptospira nh c cc ng ln
gn ca thn ca nhiu loi ng vt v c bi
tit theo nc tiu ra mi trng bn ngoi. ng
vt c th mang v thi lng ln Leptospira vo
mi trng trong thi gian di m khng c bt k
biu hin no ca bnh.
104
Ch : Bnh leptospira
Incubation period:
1 3 weeks.
Thi gian bnh:

1 3 tun.
Clinical findings:
From asymptomatic to fatal. Acute febrile illness
is related to chills, headache, severe myalgia (with
mild rhabdomyolysis), conjunctivitis and gastrointestinal symptoms. Less common findings are
hepatomegaly, rash, lymphadenopathy, jaundice
and aseptic meningo-encephalitis. Pulmonary
symptoms may occur varying from cough,
dyspnoea, and haemoptysis, to adult respiratory
distress syndrome. Weils disease is a severe form
of leptospirosis and is characterized by jaundice,
renal failure and hemorrhage with a CFR of
5-20%. Other febrile illnesses like dengue,
influenza and malaria may mimic leptospirosis.
Biu hin lm sng:

C cc th t khng triu chng n t vong. Th
bnh st cp tnh c cc du hiu st n lnh, nhc
u, au c nghim trng (vi tiu c vn nh),
cc triu chng vim kt mc v vim d dy-rut.
Cc du hiu t ph bin hn c gan to, pht ban,
hch to, vng da v vim no mng no v trng.
C th c mt s triu chng v h hp t ho,
kh th, ho mu, hi chng suy h hp ngi ln.
Bnh th Weil l mt dng nng ca leptospirosis
v c c trng bi vng da, suy thn, v xut
huyt vi t l t vong trn mi ca bnh (CFR
Case-fatality ration) trong khong 5-20%. c
im ca st c th tng t nh trong nhng
bnh c biu hin st cp nh cm, st xut huyt
v st rt.
Diagnostic tests:
Serology (requiring acute and convalescent
sera obtained at least 2 weeks apart) using the
microscopic agglutination test (MAT) is the
reference standard test. Isolation of leptospira
from blood or CSF during first 10 days of illness
and urine during 2nd and 3rd week of illness;
PCR may provide early diagnosis. Dark-field
microscopy is not recommended due to high
number of false positives.
Prevention:
Occupational hygiene by the use of protective
clothing and avoiding contaminated surface waters
(difficult to do in the face of massive flooding
in developing world setting). Environmental
control measures, like rodent and flood control,
are difficult to implement. A human vaccine is
not available. Chemoprophylaxis (doxycycline,
azithromycin) for adventure travelers, for
military personnel who visit endemic areas, and
after an accidental laboratory exposure should be
recommended.
Epidemiology:
Leptospirosis has a worldwide distribution, is
more common in tropical regions where it is both
Xt nghim chn on:

Xt nghim huyt thanh hc (yu cu ly mu
huyt thanh pha cp v pha khi bnh cch nhau
t nht 2 tun) s dng k thut ngng kt c di
knh hin vi (MAT - microscopic agglutination
test) l xt nghim tiu chun tham chiu. Nui
cy phn lp leptospira t mu hoc dch no ty
trong 10 ngy u tin ca bnh v t nc tiu
trong tun th 2 v th 3 ca bnh, chn on sm
c th da vo xt nghim PCR. K thut soi bng
knh hin vi nn en cho nhiu dng tnh gi nn
t c s dng.
D phng:
V sinh lao ng bng vic s dng qun o bo
h v trnh tip xc vi nc b mt nhim
(tuy vic ny kh kh thi trong tnh hung c l
lt). Cc bin php d phng i vi mi trng
nh qun l ng vt hoc kim sot l lt cng
rt kh khn p dng. Vc xin cho ngi vn
cha c. Thuc iu tr d phng (doxycycline,
azithromycin) dnh cho nhng ngi du lch mo
him, nhn vin qun i i vo vng c dch v
cho cc i tng c phi nhim ngh nghip ti
phng th nghim c khuyn co.
105
an occupational disease and a disease of daily
lives, mainly during heavy rainfall. Most foci are
found in Latin America and the Caribbean, India,
Southeast Asia, Oceania, and Eastern Europe.
The agent favors warm, humid environments,
such as are found in the tropics. The prevalence
of different serovars depends on which reservoir
animals are present, local environmental
conditions, and local occupation and agricultural
practices. In the tropics, occupational exposures
(rice and sugar cane farming, fishing) and other
agricultural activities remain an important risk.
Leptospirosis incidence increases during rainy
seasons. Also large recreational events with
water exposure can be an important source of big
multinational outbreaks. Leptospirosis has been
reported in Vietnam since the 1930s. Most studies
have been done in southern Vietnam, and show
that exposure to leptospires is common, but that
symptomatic disease is low. Likely people are
exposed to low virulent strains, resulting in high
seroprevalence rates of 10 to 30%.
Map sources:
Communicable disease yearbook from 2007
Medicine.
Ch : Bnh leptospira
Dch t hc:
Bnh leptospira c trn ton th gii v tp trung
ch yu vng nhit i, va l mt bnh ngh
nghip li va l mt bnh ph thng, thng
pht trin vo ma ma. Nhng vng bnh lu
hnh nhiu gm c M La Tinh, Vng Caribe, n
, ng Nam , Chu i Dng v ng u.
Cc tc nhn gy bnh thng pht hin ti nhng
mi trng m v m cao, c bit l vng
nhit i m. Nhng yu t nh cha ng vt,
c im mi trng, tnh cht cng vic v cc
truyn thng sn xut nng nghip s quyt nh
v s lu hnh ca cc bin th huyt thanh.
cc nc nhit i, phi nhim ngh nghip (cc
nng tri go, ma, thy sn...) v cc thi quen
sn xut nng nghip truyn thng vn l nhng
nguy c chnh dn n bnh. S ca mc bnh gia
tng vo ma ma. Nhng s kin l hi ln ni
m mi ngi s dng nhiu ngun nc c th
dn n nhng i dch mang tnh a quc gia.
Bnh leptospira c ghi nhn ti Vit Nam t
nhng nm 1930. Cc nghin cu c thc hin
nhiu khu vc min Nam ch ra rng phi
nhim vi bnh ny tuy ph bin nhng t biu
hin lm sng. C v nh ngi phi nhim vi
cc chng c c lc thp, t l mc huyt thanh
(seroprevalence mu huyt thanh dng tnh)
thng cao t 10 n 30%.
Ngun bn :
Nin gim thng k bnh truyn nhim t 2007
n 2011, Cc Y t d phng.

- Bhart AR, et al. (2003) Leptospirosis: a zoonotic disease of global importance. Lancet Infect Dis 3:
757 771.
- Pappas G, et al. (2008) The globalization of leptospirosis: worldwide incidence trends. Int J Infect Dis
12: 351-357.
- Thai KT, et al (2008). Seroepidemiology and serological follow-up of anti-leptospiral
IgG in children in Southern Vietnam. Acta Trop. 106(2):128-31.
- Thai KT, et al (2008). Seroepidemiology of leptospirosis in southern Vietnamese children.
Trop Med Int Health.;11(5):738-45.
- Laras K, (2002). The importance of leptospirosis in Southeast Asia. Am J Trop Med Hyg.
;67(3):278-86.
- Wertheim H, Horby P, Woodall J (2012). Atlas of Infectious Diseases. Wiley-Blackwell, Oxford, United
Kingdom.
106
Subject: Melioidosis
Ch : Bnh melioidosis (bnh Whitmore)
107
Classification:
ICD-9 025; ICD-10 A24.1-A24.4
Phn loi:
ICD-9 025; ICD-10 A24.1-A24.4

Whitmores disease.
Hi chng v ng ngha:
Bnh Whitmore.
Agent:
Burkholderia
pseudomallei,
(formerly
Pseudomonas pseudomallei), an aerobic, motile
Gram-negative bacillus of the beta-proteobacteria
group. Most virulent strains are of the l-arabinose
(ara)-negative biotype. It is oxidase positive,
resistant to a wide range of antibiotics including
gentamicin, polymyxin and the secondgeneration cephalosporins. A similar disease of
equines called glanders, now rare (extinct in the
Americas), is caused by the related bacterium
B. mallei. Both B. mallei and B.pseudomallei
are listed as potential bioweapons and bioterror
agents.
Tc nhn:
Burkholderia pseudomallei, (tn trc y l
Pseudomonas pseudomallei), trc khun Gram
(-), i kh, di ng, thuc beta-proteobacteria.
Chng c lc mnh nht l sinh type m tnh
vi l-arabinose(ara). Oxidase dng tnh, khng
mt lot cc khng sinh bao gm gentamicin,
polymyxin v cc cephalosporin th h th hai.
Mt cn bnh tng t trn nga l bnh glanders,
nay him gp ( bin mt khi chu M), gy ra
bi vi khun c h hng gn l B. mallei. C B.
mallei v B. pseudomallei c xem nh v kh
chin tranh sinh hc tim nng v tc nhn khng
b sinh hc.
Reservoir:
B. pseudomallei is a soil and water saprophyte
and can survive for long periods in moist soil and
mammalian tissues. Infection has been found in
a wide range of animals, but none are thought to
be reservoir hosts.
cha:
B. pseudomallei l mt vi khun hoi sinh sng
trong t, nc, c th sng rt lu trong t m
v m ng vt c v. Nhiu loi ng vt b
nhim khun, nhng khng loi no c khng
nh l vt ch chnh.
Transmission:
Through breaks in skin, ingestion or aspiration of
contaminated water, inhalation of contaminated
dust. Rare reports of transmission from human
or animal cases to man. Laboratory workers have
been infected by aerosols.
Ly truyn:
Thng qua vt try xc, vt thng trn da,
ung hoc ht phi nc bn, ht phi bi b
nhim vi khun. Him c trng hp ly truyn
t ngi sang ngi hoc ng vt sang ngi.
Nhn vin phng th nghim cng c th nhim
do dng kh dung.
Cycle:
From contaminated soil or water to human or
animal.
Incubation Period:
1-21 days for most acute cases but activation of
latent infection has occurred from 25-63 years
after exposure.
Chu k:
T t hoc nc b nhim sang ngi hoc
ng vt.
Thi gian bnh:
1- 21 ngy trong phn ln cc ca cp tnh nhng
s hot ha nhim ca trng tim tng c th xy
ra 25- 63 nm sau phi nhim.
108
Clinical Findings:
Range
from
asymptomatic
pulmonary
consolidation to mild bronchitis, through
acute pneumonic or rapidly fatal septicemic
presentations to chronic suppurative infection.
Pulmonary cavitation, osteomyelitis and
empyema may also be seen. Easily confused
clinically with typhoid fever and tuberculosis,
and laboratories may not recognize the causative
organism and may dismiss it as a contaminant.
Diagnostic Tests:
Isolation of agent from blood, urine, sputum,
pus or skin lesions; direct immunofluorescence;
seroconversion. PCR may be of value on samples
other than blood.
Prevention:
Avoid contamination of skin by potentially
infected soil or water; no vaccine available.
Epidemiology:
The true worldwide distribution and incidence is
unknown. Antibody prevalence in humans and
livestock in countries with sporadic cases suggest
that most human infections are subclinical or
benign, or misdiagnosed and under-reported.
Cases are mainly sporadic and have been reported
in humid areas of the tropics and subtropics
worldwide, mainly during the rainy season. Cases
have been reported in dryer areas, like northeastern
Brazil and north Iran. This is likely explained by
the fact that these two areas have irrigated rice
fields. In Southeast Asia, it is a disease of mainly
rice farmers and others who are occupationally
exposed to contaminated soil or water. In northeast Thailand, 20% of community-acquired
septicaemic cases are due to melioidosis, which
accounts for 39% of fatal septicaemias and 36%
of fatal community-acquired pneumonias. Up to
80% of cases occur in those who are predisposed
by underlying immunocompromising conditions
such as diabetes, chronic renal disease, or
alcoholism, age, chronic infection, or immunosuppressive therapy. Sporadic human infections

Biu hin lm sng:
C cc th t thm nhim phi/ng c phi
khng triu chng, vim ph qun nh, n vim
phi cp hoc biu hin nhim trng huyt cp
t vong nhanh chng hoc nhim trng m mn
tnh. Hang phi, vim ty xng nhim khun
v trn m mng phi cng c th c. Bnh d
b chn on lm sng nhm vi bnh thng
hn v bnh lao v cc phng th nghim c th
khng nhn ra vi khun gy bnh m cho l mu
b nhim bn.
Xt nghim chn on:
Phn lp tc nhn t mu, nc tiu, m, m
hoc tn thng da; min dch hunh quang trc
tip, chuyn i huyt thanh (xc nh khng
th). PCR c th c gi tr trn cc mu khng
phi mu.
Phng nga:
Trnh t hoc nc bn c th nhim vi
khun dnh ln da. Bnh khng c vc xin d
phng.
Dch t hc:
S phn b bnh v t l mc thc t trn th gii
khng c bit r. T l khng th (t l mc
huyt thanh) trn ngi v sc vt nui cc
quc gia c trng hp mc ri rc ch ra rng
nhim trng ngi ch yu l th khng c biu
hin lm sng hoc lnh tnh, hoc b chn on
nhm v bo co st.
Trng hp mc ch yu xut hin ri rc v
bnh c ghi nhn ti nhng khu vc m t
ca vng nhit i v cn nhit i trn ton th
gii, ch yu trong ma ma. Mt s trng hp
c bo co trong khu vc kh hu kh hn
nh ng bc Brazil v bc Iran. C th gii thch
bi thc t l c hai vng ny u c rung la
nc. ng Nam , bnh ch yu nhm nng
dn trng la v nhng ngi c ngh nghip tip
xc vi t hoc nc b nhim. ng bc
Thi Lan, 20% trng hp nhim trng mu mc
ti cng ng l melioidosis, chim 39% nhim
trng mu t vong v 36% vim phi t vong mc
109
with glanders (B. mallei), occur in equine

veterinarians and pathologists, horse butchers and
laboratory workers.
Sporadic cases of melioidosis have been
reported from Vietnam for decades, but clinical
and epidemiological data for the indigenous
population are still scarce. A study conducted
in Hanoi between 1997 and 2005 found that
the clinical manifestations of melioidosis was
fatal septicaemia, with a high rate of underlying
diseases (e.g. diabetes). Most cases were admitted
during the wet season. In HCMC a study was
done between 1992-1998, where B. pseudomallei
was isolated from only 9 (0.25%) of 3653 blood
cultures taken from febrile patients. Soil samples
showed that only 9 (6%) of 147 rice fields were
of the virulent l-arabinose (ara)-negative biotype.
All except 1 of the fields with the ara-negative
biotype were close to the homes of the patients
with melioidosis. The authors concluded that the
low incidence of melioidosis in southern Vietnam
may be due to the restricted distribution of aranegative B. pseudomallei in the soil.
Map sources:
Melioidosis map was made by geocoding cases
which have been reported in the medical literature
up to 2011
Land cover map from FAO.
ti cng ng. Ti 80% cc trng hp xy ra

nhng ngi c bnh nn trc gy suy yu
h min dch nh tiu ng, bnh thn mn tnh,
hoc chng nghin ru, tui cao, nhim trng
mn tnh, iu tr c ch min dch. Cc trng
hp l t ngi mc bnh nga (B. mallei) l bc
s th y, nh nghin cu bnh hc nga, ngi
m tht nga v nhn vin phng th nghim.
Cc trng hp melioidosis l t c bo co
Vit Nam trong nhiu thp k, nhng d liu lm
sng v dch t hc t dn bn a vn cn khan
him. Mt nghin cu tin hnh ti H Ni t nm
1997- 2005 cho thy th lm sng melioidosis l
nhim trng huyt gy t vong, vi t l cao ca
cc bnh nn trc (v d bnh tiu ng).
Hu ht cc trng hp nhp vin trong ma ma.
Mt nghin cu ti TP H Ch Minh trong giai
on 1992- 1998, trong B. pseudomallei c
phn lp t 9 mu (0,25%)/3653 mu cy mu
ca bnh nhn st. Cc mu t cho thy ch c 9
cnh ng (6%)/147 cnh ng la c l-arabinose
(ara) m tnh. Ngoi tr 1 mu ca cnh ng
vi sinh type m tnh ara, gn nh ca bnh
nhn melioidosis. Cc tc gi kt lun rng t l
melioidosis thp min Nam Vit Nam c th l
do s phn b kh hn hp ca B. pseudomallei
ara m tnh trong t.
Ngun bn :
Bn th hin v tr ca cc ca bnh da trn cc
bi bo n nm 2011.
Bn bao ph t t ngun ca FAO.

- Cheng AC. (2010) Melioidosis: advances in diagnosis and treatment. Curr Opin Infect Dis 23 (6):
554-559.
- Currie BJ. (2008) Advances and remaining uncertainties in the epidemiology of Burkholderia
pseudomallei and melioidosis. Trans R Soc Trop Med Hyg 102 (3): 225-227.
- Peacock SJ. (2006) Melioidosis. Curr Opin Infect Dis 19 (5): 421-428.
- Cheng AC, et al. (2005) Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol
Rev 18 (2): 383-416.
- Phuong DM, et al. (2008) Clinical and microbiological features of melioidosis in northern Vietnam.
Trans R Soc Trop Med Hyg;102 Suppl 1:S30-6.
United Kingdom.
- Doan Mai Phuong (2008). Clinical and microbiological features of melioidosis in northern Vietnam.
Transactions of the Royal Society of Tropical Medicine and Hygiene.
110
Subject: Meningitis syndrome
Ch : Hi chng vim mng no
111
Classification:
ICD-9 036.1, ICD-10 A39
Syndromes and synonyms:
Meningitis, bacterial meningitis,
meningitis
Phn loi:
ICD-9 036.1, ICD-10 A39
purulent
Agent:
The case definition for meningitis syndrome in
Vietnam is: sudden onset of high fever , severe
headache, nausea and vomiting, stiff neck, and
with/without haemorrhagic lesions. The case
definition is meant to capture those patients
with bacterial meningitis, which can be caused
by a variety of pathogens, but usually due to:
Strepococcus suis, Neisseria meningitidis,
Haemophilus influenzae type b, Streptococcus
pneumonia. Less common causes are: Listeria,
staphylococci, Enterobacteriaceae, and group
B streptococci. This fact sheet will focus on N.
meningitidis.
Reservoir:
Humans
Transmission:
The N. meningitidis bacteria are transmitted
from person-to-person through droplets of
respiratory secretions from carriers. Close and
prolonged contact is thought to help the spread
of the disease.
Incubation period:
The incubation period of meningococcal
meningitis ranges from two and 10 days, but on
average thought to be about four days.
Clinical findings:
Meningococcal infection can present with
meningitis, where the most common symptoms
are a stiff neck, high fever, photophobia,
confusion, headaches and vomiting. This
condition has a high mortality rate. Even when
the disease is diagnosed early and adequate
treatment is started, 5% to 10% of patients still
die. Bacterial meningitis may result in severe
neurological sequelae like brain damage, hearing
loss or a learning disability, which can occur in
Hi chng v t ng ngha:
Vim mng no, vim mang nao do vi khun,
vim mng no m.
Tc nhn:
inh nghia ca bnh hi chng mang nao cp
Vit Nam: khi pht t ngt bng st cao,
au u d di, bun nn va nn, c cng, co/
hoc khng co thng tn xut huyt. inh
nghia ca bnh nay nhm thu nhn ca nhng
bnh nhn bi vim mang nao do vi khun ma co
th do nhiu tac nhn gy ra, nhng thng la
do: Strepococcus suis, Neisseria meningitidis,
Haemophilus influenze typ B, Streptococcus
pneumonia (vim phi do ph cu). It ph
bin hn la do: Listeria, staphylococci,
Enterobacteriacecae, va steptococci nhom B.
Ban vit nay se tp trung vao nguyn nhn do
Neisseria meningitidis
cha:
Con ngi.
Ly truyn:
Vi khun truyn t ngi sang ngi qua nhng
git dch tit ng h hp t ngi mang vi
khun. Tip xc gn v trong thi gian di lm
gia tng s ly lan ca bnh.
Thi gian bnh:
Thi gian bnh c th nm trong khong t 210 ngy, trung bnh c cho l khong 4 ngy.
Biu hin lm sng:
Nhim no m cu c th biu hin th vim
mng no m, cc triu chng ph bin nht l
c cng, st cao, s nh sng, l ln, au u
v nn. Th ny c t l t vong cao. Ngay c
khi bnh c chn on sm v iu tr tch
cc, 5%- 10% bnh nhn vn t vong. Vim
mng no m c th dn n di chng thn kinh
nghim trng nh tn thng no, mt gim
kh nng nghe hoc mt kh nng hc tp, c
th xy ra vi khong 10%- 20% ngi sng
st.
112
up to 10% to 20% of survivors. A less common

but even more severe form of meningococcal
disease is meningococcal septicaemia, which is
characterized by a hemorrhagic rash and rapid
circulatory collapse. This condition can have a
rapid onset and is often fatal.
Mt th t ph bin nhng cn nghim trng

hn ca bnh do no m cu l vim mng no
km nhim khun huyt cp, c trng bi t
ban, mng xut huyt c hoi t trung tm v
suy tun hon nhanh chng. Th ny cp tnh v
thng gy t vong.
Diagnostic tests:
Initial diagnosis of meningococcal meningitis
is usually made from the clinical examination
followed by the appropriate relevant
investigations, such as lumbar puncture for
microscopy and culture and blood culture.
Gram stain of the cerebrospinal fluid can
sometimes show gram-negative diplococci.
The diagnosis is usually confirmed by growing
the bacteria from cerebrospinal fluid or blood.
Rapid polymerase chain reaction (PCR) tests
are also available for diagnosis.
Xt nghim chn on:

Chn on ban u th vim mng no do no
m cu thng da trn kt qu thm khm
lm sng. Tip theo l cc thm d lin quan
ph hp nh chc d ty sng ly dch soi
knh hin vi. Nhum Gram dch no ty i khi
c th pht hin song cu Gram m. Vic chn
on thng c xc nh bng nui cy vi
khun t dch no ty hoc t mu. PCR cng
c th chn on.
Prevention:
Polysaccharide vaccines against meningococcal
disease have been available for over 30 years.
Vaccines that are available are: bivalent (groups
A and C), trivalent (groups A, C and W), or
tetravalent (groups A, C, Y and W135). The
tetravalent conjugate vaccine against A, C, Y
and W135 strains have been licensed for use
since 2005 across Canada, the United States of
America, and Europe.
Epidemiology:
Meningococcal meningitis usually occurs
in small clusters throughout the world with
seasonal variation. During the last 13 years,
the incidence of endemic meningococcal
disease has ranged from 1 to 5 per 100,000
in developed countries, and from 10 to 25 per
100,000 in developing countries. The largest
burden of disease is seen in sub-saharan Africa,
in an area referred to as the meningitis belt,
which stretches from Ethiopia to Senegal.
Introduction of vaccination programs in some of
these countries has seen a significant reduction
in the number of cases diagnosed, for example,
a new meningococcal A conjugate vaccine was
introduced in Burkina Faso in December 2010,
leading to the reporting, in 2011, of the lowest
D phng:
Vc xin Polysaccharide phng bnh vim mng
no do no m cu c t hn 30 nm. Vc
xin hin c l: song gi (typ A v C), tam gi
(typ A, C v W), hoc t gi (typ A, C, Y v
W135). Vc xin lin hp t gi nga 4 typ A,
C, Y v W135 c cp php s dng nm
2005 ti Canada, Hoa K v Chu u.
Dch t hc:
Vim mng no do no m cu thng xy ra
vi cc chm ca bnh qui m nh trn ton th
gii vi s thay i theo ma. Trong 13 nm
qua, t l lu hnh vim mng no m cu dao
ng trong khong t 1- 5/100.000 ti cc nc
pht trin, v 10- 25/100.000 cc nc ang
pht trin. Khu vc di sa mc Sahara chu Phi
c lu hnh cao nht, thuc khu vc c gi
l Vnh ai vim mng no, tri di t Ethiopia
n Senegal. Chng trnh tim chng ti mt
s cc quc gia ny gp phn lm gim ng
k cc trng hp c chn on, v d, vc
xin vim mng no lin hp typ A bt u s
dng Burkina Faso thng 12 nm 2010, dn
n s trng hp vim mng no typ A thp
nht tng c ghi nhn trong ma dch 2011.
Vit Nam, no m cu typ huyt thanh C lin
can n v dch ti cc tnh pha Nam nm 19771979. T l mc vim mng do no m cu
trong thi gian ny tng t di 5/100.000
113

number of confirmed meningitis A cases ever
recorded during a meningitis season.
In Viet Nam, Serogroup C meningococcus was
implicated in an epidemic that occurred in the
southern provinces between 1977 and 1979.
The incidence rate of meningococcal disease
during this time rose from <5/100 000 in
previous years to >20/100 000, with a mortality
rate of 27.4% to 34.7% during the epidemics.
The majority of these cases occurred in children
between the ages of 3 and 15.
The estimated incidence of meningococcal
disease in Hanoi, Viet Nam, between 2000
and 2002 was 218/100 000, and in early 2012,
several cases of meningococcal meningitis
were reported from five localities in Vietnam
including Ho Chi Minh City, Hanoi, Long An,
Binh Phuoc and Quang Tri.

nm trc ln n trn 20/100.000 dn, vi t
l t vong tng t 27.4% ln n 34.7% trong
thi gian dch bnh. a s cc trng hp xy
ra tr em trong tui t 3- 15.
T l mc mi c tnh ca bnh no m cu
H Ni, Vit Nam, t nm 2000- 2002 l
21,8/100.000 dn, v vo u nm 2012, mt
s trng hp vim mng no do no m cu
c bo co t 5 tnh/TP bao gm Thnh ph
H Ch Minh, H Ni, Long An, Bnh Phc
v Qung Tr.
Ngun bn :
Nim gim thng k bnh truyn nhim t nm
2007 n 2011, Cc Y t d phng.
Map sources:
The Communicable Disease Yearbook from
2007 to 2011, General Department of Preventive
Medicine, Vietnam.

- World Health Organisation Health topics Meningococcus. http://www.who.int/mediacentre/
factsheets/fs141/en/ Accessed Nov 2012
- A. VYSE, J. M. WOLTER, J. CHEN, T. NG, and M. SORIANO-GABARRO. Meningococcal
disease in Asia: an under-recognized public health burden. Epidemiol Infect. 2011 July; 139(7):
967985.
United Kingdom.
114
Subject: Neonatal tetanus
Ch : Un vn s sinh
115
Ch : Un vn s sinh
Classification:
ICD-9 037, 771.3 ; ICD-10 A33-35
Phn loi:
ICD-9 037, 771,3; ICD-10 A33-35

Lockjaw.
Hi chng v ng ngha:
Cng hm, phong n gnh.
Agent:
Clostridium tetani, a gram-positive, sporeforming bacterium that only grows in a low
oxygen (anaerobic) environment. The spores
can remain viable in the environment for years
and are relatively resistant to heat and chemical
agents. C. tetani produces a highly potent
exotoxin, tetanospasmin, which is responsible
for the clinical features of tetanus.
Tc nhn:
Clostridium tetani, mt loi vi khun Gram
dng, c kh nng sinh nha bo, ch pht trin
trong mi trng nng oxy thp (k kh).
Cc nha bo c th tn ti ngoi mi trng
trong nhiu nm v tng i bn vng vi cc
tc nhn nhit v ha hc. C. tetani to ra mt
ngoi c t c c lc cao hng thn kinh
l tetanospasmin, gy nn nhng biu hin lm
sng c trng ca bnh un vn.
Reservoir:
Intestinal tract of animals and humans, and soil.
Route of transmission:
Contamination of wounds with soil, dust or
animal feces that contain C. tetani spores.
Puncture wounds are most commonly
associated with tetanus but it can result from
even minor abrasions. Through injection of
contaminated street drugs, particularly heroin
injected subcutaneously. Neonatal tetanus
results from infection of the umbilical cord,
either through the use of unclean instruments to
cut the cord or through dressing the stump with
contaminated materials. There is no person to
person transmission.
Cycle:
Tetanus spores enter the body through wounds
and if the conditions are anaerobic, e.g. puncture
wounds, the spores germinate and the toxin is
produced. The toxins are disseminated via the
blood and lymphatic system and bind to nerve
endings, preventing the release of inhibitory
neurotransmitters. This results in unopposed
skeletal muscle contraction.
cha:
ng rut ca ngi v ng vt, mi trng
t.
Ly truyn:
Vt thng nhim bn vi t, bi hoc phn
ng vt c cha nha bo C. tetani. Un vn
thng lin quan nhiu nht n vt thng
su, nhng bnh cng c th l kt qu ca
nhng vt try xc nh. Qua tim chch ma
ty ng ph b nhim bn, c bit l tim
heroin di da. Un vn s sinh l kt qu ca
nhim trng dy rn do vic ct dy rn bng
dng c bn hoc do p rn vi cc vt liu
nhim bn. Un vn khng ly truyn t ngi
sang ngi.
Chu k:
Cc nha bo un vn xm nhp vo c th qua
vt thng v nu gp iu kin ym kh, v d
nh vt thng su, cc nha bo thnh th sinh
dng v sn sinh c t. c t theo ng
mu v h bch huyt s gn vo cc tn cng
ca neuron, ngn cn s gii phng cc cht c
ch s dn truyn thn kinh. Kt qu dn n
hin tng co c vn khng kim sot c.
116

Incubation period:
Most cases occur within 14 days of the injury,
with an average of around 10 days, but the
incubation period may be as short as 1 day and
as long as several months. Shorter incubation
periods are associated with more heavily
contaminated wounds and an inoculation site
closer to the central nervous system. Neonatal
tetanus has a shorter incubation period, with an
average of around 6 days and a range of 3 to 28
days.
Clinical findings:
The principal clinical feature of tetanus is painful
skeletal muscle spasms and rigidity. Three
clinical forms are recognised. The commonest
is generalised tetanus, which usually begins
with spasms of the facial muscles and spreads in
a descending pattern. On presentation patients
commonly have lockjaw(trismus), neck
stiffness, difficulty swallowing, and abdominal
rigidity. Generalised spasms may result in an
arched posture (opisthotonus). Other symptoms
include elevated temperature, blood pressure,
and sweating. Localised tetanus presents as
localised spasms of muscles around the entry
wound. Cephalic tetanus is rare and results
from infection in the head and neck, and affects
cranial nerves.
Diagnostic tests:
The diagnosis is based on characteristic clinical
features. The bacterium is usually not cultured
from wounds and a positive culture does not
confirm the diagnosis since the isolate may be
a non-toxigenic strain. Antibodies are rarely
detectable.
Prevention:
Immunization with tetanus toxoid (inactivated
tetanus toxin). Immunization of pregnant
women protects infants from neonatal tetanus.
In Viet Nam, the national tetanus toxoid (TT)
immunization policy specifies that all pregnant
Ch : Un vn s sinh
Thi gian bnh:
Hu ht cc trng hp pht bnh sau khi b
thng 14 ngy, trung bnh 10 ngy, tuy nhin
thi gian bnh c th ch ngn 1 ngy hoc
di ti nhiu thng. Thi gian bnh ngn lin
quan n vt thng nhim bn nng v v tr
ng vo gn vi h thn kinh trung ng.
Un vn s sinh c thi gian bnh ngn hn,
trung bnh 6 ngy v dao ng trong khong
3 - 28 ngy.
Biu hin lm sng:
Du hiu lm sng in hnh un vn l cn co
cng c vn au n. C ba th lm sng c
cng nhn. Ph bin nht l th un vn ton
thn, thng bt u vi cn co cng cc c
mt ri lan xung cc b phn khc. Trn bnh
nhn thng c biu hin kht hm (cng
hm), cng c, kh nut, v bng cng nh g.
Co cng ton thn dn n t th cong ngi
(un vn). Cc triu chng khc bao gm st
tng dn, tng huyt p v v m hi. Un vn
khu tr, th hin bi co git nhng nhm c
xung quanh vt thng. Un vn rt him v l
kt qu nhim trng vng u mt c v c nh
hng n cc dy thn kinh s no.
Xt nghim chn on:
Vic chn on c da trn cc du hiu lm
sng c trng. Cc vi khun t vt thng
thng khng nui cy c v kt qu nui
cy dng tnh cng khng c tc dng chn
on v kt qu phn lp c th l chng khng
sinh c t. Cc khng th him khi c pht
hin c.
Phng chng:
Tim chng vi c t un vn bt hot (TT).
Tim chng cho ph n mang thai bo v tr s
sinh khi un vn s sinh. Vit Nam, chnh
sch tim chng quc gia phng un vn quy
nh tt c cc ph n mang thai c tim
chng vi TT theo lch c WHO khuyn co
tim chng cho cc b m. Ti mt s vng, ph
117

women are to be immunized with TT at
intervals defined in the WHO recommendations
for maternal immunizations. In some areas,
non-pregnant women aged 1535 years are
also immunized. The reported proportion of
pregnant women who have received at least
2 doses of TT (TT2+) has been above 80%
since 1995, with coverage in more recent years
closer to 90%. Vietnam routinely monitors the
proportion of children who are protected at
birth, by checking the mothers immunization
status at the time the first dose of diphtheria
tetanuspertussis is administered to a child. In
2004, 88% of neonates were identified as being
protected against tetanus based on the data
generated through this method.
Epidemiology:
Tetanus is globally distributed but is more
common in highly populated agricultural areas,
and in warm and wet regions. In the late 1980s
tetanus was estimated to cause around 1 million
deaths per year, mostly in newborn infants.
The current distribution of cases represents the
coverage of tetanus immunisation in children
and adults. In countries with good vaccine
coverage in children, adult cases may still be
common, as natural immunity plays no role
in the epidemiology of tetanus. The DTP3
Vaccination Coverage map shows coverage with
the third dose of a tetanus containing vaccine in
childhood. The elimination of neonatal tetanus
was set as a goal in 1989 and by mid 2010,
neonatal tetanus has been eliminated in 79%
(153/193) of WHO Member States. However,
since C. tetani will always remain present in
nature, tetanus will always remain a threat, and
high levels of immunisation must be maintained
indefinitely.
Between 1993 and 2002, the Hospital for
Tropical Diseases in Ho Chi Minh City
admitted 2422 patients with tetanus aged > or
=1 year, during which time vaccine coverage
and treatment facilities improved. A marked
Ch : Un vn s sinh
n khng mang thai tui 15- 35 cng c tim
chng. Theo bo co, t l ca ph n mang thai
c tim t nht 2 liu TT (TT2 +) l trn
80% k t nm 1995, vi t l bao ph nhng
nm gn y n 90%. Vit Nam thng xuyn
gim st t l tr c bo v lc sinh, bng
cch kim tra tnh trng tim chng ca ngi
m vo thi im tim liu DTP (Bch hu-ho
g-un vn) u tin cho tr. Trong nm 2004,
88% ca tr s sinh c bo v phng un
vn theo s liu xc nh vi phng php ny.
Dch t:
Un vn l bnh c khp ni trn th gii
nhng ph bin ti nhng khu vc lm nng
nghip c mt dn s cao, khu vc c kh
hu m v m. Vo cui nhng nm 1980, theo
c tnh, un vn gy ra hn 1 triu ca t vong
mi nm, ch yu l tr s sinh. Hin ti s
phn b ca un vn phn nh mc bao ph
ca tim chng un vn ngi ln v tr em.
Ti nhng quc gia c t l bao ph tim chng
cao cho tr em cao vn c nhiu ca mc ngi
ln v min dch t nhin khng c vai tr i
vi dch t ca bnh. Bn bao ph DTP3 cho
thy mc bao ph ca liu th ba ca vc
xin c cha un vn cho tr em. Mc tiu Loi
tr un vn s sinh c t ra t nm 1989 v
n gia nm 2010, un vn s sinh b loi
tr 79% (153/193) cc quc gia thnh vin
TCYTTG. Tuy vy, do nha bo C. tetani lun
tn ti trong t nhin, bnh vn lun l mt mi
e da, v khng mc cao phi c
duy tr v thi hn.
T nm 1993 n 2002, Bnh vin Nhit i TP
HCM ghi nhn 2.422 bnh nhn un vn t 1
tui tr ln, v trong sut thi gian , mc
bao ph v h thng chn sc sc khe c
ci thin. T l mc v t vong u gim i
ng k cc nhm l i tng ca chng
trnh tim chng quc gia. Cc c s y t chm
sc tch cc c ci thin c lin quan cht ch
vi gim t l t vong r rt, xung mc 4- 5%.
Tuy nhin un vn vn l nguyn nhn chnh
118

reduction in tetanus incidence and mortality
has occurred in age groups specifically targeted
by the national vaccination program. Improved
intensive care facilities are associated with a
significant reduction in mortality, which is now
estimated to be around 4-5% However, tetanus
continues to be a major cause of morbidity
and mortality in individuals outside the target
population. Neonatal tetanus still reported
in regions with low vaccination coverage as
depicted on the map. Furthermore, many cases
still occur in adult men with no protective
immunity after injuries.
Ch : Un vn s sinh
ca bnh tt v t vong nhng c th khng
thuc i tng tim chng m rng. Un vn
s sinh vn cn ghi nhn ti nhng vng c t l
bao ph tim chng thp nh th hin trn bn
. Ngoi ra vn c nhiu ca mc nam gii
trng thnh khng c tim phng sau khi
b thng (S liu hng nm ti VN).
Ngun bn :
2009 n 2011, Cc Y t D phng.
Map sources:
Communicable diseases yearbook from 2009
Medicine.
- WHO. Validation of neonatal tetanus elimination in Viet Nam by lot quality-assurance cluster
sampling. Wkly Epidemiol Rec;81(27):266-72.
- Thwaites CL, et al. (2003) Preventing and treating tetanus. BMJ;326(7381):117-8.
- Thwaites CL, et al. (2004) Impact of improved vaccination programme and intensive care facilities
on incidence and outcome of tetanus in southern Vietnam, 1993-2002. Trans R Soc Trop Med
Hyg;98(11):671-7.
- Roper M.H. et al. (2007) Maternal and neonatal tetanus. Lancet; 370(9603):1947-59.
United Kingdom.
- World Health Organization. (2009). WHO, UNICEF, World Bank. State of the worlds vaccines
and immunization, 3rd ed. Geneva.
119
Subject: Plague
Ch : Dch hch
120
Subject: Plague
Ch : Dch hch
Classification:
ICD-9 020; ICD-10 A20
Phn loi:
ICD-9 020; ICD-10 A20

Pestis, pest, bubonic plague, pneumonic plague,
black plague, black death.
Hi chng v ng ngha:
Dch hch th phi, dch hch en, ci cht en.
Agent:
Yersinia pestis (Y. pestis), a Gram-negative
coccobacillus. Y. pestis is considered a potential
biological warfare agent.
Reservoir:
Rodents, principally rats (Rattus spp.) and
sylvatic ground squirrels: marmots (Marmota),
susliks (Spermophilus), and prairie dogs
(Cynomys). Rabbits, carnivores, and domestic
cats may also be infected. Cats can also develop
pneumonic plague.
Vector:
Fleas, especially the rat flea (Xenopsylla
cheopis) and possibly human flea (Pulex
irritans).
Transmission:
By flea bite for the bubonic form, by the
respiratory route for the pneumonic form;
handling carcasses or eating meat of infected
animals, especially rodents, rabbits and
carnivores in regions where reservoir animals
are killed and skinned for their meat and/or fur.
Person-to-person transmission occurs through
the bite of fleas (bubonic form) or respiratory
droplets (pneumonic form).
Cycle:
There are different cycles, including a sylvatic
rodent-flea cycle, a commensal rodent-flea
cycle, and a cycle of pneumonic transmission
in humans. Y. pestis can survive in the
environment, mainly in rodent burrows in a
sylvatic cycle. In case an infected flea feeds
Tc nhn:
Yersinia pestis, trc khun Gram m. Y. pestis
c xem l mt v kh chin tranh sinh hc
tim nng.
cha:
ng vt gm nhm, ch yu l cc loi chut
(Rattus spp.) v cc loi sc trong dch
thin nhin: cc loi sc (Marmota), sc t
(Spermophilus), sc Bc M (Cynomys). Th,
ng vt n tht, mo nh cng c th b nhim
bnh. Mo nh cng c th lm ly lan bnh
dch hch th phi.
Vector:
B cht, c bit l b cht chut (Xenopsylla
cheopis) v b cht ngi (Pulex irritans).
Ly truyn:
Qua vt cn i vi dch hch th hch, qua
ng h hp i vi dch hch th phi, qua
x l xc hoc n tht ng vt b nhim bnh,
c bit l ng vt gm nhm, th hoc ng
vt n tht vng m vt ch ng vt b git
ly tht v lt da ly lng. Ly truyn t ngi
sang ngi xy ra thng qua cc vt cn ca b
cht (th hch) hoc git kh dung h hp (th
phi).
Chu k:
C nhiu chu k khc nhau, bao gm chu k
ng vt gm nhm hoang d - b cht, chu k
ng vt gm nhm gn ngi (sng cng sinh
cng ngi) - b cht, v chu k truyn bnh
vim phi ngi. Y. pestis c th tn ti trong
dch thin nhin, ch yu l trn ng vt gm
nhm hoang d sng trong hang hc. Trong
121
Subject: Plague
on a commensal rodent (rat), a rodent-fleerodent cycle starts. When the rodents dies,
their fleas move to alternative hosts, possibly
humans. If humans develop pneumonic plague,
the infection can be transmitted from person
to person via respiratory droplets. Humans
may also become infected through handling of
infected animals (or meat), including rodents
and cats. Mammal predators, birds of prey, and
birds that use rodent burrows for nesting can
spread Y. pestis over longer distances. Also,
infected commensal rats (boats) or humans may
spread plague over long distances.
Incubation period:
1-4 days for pneumonic, 2-7 days for bubonic
plague.
Clinical findings:
Sudden onset of fever, chills, headaches, body
aches, weakness, sore throat, vomiting and
nausea. There are three main forms: bubonic,
septicaemic, and pneumonic. The bubonic
form is the most common, producing swollen,
painful and eventually suppurating lymph nodes
(buboes), which are usually inguinal, but also
may be axillary or cervical. In the septicaemic
form, spread through the bloodstream without
producing buboes may very rarely produce
meningitis, but more usually affects the lungs,
resulting in the pneumonic form, ending in fatal
endotoxic shock and disseminated vascular
coagulation. The CFR of the bubonic form is
4070%; of pneumonic and septicaemic plague
in the absence of prompt treatment, virtually
100%.
Diagnostic tests:
Microscopy of stained smear from a bubo,
sputum or CSF shows characteristic safetypin shape; IFA; antigen-capture ELISA; rapid
dipstick test. Culture takes about 4 days.
Ch : Dch hch
trng hp b cht nhim bnh t, ht mu
ng vt gm nhm gn ngi (v d chut),
mt chu k ng vt gm nhm - b cht - ng
vt gm nhm bt u. Khi ng vt gm nhm
cht, b cht k sinh trn chng nhy sang
mt vt ch thay th khc, c th l ngi. Nu
ngi pht trin dch hch th phi, vi khun c
th ly truyn t ngi sang ngi qua nhng
git kh dung h hp. Con ngi cng c th
b nhim khun thng qua x l xc (hoc tht)
ca ng vt b nhim bnh, bao gm c ng
vt gm nhm v mo. Th sn mi, chim sn
mi, v cc loi chim lm t bng hang ng
vt gm nhm c th lan truyn Y. pestis trn
khong cch kh xa. Ngoi ra, chut sng trn
tu thy b nhim v ngi b nhim c th lm
ly lan bnh dch hch ti nhng khong cch
a l rt xa.
Thi gian bnh:
1- 4 ngy i vi th vim phi, 2- 7 ngy i
vi th hch.
Biu hin lm sng:
Khi pht t ngt vi st, n lnh, au u,
au nhc c th, mt mi, au hng, nn v
bun nn. C ba th chnh: th hch, th nhim
trng mu v th phi. Th hch l ph bin
nht, cc hch bch huyt sng c m, au v
cui cng mng m hoi t, thng l hch
bn, nhng cng c th l hch nch hoc c.
Trong th nhim trng mu, vi khun lan theo
ng mu m khng xut hin sng hch rt
him gy vim mng no, nhng thng nh
hng n phi, kt qu l th vim phi, kt
thc bng sc ni c t e da tnh mng hoc
ng mu ni mch lan ta. T l cht/mc vi
th hch l 40- 70%; th phi v nhim trng
mu nu khng iu tr kp thi, hu nh 100%.
Xt nghim chn on:
Soi knh hin vi tiu bn nhum soi bng
Wayson bnh phm hch, m hoc dch
122
Subject: Plague
Prevention:
A killed vaccine is available for laboratory
workers, but is not recommended for use in
epidemics. In buildings or rodent borrows in
fields, flea control with insecticide should be
followed by rat destruction (killing rats will
liberate their fleas looking for new hosts);
deratting of ships and rat control in ports.
Chemoprophylaxis of pneumonic plague
contacts with tetracyclines or chloramphenicol,
dust all clothing with insecticide. Pneumonic
cases should be isolated.
Epidemiology:
Wordwide there are an estimated 1,000-3,000
human cases per year, but there is considerable
underreporting and underdiagnosis. The last
plague pandemic in 1894 started in Hong Kong
establishing many endemic foci worldwide.
Infection control and antibiotics can decrease
plague morbidity and mortality but plague
cannot be eradicated as it is widespread in wild
rodent reservoirs. There has been a large shift in
case load from Asia to Africa, with more than
90% of all cases occurring in Africa. The most
common form is bubonic plague, but outbreaks
of pneumonic plague still occur. In Vietnam
no new cases have been reported since 2003.
Most cases occured in the central highlands
(Dak Lak and Gia Lai). The animal reservoir
is still present and there is always a risk of reemergence of plague in Vietnam.
The first plague outbreak was recorded in
1898 in the coastal city of Nha Trang. Plague
is thought to have been introduced from Hong
Kong by ship. Up to 2003, the Central Highlands
region has been a major focus of plague. From
1997 through 2002, 472 cases of plague were
reported with 24 deaths (5.1%). The incidence
of plague peaks during the dry season, with
63% of cases occurring from February through
April. Data suggest that the flea index, rodent
density and rainfall can be used as ecological
Ch : Dch hch
no ty cho thy vi khun in hnh c hnh
kim bng; Min dch hunh quang; ELISA
pht hin khng nguyn; test nhanh. Nui cy
khong 4 ngy.
Phng nga:
Vc xin t vi khun cht dng cho nhn vin
trong phng th nghim, nhng khng c
khuyn co s dng trong v dch. Dit b cht
bng thuc dit cn trng i i vi dit chut
(v dit chut s gii phng b cht ca chut
b cht i tm vt ch mi) trong cc ta nh,
trong cc hang chut; dit chut tu thy v
dit chut cng. Khng sinh d phng cho
ngi c tip xc vi bnh nhn th phi bng
tetracycline hoc chloramphenicol, phun thuc
dit cn trng ln tt c qun o. Trng hp
dch hch th phi cn c cch ly.
Dch t hc:
Trn th gii, c tnh c khong 1.000- 3.000
bnh nhn dch hch mi nm, tuy nhin c
nhiu tnh trng bo co thiu hoc khng c
chun on. i dch dch hch gn nht l vo
nm 1894, bt u ti Hng Kng to ra
nhiu dch lu hnh trn khp th gii. Kim
sot nhim khun v iu tr khng sinh c th
lm gim t l mc v cht, nhng khng th
loi tr dch hch v vi khun vn tn ti rng
ri trong cha ng vt gm nhm hoang d.
c mt s thay i ln s ca bnh t chu
sang chu Phi, vi hn 90% cc trng hp xy
ra chu Phi. Th ph bin nht l dch hch
th hch, nhng nhng v dch dch hch th
phi vn xy ra. Vit Nam khng c trng
hp mi c bo co k t nm 2003. Hu ht
cc trng hp xy ra Ty Nguyn (k Lk,
Gia Lai). cha ng vt vn cn hin din v
lun lun c nguy c dch hch ti bng pht
ti Vit Nam.
V dch dch hch u tin c ghi nhn nm
1898 ti thnh ph bin Nha Trang. Bnh dch
c cho l xm nhp t Hng Kng bng tu
123
Subject: Plague
indicators of plague risk in Vietnam.
Map sources:
Data from the national notification system.
Cases fulfilling criteria for plague are reported.
Clinical symptoms that were consistent with
a presumptive diagnosis of plague are: fever,
bubo and lymphadenopathy in the inguinal
region, axilla or neck.
The map shows the distribution of human cases
in district level from 1997 to 2003 to see the
reduction in cases in Central Highlands of
Vietnam where has been identified as major
focus of plague
Ch : Dch hch
thy. Cho ti nm 2003, khu vc Ty Nguyn l
dch dch hch chnh. T nm 1997 n 2002,
472 trng hp bnh dch hch c bo
co vi 24 ca t vong (5,1%). T l mc dch
hch tng ln nh trong ma kh, vi 63% cc
trng hp xy ra t thng hai n thng T.
D liu cho thy ch s b cht, mt ng
vt gm nhm v lng ma c th c dng
nh ch s sinh thi nh gi nguy c bnh dch
hch ti Vit Nam.
Ngun bn :
D liu t h thng bo co quc gia. Cc ca
tiu chun dch hch c bo co. Cc triu
chng lm sng ph hp vi chn on dch
hch l: st, sng vim hch khu vc bn, nch,
c.
Bn th hin s phn b ca cc ca bnh
ngi theo cp huyn t nm 1997 n nm
2003 thy c s gim cc ca bnh vng
Ty Nguyn, ni c xc nh l bnh chnh
ca bnh dch hch.

