Project News

Symposium was held at NIHE on 28 October, 2015 for review and perspective of the project activities so far with a number of stakeholders. A total of 97 participants attended it from 4 regional institutes of NIHE, PIHCMC, PINT and TIHE, 10 pilot PCPMs, WHO Vietnam Office, Ministry of Health Vietnam, short-term experts including Dr. Kurane, Director General of NIID and technical short experts of Suga Kogyo Co., Ltd. for facility maintenance from Japan, and officers from Ministry of Health, Cambodia and Laos. The symposium was organized to be divide into 4 parts; reports from Ministry of Health Vietnam and WHO Vietnam country Office, reports from 4 regional institutes and a representative pilot PCPM, scientific reports from Vietnamese researchers responsible for target pathogens picked-up by the project and the country reports from Cambodia and Laos.

Prof. Dang Duc Anh, Director of NIHE, made an opening speech and then Mr. Masuda, Senior Representative of JICA Vietnam Office made comments on their support and the effect of the project on the control of infectious diseases in Vietnam.

In the first section, there were presentations of the overviews in the efforts for control of infectious diseases in Vietnam from Ministry of Health and WHO Vietnam country Office. Mrs. Ha Thi Cam, an officer from General Department of Preventive Medicine, presented the current status in Vietnam of biosafety and related regulations, and pointed up the problems to be solved and the future efforts to be implanted in Vietnam. Next, Dr. Masaya Kato, a chief coordinator of communicable diseases of WHO Vietnam country Office, overviewed the current outbreaks such as Ebola in West Africa, MERS in South Korea, and highly pathogenic avian Influenza in the world and made a lecture on the main scheme of WHO for global public health, IHR: International Health Regulation (2005) and Asian public health, APSED: Asia Pacific Strategy for Emerging Diseases (2010) where WHO WPRO regards the capacity strengthening of laboratory diagnosis in Vietnam as important cornerstones. As lessons learn from these outbreaks, he evaluated the appropriate and prompt support of the project to establish the laboratory capacity development against Ebola threats in Vietnam and underlined the continuous efforts and partnerships to develop and invest the capacity of laboratory diagnosis during peaceful time.

In the second section, researchers responsible for the project activity from 4 regional institutes presented successively the outcome of project activities conduct so far in each region. Firstly, Dr. Nguyen Thanh Thuy, Head, Department of Biosafety and Quality Management, NIHE, explained the outline from the background of the project launch of BSL-3 facility in NIHE 2008 to establishment of laboratory network in the northern region according to the Project Management Matrix. A series of project activity spanning 10 years allowed almost of Vietnamese researchers in 4 regional institutes and 10 pilot PCPMs to participate training courses of biosafety and laboratory diagnosis of each target pathogen several times and to acquire the concept of biosafety on the occasion of training courses for practical laboratory diagnosis, which have been organized total 35 times in each region around Vietnam during 5 years of the project period, resulting with total numbers of 366 participants. Total number of 28 participants also have been trained in Japan from 4 regional institutes and 4 pilot PCPMs during the period of the project. In addition, total of 82 engineers and researchers took part of the training course on the maintenance of the facilities and equipment of biosafety and learned how to practically maintain and adjust biosafety equipment such as cabinets and autoclaves.

Next, Dr. Cao Thi Bao Van, Deputy Director of Ho Chi Min Pasteur Institute (PIHCMC), reported the current status of biosafety development in the southern region, including 3 pilot PCPM such as Tien Giang, Dong Nai and Can Tho. It should be noted that transfer of mobile BSL-3 laboratory from NIHE to PIHCMC allowed staff of PIHCMC to acquire actively the biosafety-concept and practical techniques required to run safely mobile BSL-3 laboratory with a series of training courses. On the other hand, efforts of staff of PIHCMC and pilot PCPMs should be remarked to disseminate actively biosafety-concept in the southern region in the TOT manner, resulting in 3,913 participants in biosafety training courses from other PCPM and hospitals in the region.

In succession, Dr. Ngo Le Thi Min Tam, Head Department of Biosafety and Quality Management, Pasteur Institute of Nha Trang (PINT), explained the current status of biosafety development in the central region. All relevant staff of PINT, Hue and Da Nang pilot PCPMs have attended the biosafety training courses, and ISO certification of laboratories has been progressed. Total number of 36 staff have attended to training courses on laboratory diagnosis such as avian Influenza, Rabies and Rickettsia, part of which were held in PINT, allowing the staff to acquire the capacity of laboratory diagnosis on several pathogens. In addition, 5 researchers from PINT and Da Nang PCPM have been dispatched to Japan for training courses such as biosafety, GMT/avian Influenza and GMT/Hand-foot-mouse diseases, which contributes to develop the capacity of the institute.