- Akiev AK. (1982) Epidemiology and incidence of plague in the world, 1958-79. WHO Bulletin
60 (2): 165 169.
- Gratz N. (1999) Plague Manual Epidemiology, Distribution, Surveillance and Control. WHO
report, Geneva.
- Neerinckx SB, et al. (2008) Geographic distribution and ecological niche of plague in sub-Saharan
Africa. Int J Health Geogr 7:54.
- World Health Organization. (2005) Plague. Wkly Epidemiol Rec 80: 138140.
- Stenseth NC et al. (2008) Plague: past, present and future. PLoS Med 5(1): e3.
- Pham HV et al. (2009) Correlates of environmental factors and human plague: an ecological study
in Vietnam. Int J Epidemiol. 2009 Dec;38(6):1634-41.
- ng Tun t et al (2003) Dch hch, dch t hc v phng chng. Nh xut bn Y hc
United Kingdom.
124
Subject: Scrub typhus
Ch : St m
125
Ch : St m
Classification:
ICD-9 081.2; ICD-10 A75.3
Phn loi:
ICD-9 081.2; ICD-10 A75.3

Tsutsugamushi disease, mite-borne typhus
fever, chigger-borne rickettsioses, coastal fever
(Australia).
Hi chng v ng ngha:
Bnh Tsutsugamushi, st rickettsia, st ven
bin (Australia).
Agent:
Orientia tsutsugamushi, obligate intracellular
bacterium, before 1995 known as Rickettsia
tsutsugamushi.
Reservoir:
Larval stage mites, so-called chiggers from the
genus Leptotrombidium. A number of small
rodents particularly wild rats are the natural
hosts for scrub typhus without apparent disease.
Vector:
Larval mites. Nymphs and adults do not feed
on vertebrate hosts. The vector has adapted to
various ecologies, including mountainous and
tropical regions.
Tc nhn:
Orientia tsutsugamushi, vi khun k sinh ni
bo bt buc, trc nm 1995 c gi l
Rickettsia tsutsugamushi.
cha:
u trng m thuc chi Leptotrombidium. Mt
s loi gm nhm nh c bit l chut hoang
d l vt ch t nhin khng c biu hin bnh.
Vector:
u trng m cng l trung gian truyn bnh.
Nhng v m trng thnh khng t cc loi
vt ch c xng sng. Vector thch nghi vi
cc h sinh thi khc nhau, bao gm c khu vc
min ni v vng nhit i.
Transmission:
Bite of infected larval mites (chiggers). There is
no direct person-to-person transmission.
Ly truyn:
Vt t ht mu ngi ca u trng m
nhim vi khun. Bnh khng ly trc tip t
ngi sang ngi.
Cycle:
The mite is infected by feeding on reservoir
animals (small rodents), and maintain
the infection throughout their life stages.
The infection is passed on by transovarial
transmission. O. tsutsugamushi are present in
the salivary glands of the larvae and injected
into its host during feeding.
Chu k:
u trng m b nhim khun do t ht mu
ng vt cha (cc loi gm nhm nh), v s
duy tr kh nng truyn nhim trong sut cc giai
on sng. Nhim trng c truyn dc t con
ci trng thnh sang trng. O. tsutsugamushi
c trong tuyn nc bt ca u trng v vo c
th vt ch khi u trng ht mu.
Incubation period:
10 12 days, range: 6 21 days.
Thi gian bnh:

6- 21 ngy, thng thng 10- 12 ngy
Clinical findings:
Typical skin ulcer, eschar, may develop at the
site of the mites bite. Several days later fever,
Biu hin lm sng:

Nt lot da in hnh, ng vay c th pht hin
ti v tr vt m t. Vi ngy sau c st, au
126
Ch : St m
headache, myalgia, and lymphadenopathy may

develop. Dry cough with signs of pneumonitis,
jaundice and meningoencepahlitis may occur
Scrub typhus severity and clinical presentation
is probably strain dependent.
u, au c, au v c th sng hch. Ho khan

vi du hiu vim phi, vng da v vim mng
no no c th xy ra. Mc nghim trng
biu hin lm sng st m c th ty thuc vo
chng vi khun.
Diagnostic tests:
Serology (IF, EIA); PCR; culture in mice or cell
lines.
Xt nghim chn on:

Phng php huyt thanh (Min dch hunh
quang, ELISA); PCR; nui cy trn chut nht
hoc t bo.
Prevention:
Avoid areas with mites; mite bite prevention
by impregnating clothes with miticides; mite
elimination in high risk areas; there is no
effective vaccine available.
Epidemiology:
It is estimated that over one million cases of
scrub typhus occur each year. Infections most
often occur in rural areas where diagnostic
facilities are limited. Scrub typhus is thought
to occur within the so-called Scrub typhus
triangle, boundered by Siberia (north),
Kamchatka Peninsula (east), Pakistan (west),
and Australia (south). O. tsutsugamushi
infection primarily occurs in tropical climate in
Asia, but is also found in temperate zones and
semi arid climates, including in scrub, gardens,
forests and beach areas and mountain deserts.
In southern China, human infections typically
occur in the summer and in northern areas
the disease occurs mainly during autumn and
winter. The migration of infested or infected
rodents can lead to establishment of new foci
of disease.
In Vietnam there is limited epidemiologic data
on scrub typhus, however it is a common cause
of febrile illness. It has been detected in all
regions in Vietnam. In northern Vietnam, 251
confirmed scrub typhus cases were admitted
to one hospital between 2001 and 2003. The
patients presented with typical symptoms,
like: fever (100%), headache (81.2%), diffuse
myalgias (67.7%), and eschar (64.9%). More
Phng nga:
Trnh cc khu vc c m, trnh m t bng
trang b qun o c thuc dit m; dit tr m
ti vng nguy c cao; khng c vc xin phng
nga hiu qu.
Dch t hc:
Theo c tnh, c hn mt triu trng hp st
m hng nm. Bnh thng xy ra ti cc khu
vc nng thn ni iu kin chn on hn ch.
Bnh st m c cho l ph bin ti khu vc
c gi l tam gic st m ranh gii bi
Siberia (pha Bc), bn o Kamchatka (pha
ng), Pakistan (pha ty), v c (pha nam).
Nhim O. tsutsugamushi ban u ch yu xy ra
ti vng kh hu nhit i chu , nhng cng
xut hin vng n i v vng kh hu bn sa
mc bao gm nhng vng bi rm, vn, rng,
b bin v sa mc trn cao. min nam Trung
Quc, cc ca nhim ngi thng vo ma h
v min bc, bnh ch yu trong khong ma
thu v ma ng. S di c ca cc loi gm
nhm b nhim khun hoc b nhim bnh c
th dn n s hnh thnh nhim trng thin
nhin mi.
Vit Nam, d liu dch t hc v bnh st m
cn rt hn ch, tuy nhin st m l mt nguyn
nhn ph bin gy st. Bnh c pht hin
trong tt c cc vng Vit Nam. Trn min bc
Vit Nam, 251 trng hp st m c chn on
xc nh nhp vin t nm 2001 n nm
2003 ti 1 bnh vin. Cc bnh nhn c triu
chng in hnh: st (100%), au u (81,2%),
127
Ch : St m
than 70% of the cases came from rural areas and

were farmer. The disease is present in all months
of the year, but in northern Vietnam it is higher
in the warmer months from May to November.
Map sources:
The Scrub typhus map was made by visualizing
provinces where cases have been reported in the
medical literature up to 2009.
Limitation:
Data missing from many areas accross Vietnam.
The disease is likely present throughout Vietnam
au c lan ta (67,7%), v c vt lot ng vay

(64,9%). Hn 70% cc trng hp n t cc
vng nng thn v l nng dn. Bnh xut hin
trong tt c cc thng trong nm, nhng min
Bc Vit Nam, thng cao trong nhng thng
tri nng, t 5 ti thng 11.
Ngun bn :
Bn st m th hin cc tnh ghi nhn ca mc
trong cc bi bo y hc n nm 2009.
Hn ch ca bn :
S liu b thiu rt nhiu vng trn Vit Nam
mc d bnh ny c kh nng xut hin trn
ton b t nc

- Izzard L, et al (2010). Isolation of a novel Orientia species (O. chuto sp. nov.) from a patient
infected in Dubai. J Clin Microbiol 48 (12): 4404-9.
- Kelly DJ, el al. (2009) Scrub Typhus: The Geographic Distribution of Phenotypic and Genotypic
Variants of Orientia tsutsugamushi. Clin Infect Dis 48: S203 S230.
- Kramme S, et al. (2009) Orientia tsutsugamushi bacteremia and cytokine levels in
Vietnamese scrub typhus patients. J Clin Microbiol;47(3):586-9.
- Pham TT, et al (2008). Scrub typhus in Vietnam. Abstract for the South East Asia Infectious
Disease Clinical Research Network (SEAICRN) annual meeting, Bali, Indonesia.
United Kingdom.
- World Health Organization (1989). Areas of endemic chigger-borne rickettsiosis and distribution
of the Leptotrombidium vectors. Geographical distribution of arthropod-borne diseases and their
principal vectors. Unpublished document WHO/VBC/89.967. Geneva.
- Zhang et al (2010). Scrub typhus in previously unrecorgnized areas of endemicity in China. J Clin
Microbiol 1241- 1244
United Kingdom.
- Veasna Duong (2010). Molecular epidemiology of Orientia tsutsugamushiin Cambodia and Central
Vietnam reveals a broad region-wide genetic diversity, Infection, Genetics and Evolution
128
Subject: Streptococcus suis
Ch : Lin cu ln
129
Ch : Lin cu ln
Classification:
ICD-9 A41.09; ICD-10 A40.8
Phn loi:
ICD-9 A41.09; ICD-10 A40.8

Meningitis,
septicaemia,
endocarditis.
Streptococcus suis meningitis is considered
to be the most common cause of adult human
bacterial meningitis in Vietnam.

Vim mng no, nhim khun huyt
(septicaemia), vim ni tm mc (endocarditis).
Vim mng no do lin cu ln c xem l
nguyn nhn gy bnh vim mng no thng
gp nht ngi trng thnh Vit Nam.
Agent:
Streptococcus suis, a Gram-positive alphahemolytic bacterium, with 35 serotypes based
on capsular polysaccharide antigens. The
predominant one causing human disease is
serotype 2.
Reservoir:
Mainly pigs; occasionally found in wild boar,
horses, dogs, cats and birds. Asymptomatic
adult pigs can typically carry the bacteria in
their tonsils, genitals and intestines.
Transmission:
Transmission to humans occurs mostly by
direct contact with infected pigs through
wounds on the skin, including minor abrasions,
or contaminated pork products, usually via
ingestion of raw/undercooked pork products.
No human-to-human transmission has been
documented to date.
Cycle:
Pig-to-pig, with occasional spill-over to
humans.
Incubation Period:
From a few hours up to two weeks. Inoculation
through cuts and wounds in the skin are thought
to be associated with a shorter incubation
period.
Clinical Findings:
Fever and signs of meningitis including
headache, vomiting, neck stiffness, intolerance
Tc nhn:
Lin cu Streptococcus suis, l vi khun tan
mu alpha, Gram dng, c 35 tp huyt thanh
da vo cc v polysaccharid vi khun. Tp
gy bnh ch yu ngi l tp 2.
cha:
Ch yu l ln; thnh thong tm thy cc
ng vt hoang d nh ln li, nga, ch, mo
v chim. Ln trng thnh khng triu chng
c th mang vi khun trong hu hng, b phn
sinh dc v rut non.
Ly truyn:
Ly truyn cho ngi ch yu do tip xc vi
ln b nhim vi khun thng qua vt thng
trn da, k c cc try xc nh; hoc qua cc
sn phm tht ln nhim khun thng qua vic
tiu ho cc sn phm tht ln cha nu chn
k. Cho n nay, cha tm thy bng chng ly
nhim trc tip t ngi sang ngi.
Chu k:
Ln- ln, i khi truyn sang ngi.
Thi k bnh:
T mt vi gi n 2 tun. Nhim vi khun qua
vt ct, vt thng trn da c xem l c thi
k bnh ngn hn.
Biu hin lm sng:
St v c cc du hiu vim mng no bao gm
au u, nn, cng gy, s nh sng, gim
thc l nhng du hiu chnh ca bnh. Du hiu
130

of light and decreased level of consciousness, are
common presenting features of this infection.
Signs of bleeding ranging from petechiae to
extensive ecchymosis are also commonly seen.
Hearing loss, generally permanent, is found
in around 50% of those infected. Arthritis,
pneumonia and fatal toxic shock syndrome are
also possible complications.
Diagnostic Tests:
Recovery of bacteria from the cerebrospinal
fluid, blood or fluid from arthritic joints from
culture and/or polymerase chain reaction (PCR).
Streptococcus suis can often be misidentified as
another streptococcal species and therefore this
infection is probably underdiagnosed.
Prevention:
During outbreaks: Strict control on animal
movements and slaughtering; health education
of everyone who butchers, prepares and cooks
pork, including in their homes; wearing gloves
to handle raw or uncooked pork, careful
washing of hands and utensils.
Adequate cooking essential: WHO recommends
cooking pork to reach an internal temperature
of 70C, or until the juices are clear rather than
pink.
Epidemiology:
Since 1968, worldwide, more than 700 human
cases of Streptococcus suis infection have been
reported, with most cases originating from
southeast Asia. In Vietnam, S. suis infection
was first reported in 1996 and serotype 2 has
been identified as the most frequent cause of
bacterial meningitis in adults in Vietnam. One
of the most important risk factor is contact with
pigs or uncooked pig products, typically by
farmers, veterinary personnel, abattoir workers
and butchers. Furthermore, in Vietnam as in
several other Asian countries it is common to
consume uncooked pork products, like raw
blood pudding which is a risk for acquiring the
Ch : Lin cu ln
chy mu c th t dng chm xut huyt n
ban xut huyt hoi t lan rng, cng thng
gp. Suy gim thnh lc, thng l vnh vin,
gp trong khong 50% ca nhim bnh. Vim
khp, vim phi v hi chng shock nhim
khun huyt nhim c e da tnh mng l cc
bin chng c th xy ra.
Cc xt nghim chn on:
Phn lp vi khun t cc mu bnh phm dch
no ty, mu, dch khp vim bng nui cy v/
hoc PCR. Lin cu Streptococcus suis thng
chn on nhm vi cc loi lin cu khc, do
vy bnh ny c th b b st.
Phng bnh:
Trong v dch: Kim sot cht ch vic vn
chuyn v git m gia sc; gio dc sc khe
cho ngi lm ngh git m, bn tht, ch bin
v v nu tht ln, k c lm h gia nh; eo
gng tay khi tip xc vi tht sng hoc cha
chn, ra sch tay v cc dng c.
Yu cu ch bin thc n ng: T chc Y t
Th gii khuyn co cn nu tht ln t n
nhit 70 C bn trong ming tht, hoc
n khi nc luc trong khng cn mu hng.
Dch t hc:
T nm 1968, trn th gii c khong 700 ngi
mc bnh do S. suis c ghi nhn, hu ht cc
ca bnh ny cc nc ng nam . Vit
nam, nhim lin cu ln c bo co ln u
tin nm 1996 v tp huyt thanh 2 l tc nhn
chnh gy bnh vim mng no do vi khun
ngi trng thnh. Mt trong nhng yu t
nguy c chnh l tip xc vi ln hoc tht ln
cha nu chn, in hnh l ngi nng dn
chn nui, cn b th y, ngi git m, ngi
bn tht. Hn na, Vit Nam cng nh mt s
quc gia chu khc, c thi quan n tht ln
cha nu, v d nh n tit canh, l mt ngun
nhim bnh nguy him. Nhng ngi b suy
gim min dch, v d nh ngi b ct lch, l
131

disease. Individuals who are immunosuppressed,
including those who have had a splenectomy, are
also at increased risk.
Map sources:
The Streptococcus suis map was made by
geocoding all reported human cases in Vietnam
up to 2011. Pig density data are based on data
from General Statistics Office in 2006.
Data limitations:
Not all Streptococcus suis are reported and no
incidence data are avaliable.
Ch : Lin cu ln
i tng c nguy c mc bnh cao.
Ngun bn :
Bn Streptococcus suis l tt c cc ca bnh
lin cu ln ngi c bo co Vit nam
theo v tr a l n nm 2011. Bn mt
ln da vo s liu ca Tng cc thng k Vit
Nam nm 2006.
Hn ch s liu:
Khng phi tt c cc ca bnh lin cu ln
ngi u c bo co v khng c s
liu mc.

- Nghia HD, et al (2011) Risk factors of Streptococcus suis infection in Vietnam. A case-control
study. PLoS One. 2011 Mar 8;6(3).
- Wertheim H, et al. (2009) Streptococcus suis: an emerging pathogen. Clin Infect Dis 48: 617-625.
- Nguyen THM, et al. (2008) Streptococcus suis meningitis in adults in Vietnam. Clin Infect Dis 46.
- Lun ZR, et al. (2007) Streptococcus suis, an emerging zoonotic pathogen. Lancet Infect Dis 7 (3):
201-9.
United Kingdom.
132
Subject: Trachoma
Ch : au mt ht
133
Subject: Trachoma
Ch : au mt ht
Classification:
ICD-9 076.1; ICD-10 A71
Phn loi:
ICD-9 076.1; ICD-10 A71

Chronic follicular conjunctivitis, Egyptian
ophthalmia,
granular conjunctivitis, war
ophthalmia and military ophthalmia.
Hi chng v ng ngha:
Vim kt mc mn tnh c ht, vim mt Ai Cp,
vim kt mc dng ht, vim mt thi chin.
Agent:
Repeated infection with Chlamydia trachomatis,
serovars A, B, Ba, and C cause this syndrome.
C. trachomatis is an obligate intracellular
bacterium.
Reservoir:
Humans.
Vector:
Flies contribute to the spread of ocular serovars
of C. trachomatis, in particular Musca sorbens
and M. domestica.
Transmission:
Repeated direct contact with infected secretions
from infected individual (mainly from eye or
nose); also by hands and fomites (shared cloths,
towels or bedlinen). Flies also play a role in the
transmission. High risk of infection in close
contacts of infected individuals.
.
Incubation Period:
7-14 days for conjunctivitis; years to decades
for trichiasis and eventually corneal damage
and blindness. Repeated infection over many
years can cause the inside of the eyelid to
become scarred. This scarring can be so severe
that the eyelid turns inward and the lashes
rub on the eyeball, scarring the cornea. If left
untreated, this condition leads to the formation
of irreversible corneal opacities and blindness.
Clinical Findings:
An epidode of active disease is a self-limiting
conjunctivitis, with watery or mucopurulent
discharge. Typical findings are lymphoid
Tc nhn:
Ti nhim nhiu ln vi Chlamydia trachomatis,
tp huyt thanh A, B, Ba, v C gy ra hi chng
ny. C. trachomatis l vi khun k sinh ni bo
bt buc.
cha:
Ngi.
Vector:
Rui gp phn vo s ly lan ca ca vi khun
C. trachomatis, c bit l nhm Musca sorbens
v Musca domestica.
Ly truyn:
Tip xc trc tip nhiu ln vi cht tit t
ngi b nhim bnh (ch yu t mt hoc
mi), qua tay v dng chung (khn mt, khn
tay hoc ga tri ging). Rui cng ng vai tr
truyn bnh. Tip xc gn vi ngi bnh lm
tng nguy c ly nhim.
Thi gian bnh:
7- 14 ngy i vi vim kt mc; nhiu nm
n vi thp k i vi chng lng xiu, qum
v cui cng c th dn n tn thng gic
mc v m la. Ti nhim trng nhiu ln trong
nhiu nm c th gy so kt mc. So c th
tr nn rt nghim trng lm mi cp vo, lng
mi c ln nhn cu dn n so gic mc. Nu
khng c iu tr, tnh trng ny dn n c
gic mc vnh vin v m la.
Biu hin lm sng:
Giai on hot ng ca bnh l vim kt mc
t gii hn, vi chy nc mt hoc nhiu ghn
mt. in hnh c th pht hin ht nh v ht
to (nh). Ti nhim trng nhiu ln dn n so
134
Subject: Trachoma
follicles and papillary hypertrophy. Repeated
infections lead to scarring of the conjunctiva
and trichiasis. Trichiasis damages the corneal
surface, resulting in keratitis, vascularization
of the cornea, and impaired defence against
secondary bacterial and fungal infection.
Corneal damage produced by corneal scarring
can lead to blindness.
Diagnostic Tests:
Clinical diagnosis of active disease by presence
of follicles and papillae on the conjunctival
epithelium of the upper eyelid. Trichiasis and
corneal opacity are also diagnosed clinically.
Presence or absence of infecting agent (by any
method, including PCR) has poor correlation
with presence or absence of disease or its
severity; serology has virtually no diagnostic
value.
Prevention:
Individuals with trichiasis require eyelid
surgery. Individuals with active disease require
antibiotics: a single oral dose of azithromycin
or topica tetracycline eye ointment are the
recommended options. Treatment of individual
cases has little impact, however, because of
rapid reinfection from asymptomatic contacts:
community management using the SAFE
strategy (Surgery for trichiasis, Antibiotics
to clear infection, Facial cleanliness and
Environmental improvement [water and
sanitation] to reduce transmission) is the
recommended means for control in endemic
areas; this strategy includes both treatment and
prevention.
The WHO Alliance for the Global Elimination
of Trachoma (GET 2020) seeks to eliminate
trachoma as a public health problem by 2020.
Epidemiology:
Trachoma is the leading infectious cause of
blindness worldwide and is generally a disease
of resource-poor rural communities. These
Ch : au mt ht
kt mc v lng xiu, qum. Lng xiu, qum
lm tn thng b mt gic mc, kt qu l so
c gic mc, mng mu trn gic mc v lm
gim kh nng khng vi bi nhim vi khun
v nm. Tn thng gic mc do so gic mc
c th dn n m la.
Xt nghim chn on:
Chn on lm sng mt ht hot ng da trn
s xut hin ca ht v nh trn biu m kt
mc ca m mt trn. Lng xiu, qum v m
c gic mc cng c vai tr chn on lm
sng. Pht hin tc nhn (c xc nh bng
bt k phng php no, bao gm c PCR) t c
gi tr chn on mc bnh hay mc bnh,
huyt thanh hc hu nh khng c gi tr chn
on.
Phng nga:
Nhng ngi c lng qum cn c phu thut
m mt. Ngi mc bnh th hot ng cn c
iu tr khng sinh: ung mt liu duy nht
azithromycin hoc tra thuc m tetracycline.
iu tr tng ca bnh ring bit c tc ng hn
ch, tuy nhin, bi v s ti nhim nhanh t tip
xc vi ngi khng biu hin triu chng nn
qun l cng ng vi Chin lc SAFE (Phu
thut iu tr lng qum, dng thuc khng sinh
chng nhim trng, v sinh c nhn [mt] v
ci thin mi trng [nc sch v v sinh]
gim ly truyn) l bin php kim sot vng
dch lu hnh c khuyn co, chin lc ny
ny bao gm c iu tr v phng nga.
Lin minh Ton cu Loi tr bnh mt ht ca
TCYTTG (GET 2020) t mc tiu loi tr
bnh khng cn l vn sc khe cng ng
vo nm 2020.
Dch t hc:
Bnh mt ht l nguyn nhn nhim trng hng
u gy ra m la trn ton th gii v thng
l bnh ca cc cng ng dn c nng thn
ngho. Cc cng ng ny thng cc vng
nng v kh hn. Theo c tnh, khong 41
135
Subject: Trachoma
Ch : au mt ht
communities are often in hot and dry regions.

It is estimated that there are about 41 million
people with active trachoma and 8 million with
trichiasis. Highest prevalences are found in subSaharan Africa, with a high burden in Ethiopia
and Sudan, where active trachoma in some
communities can be found in >50% of 1-9 yearold children and trichiasis in >19% of adults.
In Asia and Central and South America, the
distribution is more focal. Previous studies in
Viet Nam have shown that from 12 districts in
8 provinces of northern Viet Nam, a prevalance
rate of 7.31% of people over the age of 34
were found to be suffering from trachomatous
trichiasis. Higher rates of 13.7% were found in
the district of Me Linh in Vinh Phuc province
and in the districts of Ha Tay and Khoai Chau in
Hung Yen province. Since this work however,
an international initiative to eradicate trachoma
has begun and overall the incidence of trachoma
is declining. The disease has disappeared from
Europe and North America due to improved
living conditions.
triu ngi mc bnh mt ht hot tnh v 8

triu ngi b lng qum. T l mc cao nht
vng sa mc Sahara chu Phi, c bit l
Ethiopia v Sudan, ti mt s cng ng, t l
bnh mt ht hot ng tr 1- 9 tui > 50% v
t l lng qum ngi ln > 19%.
chu , Trung v Nam M, t l mc mang
tnh vng min. Mt nghin cu trc y ti
Vit Nam, t l lng qum do mt ht ngi
> 34 tui l 7,31% 12 huyn thuc 8 tnh pha
bc Vit Nam. T l mc cao hn l huyn M
Linh, tnh Vnh Phc (13,7%) v cc huyn
thuc H Ty, huyn Khoi Chu, tnh Hng
Yn. T nghin cu ny, mt chng trnh
hnh ng quc t loi tr bnh au mt ht
trin khai v t l mt ht ni chung ang gim.
Cn bnh ny bin mt chu u v Bc
M do iu kin sng nng cao.
Further reading:
http://informahealthcare.com/doi/abs/10.1080/
09286580600599457?journalCode=ope
or www. trachomaatlas.org
Ngun bn :
S liu t chng trnh kho st quc gia v t
l au mt ht tr em tiu hc ti cc huyn
ca 40 tnh trn ton quc nm 2006, cc Qun
l Mi trng Y t- B Y t
Map sources:
National surveillance of trachoma rate in primary
school pupils in districts of 40 provinces in
2006, Health environment management agency.
Thng tin thm:

http://informahealthcare.com/doi/abs/10.1080/
09286580600599457?journalCode=ope
hoc www. trachomaatlas.org

- Burton MJ, et al. (2010) The Global Burden of Trachoma: A Review. PLoS Negl Trop Dis; 3 (10):
e46
- Hu VH, et al.(2010) Epidemiology and control of trachoma: systematic review. Trop Med Int
Health; 15 (6): 673-691..
- Wright HR, et al. (2007) Trachoma. Lancet; 371: 1945-1954.
United Kingdom.
136
Subject: Tuberculosis
Ch : Bnh lao
137
Ch : Bnh lao
Classification:
ICD-9 010-018; ICD-10 A15-A19
Phn loi:
ICD-9 010-018; ICD-10 A15-A19

Consumption, white plague, TB (Can present
affecting any body system).

Lao lc, ho lao (c th biu hin bt c c
quan no ca c th)
Agent:
Mycobacterium
tuberculosis
complex,
including M. tuberculosis, M. africanum, M.
canetti, and M. bovis, slow growing acid-fast
rods. M. bovis is outside the scope of this fact
sheet.
Tc nhn:
Mycobacterium tuberculos complex (phc hp
loi), bao gm M. tuberculosis, M. africanum,
M. canetti, and M. bovis, trc khun khng cn
toan pht trin chm. Vi khun M. bovis khng
thuc phm vi ca ti liu ny.
Reservoir:
Mainly humans; rarely non-human primates
and other mammals.
cha:
Ch yu ngi; him gp hn cc loi linh
trng v ng vt c v khc.
Transmission:
Person-to person via inhalation of infectious
aerosols from cases with pulmonary tuberculosis,
particularly after prolonged exposure over time.
Extra-pulmonary tuberculosis is generally not
communicable. HIV-infected individuals are
about 20 times more likely than HIV-negative
people to develop TB.
Ly truyn:
T ngi sang ngi do ht phi cc ht nc
bt nhim khun t cc ca bnh lao th phi, c
bit l sau phi nhim ko di. Lao ngoi phi
thng c xem l bnh khng truyn nhim.
Mt ngi nhim HIV c nguy c nhim lao
cao hn 20 ln so vi ngi HIV m tnh.
Incubation Period:
2-10 weeks to primary lesion or tuberculin
positive skin test; around 10% progress to
active disease annually, but it may remain latent
for decades or even lifelong. This percentage is
usually higher in children and in HIV-infected
or otherwise immunosuppressed individuals.
Clinical Findings:
TB is a chronic disease with a gradual onset.
Pulmonary lesions occur in 70% of cases,
extrapulmonary (meningitis, skeletal, any other
organ, disseminated) in 30%. Extrapulmonary
TB is more common in children <5
years, and is also seen more commonly in
immunocompromised
individuals.
Early
symptoms of pulmonary tuberculosis are weight
Thi k bnh:
Sau 2- 10 tun c tn thng s nhim hoc c
phn ng da vi Tuberculin dng tnh; khong
10% thnh lao tin trin mi nm, nhng bnh
cng c th tim tng hng thp k hoc sut
i. T l ny thng cao hn tr em v ngi
nhim HIV, ngi c suy gim min dch.
Biu hin lm sng:
Lao l mt bnh mn tnh vi khi pht m .
Tn thng lao phi xut hin trong khong
70% ca bnh lao, lao ngoi phi (lao mng no,
lao xng, v lao cc c quan khc) chim
khong 30%. Lao ngoi phi thng gp hn
tr em di 5 tui v nhng ngi suy gim
min dch. Triu chng sm lao th phi l st
cn, st v ra m hi m, ho tin trin, au
ngc v ho ra mu. Triu chng lm sng lao
138
loss, fever and night sweats, cough, chest pain,
and haemoptysis. Symtoms of extrapulmonary
tuberculosis depend on infected organ(s),
and may present together with pulmonary
tuberculosis, but can also present with symtoms
such as: weight loss, fever and night sweats.
Diagnostic Tests:
Direct visualisation of acid fast bacilli in smears
or from cultures and PCR of sputum and other
body fluids, depending on clinical presentation.
Positive cultures for tuberculosis remain the
gold standard for diagnosis. Other tests such
as tuberculin skin test (Mantoux reaction) and
interferon gamma release assays (IGRAs) can
have a role in diagnosing latent tuberculosis,
but their role in active disease remains to be
fully clarified. Clinical diagnosing, based on
presentation and investigation findings such as
chest X-rays may also have a role.
Culture in liquid media is the gold standard
and allows for antibiotic susceptibility testing
but may take several weeks to months; PCR
allows for early detection, is possibly more
sensitive and recent assays include detection
of important resistance associated mutations.
Newer technologies such as the Gene-Xpert
MTB/Rif can cut down the time to diagnosis
of tuberculosis to a few hours from receiving
samples and can addionally identify resistance
to rifampicin
Prevention:
Primary: vaccination for children at birth.
The only existing vaccine against tuberculosis
(TB), Bacille Calmette-Gurin (BCG), created
in 1921, has variable protective efficacy. WHO
recommends vaccinating HIV-uninfected
infants with BCG as it provides protection
against severe extrapulmonary (non-lung)
forms of paediatric TB. However, BCG is
unreliable in protecting against pulmonary TB,
which accounts for most of the disease burden
worldwide
Ch : Bnh lao
ngoi phi thng ph thuc vo cc c quan
b lao v cng c th biu hin cng vi triu
chng ca lao phi, nhng cng c th ch st
cn, st v ra m hi m.
Xt nghim chn on:
Soi trc tip trc khun khng cn, khng toan
trong cc mu bnh phm hoc t nui cy v
dng k thut PCR cho cc bnh phm t m
v dch c th, ph thuc vo du hiu lm
sng. Nui cy vi khun lao dng tnh vn l
tiu chun vng trong chn on xc nh bnh
lao. Cc xt nghim khc nh phn ng da vi
Tuberculin dng tnh (phn ng Mantoux) v
phng php IGRAs (interferon gamma release
assays) cng ng vai tr quan trng trong chn
on lao tim tng nhng vai tr trong chn
on lao tin trin vn cn c lm r thm.
Chn on lm sng da trn cc triu chng,
biu hin bnh v cn lm sng nh X quang
ngc ng vi tr nht nh trong chn on
lao.
Nui cy trong mt trng lng l tiu chun
vng v cho php th khng sinh ca chng
lao nhng phi mt vi tun n vi thng mi
cho kt qu; PCR cho php pht hin sm hn,
l k thut nhy hn v cc xt nghim gn y
cho php pht hin c cc gen t bin khng
khng sinh ca vi khun lao. Cc k thut mi
hn nh Gene-Xpert c th gim thi gian chn
on xung cn mt vi gi sau khi nhn bnh
phm v c th pht hin thm kh nng khng
vi rifampicin.
Phng bnh:
Phng bnh ch ng (cp 1): Tim vc xin
cho tr s sinh. Loai vc xin duy nht chng
lai bnh lao, Bacille Calmette-Gurin (BCG),
c tao ra nm 1921, co hiu qua bao v rt
bin i. T chc Y t th gii khuyn cao nn
vic tim vc xin BCG cho tre s sinh khng
nhim HIV vi loai vac xin nay co th cung cp
bao v chng lai th lao ngoai phi nng tre
nho. Tuy nhin BCG khng ang tin cy trong
139
Secondary: intensive search for and treatment
of source cases; contact investigation and
treatment of tuberculin skin test/IGRA
positive cases with chemoprophylaxis.
Chemoprophylaxis consists of isoniazid for
6-12 months, or without rifampicin. Rifampicin
in combination with pyrazinamide are no
longer recommended due hepatotoxicity.
In 2006, WHO launched the STOP TB
strategy. Its goal is to dramatically reduce the
global burden of TB by 2015 in line with the
Millennium Development Goals (MDGs) and
the Stop TB Partnership targets
Objectives:
- Achieve universal access to high-quality care
for all people with TB
-Reduce the human suffering and socioeconomic
burden associated with TB
-Protect vulnerable populations from TB, TB/
HIV and multidrug-resistant TB
-Support development of new tools and enable
their timel and effective use.
-Protect and promote human rights in TB
prevention, care and control.
-Halt and begin to reverse the incidence of TB
by 2015
Targets linked to the MDGs and endorsed by
the Stop TB Partnership: by 2015: reduce
prevalence and deaths due to TB by 50%
compared with a baseline of 1990 by 2050:
eliminate TB as a public health problem
Epidemiology:
TB is a major cause of death and disability
worldwide, especially in developing countries.
Morbidity and mortality rates increase with
age, and are higher in males. In regions of high
incidence, morbidity peaks in adults of working
age. Morbidity is higher in urban than in rural
populations, among the poor, and in closed
institutions such as prisons, nursing homes,
shelters for the homeless, residential schools,
hospitals and military barracks. Globally it is
estimated that 1.3 million people died from TB
Ch : Bnh lao
vic chng lai bnh lao phi, cn bnh c
cho la tao nn ganh nng trn toan th gii.
Phng bnh cp 2: Pht hin sm v iu tr
trit cc ca bnh lao; iu tra phi nhim v
iu tr ha d phng cho cc ca phn ng da/
IGRA dng tnh. Thuc iu tr ha d phng
l isoniazid trong vng 6-12 thng cng hoc
khng cng vi rifampicin. Rifampicin kt hp
vi pyrazinamide khng cn c khuyn co
na do c tnh vi gan.
Vao nm 2006, T chc Y t thi gii a phat
ng chin dich Ngn chn Lao. Muc tiu cua
chin dich nay nhm giam nhanh chong ganh
nng bnh tt do lao n nm 2015 kt hp vi
Cc mc tiu pht trin thin nin k (MDGs)
va Hp tc ngn chn lao.
Muc tiu :
- t c tip cn ph cp chm sc cht lng
cao cho tt c nhng ngi bi lao
- Giam s au n cua con ngi va giam ganh
nng kinh t xa hi do bnh lao
- Bo v ngi dn d b tn thng do bnh
lao, lao / HIV v lao a khng thuc
- H tr pht trin cc cng c mi v cho php
s dng kp thi v hiu qu
- Bo v v thc y quyn con ngi trong
phng, chng, chm sc v kim sot bnh lao
- Ngn chn v bt u y li t l mc mi
bnh lao vo nm 2015
- Cc mc tiu lin lin kt vi chng trnh
MDGs v xc nhn bi chng trnh Hp tc
ngn chn lao: nm 2015: gim 50% t l v t
vong do bnh lao so vi nn tang ca nm 1990,
nm 2050: coi vic loi b bnh lao nh l mt
vn y t chung ca cng ng.
Dch t hc:
Lao l nguyn nhn chnh gy t vong v tn
tt trn th gii, c bit l cc nc ang
pht trin. T l mc v t l t vong tng ln
theo tui v cao hn nam gii. cc vng c
t l mc mi cao, t l mc t nh im
nhm tui lao ng. T l mc thnh th cao
hn nng thn, cao hn nhm ngi ngho
140
in 2008, with another 500,000 dying from HIVassociated TB.

Vietnam ranks 12th among the 22 highest
burden countries, which together account
for 80 % of the global TB burden. In 2011,
the estimated incidence of TB in Vietnam
was 180.000 (199/100.000), the estimated
prevalence was 323/100.000, the estimated
mortality 33/100.000. Vietnam is also one of
the 27 countries with a high burden of multidrug resistant tuberculosis (MDR-TB). In 2011,
an estimated 3.700 MDR-TB cases occurred
among notified TB cases. Vietnam has also
reported cases of extreme drug resistant
tuberculosis (XDR).
Map sources:
National Tuberculosis Control Programme of
Vietnam in 2011, National Lung Hospital.
v cao cc c s khp kn nh nh t, nh
dng lo, tri ngi v gia c, trng hc ni
tr, bnh vin v doanh tri qun i. Theo c
tnh, khong 1.3 triu ngi cht do lao nm
2008 trn ton cu v 500 nghn ca t vong
ngi nhim HIV lin quan ti lao.
Vit Nam ng th 12 trong s 22 nc gnh
nng cao, chim ti 80% gnh nng bnh tt
do lao ton cu. Trong nm 2011, t l mc
mi c tnh ca lao Vit Nam l 180.000
(199/100.000), t l hin mc c tnh l
323/100.000, t l t vong c tnh khong
33/100.000. Vit Nam cng l mt trong 27
nc chu gnh nng bnh tt do lao cao ca
lao a khng (MDR-TB). Trong nm 2011,
khong 3.700 trng hp lao a khng xy ra
nhng ca bnh lao c phat hin. Vit Nam
cng bo co cac trng hp lao siu khng
thuc (XDR).
Ngun bn :
Chng trnh phng chng Lao quc gia nm
2011, Vin phi trung ng.

- Dye C, et al. (2008) Measuring tuberculosis burden, trends, and the impact of
control programmes. Lancet Infect Dis 8: 233423.
- World Health Organization. (2008) Anti-tuberculous drug resistance in the world. WHO report
No. 4, Geneva.
- Wright A, et al. (2009) Epidemiology of antituberculosis drug resistance 200207: an updated
analysis of the Global Project on Anti-Tuberculosis Drug Resistance Surveillance. Lancet
- World Health Organization. (2011). Global Tuberculosis report 2011.
United Kingdom.
141
Subject: Typhoid
Ch : Thng hn
142
Subject: Typhoid
Ch : Thng hn
Classification:
ICD-9 002.0; ICD-10 A01.0
Phn loi:
ICD-9 002.0; ICD-10 A01.0

Enteric fever, typhus abdominalis, nervous
fever.
Hi chng v ng ngha:
St ng rut, st thn kinh.
Agent:
Salmonella enterica serovar Typhi (S. typhi ),
a Gram-negative bacillus. S. typhi belongs to
Salmonella serogroup D and possesses somatic
antigen O9, a single flagellar antigen Hd, and
virulence antigen Vi. S. Paratyphi A can cause
a similar disease syndrome.
Reservoir:
Mainly humans; rarely domestic animals.
Humans can be short-term carriers after an
infection (10%) or become chronic carriers in
biliary tract (1-5%), shedding viable bacteria
in the stool. Chronic carriers are mainly adults
with pre-existing biliary tract pathology.
Transmission:
Typhoid is transmitted through contaminated
water or food. It can also be transmitted by
the faecal oral route, via fecally contaminated
water, drinks or food from infected individuals
or carriers. The disease commonly occurs in
association with poor standards of hygiene in
food preparation and food handling.
Cycle:
Infected individuals shed bacteria into
environment, contaminating water and food
products that are subsequently ingested by
other humans.
Incubation period:
Usually 8-14 days but this can depend on the
infective dose and can vary from a few days to
two months.
Tc nhn:
Salmonella enterica bin th huyt thanh Typhi
(S. typhi ), trc khun Gram m. S. typhi thuc
nhm huyt thanh Salmonella nhm huyt
thanh D v c khng nguyn thn O9, mt
khng nguyn lng Hd, v khng nguyn v
Vi c c lc. S. paratyphi A c th gy ra hi
chng bnh tng t.
cha:
Ch yu l con ngi, him khi l vt nui.
Con ngi c th l ngi lnh mang trng
tm thi sau khi b nhim trng (10%) hoc tr
thnh ngi mang trng kinh nin hay cha
mn tnh, trong ng mt (1- 5%), pht tn vi
khun sng theo phn. cha mn tnh ch yu
l ngi ln c bnh l ng mt t trc.
Ly truyn:
Thng hn ly truyn qua nc hoc thc
phm b nhim. Bnh cng ly truyn ng
phn-ming, qua nc b nhim phn,
ung hoc thc phm t ngi b bnh hoc
ngi lnh mang trng. Cn bnh ny thng
lin quan n tiu chun v sinh thp km trong
ch bin thc phm v phc v.
Chu k:
Nhng ngi nhim thi vi khun ra mi
trng, sau nc v cc sn phm thc phm
nhim vi khun c hp th bi nhng ngi
khc.
Thi gian bnh:
Thng thng 8- 14 ngy nhng c th ph
thuc vo liu ly nhim v c th thay i t
vi ngy n hai thng.
143
Subject: Typhoid
Clinical findings:
Common presenting symptoms include fever,
chills, myalgia, headache, malaise, anorexia,
nausea, abdominal discomfort with abdominal
tenderness and hepatosplenomegaly. Adults
may have constipation, while young children
and HIV patients more often have diarrhea. In
5-30% rose spots are present on the abdomen
and chest. Children <5 years regularly have
unspecific symptoms and therefore remain
undiagnosed. Complications occur in 10-15%,
including gastrointestinal bleeding, intestinal
perforation, and typhoid encephalopathy.
Gastrointestinal bleeding, due to bleeding in
congested Peyers patches, is the most common
complication. The CFR is approximately 2%
(range: 0-18%). Patients with a reduced level
of consciousness or encephalopathy with or
without shock, have a higher mortality.
Diagnostic tests:
Bone marrow culture is the gold standard; blood
culture and stool culture are useful; Widal test
performance is poor and should not be used.
Prevention:
Improving sanitation and hygiene are the
essential measures that should be taken to
prevent typhoid. This includes improving access
to clean water, pasteurization of dairy products,
quality control and hygieneprocedures for the
food industry and excluding typhoid carriers
from food handling. Vaccination of at risk
groups and eradicating carriage also has a role
in disease prevention.
Epidemiology:
In 2000 it was estimated there were
approximately 21,650,000 new S. typhi
cases and 216,500 deaths, with large regional
variability. These estimates are based on limited
data from mainly countries with a high disease
incidence. Typhoid fever incidence is highest
Ch : Thng hn
Biu hin lm sng:
Cc triu chng biu hin thng thng gm
st, n lnh, au c, nhc u, mt mi, chn
n, bun nn, kh chu bng vi phn ng
thnh bng nh v gan lch to. Ngi ln c th
b to bn, trong khi tr em v bnh nhn HIV
thng b tiu chy. Trong 5- 30% c nt hng
ban trn bng v ngc. Tr < 5 tui thng
khng c cc triu chng c hiu nn b b st.
Cc bin chng xy 10- 15% s ca mc, trong
thng gp xut huyt tiu ha, thng rut,
vim no mng no thng hn. Xut huyt tiu
ha, do cc mng Peyers b vim xung huyt
(chy mu), l bin chng thng gp nht. T
l cht/mc thng l 2% (dao ng 0- 18%).
Bnh nhn c biu hin gim thc, mt no
c hoc khng c sc thng c t l t vong
cao hn.
Xt nghim chn on:
Nui cy ty xng l tiu chun vng, cy
mu v cy phn c gi tr chn on, phn ng
Widal khng c nhiu gi tr v khng nn s
dng.
Phng nga:
Ty u v sinh mi trng v nng cao v sinh
c nhn l nhng bin php cn thit thc hin
ngn nga thng hn. Ci thin tip cn
ngun nc sch, kh trng cc sn phm theo
phng php pasteur, kim sot cht lng v
quy nh v sinh trong ngnh cng nghip thc
phm v cm ngi mang trng tham gia vo
cc khu ch bin thc phm v phc v n
ung. Tim chng cho cc nhm nguy c v
loi tr cha c mt vai tr phng bnh.
Dch t hc:
Nm 2000, c tnh c khong 21.650.000
trng hp mi mc S. typhi v 216.500 ca t
vong, vi s khc bit ty tng khu vc. Nhng
c tnh da trn d liu hn ch v ch yu t
cc nc c t l mc bnh cao. T l thng
144
Subject: Typhoid
Ch : Thng hn
among infants and children living in South

Central and South East Asia and South Africa.
Two seasonality patterns are observed: (1)
higher incidence in warmer dry months leading
to higher bacterial loads in the water, and (2)
higher incidence in the rainy season, due to spill
over from sewage to drinking water. Declines
are seen in regions where living conditions have
improved, mainly due to access to clean water
and sanitation (Water and Sanitation map).
In Viet Nam, several epidemiological studies
looking at the rate of S. typhi have been carried
out. Recently a study of typhoid fever in five
Asian countries suggested that the isolation rate
in Viet Nam was 5.0 per 1000 cultured febrile
episodes, with an incidence rate of 24.2 cases
per 100,000 person-years.
hn l cao nht tr s sinh v tr em Nam

Trung , ng Nam v Nam Phi. Hai m
hnh theo ma c quan st thy: (1) t l mc
cao trong nhng thng kh nng dn n lng
vi khun cao trong nc, v (2) t l mc cao
trong ma ma, do trn nc thi vo ngun
nc sinh hot. T l gim r rt trong khu vc
m iu kin sng c ci thin, ch yu l do
tip cn vi nc sch v v sinh mi trng
(Bn nc v v sinh).
Vit Nam, mt s nghin cu dch t hc v
t l S. typhi c thc hin. Gn y, mt
nghin cu v bnh thng hn trong nm quc
gia chu cho rng t l phn lp ti Vit Nam
l 5.0/1000 mu nui cy ly trong giai on
st, vi t l mc 24,2 trng hp trn 100.000
ngi-nm.
Map sources:
Medicine.
Ngun bn :
2007 n 2011, Cc Y t d phng.

- Crump JA. (2004) The global burden of typhoid fever. Bull World Heath Org
- Crump JA. (2010) Global Trends in Typhoid and Paratyphoid Fever. Clin Infect Dis 50: 241- 246.
- Dolecek C. (2010) A multi-center randomised controlled trial of gatifloxacin versus azithromycin
for the treatment of uncomplicated typhoid fever in children and adults in Vietnam. PLoS ONE 3
(5): e2188.
- Ochiai RL (2008) A study of typhoid fever in five Asian countries: disease burden and implications
for controls. Bull World Health Org 86: 260 268.
- Parry CM, et al. (2002) Typhoid fever. N Engl J Med 347(22): 1770 - 1782.
United Kingdom.
145
Subject: Whooping cough
Ch : Ho g
146
Ch : Ho g
Classification:
ICD-9 033; ICD-10 A37.0
Phn loi:
ICD-9 033; ICD-10 A37.0

Pertussis, 100 days cough
Hi chng v ng ngha:
Ho g, ho 100 ngy
Agent:
Infection is caused by the gram-negative, aerobic
coccobacillus bacterium Bordetella pertussis.
Tc nhn:
Nhim trng gy ra bi trc khun Gram m, hiu
kh Bordetella pertussis.
Reservoir:
Humans
cha:
Con ngi.
Transmission:
Airborne droplets from coughing or sneezing
from infected persons.
Ly truyn:
Nhng git nc bt nh l lng trong khng kh,
b bn ra khi ngi b nhim ho hoc ht hi.
Incubation period:
The incubation period is usually 9-10 days but
can range from 6-20 days. Infected people are
considered infectious from the beginning of the
coryzal stage (runny nose, sneezing, low-grade
fever) until about the third week after the onset of
the cough or until 5 days after the start of effective
antimicrobial therapy.
Thi gian bnh:

Thi gian bnh thng l 9-10 ngy nhng c
th trong khong 6-20 ngy. Ngi b nhim bnh
c th truyn bnh t u giai on u vi vim
long (chy nc mi, ht hi, st nh) cho n
khong tun th ba sau khi c ho hoc cho n 5
ngy sau khi bt u iu tr khng sinh c hiu
qu.
Clinical findings:
The infection usually starts with coryzal symptoms
like a runny nose, congestion, sneezing, mild
cough or fever. Usually after 1-2 weeks, the
severe coughing begins.
Whooping cough can cause a series of coughing
fits that can continue for weeks, and can cause
repeated violent and rapid coughing forcing the
infected patients to inhale with a loud whooping
sound. In infants, the classical whooping cough
can be minimal or even absent. They may however
have life-threatening episodes of apnoea.
The infection is most severe in babies and younger
children. More than half of infants who get
whooping cough need hospitalization and about 1
out of 5 infected infants will develop pneumonia.
Whooping cough has also been associated with
seizures, and the apnoeic episodes related to
Biu hin lm sng:

Nhim trng thng bt u vi cc triu chng
vim long ng h hp trn nh chy nc mi,
tc nghn mi, ht hi, ho nh hoc st. Thng
sau 1-2 tun, giai on ho cn d di bt u.
Ho g c th gy ra mt lot cc cn ho lin tip
c th ko di trong nhiu tun, v c th gy ln
ho lin tc gi di v nhanh buc bnh nhn th
ht vo nghe nh ting g rt. tr s sinh, cn ho
g in hnh khng r hoc khng c. Tuy nhin
ho g c th gy ngng th e da tnh mng.
Bnh h g nghim trng nht tr s sinh v tr
nh. Hn mt na s tr b bnh ho g cn phi
nhp vin v khong 1 trong s 5 tr s sinh b
nhim bnh s tin trin thnh vim phi. Ho g
cng c th lin quan n co git v ngng th
trong ho g c th dn n tn thng no hoc
t vong.
147
Ch : Ho g
infection could lead to brain damage or death.

Diagnostic tests:
Nose and throat swabs can be cultured on BordetGengou medium, or be used for PCR. The bacteria
can only be recovered from the patient during the
first three weeks of illness, so culturing is only
useful during this time. Serological tests can also
be useful for diagnosis.
Prevention:
There is a vaccine available against whooping
cough, and it is usually combined with the
vaccines for diphtheria, tetanus (DTP). For
maximum protection against whooping cough,
children usually require five DTP shots. In 2008,
about 82% of all infants worldwide received 3
doses of pertussis vaccine and it was estimated
that this averted about 687 000 deaths.
Epidemiology:
The number of reported cases of whooping
cough varies from year to year and tends to peak
every 3-5 years. The World Health Organization
estimated that in 2008, about 16 million cases of
whooping cough occurred worldwide, and that
95% of these cases were in developing countries.
It also estimated that about 195 000 children died
from the disease that year. In 2011, 18,719 cases
were reported in the U.S.
Map sources:
Medicine.
Xt nghim chn on:

Bnh phm ngoy mi v hng c th c nui
cy trn mi trng Bordet-Gengou, hoc s dng
cho PCR. Cc vi khun ch c th c tn ti
bnh nhn trong ba tun u, nui cy ch hu ch
trong thi gian ny. Xt nghim huyt thanh hc
cng c th c ch cho chn on.
Phng nga:
Vc xin nga ho g sn c v thng c
kt hp vi vc xin nga bnh bch hu, un vn
(DTP). bo v ti a chng li bnh ho g,
tr em cn c tim nm mi DTP. Nm 2008,
khong 82% tr em trn ton th gii nhn c 3
liu vc xin nga bnh ho g v c tnh ngn
chn c khong 687.000 ca t vong.
Dch t hc:
S ca ho g bo co thay i t nm ny sang nm
khc v c xu hng t mc cao nht theo chu
k 3- 5 nm. T chc Y t Th gii c tnh trong
nm 2008, c khong 16 triu trng hp ho g
trn ton th gii, v 95% cc trng hp ny l
cc nc ang pht trin. S liu c tnh c
khong 195.000 tr em cht v bnh ho g trong
cng nm. Trong nm 2011, 18.719 trng hp
c bo co ti M.
Cc ngun bn :
Nin gim thng k bnh truyn nhim nm 2007
n nm 2011, Cc Y t d phng.

- World Health Organisation Health topics Pertussis. http://www.who.int/topics/pertussis/en/
Accessed Nov 2012
- CDC Pertussis information page. http://www.cdc.gov/pertussis/ Accessed Nov 2012
United Kingdom.
148
SECTION 3
Parasitic diseases/Cac bnh do ky sinh trung
149
Subject: Amoebic dysentery
Ch : L amip
150
Ch : L amip
Classification:
ICD-9 006; ICD-10 A06
Phn loi:
ICD-9 006; ICD-10 A06
Synonyms:
Amoebiasis, amebic dysentery.
ng ngha:
Bnh do amp, kit l amp, l amp
Agent:
A protozoan parasite, Entamoeba histolytica,
that exists in two forms: non-motile cyst and
motile trophozoite. E. histolytica needs to
be distinguished from the non-pathogenic
E. dispar. E. moshkovskii is a common
cause of non-invasive diarrhea, and is also
indistinguishable from E. histolytica and E.
dispar.
Tc nhn:
n bo k sinh, Entamoeba histolytica, tn
ti 2 th: th ngh (kn hoc khng di ng) v
th hot ng. Cn phn bit E. histolytica vi
cc n bo khng gy bnh nh E. dispar. E.
moshkovskii l nguyn nhn ph bin ca tiu
chy khng xm ln, v kh c th phn bit
gia E. histolytica vi E. dispar.
Reservoir:
Humans; the parasite has also been detected in
non-human primates (cynomolgus monkeys,
macaques). E. moshkovskii is also found in
environments ranging from clean riverine
sediments to brackish coastal pools, and sewage.
cha:
Ngi, ngoi ra k sinh trng cng c
pht hin cc loi linh trng khc (kh
cynomolgus, kh macaques). E. moshkovskii
cng c tm thy trong cc mi trng khc
nhau, t bn lng ven sng, vng nc l b
bin v cng rnh.
Transmission:
Fecal-oral route, mainly exposure to food or
water contaminated with infectious cysts.
Ly truyn:
ng phn- ming, ch yu do n ung phi
thc phm hoc nc b nhim th kn.
Cycle:
Ingested E. histolytica non-motile cysts will
excystate in the gastrointestinal tract and develop
to motile trophozoites that can penetrate the
gut mucosa. In the colon, the trophozoites will
encystate and develop to cysts that are excreted
with the faeces.
Chu k:
E. histolytica, th kn khng di ng khi vo
ng tiu ha ng vt cha s thot khi
lp v kn, pht trin thnh th hot ng
trophozoite c kh nng xm nhp nim mc
rut. Trong i trng, th hot ng trophozoite
s to lp v v pht trin thnh th kn o thi
theo phn.
Incubation period:
Days to months.
Clinical findings:
90% of the cases will be self-limited and
asymptomatic; 10% develops invasive intestinal
disease (colitis) and <1% extraintestinal disease
(liver abscess). Amebic colitis presents with
abdominal cramps, weight loss, and watery
Thi gian bnh:

Nhiu ngy n nhiu thng.
Biu hin lm sng:
90% cc trng hp s t hn ch v khng
c triu chng, 10% pht trin th bnh amp
rut xm ln (vim i trng) v <1% pht trin
bnh amp ngoi rut (p xe gan). Vim i
151

or sometimes bloody diarrhea; most patients
are a febrile. Amebic colitis rarely progresses
to necrotizing colitis, ameboma, and toxic
megacolon. Amebic colitis affects children
and adults equally, but mainly males. Amebic
liver-abscess mainly occurs in men aged 18 to
50 years, for unknown reasons. E. moshkovskii
can cause non-invasive diarrhea.
Diagnostic tests:
Microscopy of stool specimens cannot
distinguish between E. histolytica, E.
moshkovskii, and E. disparicysts; PCR is able to
distinguish between these species; stool antigen
tests are also sensitive and specific to identify
the more pathogenic E. histolytica.
Prevention:
Sanitation and access to clean water. Personal
hygiene during food preparation and sexual
activities. Screening and treatment of close
contacts.
Epidemiology:
E. histolytica is distributed worldwide,
especially in countries with poor sanitation
and little acces to clean water (see Water
and Sanitation maps). It is estimated that E.
histolytica is responsible for 40,000 to 100,000
deaths per year. E. histolytica infection endemic
countries are particularly Mexico, India, South
Africa, some Central and South American
countries, and Asian Pacific countries. As most
prevalence studies in the past did not distinguish
between E. histolytica and the non-pathogenic
E. dispar, little is known of the current disease
prevalence. The older estimates of 500 million
individuals infected with Entamoeba were
actually colonised by E. dispar. E. dispar is not
considered a pathogen, and generally does not
cause disease. In 1925 it was already proposed
there were actually two species of Entamoeba,
but it took fifty years before this hypothesis was
accepted.
Ch : L amip
trng amp c au qun bng, st cn v tiu
chy nhiu nc hoc i khi c mu, hu ht
bnh nhn c st. Vim i trng amp him khi
tin trin thnh vim i trng hoi t, u ht v
phnh i trng do c t. Vim i trng amp
xy ra tr em v ngi ln nh nhau, nhng
ch yu l nam gii. Th p xe gan amp ch
yu xy ra nam gii tui t 18- 50, khng
r l do. E. moshkovskii c th gy tiu chy
khng xm ln.
Xt nghim chn on:
Soi knh hin vi mu phn khng th phn
bit gia E. histolytica, E. moshkovski, v E.
disparicysts; PCR c th phn bit gia cc loi,
cc xt nghim khng nguyn trong phn c
nhy v c hiu cao xc nh E. histolytica
th gy bnh.
Phng nga:
Ty u v dng nc sch. V sinh c nhn
trong qu trnh chun b thc n v sinh hot
tnh dc. Tm sot v iu tr cho ngi tip
xc gn.
Dch t hc:
E. histolytica phn b trn ton th gii, c
bit l cc nc c iu kin v sinh km v
hn ch tip cn nc sch (xem cc bn
nc v v sinh mi trng). Theo c tnh,
E. histolytica gy ra 40.000 n 100.000 ca
t vong mi nm. E. histolytica lu hnh
Mexico, n , Nam Phi, mt s nc Trung
v Nam M v cc nc chu Thi Bnh
Dng. Hu ht cc nghin cu trc y
khng phn bit gia E. histolytica v E. dispar
khng gy bnh, cn t hiu bit v t l nhim
bnh hin ti. Theo c tnh trc y, 500
triu ngi b nhim Entamoeba nhng l E.
dispar. E. dispar khng c xem l tc nhn
gy bnh, v thng khng gy bnh. Vo nm
1925, c gi thuyt rng thc s l c hai
loi Entamoeba, nhng phi mt 50 nm sau gi
thuyt ny mi c chp nhn.
152

A recent study in Vietnam suggests that in
settings where human and animal excreta
and local river water areintensively used in
agriculture, socio-economic and personal
hygiene factors determine infection with E.
histolytica, rather than exposure to human
and animal excreta in agricultural activities.
However, another study in Hanoi showed that
in adults engaged in wastewater-fed agriculture
and aquaculture, diarrhoeagenic Escherichia
coli and E. histolytica were the most common
pathogens. In general any faecal-oral exposure
should be considered a risk factor.
Map sources:
Medicine
Map limitations:
In Vietnam the diagnosis is performed by
checking stool for cysts using microscopy.
However, microscopy cannot distinguish
between E. histolytica, and non-pathogenic
cysts of E. moshkovskii, and E. dispar. It
therefore remains unknown which proportion is
E. histolytica and which is non-pathogenic.
Ch : L amip
Mt nghin cu gn y Vit Nam cho thy
trong mt bi cnh m nhng ni cht thi
tit ca ngi v ng vt, nc sng c s
dng rng ri trong nng nghip, cc yu t
kinh t x hi v v sinh c nhn quyt nh
tnh trng nhim E. histolytica nhiu hn so
vi yu t tip xc vi cht thi tit ca ngi
v ng vt trong hot ng nng nghip. Tuy
nhin, mt nghin cu khc ti H Ni cho
thy, nhng ngi trng thnh tham gia
nng nghip s dng nc thi v v nui trng
thy sn s dng nc thi, tc nhn gy tiu
chy Escherichiacoli v E. histolytica l tc
nhn gy bnh ph bin nht. Ni chung, bt
k phi nhim phn- ming no cng nn xem
l yu t nguy c.
Ngun bn :
Nin gim bnh truyn nhim t 2007- 2011,
Cc Y t d phng.
Hn ch ca bn :
Vit Nam, vic chn on c thc hin
bng cch soi phn tm kn bng knh hin vi.
Tuy nhin, soi knh hin vi khng th phn bit
gia kn E. histolytica, v E. moshkovskii, E.
dispar khng gy bnh. Do , vn cha r t
l E. histolytica v cc loi khng gy bnh.

- Ali IKM, et al. (2003) Entamoebamoshkovskii infections in children in Bangladesh. Emerg Infect
Dis 9 (5): 580-584.
-Haque R, et al. (2006) Entamoebahistolytica Infection in Children and Protection from subsequent
Amebiasis. Infect Immun 74:904-909.
- Pham Duc, et al. (2011) Risk factors for Entamoebahistolytica infection inan agricultural
community in Hanam province,Vietnam. Parasites& Vectors 4:102
- Haque R, et al. (2009) Association of common enteric protozoan parasites with severe diarrhea in
Bangladesh: a prospective case-control study. Clin Infect Dis 48:1191-1197.
- Stanley Jr SL. (2003) Amoebiasis. Lancet 361: 1025 1034.
- Ximenez C, et al (2009) Reassessment of the epidemiology of amebiasis: state of the art. Infect
Genet Evol 9: 1023-1032.
United Kingdom.
153
Subject: Clonorchiasis and opisthorchiasis
Ch : Sn l gan nh
154
Ch : Sn l gan nh
Classification:
ICD-9 121.0; ICD-10 B66.0
Phn loi:
ICD-9 121.0; ICD-10 B66.0
Synonyms:
Liver fluke
ng ngha:
Sn l gan Clonorchiasis v opisthorchiasis.
Agent:
Clonorchiasis: Clonorchis sinensis, a trematode
(fluke) 10-25mm long and 3-5mm wide.
Opistorchiasis: Opisthorchis felineusin Europe
and northern Asia, Opisthorchis viverrini in
Southeast Asia, a small (6-18 mm long) trematode
liver fluke of dogs, cats and some other fish-eating
mammals.
Tc nhn:
Bnh Clonorchiasis: Clonorchis sinensis, sn
hnh l dt di 10 - 25mm v rng 3 5 mm. Bnh
Opistorchiasis: Opisthorchis felineusin chu
u v pha bc chu , Opisthorchis viverrini
ng Nam (di 6- 18 mm), sn l ch, mo v
mt s ng vt c v n c khc.
Reservoir:
Piscivorous (fish eating) mammals, including:
humans, dogs, cats, pigs, rats and several species
of wild animals. Humans can remain infected for
several decades.
Vector:
Freshwater
operculate
snails
(mainly
Parafossarulus sp. and Bithynia sp.), which ingest
egg-containing feces of infected animal hosts
and excrete motile cercariae which penetrate the
fishs skin and form cysts containing larvae in the
muscle or under the scales.
Transmission:
Consumption of raw, pickled or undercooked
infected freshwater fish, mainly Cyprinidae (carp
and minnows) or shrimp.
Cycle:
Fish eating mammals (including humans) shed
eggs that are ingested by snails, where they
develop into cercariae. The cercariae are released
into water and infect freshwater fish and encyst in
meat and skin as metacercariae. When ingested
by mammals, the metacercariae migrate into the
bile ducts where they develop into adult flukes
that produce and excrete eggs into faeces. Cycle
takes approximately 3 months.
cha:
ng vt c v n c, bao gm: con ngi, ch,
mo, ln, chut v mt s loi ng vt hoang d.
Ngi b nhim v mang sn hng chc nm.
Vector:
c nc ngt c vy (ch yu l cc loi
Parafossarulus v Bithynia), n phn ng vt
ca vt ch nhim sn, v gii phng u trng
ui bi t do, xm nhp vo qua da c v pht
trin thnh u trng nang cha y u trng k
sinh trong c hoc di vy c.
Ly truyn:
n sng, gi, ti cc loi c nc ngt nhim sn.
Ch yu l h c chp (c chp, c vng) v tm.
Chu k:
ng vt c v n c (bao gm c con ngi)
thi trng sn ra v trng b c nut, trng sn
pht trin tip thnh u trng ui. Cc u trng
ui c thi vo nc v ly nhim sang loi
c nc ngt v hnh thnh u trng nang cha
y u trng k sinh trong tht v da c. Khi ng
vt c v n phi u trng nang, cc u trng s
di chuyn theo ng mt, chng pht trin
thnh sn trng thnh, trng v trng theo
phn o thi ra ngoi. Chu k ko di khong 3
thng.
155

Incubation period:
Depends on infecting dose. Larvae reach adult
fluke stage in less than one month.
Clinical findings:
Can be asymptomatic. Generally: Loss of appetite,
epigastric discomfort, jaundice due to bile duct
obstruction, cirrhosis, liver enlargement, ascites
and oedema. After years of chronic infection
there is a risk of cholangiocarcinoma.
Diagnostic tests:
Microscopy for eggs on stool smear, Kato
Katz technique, often inconclusive due to the
similarity to eggs of other trematodes. Intradermal
test is rapid and sensitive, but not specific.
Immunodiagnosis is regarded supportive but not
confirmatory test. Radiology to demonstrate bile
duct pathology. PCR tests are available.
Prevention:
Sanitation to reduce contamination of vector
snail habitat, together with mass treatment
with praziquantel and health education. Proper
cooking, or freezing at -10C for at least 5 days
destroys the parasite. Health education. Abandon
use of human faeces to fertilize fish ponds.
Control activities in Thailand were able to reduce
the prevalence from 34% to 10% in several areas.
Epidemiology:
Fish-borne trematodiases is focal and occur in
areas where the snail and freshwater fish that
is consumed raw or undercooked coexist. The
disease is the leading cause of cholangiocarcinoma
in the world. Clonorchiasis is the most common
liver fluke in humans. Estimates show that
approximately 35 million people are infected
worldwide, of which 15 million are in China. In
endemic areas, the highest prevalence is in adults
over 30. The geographical extent of the disease
is determined by snail distribution, the eating
habits of the local population, and contamination
of freshwater with egg-containing faeces. O.
viverrini is common in Southeast Asia in the
Ch : Sn l gan nh
Thi gian bnh:
Ph thuc vo liu nhim. u trng pht trin
thnh sn trng thnh trong vng cha y mt
thng.
Biu hin lm sng:
C th khng c triu chng. Cc du hiu chung:
Chn n, kh chu vng thng v, vng da do tc
nghn ng mt, x gan, gan to, c trng v ph
n. Sau nhiu nm nhim sn mn tnh c nguy c
ung th biu m ng mt.
Xt nghim chn on:
Soi knh hin vi tm trng trong phn trn lam
knh (k thut Kato-Katz) thng khng kt lun
c do ging trng ca sn l khc. Test trong
da cho kt qu nhanh v nhy, nhng khng c
hiu. Chn on min dch ch l test h tr,
khng khng nh. Chn on hnh nh pht hin
bnh l ng mt. Xt nghim PCR c th c
p dng.
Phng nga:
V sinh mi trng hn ch nhim mi
trng sng ca c vector, cng vi iu tr i
tr Praziquantel v gio dc sc khe i chng.
Nu chn, hoc ng lnh -10C trong t
nht 5 ngy nhm tiu dit k sinh trng. Gio
dc sc khe. B tp qun s dng phn ngi
nui c trong ao h. Cc hot ng kim sot
Thi Lan lm gim t l mc t 34% xung
10% mt s vng.
Dch t hc:
Cc bnh sn l thng xy ra v tp trung
nhng vng m ngi dn c thi quen n c v
n c c nc ngt sng. Bnh l nguyn nhn
hng u ca ung th biu m ng mt trn th
gii. Clonorchiasis l bnh sn l gan ph bin
nht ngi. c tnh cho thy khong 35 triu
ngi b nhim trn ton th gii, trong c 15
triu ngi Trung Quc. Trong vng lu hnh
bnh, t l mc cao nht ngi ln trn 30 tui.
Phm vi phn b a l ca bnh c xc nh
bng s phn b c, tp qun n ung ca ngi
156

Mekong region with 8 million infected in Thailand
and 2 million in Laos.
In a commune in Nam Dinh province 77.8% of
the population consumed raw fish and 22.7%
were infected with fish-borne trematodes. Males
are about 3 times more infected than females and
increases with age, peaking at 40-59 years.
Map sources:
Data source: national studies and projects of Dr
Nguyen Van De-National Institute of Malariology,
Parasitology and Entomology. Limited studies or
reports in southern provinces.
The surveillance period was from 1990 to 2000.
Map limitations:
Very limited data from Vietnam eventhough liver
flukes are commonly diagnosed.
Ch : Sn l gan nh
dn a phng, v mc nhim nc vi
phn c trng sn. O. viverrini ph bin ng
Nam , khu vc sng Me Kng vi 8 triu ca
mc Thi Lan v 2 triu ca Lo.
Ti mt x Nam nh, 77,8% dn s n c sng
v 22,7% b nhim sn l qua c. T l mc
nam gii cao hn n khong 3 ln v tng theo
tui, t nh im 40- 59 tui.
Ngun bn :
Ngun s liu t cc ti nghin cu cp nh
nc ca Tin S Nguyn Vn - Vin St rtk sinh trng-cn trng Trung ng. Nghin cu
v bo co cc tnh pha Nam rt hn ch.
Thi gian iu tra t nm 1990 n 2006.
Hn ch ca s liu:
D liu rt hn ch d y l bnh kh ph bin
Vit Nam.

- Lun Z, et al. (2005) Clonorchiasis: a key foodborne zoonosis in China. Lancet Infect Dis.
- Kaewpitoon N, et al. (2008) Opisthorchisviverrini: the carcinogenic human liver fluke. World J
Gastroenterol 14 (5): 666-674.
- Keiser J, et al. (2009) Food-borne trematodiasis. ClinMicrobiol Rev 22 (3): 466-483.
- Marcos LA, et al. (2008) Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis.
CurrOpin Infect Dis 21 (5):523-530.
- Van De N, et al. (2012) Prevalence and intensity of fish-borne zoonotic trematodes in cultured
freshwater fish from rural and urban areas of northern Vietnam. J Parasitol;98(5):1023-5.
- De NV, et al. (2011) Human infections of fish-borne trematodes in Vietnam: prevalence and molecular
specific identification at an endemic commune in Nam Dinh province.Exp Parasitol.; 129(4):355-361.
- Dang TC, et al. (2008) Prevalence, intensity and risk factors for clonorchiasis and possible use
of questionnaires to detect individuals at risk in northern Vietnam. Trans R Soc Trop Med Hyg;
102(12):1263-8.
- Nguyn Vn , et al (2006). Xc nh thnh phn loi sn l gan nh k sinh trn ngi ti 10 tnh
Vit Nam bng phng php sinh hc phn t h gen ty th. Tp ch Nghin cu Y hc. S5, tr 17-22.
- Nguyn Vn , et al (2008). Tnh hnh nhim sn l gan ngi v thnh phn loi sn l gan Vit
Nam. Tp ch Y hc Thc hnh. S 5 (608-609). Tr 113-117
- Nguyn Vn , et al (2004). Nghin cu t l nhim sn l gan nh ti mt s im trong vng lu
hnh bnh min bc Vit Nam. Tp ch Y hc thc hnh. S 6 (481)/2004. Tr. 31-33
- Nguyn Vn , et al (2003). Tnh hnh nhim sn l gan nh v kt qu phng chng Vit Nam.
Tp ch Y hc thc hnh s 447. Tr. 70-74
United Kingdom.
157
Subject: Cysticercosis (Taenia solium)
Ch : Sn dy ln
158
Ch : Sn dy ln
Classification:
ICD-9 123.1; ICD-10 B 69.0
Phn loi:
ICD-9 123.1; ICD-10 B 69,0
Synonyms:
Taenia solium (T. solium) infection, neuro
cysticercosis, cerebral cysticercosis, taeniosis,
taeniasis.
ng ngha:
Nhim trng Taenia solium, bnh u trng sn
ln h thn kinh, bnh u trng sn ln no.
Agent:
Larval stage of the pork tapeworm T. solium.
Adult T. Solium can be 2-5 m in length and lives
in the small intestine of human host.
Reservoir:
Humans are the definitive host; pigs are an
intermediate host.
Transmission:
Cysticercosis develops after ingestion T. solium
eggs; Taeniasis (tapeworm carriage) occurs
after ingestion of raw or undercooked pork meat
with cysticerci; human to human transmission
is by faeco-oral route.
Cycle:
Pigs or humans ingest eggs from contaminated
enviroment by adult tapeworm residing in small
intestine of human and develop to larval stage.
Adult tapeworms in humans will only develop
after eating raw or undercooked pork meat
containing cysticerci. It takes 2 months for
larvae to become an adult worm and produce
eggs (up to 300,000 eggs per day).
Incubation period:
The incubation period of neurocysticercosis
(time from infection to first symptom) is
extremely variable from months to several
years.
Clinical findings:
Taeniosis is T. solium infection of the small
intestine and varies from asymptomatic (the
most frequent) to weight loss, anorexia and
Tc nhn:
Giai on u trng ca sn dy ln Taenia
solium. Sn T. solium trng thnh c th di
2- 5 m v sng trong rut non ca ngi.
cha:
Con ngi l vt ch cui cng, ln l vt ch
trung gian.
Ly truyn:
Bnh u trng sn ln (Cysticercosis) xy ra
sau khi n phi trng sn ln T. solium. Bnh
sn dy trng thnh (Taeniosis) xy ra sau
khi n phi tht ln sng hoc nu cha chn c
u trng cysticerci. Ly truyn t ngi sang
ngi bng ng phn- ming.
Chu k:
Trong mi trng nhim, ln hoc con ngi
n phi trng ca sn dy ln trng thnh c
tr trong rut non ca con ngi, trng pht
trin n giai on u trng. Sn dy trng
thnh trong c th con ngi ch pht trin t
u trng sau khi ngi n tht ln sng hoc
nu cha chn c cha u trng cysticerci. Phi
mt 2 thng u trng pht trin thnh sn
dy trng thnh v trng (ln n 300.000
trng mi ngy).
Thi gian bnh:
Thi gian bnh ca bnh u trng sn ln (thi
gian t nhim trng n xut hin triu chng
u tin) rt khc nhau t thng n vi nm.
Biu hin lm sng:
Bnh sn dy trng thnh (Taeniosis) l nhim
trng T. solium ca rut non v thay i t
159

abdominal pain. Cysticercosis is a tissue
infection with T. solium larvae with findings
depending on where cysticerci develop
(subcutaneous, eye, heart, CNS). Its localization
in the CNS, causing neurocysticercosis, is
the most severe form of the disease: seizures,
headache, focal neurologic signs, epilepsy, and
hydrocephalus may develop. CFR is low.
Diagnostic tests Taeniosis:
detection of eggs in stool by microscopy; T.
solium eggs cannot be distinguished from T.
saginata eggs; serology; Neurocysticercosis:
histology; CT or MRI scan brain; serology is
not sensitive or specific for neurocysticercosis.
Prevention:
Sanitation (particularly use of latrine and
maintaining pigs enclosed); hygiene; meat
inspection; thorough cooking of pig meat before
consumption; treatment of tapeworm carriers.
A vaccine has been developed for cattle.
Epidemiology:
Cysticerosis has a worldwide distribution,
mainly where pigs are consumed and sanitation
is substandard (see pig density map and
sanitation map). In endemic countries it is
an important cause of epilepsy, causing a
high disease burden in mainly poor families.
Neurocysticercosis is common in Latin America
and non-muslim African and Asian countries
where pig is eaten and traditional pig rearing is
practiced. Regions with the habit of eating raw
or undercooked pig meat are at increased risk.
In Europe, cysticercosis has largely disappeared
due to strong health system and good sanitation.
In Vietnam there is very little data on
neurocysticercosis. One recent burden study
estimated that around 10% of epilepsy cases in
Vietnam is due to neurocysticercosis.
Ch : Sn dy ln
khng c triu chng (thng gp nht) n
cc triu chng gim cn, chn n v au bng.
Bnh u trng sn ln l bnh nhim trng
m vi u trng T. solium v cc pht hin ty
thuc vo v tr u trng pht trin (di da,
mt, tim, thn kinh trung ng). V tr c tr
ca u trng trong thn kinh trung ng, gy u
trng sn ln h thn kinh l dng nghim trng
nht ca bnh, c triu chng: co git, au u,
du hiu thn kinh khu tr, ng kinh, no ng
thy. Bnh c t l t vong thp.
Xt nghim chn on:
Bnh sn dy trng thnh: pht hin trng
trong phn bng soi knh hin vi. Khng th
phn bit trng T. solium vi trng T. saginata;
chn on huyt thanh. Bnh u trng sn ln
h thn kinh: m hc; CT hoc MRI no, chn
on huyt thanh khng c nhy cm v
khng c c hiu vi bnh u trng sn ln
h thn kinh.
Phng nga:
V sinh mi trng (c bit l s dng nh v
sinh v duy tr nui nht ln); v sinh c nhn,
kim tra tht, nu chn tht ln trc khi n, iu
tr ngi mang sn dy. Tim vc-xin cho gia
sc.
Dch t hc:
Bnh u trng sn ln phn b trn ton th
gii, ch yu l nhng ni n tht ln v v sinh
mi trng thp km (xem bn mt ln
v bn v sinh mi trng). cc nc bnh
lu hnh, nhim u trng sn ln l nguyn
nhn quan trng ca ng kinh, gy gnh nng
bnh tt nng n, ch yu nhng h ngho.
u trng sn ln h thn kinh rt ph bin cc
nc M La tinh, cc nc chu Phi v chu
khng theo o Hi, ni c tp qun nui
ln v n tht ln. Vng n tht ln sng v tht
ln cha nu c nguy c cao hn. chu u,
nhim u trng sn ln gn nh bin mt do c
h thng y t v v sinh mi trng tt.
160

Map sources:
The map was made by medical literature review
from 2000 to 2011
Map limitations:
Antigen detection cannot detect dead cysticerci,
which may also cause clinical signs. Therefore,
the seroprevalence figures shown here may
underestimate the role of neurocysticercosis
as a causal agent of epilepsy and headaches in
Vietnam.
Ch : Sn dy ln
Vit Nam, c rt t d liu v nhim u trng
sn ln h thn kinh. Mt nghin cu gnh
nng bnh tt gn y c tnh khong 10% cc
trng hp ng kinh Vit Nam l do nhim
u trng sn ln h thn kinh.
Ngun bn :
Tham kho t cc bi bo y khoa c cng b
t nm 2000 n nm 2011
Hn ch ca bn :
Pht hin khng nguyn khng th pht hin u
trng sn ln cht vn cng c th gy ra cc
du hiu lm sng. V vy, t l huyt thanh
dng tnh c th nh gi thp vai tr tc nhn
gy bnh ca u trng sn ln trong bnh ng
kinh v au u Vit Nam.

- Carpio A. (2002) Neurocysticercosis: an update. Lancet Infect Dis 2: 751-762.
Carpio A, et al. (2008). Effects of albendazole treatment on neurocysticercosis: a randomised
controlled trial. J NeurolNeurosurg Psychiatry 79 (9): 1050-1055.
- Dixon HB, et al. (1961) Cysticercosis: an analysis and follow-up of 450 cases. Spec Rep Ser Med
Res Counc 299:1-58.
- Engels D, et al. (2003) The control of human (neuro)cysticercosis : which way forward? Acta Trop
87: 177-182.
- Roman G, et al. (2000) A proposal to declare neurocysticercosis an international reportable disease.
Bull World Health Organ 78 (3): 399-406
- Trung DD, et al. (2013) Assessing the burden of human cysticercosis in Vietnam. Trop Med Int
Health;18(3):352-6.
- Nguyn Vn , et al (2003). Gim nh phn t u trng (Cysticercus) sn dy ln phn lp trn
ngi Vit Nam. Tp ch Y hc Vit Nam 8/ 2003. Tr. 35-41
- Nguyn Vn , et al (2005). Nghin cu sn l, sn dy gy bnh ngi Vit Nam. Tp ch Y
hc thc hnh. S 509/2005. Tr. 20-26.
- Nguyn Vn , et al (1998). Nghin cu bnh sn l v sn dy. Thng tin phng chng st rt
v cc bnh K sinh trng, s 2-1998. Tr. 28-33
- Nguyn Vn (2004). Bnh sn dy v u trng sn ln ngi Vit Nam. Tp ch Thng tin
Y Dc S 9/2004. Tr. 13-16
- AL.Willingham III, et al (2012). Current stutus of Cysticercosis in Vietnam. Southeast asian
Journal of Tropical Medicine and Public Health. Volume 34 Supplement 1, 2003. P 35-50
- Wertheim H, Horby P, Woodall J. Atlas of Infectious Diseases. Wiley-Blackwell, Oxford, United
Kingdom.
161
Subject: Eosinophilic meningitis
Ch : Sn no
162
Ch : Sn no
Classification:
ICD-9 128.8; ICD-10 B83.2
Phn loi:
ICD-9 128.8; ICD-10 B83.2
Synonyms:
Eosinophilic meningoencephalitis,
angiostrongyliasis
ng ngha:
Vim no mng no tng bch cu i toan, bnh
angiostrongyliasis
Agent:
Angiostrongylus (Parastrongylus) cantonensis,
a nematode lungworm of rats. Adult worms are
17 to 25 mm long.
Tc nhn:
Angiostrongylus (Parastrongylus) cantonensis,
l giun trn, k sinh phi chut. Giun trng
thnh c chiu di t 17- 25 mm.
Reservoir:
Rats (Rattus, particularly R. norvegicus, and
Bandicotta spp.). Infected dogs, wild mammals
and marsupials have been found, but do not
contribute to disease spread.
cha
Chut (Rattus, c bit l cc loi R. norvegicus,
v Bandicotta). Ch b nhim giun, ng vt c
v hoang d v th c ti cng c coi l
cha, nhng khng c vai tr ly lan bnh.
Vector:
Snails, slugs and land planarians. The giant
African snail Achatina fulica is the major
source of infection worldwide; the imported
South American golden apple snail, Pomacea
canaliculata, has replaced it in Taiwan and
mainland China.
Vector:
c, c sng trn mt t v c sng di nc,
sn. c ln chu Phi Achatina fulica l ngun
truyn nhim ch yu trn ton th gii, c to
vng Nam M nhp c, Pomacea canaliculata,
thay th vai tr vt ch trung gian truyn
bnh ca Achatina fulica ti i Loan v Trung
Quc i lc.
Transmission:
Consumption of raw or under-cooked vector
molluscs, including inadvertently on infested
vegetables or vegetable juice, or of fish,
freshwater prawns, land crabs, frogs or monitor
lizards that have fed on vector molluscs. There
is no person-to-person transmission.
Ly truyn:
n vector l ng vt thn mm sng hoc
nu cha chn, v tnh n phi rau, nc rau b
nhim bn, hoc c, tm nc ngt, cua t, ch
hoc thn ln tng n vector l ng vt thn
mm. Khng ly truyn t ngi sang ngi.
Cycle:
Rat-mollusc-rat, tangentially to humans, which
are dead-end hosts. Larvae are passed out in rat
faeces, ingested by vector molluscs, where they
develop in 12 days to the infecting stage and
are ingested in turn by rats or humans. In the
rat they enter the brain and mature into adults,
which migrate through the blood-stream to the
lungs. There, female worms lay eggs (about
15,000 per day), which hatch into larvae, which
Chu k:
Chut - ng vt thn mm - chut, vt ch
bt thng l ngi, l vt ch cui. u trng
c thi ra trong phn chut, ng vt thn
mm vector n phi, chng pht trin trong
12 ngy ti giai on nhim v li nhim vo
chut hoc con ngi qua ng n ung.
chut, chng xm nhp no v trng thnh,
di chuyn theo dng mu n phi. Ti y,
giun ci trng (khong 15.000 trng mi
163
Ch : Sn no
in 6-8 weeks migrate through the bronchial

system up the trachea to the pharynx, are
swallowed and excreted.
ngy), trng n thnh u trng, trong 6-8 tun

di chuyn theo ph, kh qun ln hu hng, ri
b nut xung v bi tit.
Incubation period:
1 day to several months, depending on parasite
load; usually 1-3 weeks.
Thi gian bnh:

1 ngy n vi thng, ty thuc vo s lng k
sinh trng, thng thng 1- 3 tun.
Clinical findings:
Cough, rhinorrhoea, sore throat, malaise,
and fever can develop when the worms move
through the lungs. In about 2 weeks the larvae
reach the central nervous system and clinical sub
acute meningitis ensues with a disease onset of
5 to 14 days. Eosinophilic meningitis is defined
as meningitis with >=10 eosinophils/L in CSF
or at least 10% eosinophils in the total CSF
leukocyte count. Some cases have low grade
fever and temporary facial paralysis. Signs
of raised intracranial pressure, like diplopia.
Worms occasionally enter the eye. The course
of the illness ranges from a few days to several
months. Death is rare.
Biu hin lm sng:

C th ho, chy nc mi, au hng, mt mi,
st khi giun di chuyn qua phi. Trong khong
2 tun, u trng ti h thng thn kinh trung
ng v lm sng ca vim mng no bn cp
xy ra sau thi gian khi pht 5- 14 ngy. Vim
mng no tng bch cu i toan c nh ngha
l vim mng no vi > = 10 bch cu i toan/
ml dch no ty hoc t nht l 10% bch cu i
toan trong tng s lng bch cu trong dch
no ty. Mt s trng hp c st nh v lit
mt tm thi. C du hiu tng p lc ni s,
nh song th. Giun i khi chui vo mt. Cc
t ca bnh dao ng t mt vi ngy n vi
thng. t khi tin trin ti t vong.
Diagnostic tests:
Mainly a clinical diagnosis: subacute
eosinophilic meningitis in an endemic area.
Most common test is serology, but there are
often false-positives due to cross-reactivity
with other parasites. Worms are rarely seen in
CSF by microscopy. MRI or CT scan of the
brain are not diagnostic.
Xt nghim chn on:

Ch yu l chn on lm sng: vim mng no
bn cp tng bch cu i toan vng bnh lu
hnh. Test ph bin nht l chn on huyt
thanh, nhng thng c dng tnh gi do phn
ng cho vi cc k sinh trng khc. Soi knh
hin vi him khi tm thy giun trong dch no
ty. MRI hoc CT scan no khng c dng
chn on.
Prevention:
Avoid eating raw slugs, snails, other molluscs,
freshwater prawns, land crabs, and uncooked
vegetables grown in ponds (e.g. watercress)
from endemic areas. Washing of vegetables
does not guarantee freedom from larval
contamination. Boil snails and crustaceans for
5 min or freeze at -15 degrees for 24hrs.
Phng nga:
Trnh n sng sn, c, cc ng vt thn mm
khc, tm nc ngt, cua t, v cc loi rau
trng di nc cha nu chn (v d nh ci
xoong) vng lu hnh. Ra rau khng m
bo loi tr ht u trng. Luc c v ng vt
gip xc trong 5 pht hoc ng lnh -15
trong 24 gi.
164