Next Dr. Nguyen Ngoc Hung, Head, Department of Bacteriology, Tay Nguyen Institute of Hygiene and Epidemiology (TIHE), reported the current status of biosafety in the Highland region. Most of relevant researchers of TIHE, Daklak and Gia Lai pilot PCPM have already participated to biosafety training courses although process of laboratory ISO certification has been delayed because TIHE is on the way of relocation from the former old building in the central region of Buon Ma Thout city to a new building in the suburbs region. Several training courses of avian Influenza, Cholera and Rabies have been organized in TIHE and researchers of TIHE have participated to training courses of other pathogens held in the other regional institutes, which have strengthen the capacity development of laboratory diagnosis based on molecular detection of pathogens with PCR methods. Substantial PCPMs directed by TIHE do not have the ability to diagnose independently yet because they have no equipment necessary for PCR testing. These problems are counter-measured by getting knowledge how to send safely samples in doubt to the higher laboratories such as pilot PCPM and TIHE. Co-ordination and harmony with veterinary agencies may be recommended in the field of laboratory diagnosis of zoonotic disease such as Rabies, based on biosafety guideline in the near future.

Finally, on behalf of 10 pilot PCPMs, Dr. Doan Thi Hong Hanh, Deputy Director of Yen Bai PCPM in the Northern region, made an impressive presentation of effect on the change of attitude in staff of PCPM before and after the participation to the project activity in getting biosafety-concept and practical safety laboratory procedures. In Yen Bai PCPM, the biosafety committee started upon the project launch. A total of 30 staff have participated to several training courses held in regional institutes. In addition, a staff was dispatched to Japan in the training course of biosafety. Staff return from the training course actively share information and knowledge gained in the course with their colleagues in PCPM, and have improved laboratory procedures, which allowed them to reform BSL-2 laboratory and gain ISO certification of laboratories, and to make it possible to diagnose Anthrax, avian Influenza and HFMD based on standard SOP of molecular methods of PCR. Through understanding the principle of molecular diagnosis, staffs have actively applied these molecular methods to diagnosis of other pathogens, allowing them to actively discuss on laboratory diagnosis based on the scientific way of thinking. They expect that training courses of Brucellosis or Leptospirosis, which is often endemic in the region, might be organized in cooperation with other PCPMs under the similar situation.

In the third section, researchers of NIHE presented the scientific summarized reports with special reference to the progress during the project period on capacity development of laboratory diagnosis and laboratory network of pathogens selected by the project such as avian Influenza, Rabies, Anthrax and HFM disease.

First, Dr. Le Thi Quynh Mai, Deputy Director of NIHE and Director of National Influenza Center of NIHE, presented the scientific report on avian Influenza, which was the cue of BSL-3 facility installment in NIHE. There were reported 127 people infected with avian Influenza virus from 2003 to the present with 64 victims in Vietnam. They have been analyzing them with special reference to HA gene, and demonstrated by a series of phylogenic investigation that these avian Influenza virus were generated through the mechanism of drift and shift among virus strains derived from various countries. They also displayed the possibility that recent invasion of avian Influenza A/H5N6 into Vietnam occurred as reassortants among genes of different strains. These findings indicate that international cooperation is indispensable for effective strategy against possible pandemic of avian Influenza variants and that Vietnamese researchers now have the ability to play a substantial role of analyzing new variants in this field.

Next, Dr. Nguyen Tuyet Thu, Department of Virology, NIHE, presented the scientific investigation on the genetic characteristics of Rabies virus recently isolated in mountainous and central regions in Vietnam. There are reported every year in Vietnam prevalent with Rabies virus about 100 victims and 33 millions people who are treated with post-exposure vaccination in 31 prefectures, mainly in the mountainous and central regions. Eight strains were detected so far in Vietnam by phylogenic study on N gene of Rabies virus isolated from patients and rabid dogs, of which genetic type 1 is revealed to be the major type among isolates from 2013 to 2015, representing group 1b, the common majority type of strains prevalent among the northern and central regions in Vietnam and the southern region in China.

In succession, Dr. Hoang Thi Thu Ha, Deputy Head, Department of Bacteriology, NIHE, presented the current status of epidemiological surveillance on Anthrax improved through training courses of the project. Anthrax bacillus is one of zoonotic BSL-3 pathogens, also is recently regarded important from the standpoint of bioterrorism. There are reported 122 cases with 2 victims so far from 2008 in the northwest mountainous region such as Ha Giang, Lai Chau and Dien Bien prefecture. Needless to say, accurate surveillance needs accurate and prompt laboratory diagnosis of Anthrax. Starting the first training course of Anthrax in Yen Bai PCPM 2013, several training courses allowed staffs in the regions to acquire the safety method of samples in doubt and perform its molecular diagnosis with PCR or introduce simple/rapid method of LAMP. Instruction with audiovisual equipment of Anthrax sampling and laboratory diagnosis has made it possible to construct laboratory network from the commune level of health centers and veterinary stations (ADH) to the regional level of PCPM, finally safety transfer to the laboratory responsible for laboratory diagnosis, NIHE. Total of 6 strains were isolated through this laboratory network and subjected to SNP analysis at 80 points covering the whole genome of Anthrax bacillus, which revealed that these strains were clustered into two different groups of A1 and A3b. They reported these scientific findings in the international congress in Canada, or published in several English journals, which indicates the elevated level of scientific reports from Vietnamese research through the project.