Epidemiology:
Distribution is closely correlated with the habit
of consuming raw terrestrial molluscs, reptiles
or amphibians. The majority of cases are in
adults, except in Taiwan where most cases are in
children. Pomacea canaliculata, a snail native
to South America, was imported into Taiwan in
1981 as a food source and then into mainland
China. It has replaced A. fulica as the main
intermediate host of A. cantonensis and has
become the main source of human infection in
Taiwan and mainland China where, depending
on locality, up to 70% of P. canaliculata are
infected. An estimated 650 million people are
at risk in 10 provinces of China.
Eating raw frogs has resulted in human
infection in Taiwan, mainland China and the
USA, and eating monitor lizards has been the
cause of some cases in Thailand, Sri Lanka and
India. Malnutrition and debilitating diseases
exacerbate infection. There is very limited data
from Vietnam. Cases have been reported in only
a few provinces, in particular northern Vietnam.
One national referral hospital in Hanoi reported
that 19/352 (5.9%) adults admitted with signs
of central nervous system infection were acute
eosinophilic meningitis.
Map sources:
The map was made by medical literature review
up to 2011
Map limitations:
There is very limited data on eosinophilic
meningitis in Vietnam. The disease is likely
underreported as many people are at risk.
Ch : Sn no
Dch t hc:
Phn b bnh c tng quan cht ch vi thi
quen n sng ng vt thn mm trn mt t,
b st v lng c. Phn ln cc trng hp
bnh l ngi ln, ngoi tr ti i Loan,
ni hu ht cc trng hp l tr em. Pomacea
canaliculata, loi c c ngun gc t Nam M,
c nhp khu vo i Loan nm 1981 nh
mt ngun cung cp thc phm v sau nhp
vo Trung Quc i lc. Loi ny thay th
vai tr ca A. fulica l vt ch trung gian chnh
truyn bnh A. cantonensis, tr thnh ngun
truyn nhim ch yu cho ngi i Loan v
Trung Quc, ni m ty tng a phng, ti
70% c P. canaliculata b nhim. c tnh c
khong 650 triu ngi c nguy c mc bnh
10 tnh Trung Quc.
n ch sng gy mc bnh i Loan,
Trung Quc v M, v n thn ln gy ra
mt s trng hp mc Thi Lan, Sri Lanka
v n . Suy dinh dng v suy nhc lm
nhim giun thm trm trng. D liu t Vit
Nam rt hn ch. Cc ca bnh mi ch c bo
co mt vi tnh, ch yu l min Bc Vit
Nam. Mt bnh vin chuyn khoa tuyn cui
ti H Ni bo co 19/352 (5,9%) ngi ln
vo vin vi du hiu nhim trng h thn kinh
trung ng l vim mng no cp tng bch cu
i toan.
Ngun bn :
Tham kho t cc bi bo y khoa n nm 2011.
Hn ch ca bn :
S liu ca vim no tng bch cu i toan
Vit Nam l rt hn ch. C th bnh khng
c bo co y trong khi nhiu ngi c
nguy c.
165
Ch : Sn no

- Wang Q-P, et al. (2008) Human angiostrongyliasis. Lancet Infect Dis 8 (10): 621-630.
- Lv S, et al. (2009) Invasive Snails and an Emerging Infectious Disease: Results from the First
National Survey on Angiostrongylus cantonensis in China. PLoS Negl Trop Dis 3(2): e368.
- Ramirez-Avila L, et al. (2009) Eosinophilic meningitis due to Angiostrongylus and Gnathostoma
species. Clin Infect Dis 1;48 (3): 322-327.
- Taylor WR, et al (2012) The spectrum of central nervous system infections in an adult referral
hospital in Hanoi, Vietnam. PLoS One. 2012;7(8):e42099.
- Nguyn Vn , et al (2008). Bnh vim mng no tng bch cu i toan do Angiostrongylus. Tp
ch Thng tin Y Dc. S 11/ 2008. Tr.9-13
- Nguyn Vn (2005). Thng bo bnh vim mng no tng bch cu i toan do Angiostrongylus.
Tp ch Thng tin Y Dc. S 5/2005. Tr.14-16
- Le Thi Xuan et al (2007), Study of eosinophilic meningitis in Ho Chi Minh city, Vietnam, Southeast
Asian jounral of tropical Medicine Publich Health, Vol 38 (suppl 1) 2007. 47
United Kingdom.
166
Subject: Fascioliasis
Ch : Sn l gan ln
167
Ch : Sn l gan ln
Classification:
ICD-9 121.3; ICD-10 B66.3
Phn loi:
ICD-9 121.3; ICD-10 B66.3

Sheep liver fluke disease,
fascioliasis.
Bnh sn l gan cu, sn l gan ln.
pharyngeal
Agent:
Large trematode liver flukes living in blile ducts:
Fasciola hepatica and Fasciolagigantica. F.
hepatica is 20 to 30 mm long and F. gigantica
can be up to 75 mm long.
Reservoir:
Sheep, cattle, water buffalo, and other large
herbivores. Occasionally humans.
Vector:
Freshwater snails (Lymnaeidae).
Transmission:
Accidental ingestion of metacercariae via
contaminated water, watercress, or other
contaminated plants (lettuce, alfalfa juice, etc).
Rarely via consumption of raw sheep or goat
liver (pharyngeal fascioliasis). There is no
person-to-person transmission.
Cycle:
Eggs hatch in water and release miracidia larvae
that penetrate the snail, where they develop
to cercariae that encyst on aquatic plants
(e.g. watercress) and become desiccationresistant metacercariae. After the plants are
eaten by herbivores (e.g. sheep, cattle), or
water containing metacercariae is drunk, the
larvae pass through the intestinal wall into the
peritoneal cavity, enter the liver and lay eggs
in the bile duct, which are then excreted in the
faeces. The whole cycle takes 3 to 4 months.
Incubation period:
3 to 4 months, but is highly variable.
Tc nhn:
Sn l gan ln, sn sng trong ng mt ln v ti
mt: Fasciola hepatica v Fasciolagigantica. F.
hepatica di 20- 30 mm v F. gigantica c th di
n 75 mm.
cha:
Cu, b, tru v ng vt n c ln khc. i khi
l con ngi.
Vector:
c nc ngt (c Lymnaeidae).
Ly truyn:
V tnh nut phi u trng ui qua nc b
nhim, cc loi rau thy sinh (ci xoong), hoc
cc loi rau b nhim khc (x lch, rau ng, vv)
n sng, n ti. Him khi do n tht cu hoc gan
d sng (bnh sn l gan ln th hu). Khng c
ly truyn t ngi sang ngi.
Chu k:
Trng trng thnh n trong nc v gii phng
u trng lng, u trng lng xm nhp vo c,
pht trin thm thnh u trng ui ri c, bm
vo cy thy sinh (v d nh ci xoong) ri ng
kn sn kt v cng. Sau khi ng vt (cu, tru,
b) n c v rau c u trng, hoc ung nc c
cha kn sn kt v cng, u trng thot kn i
qua thnh ng tiu ha vo khoang phc mc, vo
gan thnh sn trng thnh v trng trong ng
mt, sau trng c bi tit trong phn. Ton
b chu k ko di 3- 4 thng.
Thi gian bnh:
3- 4 thng, nhng c th thay i rt khc nhau.
168
Clinical findings:
Acute: hepatomegaly, prolonged fever, anorexia,
weight loss, nausea, vomiting, cough, diarrhoea,
urticaria, lymphadenopathies and arthralgias.
Significant clinical improvement 35 days after
specific treatment is diagnostic. Chronic (which
may be asymptomatic and last for more than 10
years): biliary obstruction with upper abdominal
pain, cholecystitis, cholangitis and extrahepatic
cholestasis. Liver fibrosis may be a complication
of the infection. In ectopic infections, transient
areas of inflamed skin can be seen.
Diagnostic tests:
Microscopy for eggs on stool samples by the Kato
Katz or rapid sedimentation techniques (RST)
techniques are diagnostic for the chronic infection.
Serological tests (Fas2-ELISA) is recommended
for acute infection. The intradermal test is rapid
and sensitive, but not sufficiently specific and it
is not longer used. Radiology such as computed
tomography can demonstrate liver lesions (only
in acute infection) similar to metatastic lesions.
For chronic infections, cholangiogram can detect
bile duct pathology caused by the adult parasites.
Prevention:
Sanitation to avoid contamination of vector snail
habitat with human or animal faeces. Improve
water drainage, use molluscicides and avoid
eating uncooked aquatic plants in endemic areas
and drinking untreated water.
Epidemiology:
It is estimated that 17 million people are infected
worldwide and 91 million are at risk of infection.
F. hepatica is endemic on all continents but is
of particular public health importance in the
Andean countries. Infections with F. gigantica
are restricted to Africa and Asia. Both species of
fluke overlap in many areas of Africa and Asia,
whereas F. hepatica is the major concern in the
Americas, Europe and Oceania. The main source
of infection is the consumption of raw vegetables
Ch : Sn l gan ln
Biu hin lm sng:
Th cp tnh: gan to, st ko di, chn n, st cn,
bun nn, nn ma, ho, tiu chy, ni m ay,
sng hch v au khp. iu tr thuc c hiu
gip ci thin tnh trng lm sng sau 3- 5 ngy.
Th mn tnh (c th khng c triu chng v ko
di hn 10 nm): tc mt vi au vng h sn
hoc thng v, vim ti mt, vim ng mt
ngoi gan v mt. X gan c th l mt bin
chng ca nhim sn. Nu c nhim trng lc
ch, c th thy vng vim da thong qua.
Xt nghim chn on:
Soi knh hin vi tm trng trong mu phn bng k
thut Kato-Katz hoc k thut phong ph (RST)
l nhng k thut chn on nhim trng mn
tnh. Xt nghim huyt thanh hc (Fas2-ELISA)
c khuyn co p dng i vi nhim trng cp
tnh. Cc th nghim trong da cho kt qu nhanh
v nhy, nhng khng mnh v khng cn
c s dng. Chn on hnh nh nh chp ct
lp c nhiu tn thng gan nh chia nhnh kiu
ng hm (ch trong nhim trng cp tnh). Cc
bnh nhim trng mn tnh, chp ng mt v
ni soi mt ty ngc dng c th pht hin bnh
l ng mt gy ra bi k sinh trng trng thnh.
Phng nga:
V sinh mi trng trnh nhim phn ngi
v ng vt vo mi trng sng ca c vector.
Ci thin tiu thot nc, s dng ha cht dit
ng vt thn mm, trnh n thc vt thu sinh
cha nu chn trong vng lu hnh bnh v ung
nc cha kh trng.
Dch t hc:
c tnh 17 triu ngi b nhim sn l gan ln
trn th gii v 91 triu ngi c nguy c nhim
F. hepatica l loi lu hnh khp cc chu lc
v l vn y t cng cng nghim trng ti cc
quc gia thuc dy ni Andes. Nhim F. gigantica
ch chu Phi v chu . C hai loi sn l cng
lu hnh nhiu vng ca chu Phi v chu ,
trong khi F. hepatica thng ch ph bin chu
169
contaminated with metacercariae, such as
watercress, salads, and contaminated water from
irrigation channels.
In Vietnam, there is both pure Fasciola gigantica
and hybrid and/or introgressed populations of
liver flukes bearing genetic material from both
Fasciola gigantica and F. gigantica . A crosssectional survey in cattle in Binh Dinh province
(central Vietnam), hyperendemic for human
fasciolosis showed that overall, 54.9% of the
animals were shedding Fasciola eggs while
72.2% were Fasciola seropositive. Another study
in central Vietnam in definitive hosts (cattle) and
the intermediate hosts (Lymnaea snails) showed
that the overall prevalence of Fasciola was 45.3
%. The prevalence in the rainy season (50.8
%) was significantly different to that in the dry
season (38.1 %). Of the 3.269 Lymnaeaviridis
and 1.128 Lymnaeaswinhoei examined, 31 (0.95
%) and seven (0.62 %), respectively, were found
to be infected with Fasciola.
Map sources:
National studies and projects of Dr Nguyen Van
De-National Institute of Malariology, Parasitology
and Entomology
Map limitations:
F.gigantica could be more widespread than
shown, because it could be the species is reported
as unspecified Fasciola.
Ch : Sn l gan ln
M, chu u v chu i Dng. Nhim sn ch
yu do n rau sng, nh ci xoong, x lch v
ung nc ti b nhim u trng ui.
Vit Nam, c c Fasciola gigantica dng thun
chng v dng lai v/hoc dng lai cho qua
nhiu th h ca cc qun th sn l gan mang vt
liu di truyn t c hai Fasciola hepatica v F.
gigantica. Mt cuc iu tra ct ngang gia sc
ti tnh Bnh nh (min Trung Vit Nam), ni
lu hnh bnh sn l gan ln mc cao cho thy,
54,9% cc loi ng vt o thi trng Fasciola,
72,2% dng tnh huyt thanh vi Fasciola. Mt
nghin cu khc min Trung Vit Nam trn vt
ch chnh (gia sc) v cc vt ch trung gian (c
Lymnaea) cho thy t l mang Fasciola l 45,3%.
T l mc trong ma ma (50,8%) khc bit ng
k trong ma kh (38,1%). Trong s 3.269 con c
Lymnaeaviridis v 1.128 con Lymnaeaswinhoei
c kim tra, ln lt 31 con (0,95%) v 7
(0,62%) nhim Fasciola.
Ngun bn :
Cc ti nghin cu cp nh nc ca Tin S
Nguyn Vn - Vin St rt-k sinh trng-cn
trng Trung ng
Hn ch ca bn :
F.gigantica trong thc t c th ph bin hn
nhiu bi khi bo co c th b coi l loi Fasciola
khng xc nh.

- Marcos LA, et al. (2008) Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis.
CurrOpin Infect Dis 21 (5): 523-530.
- Nguyen ST, et al. (2012) Prevalence of Fasciola in cattle and of its intermediate host Lymnaea snails
incentral Vietnam. Trop Anim Health Prod;44(8):1847-53.
- Nguyen TG, et al. (2011) Bovine fasciolosis in the human fasciolosis hyperendemic in BinhDinh
province in Central Vietnam. Acta Trop;117(1):19-22.
- Nguyn Vn , et al (2008). Tnh hnh nhim sn l gan ngi v thnh phn loi sn l gan Vit
Nam. Tp ch Y hc Thc hnh. S 5 (608-609). Tr 113-117
- Nguyn Vn (2012). Thc trng bnh sn l gan ln fascioliasis ti Vit Nam. Tp ch Phng
chng bnh St rt v cc bnh K sinh trng. S 2/2012. Tr 17-20
United Kingdom.
170
Subject: Lymphatic filariasis
Ch : Giun ch bch huyt
171
Classification:
ICD-9 125.0, 125.1, 125.6; ICD-10 B74.0,
B74.1, B74.2
Phn loi:
ICD-9 125.0, 125.1, 125.6; ICD-10 B74.0,
B74.1, B74.2

Bancrofti and filariasis, filariasis bancrofti,
wucheriasis, Brugian filariasis, Malayan
filariasis, elephantiasis.
Hi chng v ng ngha:
Bnh giun ch, bnh ph chn voi.
Agent:
Wucheraria bancrofti, Brugia malayi, and B.
timori, threadlike nematode worms 80 to 100
mm long (W. bancrofti), or 43 to 55 mm long (B.
malayi). In Vietnam W. bancrofti and B.malayi
have been reported.
Reservoir:
Mainly humans. In Southeast Asia, monkeys,
wild carnivores, dogs and cats may also be
infected with B. malayi. W. bancrofti has no
known reservoir host. In Vietnam cats do not
appear to represent a significant reservoir of
infection.
Vector:
For W. bancrofti, Culex quinquefasciatus,C.
vishnui, and several species of Anopheles
mosquitoes; for B. malayi, various species of
Mansonia, Anopheles and Aedes; In general,
Anopheles spp. transmit parasites less
efficiently than Culex spp., and Culex spp. are
more abundant in urban settings.
Transmission:
A large number of infective mosquito bites
are necessary to establish infection in a
human. There is no direct person-to-person
transmission.
Cycle:
Microfilariae in human blood are ingested by a
vector mosquito, pass through the stomach wall
and migrate to the thoracic muscles, where they
develop in 2 weeks into larvae that enter the
Tc nhn:
Wuchereria bancrofti, Brugia malayi, v B.
timori, giun ging si ch, thuc ngnh giun
trn, di 80- 100 mm (W. bancrofti), hoc di
43- 55 mm (B. malayi). Vit Nam ch pht
hin W. bancrofti v B. malayi.
cha:
Ch yu l ngi. ng Nam , kh, ng
vt n tht hoang d, ch v mo cng c th b
nhim B. malayi. W. bancrofti khng c vt ch
l ng vt n tht c bit n. Vit Nam,
mo khng phi l cha ng k.
Vector:
Culex quinquefasciatus, C. vishnui v mt s
loi mui Anopheles l vector ca W. bancrofti;
cc loi Mansonia, Anopheles v Aedes l
vector ca B. malayi; Nhn chung, cc loi
mui Anopheles truyn giun ch km hiu qu
hn cc loi mui Culex v cc loi mui Culex
phong ph, ph bin hn khu vc thnh th.
Ly truyn:
B rt nhiu mui nhim u trng giun ch t
mi nhim bnh ngi. Khng c s
ly truyn trc tip t ngi sang ngi.
Chu k:
Mui nhim phi u trng giun ch trong mu
ngi khi t ngi, u trng xuyn thnh d
dy v di chuyn n c ngc, chng
pht trin trong 2 tun thnh u trng n phn
ming ca mui, lng ng trn da v xm nhp
vt thng gy ra bi vi khi mui ht mu tip
theo. ngi, chng di chuyn theo mch bch
huyt, thay lng hai ln pht trin thnh giun
172

mouth-parts and are deposited onto the skin and
invade thought the wound made by the proboscis
at the next feed by the mosquito. In humans,
they are thought to travel via the lymphatics,
moult twice before becoming adults, forming
nests and producing microfilariae, which
migrate to the blood and display periodicity to
coincide with the peak biting times of the local
vector.
Incubation period:
3-6 months for B. malayi worms to mature and
produce microfilariae that appear in the blood;
6-12 months for W. bancrofti.
Clinical findings:
Infection is often asymptomatic but the adult
worms live for 5-10 years and, eventually,
a small percentage of persons will develop
painful swelling (sometimes enormous) of
the legs or arms, and in cases of Bancroftian
filariasis, the breasts or scrotum (hydrocele).
Up to 40% have renal involvement with
proteinuria and hematuria. Acute cases may
have high fever, recurrent lymphadenitis and
retrograde lymphangitis. A rare finding is
tropical pulmonary eosinophilic syndrome.
Diagnostic tests:
Microscopy to detect microfilariae in fingerprick blood smears, or after concentration
of blood to detect low levels of infection;
immunochromatic test cards; ultrasound to
locate nests.
Prevention:
In 2000, WHO started the Global Programme
to Eliminate Lymphatic Filariasis that aims to
interrupt transmission and reduce morbidity in
those affected. For transmission interruption,
endemic areas are mapped with subsequent
mass treatment for the whole population at-risk
(at least 65% coverage required) for five years.
Mass treatment regimens consist of two drugs

trng thnh, to kn v sn sinh ra nhiu u
trng xm nhp v di chuyn trong mch mu,
xut hin c tnh chu k trng vi thi gian nh
im ht mu ca loi mui vector lu hnh a
phng.
Thi gian bnh:
B. malayi cn 3- 6 thng trng thnh v sn
sinh u trng trong mu. W. bancrofti cn 6- 12
thng.
Biu hin lm sng:
Nhim k sinh trng thng khng c triu
chng, nhng giun trng thnh c th sng
trong c th ngi 5-10 nm do mt s nh
ngi cui cng s pht trin sng au (i khi
au d di) ph chn voi, hoc tay, hoc vi
nhim W. bancrofti th ph v hoc ph bu
(ph dch tch t). Ti 40% c triu chng thn
vi protein niu, hng cu niu. Trng hp
cp tnh c st cao, vim hch bch huyt nhiu
ln, vim h bch huyt nghch. Hi chng tng
bch cu i toan phi nhit i him gp.
Xt nghim chn on:
Soi knh hin vi pht hin u trng trn lam git
m mu u ngn tay, hoc sau khi ly tm khi
nhim t, th test min dch mu, siu m nh
v kn.
Phng nga:
Nm 2000, T chc Y t th gii (TCYTTG)
bt u Chng trnh ton cu loi tr bnh
giun ch bch huyt nhm lm gin on s ly
truyn v gim t l t vong ngi mc.
gin on ly truyn, lp bn cc vng lu
hnh bnh ri sau iu tr hng lot ton b
qun th c nguy c cao (yu cu t l bao ph
t nht l 65%) trong 5 nm. Chng trnh iu
tr hng lot trong cng ng lm 1 nm 1 ln
vi phc 2 loi thuc. C th phi hp DME
v albendazole. Vit Nam trin khai Chng
trnh ch nh thuc hng lot trong cng ng
(MDA) ti 6 huyn lu hnh giun ch bch
173

give once per year. Possible combinations
are: DEC and albendazole. Viet Nam has
implemented mass drug administration
(MDA) for lymphatic filariasis in six endemic
districts after carrying out a national survey in
2003. Five rounds of MDA were completed
in 2008. Recent surveys show that there is no
further transmission and Vietnam is expected
to be WHO certified as lymphatic filariasis
elimination in 2016.
Epidemiology:
WHO estimates (2010) there are more than
120 million infections worldwide, with over
40 million patients incapacitated or disfigured
by the disease, principally in India and SubSaharan Africa; 90% of infections are due
to W. bancrofti. The chronic manifestations
mainly occur in the older age-classes. An
estimated 27 million men have hydrocele and
almost 16 million, the majority of whom are
women, have lymphedema or elephantiasis of
the leg. In general, countries with Bancroftian
filariasis in Asia and South America have lower
prevalences (below 8%) than the sub-Saharan
Africa (up to 37%) and Pacific Island (up to
48%) regions. Within areas of low prevalence,
pockets of high prevalence may exist. W.
bancrofti probably originated in Southeast
Asia, where it was transmitted by forest
Aedes& Anopheles mosquitoes, carried around
the world by maritime trade. China has been
declared non-endemic for lymphatic filariasis
since 2007 and Korea in 2008, achieved by
extensive control efforts. The vectors are still
present and therefore there remains a risk of reemergence.
In Vietnam, the former endemic regions of
filariasis were the lowland areas of the Red
River Delta (B. malayi) in the north and the
southern provinces Ninh Thuan and Khanh
Hoa (W. bancrofti). The most common type of
chronic clinical manifestation is shown to be leg
elephantiasis. Improved living standards and

huyt sau Tng iu tra ton quc nm 2003.
Nm vng MDA hon thnh nm 2008. Cc
cuc iu tra gn y cho thy khng cn s lan
truyn giun ch bch huyt v Vit Nam trng
ch c TCYTTG cng nhn loi tr bch
huyt vo nm 2016.
Dch t hc:
TCYTTG c tnh (nm 2010) c 120 triu
ngi nhim trn ton th gii vi 40 triu
ngi bnh b tn tt v bin dng, ch yu
n v vng di sa mc Sahara chu Phi.
90% ca nhim l do W. bancrofti. Th mn
tnh thng nhm cao tui. c tnh 27 triu
nam gii b ph dch tch t bu, 16 triu, ch
yu l n b da/m dy hay ph chn voi. Ni
chung, cc nc lu hnh bnh giun ch bch
huyt do W. bancrofti chu v Nam M c
t l hin mc (di 8%), thp hn vng di
sa mc Sahara chu Phi (ti 37%) v vng o
Thi Bnh Dng (ti 48%). Ngay trong vng
t l hin mc thp vn c th c khu vc t
l hin mc cao. W. bancrofti c l c ngun
gc t ng Nam , ni chng c truyn
bi cc loi mui rng Aedes & Anopheles v
mang i khp th gii bi giao thng ng
bin. Trung Quc, nm 2007 v Triu Tin,
nm 2008 tuyn b khng cn bnh giun ch
bch huyt lu hnh nh cc n lc kim sot
mnh m. Vector vn tn ti v do vn cn
nguy c ti bng pht.
Vit Nam, trc y, vng trng ng bng
sng Hng thuc min Bc (B. malayi) cc tnh
pha Nam l Ninh Thun v Khnh Ha (W.
bancrofti) tng c bnh lu hnh. Th mn tnh
trn lm sng ph bin nht l ph chn voi.
Ci thin iu kin sng v ha tr liu (bao
gm c MDA) lm gim giun ch bch huyt
ng k v khng cn lan truyn na. Vit Nam
ang c k vng cng nhn khng cn giun
ch bch huyt nm 2016.
174

chemotherapy (including MDA) have decreased
filariasis significantly and no new transmissions
have occurred in Vietnam. Vietnam is expeted
to be free of lymphatic filariasis by 2016.
Map sources:
Surveillance data in 2003, National Institute of
Malariology, Parasitology and Entomology
Map limitations:
No recent survey data are available and the
endemic areas on the map are historical. No
further transmission of lymphatic filariasis has
been documented in Vietnam. However the
vectors are still present and there is a risk of
reemergence.

Ngun bn :
S liu iu tra nm 2003, vin St rt K sinh
trng Cn trng Trung ng
Hn ch ca bn :
Khng c s liu iu tra gn y v cc vng
lu hnh trong bn c tnh cht lch s.
Khng cn s lu truyn giun ch bch huyt
c ghi nhn ti Vit Nam. Tuy nhin, vc t
vn hin din v vn cn nguy c ti bng pht.

- Addiss DG. (2010) Global Elimination of Lymphatic Filariasis: Addressing the Public Health
Problem. PloS Negl Trop Dis 4 (6): e471.
- Meyrowitsch DW, et al. (1998) A review of the present status of lymphatic filariasis in Vietnam.
Acta Trop;70(3):335-47.
- Nguyen VD et al. (2012) Dirofilariarepens in Vietnam: Detection of 10 Eye and Subcutaneous
Tissue Infection Cases Identified by Morphology and Molecular Methods. Korean J Parasitol;
50(2): 137-141/
- Michael E, et al. (1997) Global Mapping of Lymphatic Filariasis. Parasitol Today 13 (12): 472476.
-Paily KP, et al. (2009) A review of the complexity of biology of lymphatic filarial parasites. J
Parasit Dis33(1&2): 3-12.
- Sudomo M, et al. (2010) Elimination of lymphatic filariasis in Southeast Asia. AdvParasitol 72:
205-233.
- Taylor MJ, et al. (2010) Lymphatic filariasis and onchocerciasis. Lancet 376 (9747): 1175-1185.
- World Health Organization. (2010) Lymphatic filariasis. Progress report 2000-2009 and strategic
plan 2010-2020
-Wertheim H, Horby P, Woodall J (2012). Atlas of Infectious Diseases. Wiley-Blackwell, Oxford,
United Kingdom.
175
Ch : St rt do Plasmodium vivax
Subject: Malaria, Plasmodium vivax
176

Classification:
ICD-9 084.1; ICD-10 B51
Phn loi:
ICD-9 084.1; ICD-10 B51
Synonyms:
Vivax malaria; recurring malaria; tertian malaria;
paludism; marsh fever; ague.
ng ngha:
St rt Vivax, st rt cch nht, ng nc.
Agent:
Plasmodium vivax (Pv), an intacellular protozoan
parasite in the Phylum Apicomplexa.
Reservoir:
Humans.
Vector:
Female mosquito of the genus Anopheles; mainly
bites between dusk and dawn (see Anopheles
map).
Transmission:
By mosquito bite (Anopheles spp); no direct
human-to-human transmission; transmission has
been described in needle sharing IVDUs and
blood transfusion.
Cycle:
Infective sporozoites are inoculated by anopheles
mosquitoes bite and through blood stream and
lymphatics reach the liver where they differentiate
into tissue schizonts that release merozoites, or to
a dormant stage (hypnozoite) that can become
active after months or years, causing relapse.
Merozoites released from liver mostly infect
reticulocytes that develop to schizonts, rupture
and release merozoites that will infect new
reticulocytes (this cycle takes 48 h). Gametocytes
are able to infect mosquitos during a blood meal.
Incubation period:
12 days to several months
Clinical findings:
Common unspecific symptoms are acute febrile
illness with chills, sweats, nausea, headache and
vomiting; high fever with chill is more common in
Tc nhn:
Plasmodium vivax, mt n bo k sinh trng ni
bo trong Apicomplexa.
cha:
Con ngi.
Vector:
Mui ci thuc chi Anopheles, ch yu t ngi
lc hong hn v bnh minh (xem thm bn
Anopheles).
Ly truyn:
Qua vt mui t (Anopheles spp), khng ly trc
tip t ngi sang ngi, c s ly truyn qua
dng chung bm kim tim trong tim chch ma
ty v truyn mu.
Chu k:
Thoa trng xm nhp c th ngi qua vt mui
t v theo ng mu v h bch huyt n gan
v chng phn chia thnh th phn lit m
gm nhiu thoa trng, thoa trng gii phng, hoc
s bc vo giai on khng hot ng (th ng)
c th ti hot ng sau nhiu thng hoc nhiu
nm, gy bnh ti pht. thoa trng pht sinh t
gan xm nhp ch yu hng cu sinh sn, gy
v hng cu v cc thoa trng gii phng ny s
xm nhp hng cu mi (chu k di 48 gi). Mui
c th b nhim giao bo trong lc ht mu.
Thi gian bnh:
12 ngy n nhiu thng.
Biu hin lm sng:
Cc triu chng khng c hiu thng gp gm
st t ngt vi rt run, ra m hi, bun nn,
au u v nn ma; st cao v rt run l ph
bin hn trong st rt P. vivax hn trong st rt
177

Pv than in Plasmodium falciparum (P. f) malaria.
Recent reports provide evidence that vivax is not
as benign as previously thought. Pv can lead to
severe anemia, acute respiratory distress, liver
failure, renal failure, and even cerebral malaria.
P. falciparum. Nhng bo co gn y cung cp

bng chng cho thy vivax khng phi l st rt
lnh tnh nh suy ngh trc y. Pv c th dn
n thiu mu nng, suy h hp cp, suy gan, suy
thn, bnh st rt v thm ch bin chng th no.
Diagnostic tests:
Microscopy: in Giemsa-stained blood smears
Schfnners dots are seen; rapid diagnostic tests
(RDTs); PCR.
Xt nghim chn on:

Knh hin vi: trong xt nghim lam mu nhum
Giemsa quan st c chm Schfnner, test chn
on nhanh (RDTs); PCR.
Prevention:
Vector control; mosquito repellent; insecticidetreated bed nets; treatment of infected humans.
Phng nga:
Kim sot vector, thuc tr mui, mn tm thuc
mui, iu tr nhng ngi b nhim k sinh trng.
Epidemiology:
Vivax malaria is the second most important malaria
species after Pf and accounts for 25 - 40% of the
cases worldwide with 132 391 million cases per
year. Outside Africa it is the dominant species,
mainly in Asia. The distribution is wider than Pf
as it is able to develop at lower temperatures and
can form hypnozoites in human liver.
Following large epidemics in the early 1990s,
malaria (both Pf and Pv) control in Viet Nam
was intensified and over the past 20 years the
incidence of malaria in Viet Nam has been
greatly reduced. In 2008, 11,355 confirmed
malaria (both falciparum and vivax) cases and
25 deaths were reported, compared with over
one million cases and 4500 deaths in 1991. The
decline is probably a consequence of the synergy
between a strengthened malaria control program
and extensive socio-economic development.
However, malaria remains a problem in some
areas, particularly the central highlands, despite
control efforts that include enhanced health
services, early diagnosis and free treatment with
artemisinin derivatives, and free insecticidetreated nets. The factors believed to have been
associated with the persistence of risk in these areas
include remoteness and difficulty in delivering
and sustaining control efforts; presence in the
central highlands of the exophagic and exophilic
vector Anopheles dirus ; poor living and education
Dch t:
P. vivax ng th hai sau P. falciparum trong gy
bnh st rt v v chim 25- 40% cc trng hp
st rt trn ton th gii vi 132- 391 triu trng
hp mi nm. Ngoi chu Phi, P. vivax l loi
chim u th ph bin, ch yu l chu . S
phn b rng hn so vi P. falciparum l do P.
vivax c th pht trin nhit thp hn v c
th ng trong gan ngi.
Sau cc v dch ln u nhng nm 1990, kim
sot bnh st rt (c P. falciparum v P. vivax)
ti Vit Nam c tng cng v trong vng
20 nm qua, t l mc bnh st rt Vit Nam
gim ng k. Nm 2008, 11.355 trng hp
dng tnh (P. falciparum, P. vivax) v 25 trng
hp t vong st rt c bo co, gim rt
nhiu so vi hn mt triu trng hp mc v
4.500 t vong nm 1991. S gim l kt qu ca
s kt hp gia chng trnh phng chng st rt
tng cng v s pht trin kinh t-x hi rng
khp. Tuy nhin, st rt vn cn l mt vn
ti mt s khu vc, c bit l vng Ty Nguyn,
bt chp nhng n lc kim sot bao gm ci
thin dch v chm sc sc khe, chn on
sm v iu tr min ph vi cc thuc dn xut
artemisinin, pht min ph mn tm thuc chng
mui. Cc yu t c cho l gn lin vi nguy
c dai dng bnh st rt khu vc ny l s xa
xi v kh khn trong trin khai v duy tr cc
bin php kim sot; s hin din ca mui vector
178

standards; low perception of risk; and forestrelated activities. Forest-related activities have
been identified as an especially important risk
factor for malaria with a population-attributable
fraction of 53% estimated in one study in Viet
Nam. Poverty is also consistently identified as a
risk factor for malaria in Viet Nam and reflects the
fact that the burden of malaria is greatest in poor
ethnic minority communities living in remote
areas in close proximity to forests.
Map sources:
The map is modified from the paper: Bui HM et
al. (2011) Social and environmental determinants
of malaria in space and time in Viet Nam. Int J
Parasitol;41(1):109-16. This study assembled
data on counts of reported Plasmodium
falciparum and Plasmodium vivax malaria cases
by month (January 2007December 2008) and by
district.
Map limitations:
A major limitation of any attempt to use routine
case reports to measure risk is the completeness
and representativeness of such data sources. It
has been shown that routine reporting of malaria
cases through the health system in Viet Nam
substantially underestimates the true number of
cases.
Anopheles dirus ht mu trong nh v ngoi nh

Ty Nguyn; iu kin sng ngho nn v trnh
thp km; nhn thc yu v nguy c v cc
hot ng lin quan ti rng (i rng). Cc hot
ng i rng c coi l mt yu t nguy c c
bit quan trng ca bnh st rt vi nguy c quy
thuc l 53% theo c tnh ca mt nghin cu
ti Vit Nam. Ngho cng lun c xc nh l
yu t nguy c ca bnh st rt Vit Nam v
phn nh thc t l gnh nng bnh st rt ln
nht trong cc cng ng dn tc thiu s ngho,
sng trong vng su vng xa gn rng.
Ngun bn :
Bn c cn c theo bi bo: Bui HM et al.
(2011) Social and environmental determinants
Parasitol;41(1):109-16.
Nghin cu ny thu thp s liu s ca mc st
rt Plasmodium falciparum v Plasmodium vivax
theo thng (thng 1 nm 2007 n thng 12 nm
2008) theo cp qun huyn.
Hn ch ca bn :
Hn ch ln trong vic s dng bo co thng
k o lng nguy c l s hn ch trong tnh
y v tnh i din ca cc bo co ny. Thc
t cho thy s ca mc st rt theo bo co thng
quy ca h thng y t thp hn nhiu so vi s
lng thc.

- Bui HM et al. (2011) Social and environmental determinants of malaria in space and time in Viet Nam.
Int J Parasitol;41(1):109-16.
- Erhart A et al. (2007) Accuracy of the health information system on malaria surveillance in Viet Nam.
Trans. R. Soc. Trop. Med. Hyg; 101:216225.
- Douglas NM, et al. (2010) Artemisinin combination therapy for vivax malaria. Lancet Infect Dis 10:
405416..
- Mueller I, et al. (2009). Key gaps in the knowledge of Plasmodium vivax, a neglected human malaria
parasite. Lancet Infect Dis 9: 555-566.
- Price RN, et al. (2007) Vivax malaria: neglected and not benign. Am J Trop Med Hyg 77 (6 Suppl):
- Santa-Olalla Peralta P, et al. (2010) First autochtonous malaria case due to Plasmodium vivax since
eradication, Spain, October 2010. Euro Surveill 15 (41): 19684.
United Kingdom.
179
Subject: Malaria, Plasmodium falciparum
Ch : St rt do Plasmodium falciparum
180
Classification:
ICD-9 084; ICD-10 B50
Phn loi:
ICD-9 084; ICD-10 B5
Synonyms:
Falciparum malaria, malaria tropica, tropical
fever, blackwater fever, malignant tertian,
paludism, marsh fever, ague.
ng ngha:
St rt P. falciparum, st ng nc, st rt c tnh,
st rt dai dng.
Agent:
Plasmodium falciparum, an intacellular protozoan
parasite in the Phylum Apicomplexa. Amongst
the malaria parasites, P. falciparum causes the
vast majority of mortality in humans.
Reservoir:
Humans.
Vector:
Mosquito (Anopheles spp), mainly bites between
dusk and dawn (See Anopheles map).
Transmission:
By mosquito bite (Anopheles spp). There
is no direct person-to-person transmission.
Transmission has been described in needle
sharing IVDUs and through blood transfusion.
Tc nhn:
Plasmodium falciparum, sinh vt n bo k sinh
ni bo trong ngnh Apicomplexa. Trong s cc
k sinh trng st rt, P. falciparum gy ra phn
ln cc trng hp t vong ngi.
cha:
Con ngi.
Vector:
Mui (Anopheles spp), ch yu t lc hong hn
v bnh minh (Xem thm bn Anopheles).
Ly truyn:
Qua vt mui t (Anopheles spp). Khng ly
trc tip t ngi ny sang ngi. C th ly
truyn qua dng chung bm kim tim trong tim
chch ma ty v truyn mu.
Cycle:
Asexual phase takes place in human and sexual
phase occurs in the vector mosquito. The mosquito
injects sporozoites that invade human liver cells
where they reproduce and develop to merozoites,
which after release infect erythrocytes. The
erythrocytic stages multiply around 10-fold
every 48 hour life cycle. Erythrocytes can release
gametocytes which infect mosquitoes during a
blood meal. In the mosquito, the gametocytes
multiply and develop into sporozoites.
Chu k:
Giai on v tnh din ra trong c th ngi v
giai on hu tnh trong mui vect. Mui truyn
thoa trng cho ngi qua vt t, thoa trng xm
nhp t bo gan ngi, thoa trng sinh sn
v pht trin thnh cc lit t (merozoites), cc
merozoites sau khi gii phng s ly nhim hng
cu. Giai on ng cu chng nhn ln 10 ln
trong hng cu ko di 48 gi. Hng cu c th
gii phng giao bo m mui b ly nhim trong
lc ht mu. Trong c th mui, cc giao bo sinh
si hu tnh v pht trin thnh cc thoa trng.
Incubation period:
7 to 15 days, but can be longer.
Thi gian bnh:

7-15 ngy, nhng c th lu hn.
Clinical findings:
Uncomplicated malaria: acute febrile illness with
headache, chills, sweats, nausea and vomiting;
hepatosplenomegaly. Findings of severe malaria
can be: cerebral malaria (confusion, seizures,
Biu hin lm sng:

St rt khng bin chng: St cp tnh km au
u, rt run, ra m hi, bun nn v nn; gan lch
to. Cc pht hin ca st rt c tnh c th c: st
rt th no (l ln, co git, suy gim thc ti hn
181
impaired consciousness to coma), hemolysis

with severe anemia, hypotension, ARDS, low
blood glucose, renal failure, metabolic acidosis
and death. Often high parasite counts are found
in patients with severe malaria (>5% infected
erythrocytes).
m), tan huyt thiu mu nng, h huyt p, hi

chng suy h hp cp (ARDS), h ng huyt,
suy thn, nhim toan chuyn ha v t vong. S
lng k sinh trng tng cao nhng bnh nhn
st rt c tnh (> 5% hng cu b nhim k sinh
trng).
Diagnostic tests:
Microscopy; rapid diagnostic tests (RDTs); PCR.
Xt nghim chn on:

Soi knh hin vi, xt nghim chn on nhanh
(RDT); PCR.
Prevention:
Vector control; mosquito repellent; insecticidetreated bed nets; residual spraying of insecticides;
treatment of infected humans.
Epidemiology:
The limits of Pf malaria is determined by the
presence of vector species and control measures
within a certain region. Worldwide Pf malaria
causes approximately 500 million cases each year
and around one million deaths in sub-Saharan
Africa. Recent progress is being made by the
Global Malaria Action Plan to reduce malaria
morbidity and mortality worldwide and have a
vision for malaria elimination. Ranking countries
on elimination feasibility shows that it is most
feasible in the Americas and several countries in
Asia and West Pacific.
Following large epidemics in the early 1990s,
malaria control in Viet Nam was intensified and
over the past 20 years the incidence of malaria in
Viet Nam has been greatly reduced. In 2008, 11,355
confirmed malaria (both falciparum and vivax)
cases and 25 deaths were reported, compared
with over one million cases and 4500 deaths in
1991. The decline is probably a consequence
of the synergy between a strengthened malaria
control program and extensive socio-economic
development. However, malaria remains a
problem in some areas, particularly the central
highlands, despite control efforts that include
enhanced health services, early diagnosis and free
treatment with artemisinin derivatives, and free
insecticide-treated nets. The factors believed to
have been associated with the persistence of risk
in these areas include remoteness and difficulty
Phng nga:
Kim sot vector, thuc tr mui, mn tm thuc
mui, phun thuc tn lu tr mui, iu tr ngi
nhim k sinh trng.
Dch t hc:
S gii hn ca bnh st rt P. falciparum c
xc nh bi s hin din ca loi vector v cc
bin php kim sot mi khu vc nht nh.
Trn th gii bnh st rt P. falciparum gy ra
khong 500 triu ca mc mi nm v khong mt
triu ca t vong vng di sa mc Sahara, chu
Phi. N lc ca K hoch Hnh ng Ton cu
bnh St rt gim t l mc v t vong do st rt
v hng ti loi tr st rt c nhng tin b.
Cc nc chu M v mt s nc chu v Ty
Thi Bnh Dng c xp th hng cao v kh
nng loi tr bnh.
Sau cc v dch ln u nhng nm 1990, kim
sot bnh st rt (c P. falciparum v P. vivax)
ti Vit Nam c tng cng v trong vng
20 nm qua, t l mc bnh st rt Vit Nam
gim ng k. Nm 2008, 11.355 trng hp
dng tnh (P.falciparum, P. vivax) v 25 trng
hp t vong st rt c bo co, gim rt
nhiu so vi hn mt triu trng hp mc v
4.500 t vong nm 1991. S gim l kt qu
ca s kt hp gia chng trnh phng chng
st rt c kin ton v s pht trin kinh t-x
hi rng khp. Tuy nhin, st rt vn cn l mt
vn ti mt s khu vc, c bit l vng Ty
Nguyn, bt chp nhng n lc kim sot bao
gm ci thin dch v chm sc sc khe, chn
on sm v iu tr min ph vi cc thuc dn
xut artemisinin, pht min ph mn tm thuc
chng mui. Cc yu t c cho l gn lin vi
182

in delivering and sustaining control efforts;
presence in the central highlands of the exophagic
and exophilic vector Anopheles dirus sensu
stricto; poor living and education standards; low
perception of risk; and forest-related activities.
Forest-related activities have been identified as
an especially important risk factor for malaria
with a population-attributable fraction of 53%
estimated in one study in Viet Nam. Poverty is
also consistently identified as a risk factor for
malaria in Viet Nam and reflects the fact that
the burden of malaria is greatest in poor ethnic
minority communities living in remote areas in
close proximity to forests.
Map sources:
The map is modified from the paper: Bui HM et
al. (2011) Social and environmental determinants
Parasitol;41(1):109-16. This study assembled data
on counts of reported Plasmodium falciparum
and Plasmodium vivax malaria cases by month
(January 2007December 2008) and by district.
Map limitations:
A major limitation of any attempt to use routine
case reports to measure risk is the completeness
and representativeness of such data sources. It
has been shown that routine reporting of malaria
cases through the health system in Viet Nam
substantially underestimates the true number of
cases.
nguy c dai dng bnh st rt khu vc ny l
s xa xi v kh khan trong trin khai v duy tr
cc bin php kim sot; s hin din ca mui
vector Anopheles dirus sensu ht mu trong nh
v ngoi nh Ty Nguyn; iu kin sng ngho
nn v trnh thp km; nhn thc yu v nguy
c v cc hot ng lin quan ti rng (i rng).
Cc hot ng i rng c coi l mt yu t
nguy c c bit quan trng ca bnh st rt vi
nguy c quy thuc l 53% theo c tnh ca mt
nghin cu ti Vit Nam. Ngho cng lun c
xc nh l yu t nguy c ca bnh st rt Vit
Nam v phn nh thc t l gnh nng bnh st
rt ln nht trong cc cng ng dn tc thiu s
ngho, sng trong vng su vng xa gn rng.
Ngun bn :
Bn c cn c theo bi bo: Bui HM et al.
(2011) Social and environmental determinants
Parasitol;41(1):109-16.
Nghin cu ny thu thp s liu s ca mc st
rt Plasmodium falciparum v Plasmodium vivax
theo thng (thng 1 nm 2007 n thng 12 nm
2008) theo cp qun huyn.
Hn ch ca bn :
Hn ch ln trong vic s dng bo co thng
k o lng nguy c l s hn ch trong tnh
y v tnh i din ca cc bo co ny. Thc
t cho thy s ca mc st rt theo bo co thng
quy ca h thng y t thp hn nhiu s lng
thc.

- Bui HM et al. (2011) Social and environmental determinants of malaria in space and time in Viet Nam.
Int J Parasitol;41(1):109-16.
- Erhart A et al. (2007) Accuracy of the health information system on malaria surveillance in Viet Nam.
Trans. R. Soc. Trop. Med. Hyg; 101:216225.
- Hay SI, et al.(2009) A world malaria map: Plasmodium falciparum endemicity in 2007. PloS Med 6
(3): e1000048.
- Lancet series. (2010) Malaria Elimination. Lancet 376 (9752): 1566-1615.
United Kingdom.
183
Subject: Paragonimiasis
Ch : Sn l phi
184
Ch : Sn l phi
Classification:
ICD-121.2; ICD-10 B66.4
Phn loi:
ICD-121,2; ICD-10 B66.4
Synonyms:
Pulmonary distomiasis, Lung fluke disease
ng ngha:
Bnh sn l phi, bnh sn phi
Agent:
Several species of Paragonimus trematode
flatworms: P. westermani, P. heterotremus, P.
miyazakii, P. skrjabini and P. hueitungensis (the
last 2 may be the same) in Asia, P. africanus and
P. uterobilateralis in Africa, P. mexicanus (P.
peruvianus) and P. kellicotti in the Americas.
In Vietnam, P. heterotremus has been known
as the only proven species present and to cause
human paragonimiasis.
Tc nhn:
Mt s loi sn Paragonimus: P. westermani,
P. heterotremus, P. miyazakii, P. skrjabini v P.
hueitungensis (hai loi cui c th ging nhau)
chu , P. africanus v P. uterobilateralis
chu Phi, P. mexicanus (P. peruvianus)
v P. kellicotti chu M. Vit Nam, P.
heterotremus c bit n c l loi duy
nht c chng minh gy bnh sn l phi cho
ngi.
Reservoir:
Humans, dogs, cats, pigs and wild carnivores.
P. westermani is endemic among wildlife
in Quang Tri province; pathogenicity of P.
westermani for Vietnamese people remains
questionable.
cha:
Con ngi, ch, mo, ln v cc loi ng vt
n tht hoang d. P. westermani lu hnh trn
cc loi ng vt hoang d tnh Qung Tr.
Kh nng ly truyn P. westermani cho ngi
dn Vit Nam cha c chng minh r rng.
Vector:
Freshwater snails: Semisulcospira, Thiara,
Aroapyrgus and others.
Vector:
Cc loi c nc ngt: Semisulcospira, Thiara,
Aroapyrgus v nhng loi khc.
Transmission:
By consumption of infected raw, salted,
marinated, pickled or undercooked freshwater
crabs and crayfish. Infected humans can
excrete worm eggs in sputum and feces for
up to 20 years. There is no person-to-person
transmission.
Ly truyn:
n thc phm sng, mui, p, gi, ti b
nhim sn nh tm, cua nc ngt. Ngi b
nhim sn c th bi tit trng sn trong m v
phn ti 20 nm. Khng c ly truyn trc tip
t ngi sang ngi.
Cycle:
The reservoir host consumes crustaceans
infected with metacercaria larvae, which excyst
in the gut and migrates to the tissues, usually
the lungs. There they encapsulate mature
and lay eggs. Eggs enter the sputum which is
coughed up and swallowed, then pass out in
the feces into water and hatch in 2-4 weeks into
miracidia larvae. These penetrate the body of
Chu k:
Vt ch chnh n phi ng vt gip xc b
nhim u trng nang sn l phi, u trng vo
rut xuyn qua thnh ng tiu ha v di chuyn
n cc m, thng l phi. , chng to v,
trng thnh v trng. Trng theo m o
thi ra ngoi khi ho, hoc o thi theo phn
khi nut phi m, trng ri xung nc trong
2-4 tun n thnh u trng lng. Chng xm
nhp c th c vector, pht trin trong khong
185
Ch : Sn l phi
the vector snail, where they develop in about

2 months into cercaria larvae which enter and
encyst in freshwater crabs and crayfish.
2 thng thnh u trng ui, ri ri c v xm

nhp tm cua nc ngt v pht trin thnh u
trng nang.
Incubation period:
Flukes begin to lay eggs 6-10 weeks after
ingestion of larvae. In humans, incubation
is long and highly variable depending on the
number of larvae ingested and organ affected.
Thi gian bnh:

Sn bt u trng 6- 10 tun sau khi vt ch
n phi u trng. ngi, thi gian bnh
thng di v khc nhau ty thuc vo s lng
u trng b nut vo v c quan b nh hng.
Clinical findings:
Fever, cough, hemoptysis and pleuritic chest
pain. Flukes may invade the brain and much
more rarely the spinal cord in Asia (only rarely
in Africa), causing meningitis, intracranial
hemorrhage, epilepsy and paralysis. They may
also cause acute and chronic inflammation of
the pleura, pericardium and mediastinum. Chest
X-ray findings are similer to TB. Complications
include pleural effusion, pneumothorax,
bronchiectasis and pulmonary fibrosis.
Biu hin lm sng:

St, ho, ho ra mu v au ngc mng phi. Sn
c th xm nhp vo no, v him hn vo ty
sng chu (him khi chu Phi), gy vim
mng no, xut huyt ni s, ng kinh v lit.
Bnh cng c th gy vim cp tnh v mn
tnh mng phi, mng ngoi tim v trung tht.
Hnh nh X-quang ngc tng t lao. Cc bin
chng bao gm trn dch mng phi, trn kh
mng phi, gin ph qun v x ha phi.
Diagnostic tests:
Microscopic examination of sputum for
eggs (acid-fast staining destroys eggs), and
examination of feces after using concentration
techniques; ELISA for serology.
Prevention:
Thorough cooking of crustaceans, sanitary
disposal of sputum and feces and use of
molluscicides.
Epidemiology:
The major endemic area is China, with an
estimated 20 million people infected, followed
by India, Laos and Myanmar. In the Americas,
Ecuador has an estimated one half million
cases, but up to 2010 only 9 autochthonous
cases of paragonimiasis had been reported from
North America (excluding 2 outbreaks in 2006
in California from eating raw freshwater crab
imported from Japan).
The first case of paragonimiasis in Vietnam was
reported in 1906. There were no new reports
Xt nghim chn on:

Soi knh hin vi mu m tm trng (nhum
axit s nhanh chng ph hy trng), v kim
tra phn sau khi s dng cc k thut tp trung;
ELISA xt nghim huyt thanh.
Phng nga:
Nu k ng vt gip xc, x l v sinh m,
phn, v dng cc thuc dit sn.
Dch t hc:
Vng bnh lu hnh nng nht l Trung Quc,
vi c tnh khong 20 triu ngi b nhim,
tip theo l n , Lo v Myanmar. Ti chu
M, theo c tnh, Ecuador c khong na
triu trng hp, nhng n nm 2010 ch c
9 trng hp mc sn l phi bn a c bo
co t Bc M (khng k 2 v dch trong nm
2006 ti California do n cua nc ngt sng
nhp khu t Nht Bn).
Trng hp u tin ca sn l phi Vit Nam
c ghi nhn nm 1906. Khng c bo co
cho n nm 1994, mt s bnh nhn c chn
on sn l phi tnh Lai Chu. K t , mt
186
until 1994 when a number of patients were
diagnosed in Lai Chau province. Since then,
several surveys revealed that paragonimiasis is
endemic in mountainous areas of eight northern
provinces (Lai Chau, Dien Bien, Son La, Ha
Giang, Lao Cai, Yen Bai, Lang Son and Hoa
Binh) because of the habit of local people of
eating under-cooked mountain crabs which are
contaminated with Paragonimus metacercariae.
Most cases are among ethnic minorities. Despite
many years of mass screening, treatment and
health education, the prevalence among these
communities remain, and can be up to 12.7%.
Map Sources:
National studies and projects of Dr Nguyen
Van De-National Institute of Malariology,
Parasitology and Entomology
Surveillance period was from 1995 to 2006
Data limitation:
Only some studies or surveillance on human in
10 northern provinces
Ch : Sn l phi
s cuc iu tra cho thy sn l phi l dch
lu hnh 8 tnh min ni pha Bc (Lai Chu,
in Bin, Sn La, H Giang, Lo Cai, Yn
Bi, Lng Sn, Ha Bnh) do ngi dn a
phng thng n cua nhim u trng nang
Paragonimus cha nu k. Hu ht cc trng
hp mc l ngi dn tc thiu s. Mc d
c nhiu nm khm sng lc, iu tr v gio
dc y t i chng, t l mc ti cng ng vn
cn cao, c th ln n 12,7%
Ngun bn :
Cc ti nghin cu cp nh nc ca Tin S
Nguyn Vn - Vin St rt-k sinh trng-cn
trng Trung ng.
Thi gian iu tra t nm 1995 n 2006
Hn ch ca bn
Ch c mt s nghin cu v iu tra ngi
ch thc hin ti 10 tnh pha Bc.

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- Liu Q, et al. (2006) Paragonimiasis: an important food-borne zoonosis in China. Trends in
Parasitology,
-Prasad PK et al. (2009) Phylogenetic reconstruction using secondary structures and sequence motifs
of ITS2 rDNA of Paragonimus westermani (Kerbert, 1878) Braun, 1899 (Digenea: Paragonimidae)
and related species. BMC Genomics 10 (Suppl 3):S25.
- Doanh PN, et al. (2011) Human paragonimiasis in Viet Nam: epidemiological survey and
identification of the responsible species by DNA sequencing of eggs in patients sputum. Parasitol
Int; 60(4):534-7.
- Nguyn Quc Doanh, et al (2002). Bnh u trng sn dy trn ln mt s tnh min Bc Vit
Nam. Tp ch phng chng st rt v cc bnh k sinh trng, S 6- 2002. Tr.82-88
hc thc hnh. S 509/2005. Tr. 20-26.
- Nguyn Vn , et al (2000). Thng bo mt s bnh sn l phi mi pht hin cc tnh min
ni pha Bc. Thng tin phng chng st rt v cc bnh K sinh trng, s 1-2000. tr. 69-72
hc thc hnh. S 509/2005. Tr. 20-26.
United Kingdom
187
Subject: Soil transmitted helminths
Ch : Nhim giun truyn qua t
188
Classification:
ICD-9 128; ICD-10 B83
Phn loi:
ICD-9 128; ICD-10 B83
Synonyms:
Helminthiasis.
ng ngha:
Bnh giun sn.
Agent:
The main species that infect people are
the roundworm (Ascaris lumbricoides),
the whipworm (Trichuris trichiura) and
the hookworms (Necator americanus and
Ancylostoma duodenale).
Tc nhn:
Cc loi chnh gy bnh cho ngi l giun a
(Ascaris lumbricoides), giun tc (Trichuris
trichiura), v giun mc (Necator americanus
v Ancylostoma duodenale).
Reservoir:
Humans. Some animal species can also be a
reservoir for hookworms. Animals whipworms
do not infect humans.
Transmission:
Soil-transmitted helminths are transmitted by
eggs passed in the faeces of infected people.
Adult worms live in the intestine where
they produce thousands of eggs each day. In
areas that lack of adequate sanitation, these
eggs contaminate the soil. People become
infected with A. lumbricoides and T. trichiura
by ingesting infective parasite eggs. Eggs
that are attached to vegetables are ingested
when the vegetables are not carefully cooked,
washed or peeled. Eggs are ingested from
contaminated water sources. Eggs are ingested
by children who play in soil and then put their
hands in their mouths without washing them.
Hookworm eggs can hatch in the soil, releasing
larvae that mature into a form that can actively
penetrate the skin. People become infected with
hookworm primarily by walking barefoot on
the contaminated soil. There is no direct personto-person transmission, or infection from fresh
faeces, because eggs passed in faeces need
about three weeks to mature in the soil before
they become infective. Since these worms do
not multiply in the human host, reinfection
occurs only as a result of contact with infective
cha:
Con ngi. Mt s loi ng vt cng c th l
cha giun mc. Giun tc ng vt khng ly
bnh cho ngi.
Ly truyn:
Cc loi giun truyn qua t ly truyn bnh
qua trng c trong phn ngi mc giun. Giun
trng thnh sng trong rut v hng ngn
trng mi ngy. Trong khu vc thiu v sinh,
trng giun gy nhim t. Ngi b nhim A.
lumbricoides v T. trichiura do n phi trng
k sinh trng c kh nng gy bnh. Trng gn
trn rau khi rau khng c nu chn k, ra
sch hoc bc v. Trng giun c tiu ho t
ngun nc b nhim bn. Tr em nhim trng
giun sau khi nghch t v b tay vo ming khi
cha ra tay. Trng giun mc c th n trong
t, gii phng u trng; u trng ny chuyn
ho thnh mt dng c th ch ng xm nhp
vo da. Ngi b nhim giun mc ch yu bi
i b chn trn trn t b nhim giun. Khng
c ly truyn trc tip ngi-ngi v khng c
nhim qua phn ti v trng giun c thi ra
trong phn cn khong 3 tun trng thnh
trong t trc khi tr thnh c th gy bnh.
Giun khng nhn ln trong c th vt ch nn
vic b ti nhim ch xy ra nu c tip xc vi
cc cc giai on c th ly nhim (ca giun)
trong mi trng.
189

stages in the environment.
Incubation period:
Varies from weeks to several months, depending
on infection intensity.
Clinical findings:
Morbidity is directly related to worm burden:
the greater the number of worms in the infected
person, the greater will be the severity of disease.
People with light infections usually have no
symptoms. Heavier infections can cause a range
of symptoms including intestinal manifestations
(diarrhoea, abdominal pain), general malaise
and weakness, and impaired cognitive and
physical development. Hookworms cause chronic
intestinal blood loss that can result in anaemia.
Diagnostic tests:
Detection of eggs or worms in faeces by
microscopy. Sometimes eosinophilia is present.
Serology is of little value due to cross-reactivity.
Prevention:
WHOs control interventions are based on
the periodic administration of anthelminthics
to groups of people at risk, supported by the
need for improvement in sanitation and health
education. WHO recommends annual treatment
in areas where prevalence rate of soil-transmitted
helminthiases is between 20% and 50%, and, a
bi-annual treatment in areas with prevalence rates
of over 50%. Furthermore sanitation is associated
with a reduced risk of transmission.
Epidemiology:
Soil-transmitted helminth infections are among
the most common infections worldwide and affect
the poorest and most deprived communities. More
than 1.5 billion people, or 24% of the worlds
population are infected with soil-transmitted
helminth infections worldwide. Soil-transmitted
helminth infections are widely distributed in
tropical and subtropical areas, with the greatest

Thi gian bnh:
Khc nhau t vi tun n vi thng, ty thuc
vo mc nhim trng.
Biu hin lm sng:
T l mc bnh l c lin quan trc tip n
lng giun: s lng giun trong ngi b nhim
cng ln th mc nghim trng ca bnh
cng cao. Ngi nhim giun mc nh thng
khng c triu chng. Nhim trng nng c th
gy ra mt lot cc triu chng bao gm nhng
biu hin tiu ha (tiu chy, au bng), kh
chu ni chung v yu mt, chm pht trin tr
tu v th cht. Giun mc gy mt mu ng
rut mn tnh c th dn n thiu mu.
Xt nghim chn on:
Pht hin trng hoc giun trong phn bng soi
knh hin vi. i khi c tng bch cu i toan.
Huyt thanh chn on t c gi tr do phn ng
cho.
Phng nga:
Cc bin php can thip ca WHO c da
trn ch nh ung thuc giun nh k i vi
cc nhm c nguy c, c h tr bi cc bin
php ci thin v sinh mi trng v gio dc
sc khe. WHO khuyn co vic ung thuc
giun mi nm mt ln ti cc khu vc c t l
nhim bnh t 20% v 50%, v mi nm hai
ln nhng khu vc c t l trn 50%. Cc bin
php v sinh mi trng gip gim nguy c ly
truyn.
Dch t hc:
Nhim trung giun truyn qua t l mt trong
nhng bnh nhim trng ph bin nht trn
ton th gii v nh hng ln n nhm dn
c ngho nht d b tc ot nht. Hn 1,5 t
ngi, hay 24% dn s b nhim giun truyn
qua t trn ton th gii. Nhim giun truyn
qua t phn b rng ri trong khu vc nhit i
v cn nhit i, vi s lng ln nht ti vng
di Sahara chu Phi, chu M, Trung Quc
190

numbers occurring in sub-Saharan Africa, the
Americas, China and East Asia. Over 270 million
preschool-age children and over 600 million
school-age children live in areas where these
parasites are intensively transmitted, and are in
need of treatment and preventive interventions.
Prevalence rates for Vietnam in 2003 are estimated
to be 33.9 million people in Vietnam infected with
Ascaris (prevalence 44.4%), 17.6 million with
Trichuris (prevalence 23.1%), and 21.8 million
with hookworm (prevalence 28.6%). Prevalence
of Ascaris and Trichuris showed a declining trend
from the north to the south of the country. This
is probably related to differences in climatic
conditions. Hookworm prevalence is more
evenly distributed throughout the country, but is
concentrated in peri-urban and rural agricultural
areas. Vegetable cultivation in which faeces is
used as fertilizer is a risk factor for hookworm
infection, especially among adult women.
Helminth control programs should be targeted
at school-age children in the northern provinces.
Specific interventions are needed throughout the
country for women of agricultural communities
that are at risk for hookworm infection. One study
showed that wastewater exposure did not pose a
major risk for helminth infection in peri-urban
Hanoi. Instead, lack of sanitation facilities and
use of fresh or inadequately composted human
excreta in agriculture were important risk factors.
Map sources:
www. thiswormyworld.org/maps/Vietnam

v ng . Trn 270 triu tr em trong tui
mu gio tui v hn 600 triu tr em trong
tui i hc sng trong khu vc c k sinh trng
c lan truyn mc cao, v cn c iu
tr v nhng s phng nga can thip.
T l mc Vit Nam trong nm 2003 c
c tnh l 33,9 triu ngi b nhim giun a
(t l 44,4%), 17,6 triu nhim giun tc (t l
23,1%), v 21,8 triu nhim giun mc (t l
28,6%). T l nhim giun a v giun tc cho
thy xu hng gim t pha bc n pha nam.
iu ny c l lin quan n s khc bit v
iu kin kh hu. T l nhim giun mc phn
b ng u trong c nc, nhng tp trung
cc vng nng nghip ven th v nng thn.
S dng phn lm phn bn trong trng trt rau
l mt yu t nguy c nhim giun mc, c bit
l ph n trng thnh. Chng trnh kim sot
giun nn tp trung vo tr em tui i hc
cc tnh pha Bc. Cn c can thip c th trn
ton quc i vi ph n nng thn c nguy c
nhim giun mc. Mt nghin cu thc hin ti
khu vc ven H Ni cho thy tip xc vi
nc thi khng gy ra nguy c vi nhim giun.
Thay vo , thiu cc phng tin v sinh mi
trng v thi quen s dng phn ti hoc cc
cht thi tit ca ngi khng c x l y
trong nng nghip l yu t nguy c chnh.
Ngun bn :
www. thiswormyworld.org/maps/Vietnam.

-World Health Organization. (2012) Soil-transmitted helminth infections. Fact sheet nr 366.
- Van der Hoek W, et al. (2003) Current status of soil-transmitted helminths in Vietnam. Southeast
Asian J Trop Med Public Health;34Suppl 1:1-11.
- Do TT, et al. (2007)Helminth infections among people usingwastewater and human excreta in
peri-urban agriculture and aquaculture in Hanoi, Vietnam. Trop Med Int Health;12Suppl 2:82-90.
- Ziegelbauer K, et al. (2012) Effect of Sanitation on Soil-Transmitted Helminth Infection: Systematic
Review and Meta-Analysis. PLoS Med 9(1): e1001162.
United Kingdom.
191
SECTION 4
Viral diseases/Cac bnh do vi rt
192
Subject: Adenovirus paryngoconjunctivitis
Ch : Bnh do Adeno vi rt
193
Classification:
ICD-9; ICD-10
Phn loi:
ICD-9; ICD-10

Adenovirus, APC, pharyngoconjunctival fever,
pink eye.
Hi chng v ng ngha:
Adeno vi rut, APC, vim kt mc hng-hch,
bnh au mt o.
Agent:
The human adenoviruses are DNA viruses that
belong to the Mastadenovirus genus in the
family Adenovirus. Adenoviruses are important
etiologic agents of respiratory tract infections,
conjunctivitis, and gastroenteritis in children.
Forty-nine adenovirus serotypes are known
to infect humans. Particular serotypes tend to
infect specific sites and organs. Type 3 and 4
adenoviruses have been implicated as infectious
agents of Adenovirus paryngo conjunctivitis
(APC).
Tc nhn:
Adeno vi rut ngi l vi rut DNA thuc v
chi Mastadenovirus trong nhm Adeno vi rt.
Adeno vi rt l tc nhn gy bnh quan trng
ca nhim trng ng h hp, vim kt mc,
v vim d dy rut tr em. 49 tp huyt thanh
adeno vi rt c th ly nhim sang ngi.Mi
tp huyt thanh c xu hng ly nhim cho cc
c quan b phn ring. Adeno vi rt loi 3 v 4
c coi l tc nhn ly nhim ca APC.
Reservoir:
Infected human host. Adenoviruses are very
stable and can survive for a considerable
amount of time outside the host. As viruses
only replicate in living host cells, no increase in
numbers will occur in the environment.
Transmission:
Adenovirus infection is transmitted directly by
droplet spread and/or oral contact;
indirectly by handkerchiefs, eating utensils and
other articles freshly soiled with respiratory
discharge of an infected person; and possible
spread through the fecal-oral route. Contaminated
water bodies are another potential source, with
infection occurring by ingestion, inhalation of
aerosols, or direct contact with the eyes. Several
large outbreaks of pharyngoconjunctival fever
caused by adenovirus serotypes 3 and 4 have
been associated with swimming pools.
Incubation period:
2 10 days.
cha:
Vt ch l ngi b nhim bnh. Adeno vi rt
l rt bn vng v c th tn ti trong mt thi
gian ng k bn ngoi vt ch. Bi vi rt ch
tng sinh trong t bo vt ch sng nn ngoi
mi trng s lng vi rt s khng tng.
Ly truyn:
Nhim trng Adeno vi rt c truyn trc tip
bi git ly lan v tip xc bng ming; gin
tip qua khn tay, dng n ung, cc vt b
nhim bn bi cht thi tit ng h hp ca
ngi bnh v c th ly lan qua ng phnming. Ngun nc b nhim cng l mt
ngun ly truyn bnh, vi nhim trng xy ra
do n phi, ht phi cc ht h hp, hoc tip
xc trc tip vi mt. Nhiu t bng pht dch
st vim kt mc hu hng ln do tp huyt
thanh vi rt adeno 3 v 4 c lin quan n h
bi cng cng.
Thi gian bnh:
2-10 ngy.
Biu hin lm sng:
Vit Nam, bnh vim kt mc vim hu hng
194

Clinical findings:
In Vietnam, APC due to adenovirus is a notifiable
disease in Vietnam. The disease occurs as small
outbreaks in children and is characterized by:
conjunctivitis, pharyngitis, rhinitis, cervical
adenitis and fever. The disease is acute and last
for about 3- 5 days. The disease usually starts
with one eye; however, the other eye generally
becomes infected as well.
Diagnostic tests:
Antigen detection, polymerase chain reaction
assay, virus isolation, and serology can
be used to identify adenovirus infections.
Adenovirus typing is usually accomplished
by
hemagglutination-inhibition
and/or
neutralization with type specific antisera or
by hexon gene sequence molecular methods.
Since adenovirus can be excreted for prolonged
periods, the presence of virus does not
necessarily mean it is associated with disease.
Prevention:
Thus far, few attempts have been made to
vaccinate children from adenoviral infection.
Strict attention to good infection-control
practices, including contact and droplet
precautions. Frequent hand hygiene is
recommended.
Epidemiology:
Most children are infected by adenovirus at
an early age. By 5 years of age, 70% to 80%
of children demonstrate antibodies to at least
one serotype. Adenoviral infections occur
sporadically throughout the year, but epidemics
have been associated with child care centers,
hospitals, physicians offices, college students,
and military recruits in basic training.
Routine surveillance of APC in Vietnam started
in the 2000s when virus-related respiratory
infection such as influenza was on the rise and
caused public concerns. Currently it is one of
the 26 infectious diseases reported through
do adeno vi rt l bnh thuc h thng bo co.
Bnh xy ra thnh v dch nh tr em vi
nhng triu chng: vim kt mc, vim hng,
vim mi, vim hch c t cung v st. Bnh
cp tnh v ko di khong 3-5 ngy. Bnh
thng bt u mt bn mt, tuy nhin sau
s lan sang mt cn li.
Xt nghim chn on:
Pht hin khng nguyn, PCR, phn lp vi rt,
v huyt thanh hc c th c s dng xc
nh nhim adeno vi rt. Cc tp Adeno vi rt
thng c thc hin bng cch c ch ngng
kt hng cu v/ hoc trung ha vi cc loi
khng huyt thanh c hiu hoc bng phng
php phn t gii trnh t chui gen hexon.
Adeno vi rt c th c bi tit trong thi gian
di nn s hin din ca vi rt khng c ngha
l c cc du hiu ca bnh.
Phng nga:
n nay, vic thc hin tim chng Adeno vi rt
cho tr em t c ch trng. Tun th nghim
vic thc hnh chng nhim khun em li hiu
qu tt, bao gm phng nga ly nhim do tip
xc v qua git nh. V sinh tay thng xuyn
c khuyn khch.
Dch t hc:
Hu ht tr em b nhim adeno vi rt la tui
nh. Trc 5 tui, 70% n 80% tr em c
khng th i vi t nht mt type huyt thanh.
Nhim adeno vi rt xy ra ri rc quanh nm,
nhng dch bnh thng xut hin trung tm
chm sc tr em, bnh vin, phng khm t,
sinh vin i hc, v tn binh trong o to c
bn.
Gim st thng xuyn bnh APC ti Vit Nam
bt u trong nhng nm 2000 khi vi rt c lin
quan n nhim trng ng h hp nh cm
gia tng v tr thnh mi quan tm trong
cng ng. Hin nay n l mt trong s 26 bnh
truyn nhim c bo co thng qua h thng
gim st ca Vit Nam. APC l mt trong nm
195
the Vietnamese surveillance system. APC is

among the top five diseases with the highest
incidence rates in Vietnam. High number of
APC cases are reported each year since the
surveillance started. For example from October
2011 through September 2012, the number of
reported adenovirus APC in North of Vietnam
was 13,804 cases. During the 3rd quarter of
2010, several outbreaks of APC occurred and
10,412 cases of APC in the north were reported.
Map source:
Medicine
Limitations:
It is unclear whether also pink eye is reported in
the system which may cause an overestimation
of pharyngoconjunctival fever cases. Data on
the nature of outbreaks (number per outbreak
and risk category) would be more informative.
In case the surveillance data does not lead to any
control measure, the question remains whether
this surveillance data is needed. Reporting is
done based on clinical diagnosis
bnh hng u vi t l mc cao nht ti Vit

Nam. K t khi trin khai h thng gim st,
mt s lng ln cc trng hp APC c bo
co mi nm. V d t thng 10 nm 2011 n
thng 9 nm 2012, s lng bo co adeno vi rt
APC ti min Bc l 13.804 trng hp. Trong
qu 3 nm 2010, nhiu t bng pht bnh APC
xy ra v ghi nhn n 10.412 trng hp APC
ti pha bc.
Cc ngun bn :
2007 n 2011, Cc Y t d phng
Hn ch ca s liu:
Hin cha r liu triu chng mt c
bo co vo h thng c th lm tng cao qu
mc cc trng hp st vim kt mc vim hu
hng. D liu v bn cht ca dch (s lng
mi dch v loi nguy c) c gi tr hn. Trong
trng hp cc d liu gim st khng em li
bt k bin php kim sot no, th cu hi t
ra l liu s liu gim st ny c thc s l cn
thit. Cc ca bnh c ghi nhn da trn chun
on lm sng

- Tebruegge M, et al. (2012) Adenovirus: an overview for pediatric infectious diseases specialists.
Pediatr Infect Dis J.
- Mandell GL, et al (Eds). (2000). Principles and practice of infectious diseases. 6th edition. Elevier.
United Kingdom.
196
Subject: Chickenpox
Ch : Thy u
197
Subject: Chickenpox
Ch : Thy u
Classification:
ICD-9 052; ICD-10 B01
Phn loi:
ICD-9 052; ICD-10 B01

Varicella, pox

Varicella, pox
Agent:
This disease is caused by the varicella-zoster
virus (VZV), which is one of the herpes family
of viruses.
Tc nhn:
Bnh do vi rt varicella-zoster virus (VZV),
thuc h herpes.
Reservoir:
Humans
Transmission:
Chickenpox is spread by droplet from sneezing
and coughing, and also from the vesicles or pox
during the infective stage.
Incubation Period:
Usually 1021 days, but this can be prolonged
in the immunosuppressed. A person with
chickenpox can spread the disease from 1 to
2 days before they get the rash until all their
chickenpox blisters have formed scabs.
Clinical Findings:
This infection usually presents with a mild
fever, malaise and a rash. The rash usually
begins with maculopapular and generalizes
vesicular (blistered) and progresses to crusted
lesions over the course of a few days. Lesions
usually appear in crops and mostly on the trunk
and less on the face, scalp and limbs.
Adults, as well as newborns, pregnant women
and the immunodeficient are more likely to
suffer with more severe disease than children.
Possible complications of infection include
secondary bacterial infection of the lesions,
varicella pneumonitis, aseptic meningitis,
encephalitis and Reyes syndrome (acute
encephalopathy with fatty infiltration and
dysfunction of the liver).
Pregnant women are particularly at risk with
cha:
Ngi
Ly truyn:
Bnh thy u ly truyn qua cc ht nc do
ho hoc ht hi sinh ra, hoc t cc nt u ma
trong thi gian ly nhim.
Thi gian bnh:
Thng thng t 10-21 ngy, nhng c th ko
di i vi trng hp suy gim min dch.
Bnh nhn c th lan truyn bnh t 1 n 2
ngy trc khi xut hin nt cho n khi cc nt
v v to thnh vy.
Biu hin lm sng:
Nhim khun ny thng c st nh, au c v
c nt phng. Nhng nt phng ny thng bt
u bng cc dt c nhng nt phng nh v
to ra nhng mn nc nh (nt phng) v sau
tin trin thnh cc nt phng b v v to
nn cc tn thng c vy trong sut thi k
mt vi ngy. Cc tn thng thng xut hin
theo t v ch yu l thn, xut hin t hn
mt, chn tay v da u.
Ngi ln, cng nh tr s sinh, ph n mang
thai v nhng ngi c suy gim min dch
nhiu kh nng b mc bnh nng hn so vi tr
em. Cc bin chng c th ca nhim trng bao
gm nhim trng vi khun th cp ca cc tn
thng, vim phi do thy u, vim mng no
v trng, vim no v hi chng Reye (bnh
no cp tnh vi s thm nhim m v ri lon
chc nng gan).
198
Subject: Chickenpox
this infection, and there are risks to the fetus
and neonates of infected mothers:
- Infection during the first 20 weeks of
pregnancy can lead to an increased risk of
congenital varicella syndrome, which includes
limb hypoplasia, microcephaly, cataracts and
growth retardation and high mortality rate
- Infection a week before to a week after
delivery can lead to severe infection and often
death among neonates.
Diagnostic Tests:
Diagnosis is usually based on clinical features,
in particular the rash. Clinical diagnosis can be
confirmed by PCR from the vesicular lesions.
Serology can also be useful to determine prior
exposure to infection.
Prevention:
There are currently two vaccines available to
prevent chickenpox. Two doses of vaccine are
required, and this can prevent most cases of
severe infection.
Congenital varicella syndrome can be one of the
complications of exposure and infection with
varicella zoster during pregnancy. Varicella
zoster immunoglobulin is recommended for
antibody-negative pregnant contacts exposed
at any stage of pregnancy, provided that the
immunoglobulin can be given within ten days
of the contact. Varicella Zoster immunoglobulin
is also recommended for infants whose mothers
develop chickenpox in the period 1 week before
to 1 week after delivery, and this can be given
without antibody testing of the infant.
Epidemiology:
In unvaccinated populations, varicella is
primarily a childhood illness with more than
90% of the population in temperate countries
developing clinical or serological infection by
early adulthood, with the highest infection rates
in young children, usually between 5 and 9 years
of age. In the tropics, chickenpox often occurs
Ch : Thy u
Ph n mang thai c nguy c cao vi nhim
trng ny v thai nhi hoc tr s sinh ca cc b
m b nhim khun cng b e da:
- Nhim trng trong vng 20 tun u ca thai
k c th dn n tng nguy c ca hi chng
thy u bm sinh, trong bao gm thiu chi
thai nhi, tt nho u, c thy tinh th, chm
ln v t l t vong cao
- Nhim trng trong khong mt tun trc
n mt tun sau khi sinh c th dn n nhim
trng nng v thng gy t vong tr s sinh.
Xt nghim chn on:
Chn on thng da vo hnh nh lm sng,
c bit l nt phng. Chn on lm sng
c th c khng nh bng PCR t cc tn
thng ca nt phng. Cc xt nghim huyt
thanh hc c th c ch cho vic xc nh cc
phi nhim trc vi ngun bnh.
Phng bnh:
Hin nay c hai loi vc xin c sn ngn nga
bnh thy u. Tim hai liu vc xin c th ngn
chn hu ht cc trng hp nhim trng nng.
Hi chng thu u bm sinh c th l mt trong
nhng bin chng ca phi nhim v nhim
varicella zoster trong thi k mang thai.Cung
cp khng huyt thanh min dch (Varicella
zoster immunoglobulin) c khuyn co cho
cc b m khng c khng th bo v b phi
nhim bt c giai on no ca thai k, khng
huyt thanh min dch c th c tim trong
vng mi ngy phi nhim. Khng huyt thanh
min dch Varicella Zoster cng c khuyn
co cho tr s sinh ca sn ph mc thy u
trong thi gian 1 tun trc n 1 tun sau khi
sinh, v liu tim ny c th c thc hin m
khng cn xt nghim khng th ca tr s sinh.
Dich t hoc:
Trong qun th cha c tim vc xin, bnh
thuy u la bnh hang u tre em vi khoang
90% tr em cac nc n i bnh phat trin
thanh cac nhim khun huyt thanh va lm sang
199
Subject: Chickenpox
in older people and can cause more severe
disease. It is estimated that 30-50% of adults in
tropical region are susceptible to this infection
compared to 5-10% in temperate regions.
In Vietnam, cases of chickenpox are often seen
from February to June, with a peak in March.
In recent times, a 42% increase in the number
of cases was seen in both Hanoi and Ho Chi
Minh paediatric hospitals, shortly after the Tet
holiday in Febuary 2010.
Map sources:
Communicable disease yearbook from 2007
Medicine.
Map limitations:
Chickenpox is a common childhood disease that
generally will effect the whole population in
absence of vaccination. The reported incidence
rates are therefore questionable
Ch : Thy u
thi ky sm cua giai oan trng thanh vi ty
l nhim cao nht nhm tre t 5 n 9 tui.
cac vung nhit i, thuy u thng xut hin
cac la tui mun hn va co th gy ra bnh
canh nng hn. c tinh rng co khoang 3050% ngi ln khu vc nhit i cam nhim
vi bnh nay so sanh vi 5-10% vung n i.
Vit Nam,bnh thuy u thng gp t thang
2 n thang 6, vi inh dich vao thang 3. Thi
gian gn y, khoang 42% s ca bnh tng ln
tai cac bnh vin nhi Ha Ni va H Chi Minh,
c bit sau dip Tt 2010 (thang 2 dng lich).
Ngun bn :
Nin gim bnh truyn nhim giai on 2007
n 2011, Cc Y t d phng
Hn ch ca bn :
Thy u l mt bnh tr em m thng nh
hng n ton b dn s nu khng c vc
xin. T l mc mi c bo co vn cn nhiu
cu hi.

- Department of health Green book Chapter 34 Varicella (Updated 2011) http://immunisation.
dh.gov.uk/gb-individual-current-chapters/
- CDC chickenpox overview (Accessed 2012) http://www.cdc.gov/chickenpox/index.html
- Preblud SR, Orenstein WA, Bart KJ. (1984) Varicella: clinical manifestations, epidemiology and
health impact in children. Pediatric Infectious Disease 1984;3:505-509.
United Kingdom.
200
Subject: Dengue
Ch : St xut huyt
201
Subject: Dengue
Classification:
Dengue fever (DF): ICD-9 061, ICD-10 A90;
Dengue hemorrhagic fever/Dengue shock
syndrome (DHF/DSS): ICD-9 065.4; ICD-10
A91. In 2009 the WHO reclassified dengue
into dengue with and without warning signs.
For severe dengue there must be one of the
following signs or symptoms present: severe
plasma leakage, leading to fluid accumulation
with respiratory distress or shock, severe organ
impairment (including cardiac, liver and CNS)
and severe bleeding.
Synonyms:
Breakbone fever.
Agent:
Dengue virus (DENV) is an enveloped
RNA virus, genus Flavivirus, in the family
Flaviviridae. There are four antigenically
related, but distinct, DENV serotypes (DEN-1
to 4).
Reservoir:
Humans; forest monkeys in West Africa and
Southeast Asia.
Vector:
Most commonly, the urban container-breeding,
day-biting mosquitoes Aedes aegypti and Ae.
albopictus. Ae. aegypti is the most efficient of
the mosquito vectors because of its domestic
habits.
Transmission:
By mosquito bite.
Cycle:
DENV circulation occurs in two cycles: an
endemic/epidemic cycle between humans and
peridomestic mosquitoes, Aedes aegypti and
Ae. albopictus, and a sylvatic enzootic cycle
between non-human primates and several
arboreal Aedes species.
Ch : St xut huyt
Phn loi:
Bnh st Dengue (DF): ICD-9 061, ICD-10
A90, st xut huyt Dengue/hi chng sc
Dengue (SXHD/DSS): ICD-9 065.4; ICD-10
A91. Nm 2009, T chc Y t Th gii phn
loi li Dengue thnh bnh Dengue c v khng
c cc du hiu cnh bo. St xut huyt Dengue
nguy kch th phi c mt trong cc du hiu
hoc triu chng nh sau: thot huyt tng ra
ngoi khoang dch k vi lng ln, dn n c
c tch t dch vi suy h hp hoc sc, suy
sp a ph tng (bao gm tim, gan, thn kinh
trung ng) v xut huyt nghim trng.
ng ngha:
St Dengue.
Tc nhn:
Virus Dengue (DENV) l mt vi rt RNA c v
bao bc, chi Flavivirus, trong h Flaviviridae.
Dengue virus c bn type huyt thanh (DEN1 4) c lin quan khng nguyn nhng khc
bit.
cha:
Con ngi, kh rng Ty Phi v ng Nam
.
Vector:
Mui Aedes aegypti v Aedes albopictus, nhng
loi mui t ban ngy, trng cc dng
c cha nc thnh th, l tc nhn ph bin
nht. Mui Ae. aegypti l vector truyn bnh
hiu qu nht v thi quen sng rt gn ngi
ca chng.
Ly truyn:
Qua vt mui t.
Chu k:
S lu hnh ca virus DEN xy ra trong hai chu
k: mt chu k dch lu hnh/dch bng pht
gia ngi v cc loi mui sng gn ngi,
mui Ae. aegypti v Ae. albopictus, v mt chu
202
Subject: Dengue
Human viremia lasts 3-5 days around onset of
symptoms; the mosquito can transmit 8-12 days
after taking a viremic blood meal, depending on
the ambient temperature.
Incubation period:
3-14 days (usually 4-7 days).
Clinical findings:
Dengue encompasses a wide spectrum of
clinical presentations, from a mild febrile illness
through to a life threatening syndrome of organ
impairment, bleeding tendencies and capillary
leakage leading to hypovolaemic shock. The
clinical course in dengue can be divided into 3
phases; febrile, critical and recovery. The febrile
phase is characterized by sudden onset of fever
lasting 2-7 days, sometimes biphasic, severe
headache, myalgia, arthralgia, retro-orbital
pain, anorexia, nausea, vomiting and a maculopapular rash. The critical phase, which occurs
around deferevescence, is the period where the
increase in capillary permeability and plasma
leakage occurs. This may present clinically as
pleural effusions and or ascites depending on
the degree of plasma leakage and once a critical
volume is lost, shock ensues. The platelet count
drops shortly before or simultaneously with
the haematocrit rise and both changes occur
before defervescence and before onset of shock.
The critical period lasts for 24-48hours after
which the capillary leakage resolves and the
extravascular fluid begins to be resorbed over
the next 48-72 hours which is known as the
recovery period. Minor occurrence of petechiae,
epistaxis or gingival bleeding may be seen,
but severe haemorrhagic manifestations are
usually associated with prolonged shock. There
are currently no antiviral drugs and no vaccine
available and the management relies of judicious
fluid replacement of the severe dengue cases.
CFR for DHF can be as high as 20%, for untreated
DSS but in centers accustomed to treating severe
dengue this can be reduced to <1%.
Ch : St xut huyt
trnh bnh trn ng vt, gia ng vt linh
trng hoang d khng phi con ngi v mt
s loi mui Aedes sng trn cy.
Giai on nhim vi rut huyt ngi ko di
khong 3- 5 ngy k t khi bt u c triu
chng u tin; mui c th truyn bnh 8- 12
ngy sau ht mu c vi rt, ty thuc vo nhit
mi trng sng.
Thi gian bnh:
3- 14 ngy (thng l 4- 7 ngy).
Biu hin lm sng:
St Dengue bao gm nhiu th lm sng vi
mc rt khc nhau, c th t st nh cho n
cc hi chng e da tnh mng nh suy sp
a ph tng, d xut huyt v tng tnh thm
mao mch gy thot huyt tng dn n sc
gim th tch tun hon. Din bin lm sng
bnh st xut huyt Dengue c chia lm 3
giai on: st, tin trin nguy kch v phc hi.
Giai on st c c trng bi st t ngt
ko di 2- 7 ngy, i khi hai pha, nhc u d
di, au c, au khp, au sau h mt, chn n,
bun nn, nn v pht ban sn a hnh thi. Giai
on tin trin nguy kch, xy ra thng vo lc
h st, khi c s gia tng tnh thm thnh mao
mch v thot huyt tng. Biu hin lm sng
l trn dch mng phi v/hoc c trng, ty
thuc vo mc thot huyt tng v thot
huyt tng vi lng ln s chc chn dn n
sc gim th tch. S lng tiu cu gim ngay
trc hoc ng thi vi tng hematocrit v hai
thay i ny u xy ra trc khi h st v sc.
Giai on tin trin nguy kch ko di 24- 48
gi, sau ht r r mao mch v dch ngoi
mch bt u c ti hp th trong 48- 72
gi tip theo, c gi l giai on phc hi.
Cc biu hin xut huyt thng gp gm nt
xut huyt nh, chy mu cam hoc chy mu
chn rng, nhng biu hin xut huyt nghim
trng thng kt hp vi sc ko di. Hin nay
cha c thuc khng vi rt v vc xin phng
bnh, nguyn tc iu tr da trn b dch ph
203
Subject: Dengue
Diagnostic tests:
IgM capture ELISA; NS1 antigen test; RT-PCR
of blood or tissue; virus isolation in mosquitoes
or mosquito cell culture with identification by
IFA.
Prevention:
Removal of breeding sites in any type of
container that holds water (e.g. tank, jar, vase,
tire) through improved access to piped water
supplies, removal of rubbish around households
and managing water storage containers through
frequent drainage and cleaning or larviciding,
adulticiding with non-persistent insecticides.
Personal protection with suitable clothing,
mosquito repellents, nets and screens. There is
no vaccine yet available.
Epidemiology:
Global distribution follows vector presence
and introduction of the virus, and occurs
basically between the 10C isotherms. There is
strong seasonality, correlated with rainfall and
temperature which produces a marked increase
in vector breeding sites, survival and biting
habits. Outbreaks occur most frequently in
areas where multiple serotypes of dengue virus
are simultaneously endemic or sequentially
epidemic, and infections with heterologous
types are frequent. Dengue transmission occurs
throughout the year in endemic tropical areas
including southern Vietnam, with increased
frequency peaking during the rainy season (see
climate map). In this high transmission setting
dengue usually affects children between 2 and
15 years. In northern Vietnam, centered around
the city of Hanoi, there is a distinct seasonal
pattern, with annual outbreaks occurring of
varying size during the summer rainy season,
with little or no transmission documented
outside of this time. The incidence is much lower
and subsequently the average age of infection is
much higher, (between 18-22 years) with more
adult primary cases. In the last decade, reported
Ch : St xut huyt
hp trong cc trng hp st xut huyt nng.
T l t vong ca st xut huyt Dengue c th
cao n 20% bnh nhn st c hi chng sc
Dengue, nhng cc c s y t c kinh nghim
iu tr bnh nhn st xut huyt nng t l ny
gim xung di 1 %.
Xt nghim chn on:
Xc nh IgM bng k thut MAC-ELISA; test
khng nguyn NS1; RT-PCR mu hoc m;
phn lp vi rt trn mui hoc nui cy t bo
mui nhn dng bi IFA.
Phng nga:
Loi tr b gy, l bt c dng c cha nc
(v d: b, lu, bnh hoa, lp xe) thng qua ci
thin tip cn h thng cp nc my, loi b
dng c ph thi, qun l cc dng c cha
nc bng thng xuyn thau ra v dit b
gy (long qung), dit mui trng thnh bng
cc cc loi thuc dit mui khng tn lu. S
dng cc bin php bo v c nhn khi mui
nh qun o ph hp, thuc chng mui, mn
v li. Hin cha c vc xin phng bnh.
Dch t hc:
Phn b bnh st Dengue ton cu ph thuc
vo s hin din ca vector v s xm nhp ca
virus, v v nguyn l, bnh xy ra trong vng
gia cc ng ng nhit 10C (vng kh hu
gia hai vng cc). Bnh c tnh cht theo ma
r rt, tng quan vi lng ma v nhit , l
cc yu t lm gia tng ng k ni sinh sn, t
l sng st, hot ng ht mu ca vector. Dch
xy ra thng xuyn nht trong cc khu vc ni
m c nhiu typ huyt thanh ca vi rut Dengue
l dch lu hnh cng lc hoc dch bng pht
sau , v nhng nhim trng vi cc type khc
nhau l ph bin. S lan truyn bnh xy ra
quanh nm vng bnh lu hnh min nhit
i, bao gm min Nam Vit Nam, vi tn sut
tng n nh im trong ma ma (xem bn
kh hu). Trong bi cnh lan truyn mc
cao nh vy, dengue thng nh hng ti tr
204
Subject: Dengue
dengue cases has been increasing in Hanoi, with
the largest ever outbreak being reported in 2009.
The drivers behind this emergence are not fully
understood. Larger dengue outbreaks have been
reported superimposed on the yearly seasonal
increases, on a 2-4 year cycle, both from high
and low transmission areas. These cycles are
thought to be influenced by the circulating viral
serotypes, host immunity and possibly climate
oscillations.
Map sources:
National Institute of Hygiene and Epidemiology,
Tay Nguyen Institute of Hygiene and
Epidemiology, Institute Pasteur in Nha Trang,
Pasteur Institute Ho Chi Minh city
Ch : St xut huyt
em 2 n 15 tui. min Bc Vit Nam, ti khu
vc m tm l thnh ph H Ni, tn ti mt m
hnh theo ma c bit, vi s bng pht dch
hng nm xy ra cc v dch mc khc
nhau trong ma h ma nhiu, vi rt t hoc
khng c s lan truyn c ghi nhn ngoi
thi gian ny. T l mi mc thp hn rt nhiu
v do tui mc trung bnh cao hn r rt
(t 18- 22 tui), c nhiu trng hp ngi ln
mc ln u. Trong thp k qua, s cc trng
hp st Dengue ngy cng tng ti H Ni, vi
v dch ln nht tng c ghi nhn vo nm
2009. Nguyn nhn gy nn s bng pht ny
cha c hiu y . Cc v dch ln c
bo co c cho l tng ln c tnh cht ma
hng nm, theo chu k 2- 4 nm, c khu vc
lu hnh cao v thp. Cc chu k c coi l
chu nh hng ca s lu hnh ca vi rt vi
type huyt thanh nht nh, tnh min dch vt
ch v c th do bin i kh hu.
Ngun bn :
Vin V sinh Dch t Trung ng, Vin Pasteur
Nha Trang, Vin V sinh Dch t Ty Nguyn,
Vin Pasteur TP H Ch Minh.

- Bhatt S, et al. (2013) The global distribution and burden of dengue. Nature 496(7446):504-7.
- Guzman A, et al. (2010) Update on the global spread of dengue. Int J Antimicrob Agents 36 Suppl
1:S40-2.
- Toan do TT, et al. (2013) Hot spot detection and spatio-temporal dispersion of dengue fever in
Hanoi, Vietnam. Glob Health Action. 2013 Jan 24;6:18632. doi: 10.3402/gha.v6i0.18632.
- Coudeville L, et al. (2012) Transmission dynamics of the four dengue serotypes
in southern Vietnam and the potential impact of vaccination. PLoS One. 2012;7(12):e51244. doi:
10.1371/journal.pone.0051244. Epub 2012 Dec 10.
- Trung DT, et al. (2012) Clinical features of dengue in a large Vietnamese cohort: intrinsically
lower platelet counts and greater risk for bleeding in adults than children. PLoS Negl Trop Dis.
2012;6(6):e1679.
- Simmons CP, et al. (2012) Dengue. N Engl J Med. ;366(15):1423-32. doi: 10.1056/NEJMra1110265.
United Kingdom.
205
Subject: Diarrhea
Ch : Tiu chy
206
Subject: Diarrhea
Classification:
ICD-9; ICD-10
Ch : Tiu chy
Phn loi: ICD-9; ICD-10
Synonyms:
Viral gastroenteritis, stomach flu
ng ngha:
Vim d dy rut do vi rt, bnh au bng i
ngoi.
Agent:
Acute diarrhea is usually a symptom of an
infection in the intestinal tract, which can
be caused by a variety of bacterial, viral and
parasitic organisms. Common causes of viral
gastroenteritis are rotaviruses, adenoviruses
(type 40 and 41), sapoviruses and noroviruses.
Bacterial causes are diarrheagenic Escherichia
coli and Vibrio cholera. For shigellosis
and salmonellosis see dysentery map and
salmonellosis map.
Tc nhn:
Tiu chy cp tnh thng l mt triu chng
ca nhim trng ng rut, c th c gy
ra bi mt trong cc loi vi khun, vi rt v k
sinh trng. Cc tc nhn thng gp ca vim
d dy rut do vi rt l rota vi rt , adeno vi rt
(type 40 v 41), noro vi rt, sapo vi rt. Tc
nhn vi khun l Escherichia coli tiu chy v
vi khun t Vibrio cholera. Vi bnh l trc
khun v bnh thng hn xem bn bnh l
v bn thng hn.
Reservoir:
Humans and occasionally animals. Water
contaminated with human or animal faeces.
cha:
Con ngi v i khi ng vt. Nc b nhim
phn ngi v ng vt.
Transmission:
Fecal-oral; infection is spread through
contaminated food or drinking-water, or from
person-to-person as a result of poor hygiene.
Ly truyn:
Phn- ming, nhim trng lan qua thc phm
hoc nc ung b nhim, hoc t ngi ny
sang ngi khc do v sinh km.
Incubation period:
Usually one to two days for acute watery
diarrhea.
Thi gian bnh:

Thng thng 1- 2 ngy i vi tiu chy cp.
Clinical findings:
Diarrhea is defined as the passage of three
or more loose or liquid stools per day (or
more frequent passage than is normal for the
individual). Diarrhea can last several days, and
can leave the body without the water and salts
that are necessary for survival. Diarrhea can
be accompanied by fever and vomiting. Most
people who die from diarrhea actually die from
severe dehydration and fluid loss.
Diagnostic tests:
Generally no diagnostic test is needed.
Biu hin lm sng:

Tiu chy c nh ngha l i ngoi phn
lng trn 3 ln mi ngy (hoc i ngoi nhiu
hn bnh thng i vi c nhn). Tiu chy
c th ko di vi ngy, v c th lm c th
mt nc v mui cn thit cho s sng. Tiu
chy c th km theo st v nn. Hu ht nhng
ngi cht v tiu chy l v mt nc v mt
dch nghim trng.
Xt nghim chn on:
Ni chung khng cn xt nghim chn on.
Cy phn tm vi khun gy bnh, soi knh hin
vi tm k sinh trng, PCR v xt nghim khng
207
Subject: Diarrhea
Stool culture for bacterial pathogens, stool
microscopy for parasites, and polymerase chain
reaction and antigen tests for viral pathogens.
Prevention:
A significant proportion of diarrheal disease
can be prevented through safe drinking water
and adequate sanitation and hygiene.
Epidemiology:
Worldwide, diarrheal disease is the second
leading cause of death in children under five
years old, and is responsible for killing around
760,000 children every year. Children who
are malnourished or have impaired immunity
as well as people living with HIV are most at
risk of life-threatening diarrhea. In developing
countries, children under three years old
experience on average three episodes of diarrhea
every year. Each episode deprives the child of
the nutrition necessary for growth. As a result,
diarrhea is a major cause of malnutrition, and
malnourished children are more likely to fall ill
from diarrhea.
A molecular epidemiological study of rotavirus
(RV) and norovirus (NoV) infections was
carried out in Nha Trang city in Vietnam
between December 2005 and June 2006. RV
and NoV were detected in 87 (47.5%) and
12 (6.6%) of the 183 fecal specimens from
children hospitalized with acute gastroenteritis,
respectively. The majority of patients with RV
and NoV were children younger than 2 years of
age. The most frequent RV genotypes detected
were G3 (n=37, 42.5%) and G1 (n=28, 32.2%)
for G type, P[8] (n=61, 70.1%) for P type, and
G3P[8] (n=33, 38.0%) and G1P[8] (n=18,
20.7%) for the G and P genotype combination.
A molecular epidemiological study on common
diarrheal viruses was conducted in a childrens
hospital in Ho Chi Minh City between
December 2005 and November 2006. Human
astroviruses (HAstVs), which were detected
with a prevalence of 13.9%, became the second
Ch : Tiu chy
nguyn tm virus gy bnh.
Phng nga:
Phn ln cc bnh tiu chy c th c phng
nga bi nc ung sch, ty u v v sinh sch
s.
Dch t hc:
Trn th gii, bnh tiu chy ng th hai
trong nhng nguyn nhn gy t vong tr em
di nm tui, gy ra 760.000 ca t vong tr
em mi nm. Tr suy dinh dng hoc c suy
gim min dch cng nh nhng ngi c HIV
c nguy c cao b tiu chy e da tnh mng.
cc nc ang pht trin, tr em di 3 tui
mc trung bnh 3 ln tiu chy mi nm. Mi
ln mc gy tn tht cht dinh dng cn thit
cho s tng trng ca tr. Kt qu l, tiu chy
l nguyn nhn chnh gy suy dinh dng, v
tr em b suy dinh dng li c nhiu kh nng
mc bnh tiu chy.
Mt nghin cu dch t hc phn t v nhim
rota vi rt (RV) v noro vi rt (NoV) c
thc hin ti thnh ph Nha Trang, Vit Nam t
thng 12 nm 2005 n thng 6 nm 2006. Rota
virus c pht hin trong 87 mu (47,5%) v
noro virus c pht hin trong 12 mu (6,6%)
trong s 183 mu phn ca tr em nhp vin v
vim d dy rut cp tnh. Phn ln cc bnh
nhn nhim rota vi rt v noro vi rt l tr em
di 2 tui. Cc kiu gen rota vi rt ph bin
nht l G3 (n = 37, 42,5%) v G1 (n = 28,
32,2%) cho type G, P [8] (n = 61, 70,1%) cho
type P, v G3P [8 ] (n = 33, 38,0%) v G1P [8]
(n = 18, 20,7%) cho kiu gen t hp G v P.
Mt nghin cu dch t hc phn t trn cc vi
rt tiu chy thng thng c thc hin trong
bnh vin Nhi ng thnh ph H Ch Minh
t thng 12 nm 2005 n thng 11 nm 2006.
Cc astro vi rt ngi (HAstVs) c pht
hin vi t l 13,9%, tr thnh tc nhn vi rt
gy bnh ng rut ph bin th nh. Mc d
pht hin trong c ma kh v ma ma, phn
ln (92,8%) cc astro vi rt ngi c tm
208
Subject: Diarrhea
Ch : Tiu chy
most frequent viral enteropathogen. Although

detected in both dry and rainy seasons, the
majority (92.8%) of HAstVs in this study
were found in the rainy season. Patients aged
between 6 and 23 months were found to be
more infected from astrovirus when compared
to other age groups. The ratio between boys
and girls was 2.3:1. In another molecular
epidemiological study on common diarrheal
viruses in Ho Chi Minh City, between October
2002 and September 2003 showed that among
the diarrheal viruses detected, group A rotavirus
was the most common, with a proportion of
67.4%, whereas NoV GII, adenovirus, SaV,
and HAstV were also found in 5.5, 3.2, 0.8,
and 0.6%, respectively. In Vietnam the case
definition for reporting diarrhea is: loose stools
3 times per day or very loose stools or watery
stools.
thy vo ma ma trong nghin cu ny. Bnh

nhn trong tui t 6 n 23 thng c pht
hin l b nhim bnh astro vi rt nhiu hn so
vi cc nhm tui khc. T l gia nam v n
l 2,3:1. Trong mt nghin cu dch t hc phn
t cc virus thng gy tiu chy ti Thnh ph
H Ch Minh, t thng 10 nm 2002 n thng
9 nm 2003, cho thy trong s cc vi rt tiu
chy pht hin, rota vi rt nhm A l ph bin
nht, vi t l 67,4%, trong khi noro vi rt GII,
adeno virus, Sa vi rt v astro vi rt ngi cng
c tm thy vi t l ln lt 5,5, 3,2, 0,8, v
0,6%. Vit Nam, nh ngha ca bnh tiu chy
cn bo co l: i ngoi phn lng 3 ln mt
ngy hoc phn rt lng hoc phn ton nc.
Map sources:
Communicable diseases yearbook in 2011,
Hn ch ca bn :
D liu khng y v nguyn nhn v gnh
nng tiu chy Vit Nam.
Ngun bn :
Nim gim bnh truyn nhim nm 2011, Cc
Y t d phng
Map limitations:
There is patchy data on the etiology and burden
of diarrhea in Vietnam.
- World Health Organization (2013). Diarrhoeal disease. Fact sheet nr 330.
- Wertheim H, et al. (2012). Atlas of human infectious diseases. (Wiley Blackwell).
- Nguyen TA, et al. (2008) Identification of human astrovirus infections among children with acute
gastroenteritis in the Southern Part of Vietnam during 2005-2006. J Med Virol;80(2):298-305.
- Trang NV, et al. (2012) Detection and molecular characterization of noroviruses and sapoviruses
in children admitted to hospital with acute gastroenteritis in Vietnam J Med Virol;84(2):290-7.
- Tamura T, et al. (2010) Molecular epidemiological study of rotavirus and norovirus infections
among children with acute gastroenteritis in Nha Trang, Vietnam, December 2005-June 2006.
Jpn J Infect Dis;63(6):405-11
- Nguyen TA, et al. (2007) Diversity of viruses associated with acute gastroenteritis in children
hospitalized with diarrhea in Ho Chi Minh City, Vietnam. J Med Virol;79(5):582-90.
United Kingdom.
209
Subject: Hand, foot and mouth disease
Ch : Bnh tay chn ming
210

Vesicular stomatitis with exanthem
Hi chng v ng ngha:
Vim ming mn nc vi ban lan ta.
Agent:
Hand, foot and mouth disease (HFMD) is a syndrome caused by viruses belonging to the species Enterovirus A, genus Enterovirus, family
picornaviridae. The most common types within
this species are Coxsackievirus A16, A6, A10
and Enterovirus 71 (EV-71). EV71 is associated with outbreaks in which a proportion of
patients suffer from more severe disease.
Tc nhn:
Bnh tay chn ming (TCM) l mt hi chng
gy ra bi cac vi rt thuc loai Entorovirus A,
ging Enterovirus, nhm Picornaviridae. Thanh
vin ph bin nht ca nhm ny gy bnh
TCM l vi rt coxsackie A16, A6, A10, v vi
rt Enterovirus 71 (EV-71).EV71 thng lin
quan n cac vu dich va phn nhiu bnh nhn
bi bnh rt nng.
Transmission:
Viruses causing HFMD are highly infectious,
especially during the first week of infection
when viral shedding is at its peak. Enteroviruses are non-enveloped, therefore highly resistant to environmental conditions, but also to
mild disinfectants. Transmission occurs mainly
through the oral-fecal route, but viruses are also
isolated from respiratory droplets, blister fluids
and items and surfaces that have been in contact
with patients.
Ly truyn:
Bnh TCM c t ly nhim rt cao, c bit
l trong tun u tin sau nhim trng khi kh
nng pht tn vi rt l ln nht. Enterovirus la
loai vi rut khng co vo bao nn kha nng khang
lai cac iu kin mi trng rt cao, nhng
cung khang vi cac cht kh trung nhe. Ly
nhim ch yu xy ra qua ng phn-ming,
nhng vi rut cung thng c phn lp t cc
git nh h hp, cc dch nt phng v tip xc
vi cc vt phm, cc b mt b nhim.
Incubation period:
Usually between three and six days. A child
remains infectious after the appearance of
symptoms, usually up to seven days but
sometimes for several weeks.
Thi gian bnh:

Thng thng t ba n nm ngy, mt a tr
b nhim c th vn cn duy tr truyn nhim
cho n by ngy sau khi xut hin cc triu
chng.
Clinical findings:
Children with hand, foot and mouth disease
usually develop a characteristic (vesicular) rash
on the palms of the hands and soles of the feet.
There may also be sores/ulcers in the buccal
mucosa. The rash can be very subtle, and may
also present on any part of the limbs and buttocks. Children often develop a high temperature, sore throat, headache and malaise. The
majority of infected patients recover with no
sequelae, however a small minority of patients
have a more severe course and require hospital admission. In EV71 infected patients this
proportion is higher. Among the complications
are: aseptic meningitis with headache and neck
stiffness, polio-like acute flaccid paralysis, and
brainstem encephalitis with autonomic dys-
Biu hin lm sng:

Tr em b bnh tay chn ming thng xut
hin pht ban phng rp c trng trn lng
bn tay v lng bn chn. Tr cng c th b
au nim mc ming, c th pht trin thnh
vt lot. Cac vt phat ban co th xut hin rt it
hoc co th xut hin bt ky phn nao trn tay
chn va mng. Tr em thng c st, au hng,
nhc u v kh chu. a s bnh nhn s t
khi m khng cn iu tr, tuy nhin mt s
t bnh nhn phi nhp vin ch yu l do bin
chng thn kinh nh vim mng no v vim
no.Hin tng nay chim phn nhiu trong cac
bnh nhn nhim EV71. Co mt s bin chng:
vim mng no khng do nhim khun kem
theo au u v cng c, bi lit nh lit mm
cp tnh, vim thn no vi ri lon t min v
211

regulation and cardiopulmonary compromise.
There have been several outbreaks of severe
disease in South East Asia, since 1997. These
outbreaks were associated with EV71. Prognostic factors for progression to more severe
disease are younger age at onset, high and/or
prolonged fever, lethargy and myoclonus.
Diagnostic tests:
The diagnosis of HFMD is often made clinically, depending on the presenting features and the
age of the patients. Throat swabs, vesicle swabs
and stool samples can be investigated with RTPCR.
Therapy:
There is no specific treatment for this infection.
Management of mild disease is symptomatic;
sometimes a topical oral anaesthetic can help
with the pain of oral ulcers. National guidelines
describe the use of antipyretics and sedatives
for children with high fever and myoclonus,
and for more advanced disease intravenous immunoglobulin, milrinone and haemofiltration
are used.
Prevention:
A vaccine is currently not available but data
from the first phase III inactivated vaccine trial
from China are hopeful and show good safety
and efficacy of 90% against EV71 associated
disease. Good hygiene measures help to prevent spread of infection, like washing hands
after changing nappies, thoroughly cleaning
objects and surfaces that may have been contaminated with a virus causing infection etc.
Avoiding close contact with children who are
infected may also prevent spread of infection.
Epidemiology:
HFMD is typically a benign self-limited illness among young children and infants, with
the large majority occurring in children under
5. Outbreaks occur worldwide and are often
associated with day-care centres, kindergartens, and elementary schools. Since 1997,
large HFMD outbreaks have been reported in
Southeast Asia and the West Pacific region of a

suy h hp tun hoan. Co mt vai vu dich bung
phat ng Nam A t nm 1997 va co lin
quan n EV71
Yu t tin lng cho s tin trin nng ca
bnh l tr tui khi pht, st cao v/hoc ko
di, hn m v co git.
Xt nghim chn on:
Vic chn on bnh TCM thng c da
trn du hiu lm sng, ty thuc vo cc du
hiu v tui ca bnh nhn. Dch hng, mu
dch mn nc v mu phn c th dng
phn lp vi rt hoc xt nghim PCR.
iu tr:
Khng c iu tr c hiu cho bnh ny. iu
tr triu chng, i khi gy t ti ch vng
ming nu bnh nhn c au do lot ming.
Hng dn quc gia m t vic s dng thuc
h st v thuc an thn cho tr em b st cao
v co git, v i vi trng hp nng truyn
tnh mch immoglobulin, milrinone v loc mau
c ap dung.
Phng bnh:
Hin tai cha co vc xin nhng t d liu cua
giai oan III th nghim vc xin u tin t
Trung Quc hy vng v cho thy s an ton v
hiu qu ti 90% phong EV71. Cc bin php
v sinh tt gip ngn nga s ly lan ca nhim
trng, nh ra tay sau khi thay t, lm sch trit
cc i tng v cc b mt c th b
nhim mt loi vi rut gy nhim trng. Trnh
tip xc gn gi vi tr em b nhim cng c th
ngn chn s ly lan ca nhim trng.
Dch t hc:
Bnh TCM l mt bnh lnh tnh thng gii
hn tr em v tr s sinh, vi phn ln xy
ra tr em di 5 tui. Cac vu dich xut hin
trn ton th gii v thng xay ra cc trung
tm chm sc ban ngy, trng mu gio, v
trng tiu hc. T nm 1997, vu dich TCM
ln c bo co trong khu vc ng Nam
v khu vc Ty Thi Bnh Dng vi mc
nghim trng hn va lin quan n EV71. Cac
212

more severe phenotype associated with EV71.
Notable large HFMD outbreaks have since occurred in 1998 in Taiwan (1,500,000 cases),
in 2008 in China (490,000) and in 2011-12 in
Vietnam (250,000). The frequency of EV71 detection increases with the severity and lethality
of complications. Outbreaks of severe disease
have incentivised increasing surveillance for
this disease. In Viet Nam, in 2011 52 out of 62
provinces reported cases, with most cases being
reported from the southern region (80%). There
were ~110000 hospitalizations with 160 deaths
in 2011 and ~135000 hospitalizations with 43
deaths in 2012. In comparison, in 2010 around
10000 cases were reported. In 2012 the disease
was also reported from the northern regions
relatively more frequently.
Map sources:

vu dich ang lu y a xay ra ai Loan nm
1998 (1.500.000 ca), Trung Quc nm 2008
(490.000) va nm 2011, 2012 tai Vit Nam
(250.000)
Tn sut pht hin EV71 tng vi mc
nghim trng v bin chng gy t vong. S
bng pht ca bnh nghim trng a lam tng
gim st i vi bnh ny. Vit Nam, trong
nm 2011, 52 trong s 62 tnh co bao cao ca
bnh, vi hu ht cc trng hp c bo co
t khu vc pha Nam (80%). C ~ 110.000 ca
nhp vin vi 160 trng hp t vong trong
nm 2011 v ~ 135.000 ca nhp vin vi 43 ca
t vong trong nm 2012. Trong khi , trong
nm 2010 khong 10.000 trng hp c
bo co. Trong nm 2012 bnh cng c
bo co t khu vc pha Bc tng i thng
xuyn hn
Ngun bn :
Nin gim thng k bnh truyn nhim nm
2011, Cc y t d phng

- Kwai Peng Chan, Kee Tai Goh, Chia Yin Chong, Eng Swee Teo, Gilbert Lau, Ai Ee Ling. Epidemic
Hand, Foot and Mouth Disease Caused by Human Enterovi rt 71, Singapore. Em Infect Dis; Vol.
9, No. 1, Jan 2003
- World Health Organisation information for WPRO. http://www.wpro.who.int/topics/hand_foot_
mouth/en/ Accessed Nov 2012.
United Kingdom.
213
Subject: Human immunodeficiency virus (HIV) Ch : Vi rt suy gim min dch ngi
214
Classification:
ICD-9 042-044; ICD-10 B20-24
Phn loi:
ICD-9 042-044; ICD-10 B20-24
Synonyms:
HIV, SIDA, wasting syndrome, acquired
immune deficiency syndrome (AIDS).
ng ngha:
HIV, SIDA, hi chng suy mn, hi chng suy
gim min dch mc phi (AIDS).
Agent:
Human Immunodeficiency Virus (HIV), an
enveloped single stranded RNA virus of the
Lentivirus genus and Retroviridae family, is
divided into two main species HIV-1 and HIV-2.
HIV-1 is more infectious and more virulent than
HIV-2 and predominates globally, with HIV-2
transmission restricted to parts of Western and
Central Africa. HIV-1 is divided into groups
and further divided into sub-types (or clades)
based on genetic differences. HIV replicates
within host cells (predominantly macrophages
and CD4+ T-cells) following transcription of
the HIV RNA genome into complementary
DNA by reverse transcriptase and integration
of viral DNA into the host genome. Continuous
replication of HIV in infected cells together
with elimination of host cells and chronic
immune activation destroys the immune system
over the years.
Tc nhn:
Vi rut gy suy gim min dch ngi (HIV),
mt s loi vi rt c chui xon n RNA c
bao bc trong lp v, vi rt HIV thuc nhm
Lentivirusi v h Retroviridae, c chia thnh
hai chng chnh: HIV-1 v HIV-2. HIV-1 l loi
ph bin trn ton cu n c tnh gy nhim cao
v c lc vi rt mnh hn HIV-2, HIV-2 ly
truyn ch yu trong khu vc Ty v Trung Phi.
HIV-1 c chia thnh cc nhm v cc phn
nhm da trn s khc bit v kiu gen. HIV ti
to trong t bo vt ch (ch yu l cc i thc
bo v t bo T CD4 +) sau phin m nh men
sao chp ngc AND b sung c to thnh
t b gen RNA ca vi rt HIV v tch hp DNA
ca vi rt vo h gen vt ch. S nhn ln lin
tc ca HIV trong cc t bo b nhim cng vi
loi b cc t bo vt ch v kch hot min
dch mn tnh ph hy h thng min dch theo
thi gian.
Reservoir:
Humans. HIV is thought to have originated
from primates but humans are now the natural
host and animal reservoirs play no role.
cha:
Ngi. HIV c cho l c ngun gc ban u
t ng vt linh trng nhng ngy nay con
ngi l vt ch t nhin v cha ng vt
khng cn vai tr trong ly truyn na.
Transmission:
HIV is transmitted through contact with HIV
infected body fluids (blood, semen, and vaginal
secretions) and is predominantly transmitted by
unprotected sexual intercourse with an infected
partner worldwide. Other common routes of
transmission include: sharing of contaminated
needles or injection equipment; mother-tochild transmission during pregnancy, childbirth and breastfeeding. Less common routes
Ly truyn:
HIV c ly truyn qua tip xc vi dch c
th b nhim HIV (mu, tinh dch v dch tit
m o) v quan h tnh dc khng an ton vi
bn tnh b nhim bnh l ng ly truyn ch
yu trn th gii. Cc ng ly truyn ph
bin khc gm: dng chung kim hoc dng c
tim b nhim bn hoc dng c tim truyn;
ly truyn t m sang con trong thai k, sinh
215
of transmission include: blood or blood product
transfusion; organ or tissue transplantation;
and needle stick accidents. Saliva has not been
shown to transmit HIV.
Incubation period:
Up to 70% of infected individuals develop a
self-limiting acute HIV infection syndrome
resembling a viral illness 1-12 weeks after
infection. During this illness HIV can be
detected in the blood. Anti-HIV antibodies can
be detected 1-3 months after infection. The time
from infection to development of clinically
apparent immunodeficiency is usually 5-10
years, but ranges from less than 1 year to over
15 years. There is considerable variation in the
progression of disease, partly mediated by host
genetic factors.
n v b m. Cc ng ly nhim t ph bin
bao gm: truyn mu hoc cc ch phm t
mu, cy ghp c quan hoc m v tai nn kim
m. Ly truyn qua nc bt cha c chng
minh l khng ly truyn HIV.
Thi gian bnh:
C ti 70% s ngi nhim vi rt tin trin
thnh hi chng nhim HIV cp tnh t gii
hn gy bnh cnh nhim vi rt trong 1-12 tun
sau khi nhim. Trong giai on ny HIV c th
c pht hin trong mu. Khng th khng
HIV c th c pht hin 1-3 thng sau khi
nhim virus. Thi gian t lc nhim vi rt n
khi pht trin cc triu chng lm sng r rt do
suy gim min dch thng l 5-10 nm, nhng
dao ng t di 1 nm n hn 15 nm. C
s khc bit ng k trong tin trin ca bnh,
phn no l do yu t di truyn ca vt ch.
Clinical findings:
Acute HIV infection is usually a non-specific
illness with fever, headache, myalgia, fatigue,
and a sore throat. Generalized lymphadenopathy
and a maculopapular rash may occur. Following
primary infection there is a prolonged
asymptomatic period before the appearance
of the clinical manifestations of a loss of
immune control over infectious pathogens and
cancers. Common presenting AIDS defining
illnesses include: recurrent bacterial infections,
mycobacterial infections (tuberculosis and nontuberculosis), fungal infections (candidiasis
penicilliosis, Pneumocystis jirovecii pneumonia
cryptococcal meningitis), viral infections
(Herpes, Varicella, Cytomegalovirus), and
cancers (Kaposi sarcoma, lymphoma. cervical
cancer).
Biu hin lm sng:

Nhim HIV cp tnh thng l mt bnh cnh
khng c hiu vi st, au u, au c, mt
mi v au hng. Ni hch ton thn v mt
ban dt sn c th xy ra. Sau nhim trng tin
pht c mt giai on khng c triu chng kh
di trc khi c s xut hin ca cc biu hin
lm sng r ca mt kim sot min dch i
vi cc tc nhn gy bnh truyn nhim v ung
th. nh ngha v cc trng hp AIDS in
hnh bao gm: nhim khun ti pht, nhim
khun mycobacteriaceae (bnh lao v khng
lao), nhim nm (nm candida, Pneumocystic
jirovecii vim phi vim mng no), nhim
virus (Herpes, thy u, Cytomegalovirus), v
ung th (sarcoma Kaposi, u lympho, ung th c
t cung.).
Prevention:
The current cornerstones of HIV prevention
worldwide are: reducing sexual transmission
through the promotion of condom use, male
circumcision, detection and treatment of sexually
Phng nga:
Cc nn tng hin nay ca d phng HIV trn
th gii l: lm gim ly truyn qua ng tnh
dc thng qua vic thc y s dng bao cao
su, ct bao quy u, pht hin v iu tr cc
216
transmitted infections, and antiretroviral
treatment as prevention; raising awareness
of individual HIV status through voluntary
counseling and testing; protecting intravenous
drug users through needle/syringe exchange
and methadone replacement programs;
reducing mother to child transmission through
voluntary counseling and testing and provision
of antiretroviral drugs.
bnh ly truyn qua ng tnh dc, iu tr d

phng bng thuc khng vi rt, nng cao nhn
thc v tnh trng nhim HIV c nhn thng
qua t vn v xt nghim t nguyn; bo v
ngi tim chch ma ty thng qua cc trng
trnh trao i bm kim tim v iu tr thay th
bng methadone, gim ly truyn t m sang
con thng qua t vn v xt nghim t nguyn
v cung cp cc thuc khng vi rt.
Epidemiology:
HIV was first recognized clinically in 1981
and is thought to have first crossed the species
barrier from non-human primates in the late
19th or early 20th century. As of 2009, over
25 million people were estimated to have
died from HIV and around 33 million people
were living with HIV. HIV epidemics are
categorized into low level (HIV prevalence
<1% in the general population and < 5% in
vulnerable group such as men who have sex
with men (MSM), injecting drug users (IDUs),
and sex workers), into concentrated level (HIV
prevalence <1% in the general population but >
5% in at least one vulnerable group), and into
generalized level (HIV prevalence >1% in the
general population). The greatest global burden
of HIV is in Sub-Saharan Africa, with 68% of
all people living with HIV and 72% of all HIV
related deaths in 2009. No countries in Asia
have a generalized epidemic.
The first HIV-infected patient was diagnosed in
HCMC in 1990. HIV is now detected in all 64
provinces in Vietnam. The national prevalence
among adults is 0.44% (VAAC, 2009). The
highest prevalence rates are found in Dien Bien,
Son La, Ho Chi Minh City, Thai Nguyen and
Yen Bai. The majority of people living with
HIV are aged <30 years. As many countries
in Asia, IDU is driving the HIV epidemic in
Vietnam, and IDUs compromise 50-60% of
reported HIV infections. The HIV prevalence
among commercial sex workers is about
Dch t hc:
Ca nhim HIV u tin c pht hin lm sng
vo nm 1981 v c cho l ln u tin bnh
vt qua hng ro gia cc loi t cc loi linh
trng khng phi con ngi trong nhng nm
cui th k 19 hoc u th k 20. Tnh n
nm 2009, c tnh hn 25 triu ngi cht
v HIV v khong 33 triu ngi sng chung
vi HIV. Dch HIV c phn loi mc
thp (t l hin nhim HIV <1% trong qun
th dn c chung v <5% trong nhm d b tn
thng nh nhm nam quan h tnh dc ng
gii (MSM), ngi tim chch ma ty (NCMT),
v nhm mi dm), dch tp trung (t l hin
nhim HIV <1% trong qun th dn c chung
nhng> 5% trong t nht mt nhm d b tn
thng), v dch ton th (t l hin nhim HIV
> 1% trong qun th dn c chung). Cc nc
b nh hng nng n bi dch HIV l cc nc
bn sa mc Sahara chu Phi, vi 68% dn s
sng chung vi HIV v 72% cc ca t vong c
lin quan n HIV trong nm 2009.
Bnh nhn nhim HIV u tin Vit Nam
c chn on ti TP.HCM vo nm 1990.
Hin nay HIV c pht hin tt c 64 tnh
thnh Vit Nam. T l hin nhim quc gia
ngi trng thnh l 0,44% (VAAC, 2009).
T l hin nhim cao nht in Bin, Sn La,
Thnh ph H Ch Minh, Thi Nguyn v Yn
Bi. a s nhng ngi sng chung vi HIV
trong tui <30. Cng nh nhiu quc gia
chu , tim chch ma ty l nguyn nhn chnh
ca dch HIV ti Vit Nam, v tim chch ma
217
16%. The percentage of HIV infections in
women is increasing, indicating an increase in
heterosexual transmission between male IDUs
and clients of sex workers and their female
sex partners. There is an emerging epidemic in
MSMs, accounting for more transmission than
IDUs .
Map sources:
Vietnam Administration of HIV/AIDS control
in 2011.
ty chim 50-60% trng hp nhim HIV c

bo co. T l hin nhim HIV trong nhm mi
dm l khong 16%. T l nhim ph n trong
s ngi nhim HIV ngy cng tng, cho thy
s gia tng ly truyn trong quan h tnh dc
khc gii gia nam tim chch ma ty v khch
hng ca gi mi dm v bn tnh n ca h.
Gn y c s bng pht dch trong nhm nam
quan h tnh dc ng gii, chim t l cao hn
nhm tim chch ma ty.
Ngun bn :
Cc Phng chng HIV / AIDS, s liu nm
2011 Vit Nam

- Global report: UNAIDS report on the global AIDS epidemic 2010. Joint United Nations Programme
on HIV/AIDS (UNAIDS). ISBN 978-92-9173-871-7.
- Hemelaar J et al. (2006) Global and regional distribution of HIV-1 genetic subtypes and
recombinants in 2004. AIDS;20(16):W13-23.
- European Union, WHO, UNICEF, et al. (2006) Vietnam: Epidemiological Fact Sheet on HIV/
AIDS and Sexually Transmitted Infections- 2006 Update.
United Kingdom.
218
Subject: HIV/AIDS Pencilillium marneffei
Ch : HIV/AIDS Pencilillium marneffei
219
Classification:
ICD-9 117.3; ICD-10 B48.4
Phn loi:
ICD-9 117,3; ICD-10 B48.4
Agent:
Penicillium marneffei is a dimorphic fungus
endemic in areas of Southeast Asia. It is
the only one of more than 200 Penicillium
species that is dimorphic: at body temperature
(37C) it grows as a yeast and divides by
binary fission; at room temperatures it grows
as a mold. P. marneffei primarily causes
disease in immunocompromised patients,
particularly in patients infected with Human
Immunodeficiency Virus (HIV)
Tc nhn:
Penicillium marneffei l mt loi nm lng
dng lu hnh trong khu vc ng Nam . N
l loi duy nht trong hn 200 loi Penicillium
c tnh cht lng dng: nhit c th (37
C) n pht trin nh nm men v sinh sn theo
cch phn i, nhit phng n pht trin
nh nm a bo (thnh chui). P. marneffei ch
yu gy bnh nhng bnh nhn suy gim min
dch, c bit l nhng bnh nhn b nhim vi
rt gy suy gim min dch ngi (HIV)
Reservoir:
The natural reservoir of P. marneffei has not
been found. Bamboo rats (Rhizomys sinensis,
R. pruinosus, R. sumatrensis, and Cannomys
badius) are the only non-human hosts of P.
marneffei. The fungus is infrequently detected
in the soil of bamboo rats burrows. P. marneffei
can survive in sterile soil for several weeks but
only for a few days in nonsterile soil, suggesting
that natural soil is unlikely a primary reservoir
for P. marneffei.
cha:
Cc cha t nhin ca P. marneffei khng
c tm thy. Loi chut tre (Rhizomys
sinensis, R. pruinosus, R. sumatrensis, v
Cannomys badius) l vt ch duy nht khng
phi con ngi ca P. marneffei. Cc loi nm
t khi c tm thy trong t ca hang chut
tre. P. marneffei c th tn ti trong t v trng
trong vi tun nhng ch trong mt vi ngy
trong t khng v trng, cho thy rng t t
nhin khng phi l mi trng l tng cho P.
marneffei.
Transmission:
The mode of transmission remains unclear, but
inhalation and direct inoculation have been
implicated. There is no evidence of bamboo rat
to human or human to human transmission.
Incubation:
The incubation period is still unclear.
Immunocompromised patients from nonendemic regions traveling to Southeast Asia can
develop disease within a few weeks to months of
returning home. In immunocompetent patients
the infection remains latent for years and can
cause disease when their immune system is
weaken. An incubation period of 1-3 weeks has
been suggested by a study of penicilliosis in
patients with advanced HIV in Vietnam.
Ly truyn:
Phng thc ly truyn vn cha r rng,
nhng ht phi hay tim trc tip c coi l
c lin quan n nhim bnh. Khng c bng
chng v lan truyn trc tip chut-ngi hoc
ngi-ngi
Thi gian bnh:
Thi gian bnh vn cha r rng. Bnh nhn
suy gim min dch t cc vng khng lu hnh
i du lch n khu vc ng Nam c th mc
bnh trong vng vi tun n vi thng sau khi
tr v nh. nhng bnh nhn suy gim min
dch, nhim trng vn cn tim n trong nhiu
nm v c th gy bnh khi h thng min
dch ca h yu i. Mt nghin cu v nm
Penicillium bnh nhn HIV ang tin trin ti
220

Clinical findings:
Clinical presentation varies and ranges from
localized disease in immunocompetent
to disseminated disease in severely
immunocompromised patients. P. marneffei
is an opportunistic infection in HIV-infected
patients with CD4 counts of < 100 cells/L.
Most patients present with fever, malaise,
weight loss, and typical skin lesions. Other
findings include anemia, lymphadenopathy,
and hepatosplenomegaly. Respiratory and
gastrointestinal symptoms and signs can also
be observed. Skin lesions are papules with
central necrosis on the face and neck, but other
body sites can also have lesions. Co-infection
with other opportunistic infections, particularly
tuberculosis, should be excluded in these
patients. In the immunecompetent host this
fungal infection causes granuloma formation,
resembling tuberculosis. Injection drug use,
shorter disease onset, absence of fever or skin
lesions, respiratory difficulty, and lower platelet
count predict poor hospital outcome.
Diagnostic tests:
Microscopic identification of a midline septum
in a dividing intra- or extracellular yeast cell
in infected tissues or fluids is specific for P.
marneffei. Confirmation by isolation of P.
marneffei from standard culturing techniques
demonstrating
temperature
dependent
switching of yeast to mold phase is the gold
standard diagnostic test. P. marneffei can be
isolated from blood, bone marrow, skin lesion,
lymphnode, or other sterile body fluids
Prevention:
In patients infected with HIV, secondary
prophylaxis with itraconazole until CD4 cell
counts rise above 100 cells/L for 6 months
is recommended. For those living in endemic
areas, primary prophylaxis may be indicated in
case of low CD4 counts. Experts believe that
patients with low CD4 counts (< 100 cells/L)
should not travel or should take itraconazole

Vit Nam cho thy thi gian bnh c th t
1-3 tun.
Biu hin lm sng:
Biu hin lm sng khc nhau v thay i t
khu tr vi ngi suy gim min dch ti bnh
lan ta bnh nhn suy gim min dch nghim
trng. P. marneffei l nhim trng c hi
nhng bnh nhn nhim HIV c CD4 <100 t
bo/ ml. Hu ht bnh nhn c biu hin st,
mt mi, gim cn, v tn thng da in hnh.
Cc pht hin khc bao gm thiu mu, ni
hch v gan lch to. C th c cc triu chng,
du hiu v h hp v tiu ha. Tn thng da
dng sn vi hoi t trung tm mt v c,
nhng cc v tr khc ca c th cng c th c
tn thng. ng nhim vi nhim trng c hi
khc, c bit l bnh lao, cn c loi tr
nhng bnh nhn ny. cc vt ch suy gim
min dch, nhim nm ny gy ra s hnh thnh
u ht, ging nh bnh lao. Tin lng km vi
nhng ngi tim chch ma ty, nhng ngi
khi pht bnh ngn, khng c st hay da tn
thng, kh th v s lng tiu cu thp.
Xt nghim chn on:
Soi di knh hin vi tm vch ngn gia ca
ni hoc ngoi bo t bo nm men trong cc
m hoc dch tit ca bnh nhn c hiu cho P.
marneffei. Xc nhn bng phn lp P. marneffei
t k thut nui cy tiu chun cho thy s
chuyn i c ph thuc nhit ca sinh sn
dng nm men hay nm a bo (ny chi) l tiu
chun vng cho chn on. P. marneffei c th
c phn lp t mu, ty xng, tn thng
da, hch lympho, hoc cc cht dch v trng
Phng nga:
nhng bnh nhn b nhim HIV, d phng
th pht bng thuc itraconazole cho n khi
CD4 tng ln trn 100 t bo/ml trong vng
6 thng. i vi nhng ngi sng trong vng
lu hnh bnh, d phng nguyn pht c th
c ch nh trong trng hp s lng CD4
thp. Cc chuyn gia tin rng nhng bnh nhn
221

for primary prophylasix during traveling to
endemic areas.
Epidemiology:
Together with tuberculosis and cryptococcosis,
penicilliosis is a common opportunistic
infection in HIV-infected patients. Before
the HIV epidemic it was a rare disease in
immunocompromised patients residing in or
traveling to endemic areas. All cases that occur
outside of endemic regions have a history of
travel to Southeast Asia, except for one case of
an African immigrant in Germany where there
was no clear history of travel to Southeast Asia
and one case of laboratory transmission in a
HIV-infected patient from Africa attending a
microbiology course in Paris.
Penicilliosis incidence correlates with the HIV/
AIDS epidemic in Vietnam and is reported
throughout Vietnam (see HIV/AIDS map). A
recent study from southern Vietnam suggests that
humidity is the most important environmental
predictor of P. marneffei admissions, and may
drive exposure by facilitating fungal growth or
spore release in the environment.
Map sources:
Data (from 2006 to 2009) from patients
admitted to the National Hospital of Tropical
Diseases (NHTD) in Hanoi and (2004-2011) to
the Hospital for Tropical Diseases (HTD) in Ho
Chi Minh City.
Map limitations:
There is limited data on penicilliosis in Vietnam.
These data were obtained from NHTD and
HTD and only reflects the patients that were
admitted there.

c s lng CD4 thp (<100 t bo / ml) khng
nn i du lch hoc nn dng itraconazole
phng bnh trong qu trnh i du lch n vng
lu hnh.
Dch t hc:
Cng vi bnh lao v nhim nm cryptococcus,
Penicillium l mt bnh nhim trng c hi
thng gp nhng bnh nhn nhim HIV.
Trc khi c dch HIV, l mt cn bnh him
ch gp nhng bnh nhn suy gim min dch
nng c tr ti hoc i du lch n vng lu
hnh. Tt c cc trng hp xy ra bn ngoi
vng c dch lu hnh c tin s i du lch n
khu vc ng Nam , ngoi tr mt trng
hp c bit ca mt ngi nhp c chu Phi ti
c, khng c thng tin r rng v i du lch
n khu vc ng Nam v l mt trng hp
ly truyn trong phng th nghim, bnh nhn
chu Phi nhim HIV tham d kha hc vi sinh
ti Paris.
T l Penicillium tng quan vi dch HIV/
AIDS ti Vit Nam v c bo co trn ton
Vit Nam (xem bn HIV/AIDS). Mt nghin
cu gn y t min nam Vit Nam cho thy
m l yu t d bo mi trng quan trng nht
ca nhim P. marneffei, v m lm tng phi
nhim bng cch to iu kin pht trin cho
bo t nm trong mi trng.
Ngun bn :
D liu t nm 2006 n nm 2009 t bnh
nhn nhp vin ti Bnh vin Bnh Nhit i
trung ng (NHTD) v (2004-2011) n Bnh
vin Bnh Nhit i (HTD) ti thnh ph H
Ch Minh.
Hn ch ca bn :
C rt t thng v Penicillium ti Vit Nam.
Nhng d liu ny c ly t NHTD v HTD
v ch phn nh bnh nhn nhp vin ti hai c
s ny.
222

- Bystriakova N, et al. (2003) Distribution and conservation status of forest bamboo biodiversity in
the Asia-Pacific Region. Biodiversity Conservation 12: 18331841.
- Pryce-Miller E, et al. (2008) Environmental detection of Penicillium marneffei and growth
in soil microcosms in competition with Talaromyces stipitatus. Fungal Ecol 1: 4 95 6.
- Vanittanakom N, et al. (2006) Penicillium marneffei Infection and Recent Advances in the
Epidemiology and Molecular Biology Aspects. Clin Microbiol Rev 19 (1): 95-110.
- Le T, et al. Epidemiology, seasonality and Predictors of Outcome in Penicillium marneffei
Infection in Ho Chi Minh City, Viet Nam. Clin Infect Dis 2011 Arp 1; 52(7):945952
- Bulterys PL, et al. (2013) Environmental predictors and incubation period of AIDS-associated
penicillium marneffei infection in Ho Chi Minh City, Vietnam. Clin Infect Dis;56(9):1273-9.
United Kingdom.
223
Subject: Influenza A/H5N1
Ch : Cm A/H5N1
224
Ch : Cm A(H5N1)
Classification:
ICD-9 488.01; ICD-10 J09
Phn loi:
ICD-9 488.01; ICD-10 J09
Synonyms:
Bird flu, avian influenza, highly pathogenic
avian influenza, H5N1.
ng ngha:
Cm chim, cm g, cm gia cm c lc cao,
H5N1.
Agent:
Influenza A subtype H5N1 are RNA viruses
of the family Orthomyxoviridae. Influenza A
viruses are subtyped based on differences in
two surface glycoproteins, haemagglutinin
(HA) and neuraminidase (NA). There are 18
HA and 11 NA subtypes, H17-18 and N10-11
were recently discovered in bats. All possible
combinations of these 16 HAs and 9 NAs
have been detected in wild aquatic birds, which
represents the natural reservoir of influenza A
viruses, but only a small number of subtypes
have established themselves in mammalian
species, including humans. Avian influenza
H5N1 occurs in two forms in birds, a virulent
form known as highly pathogenic avian
influenza H5N1 (HPAI H5N1) and a milder
form known as low pathogenic avian influenza
(LPAI H5N1). Molecular characterization of the
H5N1 viruses isolated from poultry and humans
in Vietnam show that genetically distinct clades
of H5N1 viruses are present. Clade 1 and clade
2 viruses are detected throughout Vietnam
with clade 1 predominant in south and clade 2
predominant in the north.
Tc nhn:
Cm A phn typ H5N1 l vi rt RNA thuc h
Orthomyxoviridae. Vi rut cm A c phn
typ da theo khc bit ca 2 protein b mt l
haemagglutinin (HA) v neuraminidase (NA).
C 18 HA v 11 NA phn typ, H17-18 v 11
NA gn y c pht hin di. Tt c cc
t hp ca 16 HA v 9 NA c pht hin
cc loi chim v gia cm, cng l nhng
cha t nhin ca vi rut cm A, nhng ch c
mt s t t hp c th tn ti trn ng vt c
v, bao gm c con ngi. Trn gia cm, cm
gia cm A(H5N1) gm c 2 dng l: loi c
lc cao l cm gia cm c lc cao (HPAI
H5N1) v loi nh hn l cm gia cm c
lc thp (LPAI H5N1). c tnh phn t vi
rut H5N1 phn lp t gia cm v ngi VN
cho thy nhng im c trng v di truyn hc
theo nhnh ca H5N1. Nhng vi rut nhnh 1
v nhnh 2 c tm thy Vit Nam, nhnh 1
ni tri Min Nam trong khi nhnh 2 ni tri
Min Bc.
Reservoir:
LPAI H5N1viruses naturally circulate in wild
birds, principally waterfowl and gulls, in which
they generally cause no symptoms. LPAI H5N1
viruses are transmitted to terrestrial poultry
(chickens, turkeys). LPAI H5N1 most likely
evolved to HPAI H5N1 in aquatic birds (ducks
and geese). Transmission of HPAI H5N1 into
migratory birds can result in large die-off.
Transmission:
Humans acquire H5N1 from poultry infected
cha:
Vi rt LPAI H5N1 lu hnh trong t nhin
cc loi chim hoang d nh chim nc (mng
kt, le le..) v mng bin v thng khng c
triu chng. LPAI H5N1c th ly sang cc loi
gia cm nh g, g ty. LPAI H5N1c th tin
trin thnh HPAI nhng loi thy cm (vt,
ngng). Ly truyn HPAI H5N1qua loi chim
di c c th gy ra nhng v i dch.
Ly truyn:
Ngi mc H5N1 t gia cm nhim HPAI
H5N1. Tip xc trc tip vi gia cm bnh hoc
cht l phng thc phi nhim ph bin nht,
v nhim trng xy ra khi ht phi cc ht vi rut
225

with HPAI H5N1. Direct contact with sick
or dead poultry is the commonest reported
exposure, and infection may occur by inhalation
of virus-laden particles or the inoculation of
contaminated material into the eyes or upper
respiratory tract mucosa. Other postulated
routes of infection include ingestion of water
contaminated with the feces of infected birds
during swimming or bathing, and consumption
of under-cooked products from infected birds.
Often however the route of exposure is not
clear. Limited person-to-person transmission
of HPAI H5N1 is possible following prolonged
close contact with an infected patient.
Incubation period:
3 days (range 2-9 days).
Clinical findings:
The illness is initially indistinguishable from
other respiratory infections, beginning with a
fever and cough. Other reported early symptoms
have included myalgia, headache, vomiting,
diarrhoea, nausea, and epigastric pain. The
patients condition becomes increasingly severe
and patients are usually admitted around 6 days
after illness onset with difficulty breathing,
poor oxygenation, and pneumonia on chest
X-ray. Occasionally patients may initially
present with a non-respiratory illness, e.g.
encephalitis or gastroenteritis. Patients usually
die of respiratory failure (CFR is around 60%).
Diagnostic tests:
Virus detection by RT-PCR of respiratory
specimens is recommended method. Virus culture
and subsequent virus identification by RT-PCR,
immunofluorescence, or haemagglutination
inhibition assay (HI). Microneutralization
assay is the currently recommended test for the
measurement of antibodies to highly pathogenic
avian influenza A/H5N1. Rapid antigen tests
are not recommended due to lack of sensitivity.
Ch : Cm A(H5N1)
hoc dnh cht nhim vo mt hoc nim mc
ng h hp. Cc ng ly truyn r rng
khc bao gm ung phi nc b nhim phn
ca gia cm nhim bnh khi bi li hoc tm,
n sn phm cha chn k ca gia cm nhim
bnh. Tuy nhin thng th cc ng thm
nhp ny l khng r rng. C s ly truyn
nht nh trong cc tip xc trc tip t ngi
sang ngi khi c tip xc gn v lu vi
mt bnh nhn b nhim bnh.
Thi gian bnh:
3 ngy (khong 2-9 ngy).
Biu hin lm sng:
Bnh giai on sm kh phn bit vi cc bnh
l nhim trng ng h hp khc, cc triu
chng in hnh gm c ho, st. Mt s trng
hp ghi nhn c yu c, au u, nn, bun nn,
tiu chy v au thng v. Bnh tin trin nng
v bnh nhn thng nhp vin trong khong 6
ngy sau khi pht vi cc biu hinkh th,
gim oxy mu, hnh nh tn thng phi trn
X quang. Bnh nhn ban u c km nhng
triu chng khc gm vim no hoc au bng.
Nguyn nhn t vong thng l do suy h hp
(CFR khong 60%).
Xt nghim chn on:
Pht hin vi rut bng phng php RT-PCR
mu bnh phm ng h hp l phng php
hiu qu nht. Nui cy vi rt ri xc nh bng
RT-PCR, min dch hunh quang, c ch ngng
kt hng cu (HI). Phng php Trung ha vi
lng c dng nh lng khng th i
vi cm gia cm c lc cao. Kim tra nhanh t
c khuyn co s dng do nhy thp.
Phng bnh:
Trnh phi nhim vi cha nh thy cm
hoang d v gia cm nui (sinh hc trong chn
nui). Gim st n gia cm b nhim bnh v
tiu hu cc n b nhim bnh. Ngi chn
nui v git m gia cm g vt phi mc qun
o bo h. Tim phng gia cm mt s nc
226

Prevention:
Prevention of exposure to the wild aquatic
bird reservoir and domestic poultry (farm
biosecurity). Surveillance for infected poultry
flocks and culling of infected flocks (stamping
out). Poultry workers and cullers must wear
protective clothing. Poultry vaccination is
used in some countries to reduce the incidence
of HPAI and reduce the amount of virus in
the environment. Regulation of the poultry
production system and the movement,
marketing and sale of live poultry in order to
limit dissemination of infection.Education
of poultry farmers and the general public to
reduce high-risk exposures (e.g. handling and
consumption of sick poultry). Human cases
must be isolated, close contacts monitored for
signs of infection, and health care workers must
wear personal protective equipment.
Epidemiology:
Since the end of 2003 the A/H5N1 virus has
spread globally, infecting poultry in over 60
countries and causing the loss of over 250
million poultry. In 2010 HPAI H5N1 remained
entrenched in poultry in several Asian countries
(e.g. Indonesia, China, Bangladesh, Vietnam)
and in Egypt. Whilst migratory waterfowl
play a role in the long-distance spread of
H5N1, the intensification of poultry farming
and poorly regulated movement and trade in
poultry is probably the most important factor
in sustaining the current epizootic. HPAI H5N1
is highly contagious between birds and has a
high fatality in most poultry species, making it
an economically important disease. However, it
is the risk to humans that has driven most of the
control activities. Over 600 human cases have
been detected in 15 countries and whilst this
represents a very low overall risk of transmission
of H5N1 from poultry to humans.In Vietnam
until April 2013 a total of 125 cases have been
reported of which 62 died. The human case load
has reduced considerably in Vietnam. There is a
national vaccination program for poultry.
Ch : Cm A(H5N1)
gim t l mc dch cm gia cm c lc cao
v lm gim lng vi rt trong mi trng. Xy
dng cc quy nh h thng chn nui gia cm
v vn chuyn, tip th v bn gia cm sng
hn ch nhim khun trn din rng. Nng cao
nhn thc ca ngi chn nui gia cm v cng
chng ni chung gim nhng tnh hung
phi nhim nguy c cao (v d nh x l v
tiu th gia cm b bnh). Bnh nhn phi c
cch ly, gim st cc tip xc gn nhm theo
di cht ch cc du hiu nhim trng v nhn
vin y t phi eo dng c bo v c nhn.
Dch t hc:
T cui nm 2003, vi rt A(H5N1) lan rng
trn ton cu, ly nhim cho n gia cm hn
60 quc gia v gy thit hi hn 250 triu gia
cm. Trong nm 2010 cm gia cm c lc cao
H5N1 vn tn ti gia cm mt s nc chu
(v d nh Indonesia, Trung Quc, Bangladesh,
Vit Nam) v ti Ai Cp. Thy cm di c ng
mt vai tr trong s ly lan v ni rng khong
cch a l ca H5N1. Cc qui nh lng lo
v chn nui, vn chuyn v bun bn gia cm
l yu t quan trng nht trong vic duy tr
cc bnh dch ng vt hin ti. Dch cm gia
cm H5N1 rt d ly lan gia cc loi chim v
c t l t vong cao trong hu ht cc loi gia
cm, lm cho bnh tr thnh gnh nng v kinh
t. Tuy nhin, v bnh l nguy c i vi con
ngi nn thc y hu ht cc hot ng
kim sot gia cm. Hn 600 trng hp ngi
c pht hin 15 quc gia v con s ny
ch l mt phn nh so vi nguy c tng th ly
truyn H5N1 t gia cm sang ngi.Ti Vit
Nam, cho n thng 4 nm 2013 c tng cng
125 trng hp c bo co trong 62 t
vong. Chng trnh tim vc xin cho gia cm
c p dng trn ton quc.
Ngun bn :
S liu ti Vin v sinh Dch t Trung ng v
Cc Th Y t nm 2003 ti nm 2013
227
Ch : Cm A(H5N1)
Map sources:
and Department of Animal Health from 2003 to
2013.
- Abdel-Ghafar AN, et al. (2008) Virus Update on avian influenza A (H5N1) virus infection in
humans. N Engl J Med 358 (3): 261-273.
- Gambotto A,et al. (2008) Human infection with highly pathogenic H5N1 influenza virus.
Lancet;371(9622):1464-75.
- Food and Agriculture Organisation. (2008). The Global Strategy for the Prevention and Control of
H5N1 Highly Pathogenic Avian Influenza.
- Peiris JSM, et al. (2007) Avian Influenza vrus (H5N1): a threat to human health. ClinMicrob Rev
20: 243-267.
- Zhao D, et al. (2012) Phylogenetic and pathogenicanalyses of avian influenza A H5N1 viruses
isolated from poultry in Vietnam. PLoSOne;7(11):e50959. doi: 10.1371/journal.pone.0050959.
United Kingdom.
228
Subject: Influenza illness and influenza subtypes
229
Ch : Hi chng cm
Ch : Hi chng cm
Classification:
ICD-9 487; ICD-10 J10, J11
Phn loi:
ICD-9 487; ICD-10 J10, J11

Influenza like illness, the flu
Hi chng v ng ngha:
Cm cm, hi chng cm.
Agent:
Multiple species of the influenza virus. In virus
classification influenza viruses are RNA viruses
that make up three of the five genera of the
family Orthomyxoviridae: Influenzavirus A, B,
C. These viruses are only distantly related to the
human parainfluenza viruses, which are RNA
viruses belonging to the paramyxovirus family
that are a common cause of respiratory infections
in children such as croup, but can also cause a
disease similar to influenza in adults.
Tc nhn:
Cc loi vi rt cm rt a dng. Trong phn loi
vi rt, vi rt cm c nhn RNA gm 3 trong 5 chi
Orthomyxoviridae gm A, B v C. Cc loi vi
rut ny c lin quan xa vi cc vi rt cm trn
ngi, l vi rut RNA thuc h paramyxovirus
l mt trong cc cn nguyn ph bin gy ra
cc bnh nhim trng h hp tr em nh vim
thanh qun, nhng cng c th gy bnh tng
t nh cm ngi ln.
Reservoir:
Humans are normally infected by human
influenza viruses (H3N2, H1N1 and B), and
form the primary reservoir for these human
viruses. With some notable exceptions, seasonal
influenza usually is not a zoonotic disease.
Transmission:
Most experts believe that flu viruses spread
mainly by droplets made when people with
flu cough, sneeze or talk. These droplets can
land in the mouths or noses of people who are
nearby. Less often, a person might also get flu
by touching a surface or object that has flu virus
on it and then touching their own mouth, eyes or
possibly their nose.
Influenza virus shedding (the time during which
a person might be infectious to another person)
begins the day before symptoms appear and
virus is then released for between 5 to 7 days,
although some people may shed virus for longer
periods. People who contract influenza are most
infective between the second and third days after
infection. The amount of virus shed appears to
correlate with fever, with higher amounts of virus
shed when temperatures are highest. Children
are much more infectious than adults and shed
cha:
Ngi thng b nhim vi rt cm (H3N2, H1N1
v B) s hnh thnh cha cho chnh nhng loi
vi rt ny. Vi mt vi ngoi l nht nh, cm
theo ma khng ly truyn ng vt.
Ly truyn:
Hu ht cc chuyn gia tin rng vi rt cm ly lan
ch yu bi nhng git nh pht sinh khi ngi
b cm ht hi, ho hoc ni chuyn. Nhng git
nh c th xm nhp vo trong ming hoc mi
ca nhng ngi xung quanh. Vi mt s trng
hp, ngi cng c th mc bnh cm do chm
vo b mt hoc vt dng c vi rt cm v sau
chm vo ming, mt hoc mi mnh.
Thi gian pht tn vi rt cm (thi gian t khi
mt ngi c th bt u ly bnh n khi ly
cho ngi khc) bt u mt ngy trc khi cc
triu chng xut hin ko di t 5-7 ngy, mt s
ngi c th pht tn vi rt trong thi gian di
hn. Ngi mc cm c kh nng ly truyn cao
nht vo gia cc ngy th hai v th ba sau khi
b nhim. Lng vi rt o thi c lin quan n
st, s lng vi rt o thi ra nhiu hn khi st
cao. Tr em d truyn bnh hn ngi ln v pht
tn vi rt t ngay trc khi xut hin cc triu
chng cho n hai tun sau khi b nhim. Cm
ma ly theo ba ng chnh: Truyn trc tip
230

virus from just before they develop symptoms
until two weeks after infection. Influenza
can be spread in three main ways: by direct
transmission (when an infected person sneezes
mucus directly into the eyes, nose or mouth
of another person); the airborne route (when
someone inhales the aerosols produced by an
infected person coughing, sneezing or spitting)
and through hand-to-eye, hand-to-nose, or handto-mouth transmission, either from contaminated
surfaces or from direct personal contact such as
a hand-shake. The relative importance of these
three modes of transmission is unclear, and they
may all contribute to the spread of the virus.
How long influenza survives in airborne droplets
seems to be influenced by the levels of humidity
and UV radiation: with low humidity and a lack
of sunlight in winter aiding its survival. As the
influenza virus can persist outside of the body, it
can also be transmitted by contaminated surfaces
such as banknotes, doorknobs, light switches
and other household items. The length of time
the virus will persist on a surface varies, with
the virus surviving for one to two days on hard,
non-porous surfaces such as plastic or metal, for
about fifteen minutes from dry paper tissues, and
only five minutes on skin.
Period of contagiousness:
In adults, viral shedding and probable
communicability is greatest in the first 35 days
of illness. In young children, virus shedding can
occur for longer, 710 days, and may be even
longer in severely immunocompromised persons.
Most healthy adults may be able to infect others
beginning 1 day before symptoms develop and
up to 5 to 7 days after becoming sick. Some
people, especially young children and people
with weakened immune systems, might be able
to infect others for an even longer time.
Incubation period:
Average 2 days (range 15) for seasonal
influenza..
Ch : Hi chng cm
(khi mt ngi b nhim bnh ht hi nhy trc

tip vo mt, mi hay ming ca ngi khc),
qua cc ht nc nh trong khng kh (khi c
ai ht vo cc ht nc pht ra khi mt ngi
nhim bnh ho, ht hi hoc nh nc bt) v
qua tay - mt, tay - mi, hoc tay-ming, t cc
b mt b nhim hoc tip xc c nhn trc tip
(chng hn nh bt tay). Mc ca ba phng
thc ly truyn l khng r rng, tt c u c th
ng gp vo s ly lan ca vi rt.
Thi gian cm tn ti trong cc git nc nh
trong khng kh c qui nh bi m v mc
bc x UV: m thp v thiu nh sng mt
tri trong ma ng l iu kin thun li cho
vi rt. Bi vi rt cm c th tn ti bn ngoi c
th, n cng c th c ly truyn qua cc b
mt b nhim nh tin giy, tay nm ca, cng
tc in v cc gia dng khc. Thi gian vi rt
tn ti trn mt b mt l khc nhau, vi b mt
cng, khng xp nh nha hoc kim loi l 1-2
ngy, vi khn giy kh l trong khong mi
lm pht, v ch nm pht trn da .
Thi gian ly bnh:
ngi ln, pht tn vi rt v kh nng gy
nhim xy ra l nhiu nht trong vng 3-5 ngy
u tin ca bnh. tr nh, vi rt pht tn c
th lu hn, khong 7-10 ngy, v c th thm
ch lu hn na nhng ngi b suy gim min
dch. Hu ht ngi ln khe mnh c th ly
nhim cho ngi khc bt u 1 ngy trc khi
cc triu chng pht trin v ln n 5-7 ngy
sau khi b bnh. Mt s ngi, c bit l tr nh
v nhng ngi c h thng min dch suy yu,
c th ly nhim cho ngi khc trong mt thi
gian lu hn.
Thi gian bnh:
Trung bnh l 2 ngy, trong khong t 1-5 ngy.
Biu hin lm sng:
Bnh c cc th t khng triu chng n t
vong. Cc triu chng c trng ca nhim vi
rt cp tnh ng h hp l st, s mi, ho (ho
khan) au u, au c, mt mi v au hng.
231

Clinical findings:
From asymptomatic to fatal. An acute viral
disease of the respiratory tract characterized by
fever, cough (usually dry), headache, myalgia,
prostration, coryza, and sore throat. Cough
is often severe and can last 2 or more weeks;
fever and other symptoms generally resolve in
57 days. In temperate climates, recognition is
commonly based on clinical presentation during
winter months with a syndrome consistent with
influenza. Diagnosis improves when influenza
surveillance information is available to indicate
influenza viruses are in circulation. Influenza
may be clinically indistinguishable from disease
caused by other respiratory viruses, such as
rhinovirus, RSV, parainfluenza, adenovirus
and other pathogens. In children, GI tract
manifestations (nausea, vomiting, diarrhea)
may accompany the respiratory phase, and have
been reported in up to 25% of children in school
outbreaks of influenza B and A (H1N1). GI
manifestations are uncommon in adults. Infants
may present with a sepsis-like syndrome. Older
adults with influenza can present with worsening
of underlying conditions such as congestive
heart failure, and may not have an elevated
temperature.
Diagnostic tests:
Laboratory confirmation of influenza infection
can be done by isolation of viruses from throat,
nasal, and nasopharyngeal secretions or tracheal
aspirate or washings using cell culture or in
embryonated eggs; direct identification of viral
antigens in nasopharyngeal cells and fluids (FA
test or ELISA); rapid diagnostic tests; or viral
RNA amplification. Demonstration of a 4-fold
or greater rise in specific antibody titer between
acute and convalescent sera can also be used
to confirm acute infection. Single serological
specimens cannot be used to diagnose an acute
infection. Ideally, respiratory specimens should
be collected as early in the illness as possible.
Virus shedding starts to wane by the 3rd day of
symptoms, and in most cases virus is not detected
Ch : Hi chng cm
Ho nhiu v c th ko di hn 2 tun, st v
cc triu chng khc thng ht trong khong
5-7 ngy. vng kh hu n i, chn on
thng c da trn biu hin lm sng trong
ma ng c km mt hi chng ph hp vi
cm. Chn on chnh xc hn khi c thng tin
t cc chng trnh gim st cm cho rng vi
rut cm ang lu hnh. Cm c phn bit v
mt lm sng vi cc bnh ng h hp khc,
chng hn nh rhinovirus, RSV, cm, v cc
tc nhn gy bnh khc. Hi chng c trng vi
cm bao gm bnh cp tnh ng h hp trn,
vim thanh qun, vim tiu ph qun, st cao co
git, v vim phi. tr em, vim ng tiu
ha (bun nn, nn, tiu chy) c th i km vi
du hiu h hp, v ghi nhn 25% s tr em
trong v dch cm B v A (H1N1). Triu chng
tiu ha t ph bin ngi ln. Tr nh c th
c hi chng nh nhim trng huyt. Ngi ln
tui b cm c th c lm tng tnh trng suy tim
sung huyt nhng khng c st.
Xt nghim chn on:
Cm c xc nh bng cch thc hin phn
lp vi rt t hng, mi, cc cht tit mi hng,
dch kh qun hoc dch ra mi hng khi nui
cy trn t bo hoc phi trng g, xc nh trc
tip cc khng nguyn vi rut trong cc t bo
mi hng v cc cht lng (test FA hoc ELISA);
cc test nhanh, hoc khuch i RNA vi rt.
xc nhn nhim trng cp tnh c th da vo
vic gia tng gp 4 ln hoc cao hn ca hiu gi
khng th c hiu gia huyt thanh giai on
cp v giai on hi phc. Mt mu huyt thanh
n thun khng c s dng chn on
mt bnh nhim trng cp tnh. L tng nht,
bnh phm h hp nn c thu thp trong giai
on sm ca bnh. Vi rt pht tn bt u suy
yu vo ngy th 3 sau khi c triu chng, v
trong hu ht cc trng hp vi rt kh pht hin
sau 5 ngy ngi ln, mc d vy tr em vi
rt c th c pht hin vi thi gian di hn.
D phng:
1) Gio dc cng ng v cc nhn vin y t
232

after 5 days in adults, though virus shedding can
occur longer in children.
Prevention:
1) Educate the public and health care personnel in
basic personal hygiene, including hand hygiene
and cough etiquette, and especially transmission
via unprotected coughs and sneezes, and from
hand to mucous membranes. 2) Immunization
with available inactivated influenza vaccines
(IIV) and live virus vaccines may provide 70%
90% protection against infection in healthy young
adults when the vaccine antigen closely matches
the circulating strains of virus. In the elderly,
although immunization may be less effective
in preventing illness, inactivated vaccines may
reduce severity of disease and incidence of
complications by 50%60%, and deaths by
approximately 80%. Influenza immunization
should preferably be coupled with immunization
against pneumococcal pneumonia for groups
recommended to receive both vaccines. 3)
Chemotherapy prevention include Amantadine,
rimantadine, zanamivir v oseltamivir also have
effective on seasonal influenza.
Epidemiology:
Yearly seasonal influenza epidemics impose
a substantial health burden on all age groups,
but the highest risk of complications occur
among children less than 2 years, adults older
than 64 years, and persons of any age with
certain medical conditions, including chronic
cardiovascular, pulmonary, renal, hepatic,
hematologic or metabolic disorders (e.g.
diabetes); immunosuppression; pregnancy;
and
neurologic/neuromuscular
conditions
that can compromise respiratory function or
handling of respiratory secretions. Secondary
complications of influenza include bacterial
pneumonia, including co-infection with MRSA
and S. pneumonia; viral pneumonia; worsening
of underlying conditions; sinusitis; otitis media;
febrile seizures; encephalitis/encephalopathy;
myositis; and Reye syndrome in association
Ch : Hi chng cm
v v sinh c nhn c bn, bao gm v sinh tay,

che ming khi ho, v c bit l truyn thng v
nguy c ly nhim khi ho, ht hi khng che, v
nguy c ly bnh t bn tay. 2). Tim vc xin
cm bt hot (IIV) v vc xin vi rt sng c tc
dng bo v 70% -90% ngi ln khe mnh,
nht l nu khng nguyn vc xin ph hp vi
cc chng vi rt lu hnh. ngi gi, mc d
tim chng c th t hiu qu trong vic ngn
nga mc bnh, loi vc xin bt hot c th lm
gim mc nghim trng ca bnh v t l bin
chng mc 50-60% v t l t vong khong
80%. Tim chng nga cm tt nht nn c kt
hp vi tim chng phng ph cu. 3). D phng
bng thuc bao gm Amantadine, rimantadine,
zanamivir v oseltamivir cng c tc dng vi
cm ma.
Dch t hc:
Dch bnh cm ma gy nn gnh nng v bnh
tt ng k cho tt c cc nhm tui, nhng nguy
c bin chng cao nht xy ra tr em di 2
tui, ngi ln trn 64 tui, v mi ngi ang
mang bnh v tim mch, phi, thn, gan, ri lon
huyt hc hoc trao i cht (v d nh bnh tiu
ng), suy gim min dch; mang thai; v cc
bnh thn kinh / thn kinh c c lin quan n
chc nng h hp hoc chc nng x l cc cht
tit ng h hp. Bin chng th pht ca cm
bao gm vim phi do vi khun bao gm ng
nhim MRSA v vim phi ph cu, vim phi
do vi rt, th trng suy nhc, vim xoang, vim
tai gia, co git st cao, vim no/bnh no;
vim c v hi chng Reye ngi c s dng
salicylate . T l tn cng ca cm ma mc
5-10% ngi ln v 20-30% tr em. Khi dch
cm bng pht, 5-15% dn s b vim ng h
hp trn. Mc d t vong do cm theo ma c th
xy ra bt c la tui, trn 90% cc ca t vong
cm xy ra nhng ngi t 65 tui tr ln.
Hng nm dch c th bng pht v gy qu ti
cho cc c s y t. Hu ht cc nghin cu v
dch t hc ca bnh cm c tin hnh ti
cc nc pht trin trong vng kh hu n i,
nhng nhiu thng tin qu gi li c thu c
233

with use of salicylates. Attack rate of seasonal
influenza is 5-10% in adult and 20-30% in
children. During influenza outbreak, 5-15%
population has upper respiratory infection.
Although seasonal influenza deaths can occur
in any age group, over 90% of influenza
deaths occur among those aged 65 years and
older. Annual epidemics of influenza can be
explosive and overwhelm health care services.
Most studies of the epidemiology of influenza
have been conducted in developed countries
in temperate climates, but more information
is now being obtained from developing and
tropical countries that have found higher risk
of influenza complications and death among
children less than 5 years, the elderly, and those
with chronic diseases. Reports of influenza
outbreak investigations in Africa and Indonesia
suggest malnutrition and poor access to health
care are likely to contribute to higher rates of
complications and death.
Ch : Hi chng cm
t cc nghin cu ti cc quc gia nhit i.

Cc quc gia ny c t l cao i vi nguy c
bin chng do cm v t vong tr em di
5 tui, ngi gi, v nhng ngi c bnh mn
tnh. Bo co cm iu tra dch chu Phi v
Indonesia cho thy suy dinh dng v kh nng
tip cn dch v y t ca ngi ngho c lin
quan mt thit n t l gia tng bin chng v
t vong.
Ngun bn :
Vin V sinh dch t Trung ng v nin gim
thng k bnh truyn nhim t 2009 n 2011,
Cc Y t d phng.
Map sources:
Communicable diseases year book, General
Department of Preventive Medicine
from 2009 to 2011.

- http://vncdc.gov.vn/DiseasesDetail.aspx?id=36 GDPM last access 14/04/2013.
- SEASONAL INFLUENZA ICD-9 487; ICD-10 J10, J11 [CCDM19: C. B. Bridges, A. Fry, K.
Fukuda, N. Shindo]; [CCDM18: K. Sto hr]
- http://www.who.int/mediacentre/factsheets/fs211/en/ last access 14/04/2013.
United Kingdom.
234
Subject: Japanese encephalitis vaccine coverage
235
Ch : vc xin vim no Nht Bn
Classification:
ICD-9 062.0; ICD-10 A83.0
Phn loi:
ICD-9 062.0; ICD-10 A83.0
Synonyms:
Japanese encephalitis
ng ngha:
Vim no Nht Bn
Agent:
Japanese encephalitis virus (JEV), an enveloped,
single-stranded, positive sense RNA, family
flaviviridae. It is divided into five antigenic
groups and four genotypes, which may be
linked to differences in virulence.
Tc nhn:
Vi rt vim no Nht Bn (JEV). L vi rt RNA
si n c v bao bc, thuc h flaviviridae.
N c chia thnh nm nhm khng nguyn
v bn kiu gen, c lin quan n s khc bit
v c lc.
Reservoir:
Birds and domestic pigs that amplify the virus
asymptomatically; mosquitoes by trans-ovarial
transmission and possibly over-wintering
adults.
cha:
Chim, ln khuych i vi rt m khng c triu
chng, mui c th truyn vi rt qua trng hoc
gi vi rt qua ng.
Vector:
Mosquito species that breed in rice fields and
marshes, principally Culex tritaenorhynchus
group; also C. gelidus and C. vishnui.
Transmission:
By mosquito bite.
Cycle:
Birds and pigs have sufficient viremia to infect
mosquitoes. The mosquito picks up the virus
from the blood of a viremic host. The virus
crosses the gut wall and multiplies in the organs
of the mosquito. After a few days, depending
on the ambient temperature, the virus reaches
the salivary glands and is injected into the
next host when bitten. Humans are incidental
and dead-end hosts as viremia does not reach
sufficient levels to infect mosquitoes.
Incubation period:
6-16 days.
Clinical findings:
Most JE infections (>96%) are asymptomatic
Vector:
loi mui trong rung la v m ly, ch yu
l mui Culex tritaenorhynchus; Culex gelidus
v Culex vishnui.
Ly truyn:
Qua mui t.
Chu k:
Chim v ln c lng vi rt ly nhim
sang mui. Mui nhim vi rt t mu ca vt
ch cha vi rt. Vi rt i qua thnh rut v cc
tng ca mui. Sau mt vi ngy, ty thuc
vo nhit mi trng xung quanh, vi rt di
chuyn n cc tuyn nc bt v sau c
ly nhim vo cc vt ch khc qua vt t.
Con ngi l vt ch cui cng v khi vo mu
ngi, lng vi rt khng ly ngc li
cho mui.
Thi gian bnh:
6-16 ngy.
Biu hin lm sng:
Trn 96% cc ca bnh nhim vi rt VNNB
khng c triu chng hoc c biu hin triu
236

or present as a mild disease with flu-like
symptoms. Among symptomatic patients who
present with encephalitis, the case-fatality
ratio can be as high as 10%30%. Symptoms
reported include: high fever with headache,
chills, neck stiffness, anorexia, nausea and
vomiting, progression to aseptic meningitis
or encephalitis with disorientation, coma,
seizures, spastic paralysis, drowsiness, stupor.
Death occurs from respiratory complications
or seizures. Those who survive suffer lasting
damage to the central nervous system.
Diagnostic tests:
Serology: IgM capture ELISA on serum or CSF;
antibodies can be detected in CSF as of four
days of disease onset, and in serum after seven
days. Virus isolation or RT-PCR are insensitive.
Prevention:
A number of vaccines are available, including
a mouse brain-derived inactivated JE virus
vaccine produced by NIHE Vietnam. A JE
immunization. Program was introduced in
1997 in high-risk districts and expanded to
437 districts by 2007 through the national
immunization program. Personal anti-mosquito
precautions should be taken. Intermittent
irrigation of rice fields disrupts vector breeding;
vaccination of pigs reduces amplification.
Epidemiology:
JE is the leading cause of viral encephalitis
in Asia; 35,000-50,000 cases are reported
annually but this believed to be a significant
underestimate of the true disease burden. It is
epidemic in temperate parts of Asia, linked to
the seasonal occurrence of mosquitoes, and
endemic in tropical regions of Asia due to the
year-round mosquito activity. Intensification
and expansion of irrigated rice production
systems in South and South-East Asia over the
past 20 years have had an important impact
on the disease burden caused by Japanese

chng nh ging nh cm. Trong s bnh nhn
c biu hin triu chng vim no, t l t vong
c th cao t 10% -30%. Cc triu chng c
bo co bao gm: st cao vi au u, n lnh,
cng c, chn n, bun nn v nn, tin trin
thnh vim mng no v trng hoc vim no
vi triu chng mt phng hng, hn m, co
git, lit co cng, l m, sng s. T vong xy
ra do cc bin chng h hp hoc co git. Bnh
nhn khi vn b tn thng lu di h thng
thn kinh trung ng.
Xt nghim chn on:
Pht hin IgM c hiu bng MAC- ELISA
trong huyt thanh hoc dch no ty. Khng th
c th c pht hin trong dch no ty bn
ngy sau khi khi pht bnh, v trong huyt
thanh sau by ngy. Phn lp vi rt hoc RTPCR khng nhy.
Phng bnh:
C mt s vc xin ang c s dng, bao gm
vc xin bt hot ch t no chut c sn xut
ti VABIOTECH Vit Nam. Chng trnh
tim vacxin vim no Nht Bn c trin khai
t nm 1997 cc huyn nguy c cao v m
rng n 437 huyn vo nm 2007 thng qua
chng trnh tim chng m rng quc gia.
Thc hin cc bin php phng mui t i
vi c nhn. Cc bin php thy li ti tiu
nhng cnh ng la ngn chn s sinh
sn ca mui. Tim vc xin cho ln gim s
nhn ln ca vi rt.
Dch t hc:
VNNB l nguyn nhn hng u ca vim no
vi rt chu ; 35.000-50.000 trng hp c
bo co hng nm, nhng con s ny vn c
cho l thp hn nhiu so vi gnh nng bnh
tt thc s. y l bnh gy dch cc vng
n i chu , lin quan n s xut hin mui
theo ma, v lu hnh vng nhit i chu
do hot ng mui din ra quanh nm. Tng
cng v m rng sn xut la go Nam v
237

encephalitis, since the vectors breed in rice
fields. The vectors prefer non-human hosts, but
do feed on humans in periods of peak activity.
The disease is mainly seen in children under
the age of 15, peak age is 3-5 years. JEV was
isolated in 1951for the first time in Vietnam.
Since the introduction of the JE vaccine there
has been a slight decrease in the incidence
of acute encephalitis syndrome (AES), of
which in the north about 52% have laboratory
evidence of recent JEV infection. Good quality
JE surveillance data are needed in Vietnam to
monitor and evaluate the vaccination program.
Map sources:
Data for the Japanese encephalitis vaccine map
were obtained from Expanded Program on
Immunization, National Institute of Hygiene
and Epidemiology (NIHE)

ng Nam trong 20 nm qua c tc ng
quan trng n gnh nng bnh tt ca vim
no Nht Bn v vect sinh sn cc cnh ng
la. Vt ch a thch ca vect khng phi l
ngi, nhng trong thi gian vect hot ng
cao im n tn cng con ngi. Bnh ch yu
gp tr di 15 tui, nhm tui mc cao nht
l 3-5 tui. Vi rt VNNB ln u tin c phn
lp ti Vit Nam vo nm 1951. K t khi trin
khai tim vc xin VNNB, t l mc hi chng
vim no cp (AES) gim xung, trong
khong 52% dng tnh vi VNNB ti min
Bc. Cn phi c s liu gim st VNNB c
cht lng theo di v nh gi chng trnh
tim chng ti Vit Nam.
Ngun bn :
S liu t l tim chng 3 mi vc xin Vim no
Nht Bn c ly t Chng trnh tim chng
m rng, Vin v sinh dch t trung ng.

- Barrett ADT. (2001) Japanese encephalitis. In Encyclopedia of Arthropod-transmitted Infections,
M. Service [ed.], p.239-246. CAB International
- Heymann DL (ed.) (2009) Control of Communicable Diseases Manual, 19th edn. p.42-46. APHA
- Mackenzie JS et al. (2004) Emerging flaviviruses: the spread and resurgence of Japanese
encephalitis, West Nile and dengue viruses. Nat Med 10: S98S109.
- Marks F, et al. (2012) Effectiveness of the Viet Nam Produced, Mouse Brain-Derived, Inactivated
Japanese Encephalitis Vaccine in Northern Viet Nam. PLoS Negl Trop Dis 6(12): e1952. doi:10.1371/
journal.pntd.0001952
- Yen NT, et al. (2010) Surveillance for Japanese Encephalitis in Vietnam, 19982007. Am J Trop
Med Hyg 83(4): 816819.
United Kingdom.
238
Subject: Measles
Ch : Si
239
Subject: Measles
Ch : Si
Classification:
ICD-9 9055.0; ICD-10 B05.0
Phn loai:
ICD-9 9055.0; ICD-10 B05.0
Synonyms:
Rubeola, morbilli,
contagion
ng ngha:
Rubeola, morbilli,
contagion
contagious
disease,
Agent:
Measles virus, a single-stranded RNA negativesense morbillivirus from the Paramyxoviridae
family.
Reservoir:
Humans.
Transmission:
Airborne droplets from or contact with nasal
and throat secretions from infected persons.
The transmission rate is very high from 4 days
before to 4 days after rash appears. Droplets
remain infectious for several hours, and even
longer under conditions of low humidity.
Incubation period:
Median 12.5 days, range 13 weeks.
Clinical findings:
High fever, conjunctivitis, coryza, cough,
maculopapular rash beginning on the face,
spreading downwards to reach the hands and
feet. Characteristic small white spots (Koplik
spots) on the buccal mucosa.
Complications can include of otitis media,
pneumonia, laryngotracheal bronchitis (croup),
severe skin infections, severe diarrhea and
encephalitis which can be fatal. Complications
are more common and more severe in people
who are malnourished, vitamin A deficiency,
and chronic diseases. Very rarely, subacute
sclerosing panencephalitis may appear from six
to 15 years after the initial infection.
Measles caught during pregnancy may result
in a miscarriage, stillbirth or pre-term (early)
contagious
disease,
Tac nhn:
Vi rut si, l vi rt RNA c mt si n, ging
Morbillivirus thuc ho Paramyxoviridae.
cha:
Ngi
Ly truyn:
Qua ng khng khi b nhim dch tit mi,
hng ca bnh nhn hoc tip xc trc tip vi
dch tit mi, hng cua bnh nhn. Ty l ly
truyn la rt cao t 4 ngay trc n 4 ngay sau
khi phat ban. Cac hat nc nhim vi rt trong
khng khi co th duy tri kha nng ly bnh
trong vong mt vai gi, thm chi lu hn trong
iu kin m thp.
Thi gian u bnh:
Trung binh 12,5 ngay, co th keo dai 13 tun.
Biu hin lm sang:
St cao, vim kt mac mt, s mui, ho, ban
bt u t mt, lan xung tay v chn. C m
trng nh c trng (m Koplik) trn nim
mc ming.
Bin chng co th bao gm vim tai gia, vim
phi, vim ph quan, nhim trung da nng, tiu
chay nng va vim nao co th dn n t vong.
Bin chng thng gp nng hn tre bi suy
dinh dng, thiu vitamin A va mc cac bnh
man tinh khac. Bin chng vim no s cng
bn cp xut hin t 6-15 nm sau khi b nhim
vi rt si l rt him gp. Mc bnh si trong
thi ky mang thai co th gy ra sy thai hoc
e non.
T l mc si cc nc v ang pht trin
240
Subject: Measles
delivery. CRFs of measles in developed
and developing countries is 0.1 % to 0.3%,
respectively
Diagnostic tests:
Detection by PCR on blood or swabs of
nasopharyngeal mucosa, IFA on swabs or virus
isolation from swabs, blood, or urine. Detection
of measles specific IgM or significant rise in
antibody titer in paired samples.
Prevention:
Vaccination with live attenuated virus vaccine
should be routine for children (minimum age: 9
months), preferably with the combined measles,
mumps, and rubella vaccine (MMR), with a
booster at age 18 months. Infected children
should be kept out of school and away from
other child contacts. Displaced persons (e.g.
refugees) should be vaccinated within a week
of their arrival in a camp. For post-exposure
prophylaxis, vaccination is recommended within
72 hours of exposure, with a booster in 56 weeks
and human immunoglobulin is recommended
for the immuno-compromised and for those in
whom the vaccine is contraindicated.
Epidemiology:
This virus is present world-wide. Measles
deaths world-wide fell by 78% from an
estimated 733,000 in 2000 to 164,000 in 2008,
but some countries are now seeing a resurgence
of infection due to poor uptake of vaccines. All
regions except one have achieved the United
Nations goal of reducing measles mortality by
90%, however, it remains the leading cause of
vaccine-preventable deaths in children. Worldwide WHO figures for 2008 were 282,000
reported cases, with many thousands more
unreported.
In Viet Nam, since the introduction of
cases based surviellance and immunisation
campaigns, confirmed measles cases dropped
Ch : Si
l 0,1% v 0,3%.
Xet nghim chn oan:
Phat hin bng xet nghim PCR cac mu bnh
phm mau, dich nhy hong, xet nghim min
dich huynh quang dch mi hng hoc phn lp
vi rut t dich nhy, mau hoc nc tiu. Phat
hin IgM c hiu si hoc tng hiu gia khang
th ng k trong cp mu huyt thanh kp.
Phong bnh:
Tim vc xin thng xuyn cho tre em vi loai
vc xin sng giam c lc (it nht la 9 thang
tui), khuyn cao nn tim liu kt hp vi
quai bi va rubella (MMR), vi mt liu nhc li
vao 18 thng tui. Tre mc bnh si cn cach
ly khng n trng hoc va tranh tip xuc vi
cac tre khac. Nhng ngi khng co nha ca
(vi du nh ngi ti nan) nn tim vc xin si
trong vong 1 tun sau khi nhp vao trai. i
vi d phong sau tip xuc, vc xin cung c
khuyn cao tim trong vong 72 gi sau tip xuc,
va nhc lai 5-6 tun sau o, khang huyt thanh
ngi cung c khuyn nghi tim cho nhng
ai bi suy giam min dich hoc chng chi inh
vi vc xin.
Dich t hoc:
Vi rut nay co mt trn toan th gii. T vong do
si giam 78%, t khoang 733.000 trng hp
cht nm 2000 xung cn 164.000 nm 2008,
nhng mt s nc xut hin bnh si do thc
hin tim vc xin cha tt. Tt ca cac khu vc,
ngoi tr mt khu vc, at c muc tiu
cua Lin hp quc la giam ty l t vong 90%.
Tuy nhin, bnh si vn la nguyn nhn hang
u gy t vong tre em trn th gii trong cac
bnh co th phong c bng vc xin. Theo
s liu cua T chc Y t th gii, nm 2008 co
282.000 ca bnh c bao cao, tuy nhin cn
hang chuc nghin ca bnh khng c bao cao.
Vit Nam, t khi thc hin chin dich tim
chung va giam sat ca bnh, ca si c chn
oan xac inh a giam xung t 2001 to 2004,
241
Subject: Measles
Ch : Si
steadily from 2001 to 2004, with 3708 confirmed

cases in 2001, 1806 confirmed cases in 2002,
855 confirmed cases in 2003 and 95 confirmed
cases in 2004. However, from October 2008
until January 2010, 7948 confirmed measles
cases were reported from 60 of 63 provinces.
Map sources:
Medicine.
vi 3708 ca nm 2001, 1806 ca nm 2002, 855

ca nm 2003 va 95 ca nm 2004. Tuy nhin,
t thang 10 nm 2008 n thang 1 nm 2010,
7948 ca bnh xac inh c bao cao t 60/63
tinh, thanh ph.
Ngun s liu:
n 2011, Cc Y t d phng

- De Quadros CA (2004) Can measles be eradicated globally? Bull World Health Organ 82 (2):134138.
- Kelly H, et al. (2009) WHO criteria for measles elimination: a critique with reference to criteria
for polio elimination. Euro Surveill 14 (50): 19445.
- Sniadack DH, Mendoza-Aldana J, Huyen DT, Van TT, Cuong NV, Olive JM, Toda K, Hien NT.
Epidemiology of a measles epidemic in Vietnam 2008-2010. J Infect Dis. 2011 Jul;204 Suppl
1:S476-82.
- World Health Organization (2009) State of the Worlds Vaccines and Immunization, 3rd edn.
WHO, UNICEF, World Bank. Geneva.
-Wertheim H, Horby P, Woodall J (2012). Atlas of Infectious Diseases. Wiley-Blackwell, Oxford,
United Kingdom.
242
Subject: Mumps
Ch : Quai b
243
Subject: Mumps
Ch : Quai b
Classification:
ICD-9 072; ICD-10 B26
Phn loi:
ICD-9 072; ICD-10 B26

Infectious parotitis, epidemic parotitis.
Vim tuyn nc bt truyn nhim, vim tuyn
nc bt gy dch,
Agent:
Mumps virus, an enveloped RNA virus of the
family Paramyxoviridae. Twelve genotypes are
currently recognized.
Tc nhn:
Vi rt quai b, l vi rt RNA c v bc, thuc h
Paramyxoviridae. Vi rt c mi hai kiu gen.
Reservoir:
Humans
cha:
Con ngi
Transmission:
Infectious respiratory droplets or saliva.
Ly truyn:
Truyn qua git nh ng h hp hoc nc
bt.
Incubation period:
The incubation period of mumps is usually 16
18 days, but can range from 1225 days.
Clinical findings:
Up to one-third of cases are subclinical.
The illness begins with a prodrome of fever,
malaise, and headache followed by unilateral
or, more commonly, bilateral tender swelling of
the parotid (parotitis) or other salivary glands.
Parotitis can be absent in 30 to 40% of clinical
cases.
The commonest nervous system manifestation
of mumps infection is meningitis, which can
be seen in up to 10% of cases but is usually
self-limiting and does not result in death or
disability. Other clinical complications include
hearing loss, encephalitis, and pancreatitis,
although these are very rare.
Infection and inflammation of the testicles
(orchitis) occurs in up to 30% of adult males
but is rare before puberty. Orchitis can results
in testicular atrophy but rarely causes sterility.
Adult women may rarely suffer inflammation
of the ovaries (oophoritis). Mumps infection
in early pregnancy may be associated with an
increased risk of spontaneous abortion.
Thi gian bnh:

Thi gian bnh ca bnh quai b thng l 1618 ngy, nhng c th dao ng t 12-25 ngy.
Biu hin lm sng:
C ti mt phn ba s trng hp mc c biu
hin lm sng. Bnh bt u vi triu chng
st, mt mi, au u v sau xut hin sng
tuyn nc bt mang tai (vim tuyn mang tai)
mt bn hoc c 2 bn hoc tuyn nc bt
khc. C th khng c vim tuyn mang tai
30-40% cc trng hp lm sng.
Cc triu chng h thn kinh ph bin nht ca
bnh quai b l vim mng no, c ti 10% cc
trng hp mc, nhng thng l nh v khng
gy t vong hoc di chng. Cc bin chng lm
sng khc bao gm mt thnh gic, vim no,
vim ty, tuy nhin rt him.
Nhim trng v vim tinh hon xy ra ti 30%
nam gii, nhng rt him bnh nhn cha dy
th. Vim tinh hon c th dn n teo tinh hon
nhng him khi gy ra v sinh. Ph n trng
thnh c th b vim bung trng. Bnh quai b
trong u thai k c th lm tng nguy c sy
thai.
244
Subject: Mumps
Ch : Quai b
Diagnostic tests:
Virus can be detected in saliva, cerebrospinal
fluid, urine, or seminal fluid by RT-PCR, or
detection of mumps specific IgM or a significant
rise in antibody titer in paired samples can also
be diagnostic.
Xt nghim chn on:

Vi rt c pht hin trong nc bt, dch no
ty, nc tiu, hoc tinh dch bng RT-PCR,
hoc pht hin khng th IgM c hiu khng
vi rt quai b hoc tng hiu gi khng th ng
k trong mu huyt thanh kp.
Prevention:
Mumps is preventable by the use of live
attenuated mumps virus vaccines. Various
vaccine strains are available and may vary in
immunogenicity and the incidence of adverse
effects, such as fever, rash, parotitis, or
meningitis.
Mump is not in the EPI program of Vietnam
Phng nga:
C th phng bnh quai b bng tim chng vc
xin quai b sng gim c lc. C nhiu chng
vc xin khc nhau v c th khc nhau v tnh
sinh min dch, v cc phn ng ph nh st,
pht ban, vim tuyn nc bt, hoc vim mng
no.
Quai b khng nm trong chng trnh tim
chng m rng quc gia Vit Nam
Epidemiology:
The epidemiology of mumps is poorly
characterized in developing countries. The true
number of mumps cases is not known, since it is
often a mild disease and reported cases probably
represent fewer than 10% of all infections.
There is geographic variation in circulating
mumps virus genotypes, and there can be
several genotypes circulating simultaneously in
one area with shifts over time in predominant
genotypes.
Mumps vaccination is recommended at age
1218 months and is included in the standard
immunization program of most developed
countries, usually in a trivalent vaccine with
measles and rubella (MMR vaccine). A booster
dose in later childhood is also recommended for
countries with a good immunization program.
Several developed countries with a wellestablished mumps vaccination program have
experienced significant outbreaks in young
adults, who were too old to be included in the
childhood immunization schedule and had not
been exposed to natural infection due to an
overall reduction in the transmission of mumps
in the population. Other possible reasons for
mumps outbreaks in vaccinated populations
include a waning of vaccine-induced immunity
Dch t hc:
Tnh hnh dch t ca bnh quai b t c m t
ti cc nc ang pht trin. Khng bit c
s mc thc ca bnh quai b, v bnh thng
nh v s bo co ch i din cho khong di
10% ca tt c cc ca bnh. C nhiu kiu gen
vi rt quai b lu hnh theo cc vng a l khc
nhau v c th mt s kiu gen lu hnh ng
thi trong mt vng vi s lun phin kiu gen
theo thi gian.
Tim chng quai b c khuyn co tui
12-18 thng v c a vo trong chng
trnh tim chng ca hu ht cc nc pht
trin. Vc xin quai b thng c s dng
trong vc xin tam lin cng vi si v rubella
(MMR). Tim mt liu nhc li cho tr em tui
thiu nin cng c khuyn co ti cc nc
c chng trnh tim chng tt. Mt s nc
pht trin vi chng trnh tim chng quai b
tt cng tng tri qua v dch i tng
thanh nin. Nhng i tng ny nhiu tui
nn khng c a vo lch tim chng tr em
v cng khng phi nhim vi nhim trng t
nhin do gim s lan truyn quai b trong cng
ng. L do khc dn n bng pht dch quai
b trong qun th tim chng l do min dch
ca vc xin gim dn hoc khng ph hp kiu
245
Subject: Mumps
and genotype mismatch between the vaccine
strain and the wild-type virus in circulation.
Comprehensive mumps vaccination programs
are however associated with a massive overall
decrease in the burden of mumps morbidity.
Map sources:
26 communicable disease yearbook from 2007
Medicine.
Map limitations:
Mump is a common childhood disease that
generally will effect the whole population in
absence of vaccination. The reported incidence
rates are therefore questionable.
Ch : Quai b
gen gia chng vi rt vc xin v chng vi rt
hoang di ang lu hnh. Tuy nhin chng
trnh tim chng quai b ton din lm gim
tng th gnh nng bnh tt.
Ngun bn :
Nim gim thng k 26 bnh truyn nhim t
nm 2007 n 2011, Cc Y t d phng
Hn ch ca bn :
Quai b l mt bnh tr em m thng nh
hng n ton b dn s nu khng c vc
xin. Do t l mc mi c bo co vn cn
nhiu cu hi.

- Galazka AM, et al. (1999) Mumps and mumps vaccine: a global review. Bull World Health Org
77:314.
- Hiivd A, et al. (2008) Mumps. Lancet 371:932944.
- World Health Organization (2012) Information about mumps, available at: http://www.who.int/
immunization/topics/mumps/en/index.html
United Kingdom.
246
Subject: Rabies
Ch : Di
247
Subject: Rabies
Ch : Di
Classification:
ICD-9 071; ICD-10 A82
Phn loi:
ICD-9 071; ICD-10 A82

Lyssa, hydrophobia.

Bnh Lyssa, bnh s nc.
Agent:
Rabies is a zoonotic disease caused by a
neurotropic virus from the Lyssavirus genus.
Tc nhn:
Bnh di l mt bnh ngun gc ng vt gy
ra bi mt loi vi rt hng thn kinh, thuc
Lyssavirus.
Reservoir:
All mammals are susceptible to rabies, but only
a few form important reservoirs for the virus.
These include raccoons, skunks, foxes, bats and
coyotes.
Dogs are the main hosts and transmitters for this
disease, and recently bats have also emerged as
another important vector for infection.
Transmission:
Humans become infected through the skin
following a bite or scratch by an infected
animal. Dogs are the source of infection in an
estimated 55000 human rabies deaths annually
in Asia and Africa. Transmission also occurs
when infectious material like saliva comes
into direct contact with fresh skin wounds or
human mucosal surfaces. Human-to-human
transmission by bite is theoretically possible
but has never been confirmed.
Incubation Period:
Typically 1-3 months, but may vary from less
than 1 week to more than 1 year.
Clinical Findings:
Initial symptoms of rabies include fever and
pain or an unusual or unexplained paraesthesia
at the wound site. The virus then spreads
through the central nervous system causing a
progressive, fatal inflammation of the brain and
spinal cord.
Two forms of this disease have been described:
1. Furious rabies: Affected humans show
cha:
Tt c cc ng vt c v u nhy cm vi vi
rut di, nhng ch mt vi loi l cha vi rut
quan trng. Bao gm gu mo M, chn hi,
co, di v ch si ng c Bc M.
Ch l vt ch chnh v ngun truyn bnh, gn
y di cng tr nn ngun truyn bnh quan
trng.
Ly truyn:
Ngi b nhim vi rut qua da sau khi b ng
vt nhim vi rt cn, co. Ch l ngun truyn
nhim v theo c tnh 55.000 ngi cht v
bnh di hng nm ti chu v chu Phi.
Ly truyn cng c th xy ra khi cc vt cht
nhim virus nh nc bt tip xc trc tip vi
vt thng da mi hoc b mt nim mc ca
ngi. Truyn trc tip t ngi sang ngi do
cn c th xy ra trn l thuyt nhng cha bao
gi c xc nhn.
Thi gian bnh:
Thng thng t 1- 3 thng, nhng c th thay
i t di 1 tun n hn 1 nm.
Biu hin lm sng:
Cc triu chng ban u ca bnh di bao gm
st v au hoc d cm ti v tr vt thng. vi
rt sau ly lan thng qua h thn kinh trung
ng gy ra vim no v ty sng tin trin t
vong.
Bnh c m t di hai th bnh:
1. Bnh di th cung: Ngi bnh c du hiu
248
Subject: Rabies
signs of hyperactivity, excited behaviour,
hydrophobia and sometimes aerophobia. After
a few days, death occurs by cardio-respiratory
arrest.
2. Paralytic rabies: This accounts for about
30% of the total number of human cases. This
form of rabies usually runs a longer course than
the furious form. Muscles gradually become
paralysed, starting at the site of the bite or
scratch followed by a slowly developing coma
and then death.
Diagnostic Tests:
Detecting virus or viral RNA in saliva, CSF,
or skin biopsy of the hair follicles at the nape
of the neck. The most widely used test is
the fluorescent antibody test (FAT), which
is considered the gold standard for rabies
diagnosis. Post mortem, the standard diagnostic
technique is to detect rabies virus antigen in
brain tissue by fluorescent antibody test.
Prevention:
Rabies is a vaccine-preventable disease.
Preventing rabies in people can occur by
eliminating rabies in dogs, which can happen
through vaccination. This is the most costeffective strategy for preventing human
infection. Vaccination programmes in animals
(mostly dogs) has already reduced the number
of human rabies cases seen in several countries
Epidemiology:
Rabies occurs in more than 150 countries and
territories, and worldwide, more than 55000
people die from this disease every year. Dogs
appear to be the source of 99% of human rabies
deaths. 15 million people worldwide receive
a post-exposure preventative regimen every
year to avert the disease, which is estimated to
prevent 327000 rabies deaths annually.
In Vietnam, from 2001 to 2003, suggest around
30 people were confirmed to have died of this
disease each year. However, more recently
Ch : Di
kch thch vn ng thi qu, hnh vi kch ng,
s nc v i khi c s gi. Sau mt vi ngy,
t vong xy ra do ngng h hp, ngng tim.
2. Bnh di th lit: Chim khong 30% tng
s ca bnh trn ngi. Th ny ca bnh di
thng ko di hn th cung. C dn b lit,
bt u t v tr vt cn hoc co, tip theo l
hn m tin trin t t ri dn n t vong.
Xt nghim chn on:
Pht hin virus hoc RNA ca vi rut trong nc
bt, dch no ty hoc sinh thit da cc nang tc
gy. Th nghim c s dng rng ri nht
l phng php min dch hunh quang (FAT),
c coi l tiu chun vng chn on bnh
di. Vi khm nghim t thi, k thut chn on
tiu chun pht hin khng th di trong m no
l phng php min dch hunh quang.
D phng:
Bnh di l bnh c th phng nga bng vc
xin. ngn bnh di ngi c th thc hin
bng loi tr bnh di ch thng qua tim
phng cho ch. y l chin lc c hiu qu
kinh t cao nht nga ly di sang ngi. Cc
chng trnh tim phng di cho ng vt (ch
yu l ch) gp phn gim s lng cc
trng hp bnh di ngi ti mt s nc.
Dch t hc:
Bnh di xy ra ti hn 150 quc gia v vng
lnh th, trn ton th gii, hn 55.000 ngi
cht v cn bnh ny mi nm. Ch l ngun
truyn bnh ca 99% cc ca t vong bnh di
ngi. 15 triu ngi trn ton th gii c
tim phng vc xin, iu tr khng huyt thanh
theo phc sau phi nhim mi nm ngn
chn cn bnh ny, trong c tnh ngn
chn 327.000 ca t vong do di mi nm.
Ti Vit Nam, s liu t 2001 n 2003, cho
thy khong 30 ngi c xc nhn t
vong v cn bnh ny mi nm. Tuy nhin, gn
y hn, nm 2007, s ngi cht c xc
nhn tng ln n 131 ca, tip theo 91 ca
249
Subject: Rabies
Ch : Di
in 2007 the number of confirmed fatalities

increased to 131 followed by 91 in 2008 and
64 in 2009. For a variety of reasons including
diagnostic issues, these figures probably
represent an under-estimation of the numbers of
humans affected in this region.
The rate of dog vaccination in the country
varies between the different provinces, but was
documented to be about 64% in 2011.However,
this may be an overestimate as many dogs are
not registered.
Map sources:
Communicable disease year book from 2007
Medicine.
nm 2008 v 64 ca trong nm 2009. Tuy vy,

do nhiu nguyn nhn, trong c hn ch v
chn on, con s ny c th thp hn s lng
thc t s ngi b di.
T l tim phng cho ch trong nc dao ng
theo cc tnh khc nhau, nhng c ghi nhn
vo khong 64% trong nm 2011. Tuy nhin t
l ny c th khng chnh xc do rt nhiu ch
khng c ch khai bo nn khng th qun l
c ng s lng
Ngun bn :
Nin gim bnh truyn nhim giai on 2007

- Department of health Green book Chapter 27 Rabies http://immunisation.dh.gov.uk/gbindividual-current-chapters/
- World Health Organisation (2011) Rabies: A neglected zoonotic disease. http://www.who.int/
rabies/en/
- Bourhy et. al . (2010) Rabies, Still Neglected after 125 Years of Vaccination. Plos neglected
tropical diseases. 2010; 4 (11)
United Kingdom.
250
Subject: Rubella
Ch : Rubella
251
Subject: Rubella
Ch : Rubella
Classification:
ICD-9 056; ICD-10 B06.0
Phn loi:
ICD-9 056; ICD-10 B06.0
Synonyms:
German measles, Roseola, the third disease
ng ngha:
Bnh si c, rubeon, si ba ngy
Agent:
Rubella virus, a single-stranded RNA positivesense rubivirus of the family Togaviridae.
Tc nhn:
Vi rut Rubella, l mt ribuvirus thuc h
Togaviridae, si n RNA dng tnh.
Reservoir:
Humans.
cha:
Con ngi.
Transmission:
Airborne droplets from respiratory secretions of
infected persons. The virus may be transmitted
to the fetus if the mother is infected during
pregnancy.
Ly truyn:
Tip xc vi git dch tit ng h hp ca
ngi b nhim. C th ly truyn t m sang
thai nhi nu m b nhim bnh trong thi k
mang thai.
Incubation period:
16-18 days (range 12-24 days). The most
infectious period is usually 15 days after the
appearance of the rash.
Thi gian bnh:

16- 18 ngy (dao ng khong 12- 24 ngy).
Giai on ly nhim cao nht thng trong
vng 1- 5 ngy sau khi pht ban.
Clinical findings:
Symptoms are often mild, and up to 50%
of infections may be subclinical. Clinically,
infection is generally a mild and short lived
illness with fever, coryza, conjunctivitis,
lymphadenopathy, and a fine maculopapular
rash beginning on the face later spreading to
the trunks and limbs. Post-auricular, occipital
or posterior cervical lymphadenopathy may
precede the rash by 5-10 days.
Around half of rubella infections are subclinical
and constitutional symptoms may be minimal
in children. Arthropathy may occur, especially
in young women. Other complications can
include encephalitis, which is rare but tends to
be more severe in adults than children. The most
important clinical consequence of rubella is
congenital rubella syndrome (CRS), which may
result from intra-uterine infection in the first 16
weeks of pregnancy. As many as 85% of infants
Biu hin lm sng:

Cc triu chng thng nh v trn 50% cc
ca nhim vi rt khng biu hin lm sng. Cc
triu chng lm sng, nhim trng thng nh
v ngn gm st, s mi, vim kt mc, ni hch
v ban dt sn xut hin tun t, bt u t mt,
thn ri lan sang cc chi. C th ni hch vng
sau tai, chm, c trc pht ban 5- 10 ngy.
Khong 50% ca nhim rubella khng c triu
chng lm sng v triu chng ton thn c th
rt hn ch tr em. au khp c th c, c
bit ph n tr. Cc bin chng khc c th
c, bao gm vim no, him v c xu hng
nng ngi ln hn tr em. Di chng lm
sng nghim trng nht ca nhim rubella l
hi chng rubella bm sinh (CRS), c th l do
nhim vi rt trong t cung trong 16 tun u ca
thai k. n 85% tr s sinh b nhim virus qu
u ca thai k c pht hin c b nh hng
khi khm sau sinh. CRS l mt bnh nghim
252
Subject: Rubella
infected in the first trimester of pregnancy
will be found to be affected if followed after
birth. CRS is a severe disease characterized by
deafness, cataract, cardiac abnormalities, and a
range of neurological impairments.
Diagnostic tests:
Rubella specific IgM or significant rise in
antibody titer in paired samples; PCR or virus
isolation from throat swab, or other specimens
in CRS.
Prevention:
Live attenuated virus vaccine, usually in
combination with measles and mumps virus
vaccine, at 12-18 months with a pre-school booster.
Rubella is not in EPI in Vietnam.
Epidemiology:
This infection has a worldwide distribution.
In the absence of vaccination the prevalence
of rubella infection by the age of 13 years
ranges from 20-95%, but is most often over
50%. Reported data on clinical rubella is an
underestimate as it is a mild disease with
a clinical picture similar to several other
infections. CRS is also grossly under-reported.
For example, it is estimated that over 45,000
CRS cases occur annually in South East Asia
yet only an average of 13 CRS cases per year
were reported to WHO between 2000 and 2009.
Rubella is a public health concern because of
CRS and in 1996 it was estimated that 110,000
CRS cases occurred annually in developing
countries. A poor rubella immunisation program
may actually increase the incidence of CRS if
the burden of illness is shifted to young adults,
where pregnancy is common. Therefore rubella
immunization programs have to achieve and
maintain high immunization rates (>80%) or be
supplemented by the immunization of women
of childbearing age. In 2009 two-thirds of
countries included a rubella containing vaccine
Ch : Rubella
trng c trng bi ic, c thy tinh th, d
tt tim v mt lot cc khim khuyt thn kinh.
Xt nghim chn on:
IgM rubella c hiu v gia tng ng k hiu
gi khng th trong cc mu kp; PCR hoc
phn lp virus t mu dch ngoy hng hoc
cc mu khc trong CRS.
Phng nga:
Vc xin vi rt sng gim c lc, thng l vc
xin kt hp phng bnh si v quai b, tim vo
lc tr 12-18 thng tui v mt mi b sung
trc khi tr n tui i hc.
Rubella khng nm trong trng trnh tim
chng m rng quc gia ti Vit Nam
Dch t hc:
y l bnh kh ph bin trn ton th gii.
Nu khng c tim phng, t l nhim
rubella tui 13 khong 20-95%, thng thng
trn 50%. S liu bo co rubella lm sng c
th thp hn so vi thc t v bnh nh vi hnh
nh lm sng tng t nh mt s bnh nhim
trng khc. CRS cng b bo co thiu. V d,
theo c tnh, c hn 45.000 trng hp CRS
hng nm khu vc ng Nam nhng ch
c trung bnh 13 trng hp CRS c bo co
cho T chc Y t th gii t nm 2000- 2009.
Rubella l mt vn sc khe cng ng do
CRS v theo s liu nm 1996, c tnh c
khong 110.000 trng hp CRS xy ra hng
nm cc nc ang pht trin. Chng trnh
chng phng rubella km thc s c th lm
tng t l mc CRS nu gnh nng bnh chuyn
sang thanh nin, nhm c t l mang thai cao.
Do chng trnh tim chng rubella cn t
v duy tr t l tim cao (> 80%) hoc b sung
tim cho ph n tui sinh . Trong nm
2009 hai phn ba ca cc nc a vaccine
c phng rubella vo lch tim chng trn ton
quc nhng ti nhiu quc gia ang pht trin
vc xin rubella vn cha c a vo do thiu
253
Subject: Rubella
in their national immunisation schedule yet
in many developing countries rubella vaccine
has not been included because of lack of
information on the burden of CRS and costs.
In Vietnam a large increase in the number of
cases of Rubella infection was seen in 2011.
They were admitted to the National Hospital
of Tropical Diseases in Hanoi. Over 848 cases
were admitted and managed over a 2 month
period. According to the WHO, of the 4186
samples tested for rubella IgM in Vietnam, in
2011, 2497 were found to be positive.
Map source:
General Department of Preventive Medicine.
Ch : Rubella
thng tin v gnh nng bnh tt ca CRS v do
thiu chi ph.
Vit Nam, c s gia tng ln v s lng
cc trng hp nhim rubella nm 2011. Bnh
nhn c nhp vin ti bnh vin Bnh nhit
i Trung ng ti H Ni. Hn 848 trng
hp nhp vin v iu tr trong vng 2 thng.
Theo T chc Y t th gii, pht hin 2.497
mu rubella IgM dng tnh trong hn 4.186
mu xt nghim ti Vit Nam nm 2011.
Ngun bn :
Nim gim thng k bnh truyn nhim nm
2011, Cc Y t d phng.

- Brown DW, et al. (2004) Rubella. Lancet 363 (9415): 1127-1137.
- Centers for Disease Control and Prevention (CDC). (2010) Progress Toward Control of Rubella
and Prevention of Congenital Rubella Syndrome - Worldwide, 2009. MMWR 59 (40): 1307-1310.
- Cutts FT, et al. (1999) Modelling the incidence of congenital rubella syndrome in developing
countries. Int J Epidemiol; 28 (6): 1176-1184.
- World Health Organization. (2009) WHO, UNICEF, World Bank. State of the worlds vaccines
and immunization, 3rd ed. Geneva.
- WHO Measles-Rubella Bulletin (2012). Accessed Nov 2012. http://www.wpro.who.int/
immunization/documents/MRBulletin_Vol6Issue9.pdf
United Kingdom.
254
Subject: Severe Acute Respiratory Syndrome (SARS)
255
Ch : Hi chng h hp cp tnh nng
Classification:
ICD-10 U04
Phn loi:
ICD-10 U04
Synonyms:
SARS
ng ngha:
Bnh SARS
Agent:
SARS coronavirus (SARS-CoV) is a positivesense, single-stranded, enveloped RNA virus of
the family Coronaviridae. The viral membrane
contains a transmembrane (M) glycoprotein,
spike (S) glycoprotein, and envelope (E)
protein. Coronaviruses derive their name from
the crown-like (corona-like) morphology on
electron microscopy.
Tc nhn:
Coronavirus SARS (SARS-CoV) l vi rut c
RNA chui xon n, dng tnh c v bao
bc thuc h Coronaviridae. Mng vi rut c
cha (M) glycoprotein xuyn thu mng, (S)
glycoprotein gai, v (E) protein v bc. Cc
coronavirus c tn h t hnh dng ging vng
min khi nhn trn knh hin vi in t.
Reservoir:
Although SARS-like coronaviruses with very
high genetic homology to SARS-CoV have
been identified in masked palm civets, civets
are thought to be a non-reservoir, spill-over
species. Horseshoe bats are thought to be the
natural reservoir of the progenitor of the SARS
virus.
Transmission:
Direct person-to-person transmission, usually
following close contact with a symptomatic case
or the respiratory secretions or body fluids of a
symptomatic case. Health care facilities were
key in amplifying the transmission of SARS
in 2003. Respiratory droplets or contaminated
surfaces are thought to be the principle routes
of transmission, although one outbreak in a
residential block in Hong Kong was attributed
to aerosol spread.
Incubation Period:
4-5 days.
Clinical Findings:
SARS presents initially with fever, headache,
myalgia and a non-productive cough that
cha:
Mc d nhng corona vi rut ging SARS c
tng ng di truyn rt cao vi SARS-CoV
c pht hin loi cy hng, cy hng
khng c coi l cha hay loi lan truyn.
Loi di mng nga c cho l cha t
nhin ca vi rut SARS.
Ly truyn:
Ly truyn trc tip t ngi sang ngi, thng
sau tip xc gn vi mt ca bnh c triu chng
hoc tip xc dch tit ng h hp hoc cc
cht dch c th ca ca bnh c triu chng. Cc
c s y t chnh l ni khuch i s lan truyn
SARS nm 2003. Cc git dch tit ng h
hp hoc cc b mt b nhim c cho l
ng ly truyn ch yu, mc d 1 v dch
khu chung c ti Hng Kng c xc nh l
ly lan theo ng khng kh.
Thi gian bnh:
4- 5 ngy.
Biu hin lm sng:
Triu chng ban u ca SARS vi st, au
u, au c v ho khan c th tin trin thnh
kh th vi du hiu thm nhim phi trn X
quang ngc. Triu chng tiu ha cng c th
256
may progress to dyspnoea with pulmonary

infiltrations on chest x-ray. Gastrointestinal
symptoms may also be present in early SARS
illness. Case fatality is around 10%, and is
higher in older adults than children and young
adults.
Diagnostic Tests:
Reverse transcription polymerase chain
reaction (RT-PCR), positive for SARS-CoV,
virus isolation, or seroconversion by IFA or
ELISA
Prevention:
The control of wildlife farms and markets to
reduce the risk of transmission from bats to
humans through an intermediate species. Rapid
case detection and isolation, contact tracing
and quarantine, and stringent hospital infection
control effectively controlled the SARS
outbreak.
Epidemiology:
SARS is thought to have emerged in Guangdong
Province, China in November 2002 and within
six months cases were detected in 26 countries,
with local transmission occurring in six. In total
over 8000 cases and almost 800 deaths were
recorded and, remarkably, much of the global
transmission of SARS can be traced to a single
individual who disseminated infection at a hotel
in Hong Kong. Super spreading events (where
one person infects an unusually large number
of people) such as occurred at the Hong Kong
Hotel appear to be an important feature of SARS
epidemiology. The precise circumstances and
timing of the inter-species transfer of SARSCoV remains unknown. Many of the early cases
in Guangdong had epidemiological links to the
wild animal trade but later the transmission of
SARS was exclusively person to person with a
large nosocomial element. Laboratory-accident
associated cases in late 2003 and April 2004,
xut hin trong giai on u bnh SARS. T

vong chim khong 10%, v cao ngi ln
tui hn l tr em v thanh nin.
Xt nghim chn on:
RT-PCR dng tnh vi SARS-CoV, phn lp
vi rut, hoc c chuyn i huyt thanh bng
phng php IFA hoc ELISA .
Phng nga:
Vic kim sot cc trang tri nui ng vt
hoang d v ch bun bn ng vt gim
nguy c ly truyn t di sang ngi thng qua
loi trung gian. Nhanh chng pht hin v cch
ly ca bnh, pht hin ngi tip xc, kim dch,
v kim sot nghim ngt nhim khun bnh
vin gp phn kim sot hiu qu dch SARS.
Dch t hc:
SARS c cho l xut hin u tin tnh
Qung ng, Trung Quc vo thng 11 nm
2002 v trong vng su thng cc ca bnh c
pht hin 26 quc gia, trong 6 quc gia
c lan truyn ti ch. Trong tng s hn
8000 trng hp mc v gn 800 trng hp t
vong c ghi nhn, phn ln cc trng hp
mc SARS c th truy ngun t mt c nhn l
ngi bnh pht tn nhim vi rut ti mt khch
sn Hng Kng. S kin siu ly lan (trong
mt ngi truyn bnh cho rt nhiu ngi
vi s lng cc ln) nh xy ra ti khch
sn Hong Kong l mt c trng dch t hc
bnh SARS. Cha c hiu bit v nhng iu
kin v thi gian c th ca ly truyn gia cc
loi ca SARS-CoV. Nhiu ngi trong s cc
trng hp mc bnh u tin Qung ng c
mi lin quan dch t hc vi bun bn ng vt
hoang d nhng sau s ly truyn SARS l
t ngi sang ngi vi mt yu t nhim trng
bnh vin qui m ln. Cc ca mc do nhim tai
nn ngh nghip trong phng th nghim vo
cui nm 2003 v thng 4 nm 2004, v mt
chm ca bnh lin quan n vic bun bn ng
257
and a cluster linked to the wild animal trade in

January 2004, highlight the potential for the reemergence of SARS.
A total of 62 SARS case-patients were detected
in Vietnam with the first patient admitted on
February 26, 2003, and the last case-patient
admitted on April 8, 2003. The outbreak started
when a traveler arriving from Hong Kong sought
medical care at the French hospital in Hanoi,
initiating a serious and substantial transmission
event within the hospital, and subsequent limited
spread within the community. The initial casepatients were admitted to the French hospital,
and the later case-patients were admitted to the
nearby National Hospital for Tropical Diseases.
61/62 (98.4%) of the patients were seropositive
for SARS-CoV.
Map sources:
- National Institute of Hygiene and Epidemiology.
-Wertheim H, Horby P, Woodall J (2012).
Atlas of Infectious Diseases. WileyBlackwell,
Oxford,
United
Kingdom.
vt hoang d nm 2004, cnh bo v nguy c

vic ti xut hin ca bnh SARS.
Tng cng c 62 ca bnh SARS pht hin ti
Vit Nam vi bnh nhn u tin vo vin ngy
26 thng 2 nm 2003, v trng hp cui cng
vo ngy 8 thng 4 nm 2003. V dch bt u
khi mt khch du lch t Hng Kng n khm
cha bnh ti bnh vin Vit Php, H Ni,
khi u s lan truyn dch nghim trng vi
quy m ln ngay trong bnh vin v sau ly
lan ra cng ng vi quy m hn ch. Cc ca
bnh u tin iu tr ngay ti bnh vin Vit
Php, mt s ca sau c iu tr ti Bnh vin
Bnh nhit i Trung ng bn cnh. 61/62
(98,4%) bnh nhn c xt nghim huyt thanh
dng tnh vi SARS-CoV.
Ngun bn :
- Vin V sinh Dch t Trung ng
-Wertheim H, Horby P, Woodall J (2012).
Atlas of Infectious Diseases. Wiley-Blackwell,
Oxford, United Kingdom.

- Anderson RM, et al. (2004) Epidemiology, transmission dynamics and control of SARS: the 20022003 epidemic. Philos Trans R Soc Lond B Biol Sci;359(1447):1091-105.
- Poon LL, et al. (2004) The aetiology, origins, and diagnosis of severe acute respiratory syndrome.
Lancet Infect Dis;4(11):663-71.
- Wanh LG, et al. (2006) Review of bats and SARS. Emerg Infect Dis;12(12):1834-40.
- Reynolds MG, et al. (2006) Factors associated with nosocomial SARS-CoV transmission among
healthcare workers in Hanoi, Vietnam, 2003. BMC Public Health; 6:207.
- Tuan PA, et al. (2007) SARS transmission in Vietnam outside of the health-care setting. Epidemiol
Infect;135(3):392-401.
- Vu HT, et al. (2004) Clinical description of a completed outbreak of SARS in Vietnam, FebruaryMay 2003. Emerg Infect Dis;10(2):334-8.
United Kingdom.
258
Subject: Viral hepatitis
Ch : Vim gan do vi rt
259
Classification:
ICD-9070; ICD-10 B15-19.
Synonyms:
Epidemic hepatitis, infectious
infectious jaundice, acute hepatitis.
Phn loi:
ICD-9070; ICD-10 B15-19.
hepatitis,
Agent:
Viral (acute) hepatitis can be caused by
hepatitis A virus (HAV), hepatitis B virus
(HBV), hepatitis C virus (HCV) and hepatitis
E virus (HEV). HAV is a picorna virus. HBV
is a DNA virus belonging to the family of
Hepadnaviridae with eight genotypes (A
to H). HCV is an enveloped RNA virus,
hepacavirus, and has at least 6 genotypes. HEV
is a non-enveloped single stranded RNA virus,
genus Hepevirus, the single member in the
Hepeviridae family. The virus can be clasified
into four genotypes (genotype HEV-1 to HEV4), and>24 subgenotypes (1a-1e, 2a-2b,3a-3j
and 4a-4g).
ng ngha:
Dch vim gan, vim gan, vng da truyn nhim,
vim gan cp tnh.
Tc nhn:
Vim gan vi rut (cp tnh) gy ra bi vi rut vim
gan A (HAV), vi rut vim gan B (HBV), vi rut
vim gan C (HCV) v vi rut vim gan E (HEV).
HAV l mt picorna vi rut c RNA. HBV l mt
loi vi rut c DNA thuc h Hepadnaviridae
vi tm kiu gen (A n H). HCV l vi rut c
RNA c v bc, hepacavirus, v c t nht 6
kiu gen. HEV l mt vi rut RNA chui xon
n, khng v bc, thuc chi Hepevirus, thnh
vin duy nht trong h Hepeviridae. Vi rut ny
c th c phn thnh bn kiu gen (kiu gen
HEV-1 n HEV-4), v trn 24 kiu gen ph
(1a-1e, 2a-2b, 3a-3J v 4a-4g).
Reservoir:
Humans are the main reservoir; for HAV
also non-human primates can be infected.
Numerous mammals have serologic evidence
of HEV disease, including but not limited to:
pigs, cattle, sheep, goats, horses, macaques,
cats, dogs, rabbits, mongoose, deer, wild boar,
rats and mice. HEV in pigs is asymptomatic,
but there is transient viremia and excretion of
virus into the environment.
cha:
Con ngi l cha chnh, vi vim gan vi
rut A th c ng vt linh trng khng phi
ngi cng c th b nhim bnh. Nhiu ng
vt c v c bng chng huyt thanh hc ca
bnh vim gan vi rut E, bao gm nhng khng
ch c : ln, tru b, cu, d, nga, kh, mo,
ch, th, cy, hu nai, ln rng, chut cng
v chut nht. Vim gan E ln khng c triu
chng, nhng c giai on vi rut huyt thong
qua v c s bi tit vi rut ra mi trng
Transmission:
HAV: Person-to-person transmission via fecaloral route (hands, food, water, sexual contact).
HBV: Percutaneous or permucosal exposure to
blood or body fluids (e.g. semen, vaginal fluid,
saliva) of an infected individual. Person-toperson HBV transmission via sexual contact,
needle sharing in IVDUs, sharing toothbrushes
or razors, and blood transfusion. Mother to child
HBV transmission occurs transplacentally or
during birth (not via breastfeeding). For HCV
Ly truyn:
Vim gan vi rut A ly t ngi sang ngi
khc qua ng phn- ming (tay, thc phm,
nc, quan h tnh dc). Vim gan vi rut B:
Phi nhim qua da nim mc vi mu v dch
c th (v d: tinh dch, dch m o, nc bt)
ca ngi b nhim vi rut. Vim gan vi rut B
truyn t ngi sang ngi trong quan h tnh
dc, dng chung kim tim trong nhm ngi
tim chch ma ty, dng chung bn chi nh
rng hoc dao co, v truyn mu. Vim gan
260
Subject: Viral Hepatitis

transmission occurs parentally (blood to blood)
via transfusion, needles, or transplacentally
(when mother is co-infected with HIV).
Incubation period:
The time to onset of acute hepatitis is typically
2 to 24 weeks; unlikely after 52 weeks or before
4 days.
Clinical findings:
Typically an insidious onset of fatigue and
nausea, followed by anorexia, abdominal
discomfort (liver pain) and then dark urine and
jaundice. There may be low grade fever and
transient, indefinite rash during the incubation
period. Itching is typically absent early in the
course, but may arise if jaundice is prolonged.
Illness typically lasts 2 to 4 weeks and ultimately
resolves, but severe instances can result in acute
liver failure and death. HBV disease has an
acute and chronic form. Chronic disease mainly
develops in children who acquire HBV at a
young age: 90% of infants who are infected in
their first year develop chronic infection. Only
10% of adults who acquire infection develop
chronic disease, the majority is able to clear the
virus within 6 months. In HCV, the majority is
asymptomatic, but approximately 80% develop
chronic HCV disease. Chronic HBV and HCV
disease can lead to cirrhosis or hepatocellular
carcinoma and eventually death.
Diagnostic tests:
Serology; PCR to detect viral DNA/RNA in
blood or stool. For HBV and HCV quantitative
PCR to monitor treatment.
virut B truyn t m sang con xy ra trong thi
k mang thai hoc khi chuyn d (khng qua
nui con bng sa m). Vim gan vi rut C ly
truyn trc tip (t mu sang mu) qua truyn
mu, tim chch, qua rau thai (khi m mang thai
ng nhim HIV).
Thi gian bnh:
Thi gian khi pht bnh vim gan cp tnh
thng l 2-24 tun, rt him sau 52 tun v
trc 4 ngy.
Biu hin lm sng:
Thng khi pht vi mt mi m ko di v
bun nn, tip theo l chn n, au bng (vng
gan) v sau nc tiu sm mu v vng
da. C th c st nh v thong qua, pht ban
khng c b trong thi gian bnh. Thng
khng c nga trong giai on u ca bnh,
nhng c th xy ra nu vng da ko di. m v
mt mi thng ko di 2- 4 tun v s hi phc
dn, nhng cc trng hp nng c th dn n
suy gan cp v t vong. Bnh vim gan vi rut
B c th cp tnh v th mn tnh. Th mn tnh
thng xy ra tr em mc vim gan vi rut B
trong nhng thng u i: 90% tr b nhim
vim gan B trong nm u i tr thnh nhim
vi rut mn tnh. Ch 10% ngi ln nhim vi
rut tin trin thnh bnh mn tnh, a s c th
loi tr ht vi rut trong vng 6 thng. i vi
vim gan vi rut C khng c triu chng, nhng
khong 80% tin trin thnh vim gan C mn
tnh. Bnh vim gan vi rut B v vim gan vi rut
C mn tnh c th dn n x gan hoc ung th
t bo gan v cui cng dn ti t vong.
Prevention:
An effective vaccine is available for HAV, HBV
and HEV; vaccination should be offered to high
risk groups; hygiene; clean water; sanitation.
Xt nghim chn on:

Huyt thanh hc; PCR pht hin DNA/RNA
ca vi rut trong mu hoc phn. i vi vim
gan vi rut B v vim gan vi rut C, dng PCR
nh lng theo di iu tr.
Epidemiology:
High HAV endemic areas are generally in poor
regions with poor sanitation and lack of access
Phng nga:
C vc xin phng bnh vim gan vi rut A, B v
261

to clean water. Improving living conditions lead
to intermediate endemicity,which causes high
disease rates because now more infections occur
in older people (as disease averted in children),
who are symptomatic. HAV epidemiologyin
high endemic areas is shifting to intermediate
endemicity, which results in an increase in
disease burden. Large variations exist within
countries in HAV incidence. In (very) low
endemic areas, children will not acquire the
disease and the adult population will remain
susceptible, leading to localized outbreaks. In
developed countries outbreaks are often caused
by contaminated food products, like shellfish
(can concentrate virus) and other food products
that are contaminated by an infected food
handler.
Hepatitis B is a very common disease
worldwide, despite the existence of an effective
vaccine. The WHO estimates that globally 2
billion individuals have been infected, of which
about 360 million have chronic disease. Yearly,
it is estimated that there are 500,000 to 700,000
HBV associated deaths worldwide. In high
endemic regions like Southeast Asia, Africa and
the Amazon, most individuals become infected
during childhood (mother-to-child or childto-child). In developed regions like western
Europe and North America the prevalence is
low and important routes of transmission are
different, consisting mostly of unsafe sexual
practices, IVDU, and occupational transmission
in healthcare workers. Chronic HBV associated
cirrhosis is more common in developed nations
than in Southeast Asia, but the incidence of
hepatocellular carcinoma is lower. It is not yet
fully clear whether this is due to differences
HBV genotype, age of infection or gender.
HCV infection has a worldwide prevalence
of 2%, with highest prevalences in Africa and
Asia. In developing countries the higher rates
are likely due to poor infection control practices
in healthcare system (improper needle use).
Also local practices in the community like
acupuncture or drug injections may be a cause.
E rt hiu qu. Cn tim vc xin cho cc nhm
nguy c cao, thc hin v sinh c nhn, nc
sch v v sinh mi trng.
Dch t hc:
Vng lu hnh bnh vim gan vi rt A cao
thng l vng ngho vi iu kin v sinh
km v thiu nc sch. Khi iu kin sng
ci thin, s dn n lu hnh dch mc trung
gian, gy ty l mc bnh cao do mc la tui
ln hn (bnh tr em c ngn chn), l
nhm c biu hin triu chng lm sng. Dch
t hc vim gan vi rt A trong vng lu hnh
cao c chuyn sang lu hnh mc trung gian
dn n s gia tng gnh nng bnh tt. C s
khc bit ln v t l mc mi HAV trong phm
vi mi nc. Trong vng lu hnh thp, tr em
khng mc bnh v dn s trng thnh vn
cn tnh cm nhim, dn n bng pht dch
khu tr. cc nc pht trin dch thng gy
ra bi sn phm thc phm b nhim, nh cc
loi s (c th mang vi rt) v cc sn phm
thc phm khc b nhim vi rt bi ngi ch
bin thc phm b nhim bnh.
Vim gan vi rut B l bnh rt ph bin trn ton
th gii, d c mt loi vc xin hiu qu. T
chc Y t Th gii c tnh rng trn ton cu
2 t ngi tng b nhim bnh, trong c
khong 360 triu ngi ang nhim mn tnh.
Hng nm, ngi ta c tnh rng c 500.000
n 700.000 trng hp t vong lin quan n
vim gan vi rt B trn ton th gii. Trong vng
lu hnh cao nh ng Nam , Chu Phi v
Amazon, hu ht cc c th b nhim bnh trong
thi k th u (ly truyn t m sang con hoc
t tr ny sang tr khc). cc khu vc pht
trin nh Ty u v Bc M, t l hin mc
thp v ng ly truyn cng khc, bao gm
ch yu l tnh dc khng an ton, trong nhm
tim chch ma ty v ti nn ngh nghip
nhn vin y t. Vim gan vi rt B mn tnh lin
quan n x gan ph bin cc nc pht trin
hn cc nc khu vc ng Nam , nhng t
l mc ung th biu m t bo gan thp hn.
Cha bit c r rng c phi do s khc bit
262

Furthermore sharing of needles among IVDU
transmits HCV in this group.
HEV is more prevalent in areas with hot
climates and poor sanitation. Outbreaks are
more common during heavy rainfall and
flooding, which leads to fecal contamination of
the drinking water. Food-borne outbreaks also
occur, especially with contaminated shellfish.
HEV genotypes have their own geographic
distribution. HEV-1 is common in high endemic
areas of Asia and Africa.
One study looked at causes of acute hepatitis
in NhaTrang in 2002. HBV was more frequent
(73%) than HCV (9%). HBV was more prevalent
among young people whereas anti-HCV was
only detected in adults. No case of acute HAV
infection was diagnosed in NhaTrang. AntiHEV IgG were infrequent (2% in NhaTrang).
Map sources:
Medicine
kiu gen vi rt vim gan B, tui nhim vi rut
v gii tnh.
Bnh vim gan vi rt C c t l hin mc trn
ton th gii l 2%, vi t l cao nht chu
Phi v chu . cc nc ang pht trin, t
l cao hn c th do thc hnh kim sot nhim
trng bnh vin km (s dng bm kim tim
khng ng quy cch). V thc hnh y t trong
cng ng ti a phng nh chm cu hay
tim truyn khng an ton c th l mt nguyn
nhn. Hn na dng chung kim tim trong
nhm tim chch ma ty cng l nguyn nhn
ly truyn vim gan vi rt C trong nhm ny.
Vim gan vi rut E ph bin hn cc vng
c kh hu nng v v sinh km. Dch ph
bin hn khi c ma nhiu v l lt, dn n
nhim phn vo nc ung. Dch ly truyn
qua thc phm cng xy ra, c bit l vi s
c b nhim. Cc vi rut vim gan E kiu gen
khc nhau c phn b a l ring. HEV-1 ph
bin cc vng lu hnh cao ca Chu v
Chu Phi.
Mt nghin cu v tc nhn vim gan cp trn
bnh nhn c ALT v AST tng cao ti Nha
Trang nm 2002. Vim gan B c t l cao hn
(73%) so vi vim gan vi rt C (9%). Vim gan
vi rt B ph bin hn nhng ngi tr tui
trong khi khng th anti-HCV ch c pht
hin ngi trng thnh. Khng c trng
hp nhim vim gan vi rt A cp tnh no c
chn on Nha Trang. Khng th anti-HEV
IgG him (2%) Nha Trang).
Ngun bn :

- Beth BP. (2002) Global epidemiology of hepatitis A: implications for control. Proceedings of
10th International Symposium on Viral Hepatitis and Liver Disease.
- Liaw YF, et al. (2010) The natural history of chronic HBV infection and geographical differences.
AntivirTher15 (S3):25-33.
- World Health Organization. (2008) Hepatitis B virus. Factsheet nr 204.
- Buchy P, et al. (2004) Prevalence of hepatitis A, B, C and E virus markers among patients with
elevated levels of Alanine aminotransferase and Aspartate aminotransferase in Phnom Penh
(Cambodia) and NhaTrang (Central Vietnam). Bull SocPatholExot; 97(3):165-71.
United Kingdom.
263

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12 thng; nhc sau 1-2 tun, nhc li 1 nm sau

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COMMUNICABLE DISEASE SURVEILLANCE SYSTEM IN VIETNAM

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