Next Dr. Ngo Tuan Cuong, Laboratory of Enteric Bacteria, NIHE, reported application of LAMP method to detect Cholera in the environments such as water. LAMP method represents a simple and rapid amplification of target genes at isothermal reaction at about 62°C with 6 primers and strand-displaced DNA synthesis polymerase such as Bst I, invested by Japanese researchers and has been so far applied to detection of various pathogens and employed into the training courses of laboratory diagnosis of Anthrax, avian Influenza and Rabies in the project. Dr. Cuong presented the results of LAMP method to detect toxic gene ctx and atpA of Vibrio cholerae in the water collected in several points of Hai Phong city and displayed the advantage of LAMP method application to environmental surveillance of Cholera bacteria. Laboratory network of Cholera has proceed to other pathogens of the project because training courses of Cholera laboratory diagnosis have already been held in all 4 regional institute by last year and was organized this year in Nghe An PCPM together with northern PCPMs. Development of Cholera surveillance system might be expected through introduction of a standard SOP employing a simple/rapid LAMP method.

Finally Dr. Tran Thi Nguyen Hoa, Laboratory of Enteric Virus, NIHE, presented the current status of laboratory diagnosis of Hand-Foot-Mous Disease (HFMD) in Vietnam and capacity development through the project. There were a large epidemic of HFMD in Vietnam from 2012 to 2013 and reported 189 victims even in a couple of years. The enormity of social damage prompted the project to add this disease to one of target pathogens and has organized the training course of laboratory diagnosis in NIHE 2014 and PIHCMC 2015 with the goal of setting a national standard SOP. Dr. Hoa demonstrated the epidemiological situation at that time and background of organizing the training courses and explained that introduction of modified Multiplex PCR improved the simultaneous detection rate of enterovirus causing HFMD such as EV71, CVA6 and CVA1, and expected that further improvement of SOP might allow them to establish the surveillance system of enterovirus, resulting in reduction of victims in future.

Taken together, laboratory network and capacity development of laboratory diagnosis have been substantially augmented and clearly achieved in several target pathogens, including 4 regional institutes and 10 pilot PCPMs through the 5 years period of the project.

In the last section 4, governmental officers invited from Cambodia and Laos presented the current status of surveillance system against infectious diseases with special reference to biosafety in the perspective of future cooperation with Vietnam and JICA.

First Dr. Sau Sokunna, Deputy Director, Department of Hospital service, Ministry of Health, and a chairman, a national network of medical microbiology, presented the current outline of infectious disease control in Kingdom of Cambodia. They have just made guideline of biosafety concerning medical laboratory last year and the Committee has just been launched, which needs enhancement to adjust the current status of Cambodia Health System. In Cambodia, they have established a infectious disease control system of 8 national institutes and 5 reference laboratories distributed nationwide, which perform laboratory diagnosis of samples in doubt sent from 85 provincial hospitals of infectious diseases. Final laboratory diagnosis of several pathogens depends upon Pasteur Institute in Cambodia or USCDC although this system has been tried to be construct according to IHR and APSED of WHO and WPRO in order to develop the capacity of laboratory diagnosis of infectious pathogens in national institutes with standard SOP. Training courses of biosafety and quality management have been so far organized several times for staffs of National Institute of Public Health and Referral Hospitals, but are not sufficient to educate and develop the capacity of staffs without a standard curriculum and SOP. They expected support of Vietnam and JICA together with WHO and USCDC for legislation and regulation of biosafety and biosecurity, and know-how to organize training courses of laboratory diagnosis based on biosafety and sharing information and experience of Vietnam.

Then Dr. Rattanaxay Phetsouvanh, Deputy Director, Department of Communicable Diseases Control, Ministry of Health. Laos PDR, presented the outline of infectious diseases control system of Laos PDR. The country health system consists of both national institutes related with public health and clinical laboratories belonged to national hospitals. National institutes for public health are specified for diagnosis and testing of specific pathogens such as National Center for Laboratory and Epidemiology, National Institute of Malariology, Parasitology and Entomology, National Institute of Tuberculosis and Pasteur Institute in Lao whereas clinical laboratories of 4 central hospitals in Vientiane and 4 core regional hospitals play a main role in clinical laboratory network, and direct laboratories of 12 provincial hospitals, 129 district hospitals and 894 health centers. This hospital network is responsible for general diseases and not specified for infectious diseases. As for biosafety and biosecurity, they are on the way of translating Biosafety Manual of WHO 3rd version into Lao and preparing related regulations and legislations. They expect sharing of information, support and cooperation from JICA and Vietnam since biosecurity and quality management remains to be established in Lao PDR.

As for summary of the symposium, Dr. Ichiro Kurane, Director General of NIID, and Prof. Dang Duc Anh, Director of NIHE made closing remarks that dispatch of short- and long-term experts and cooperation with Vietnamese researchers in organizing training courses in Vietnam have made profound and nationwide effect on the capacity development of biosafety and laboratory diagnosis in conjunction with laboratory network and that international cooperation such as information sharing of infectious diseases is indispensable especially among Vietnam, Cambodia and Laos in Indochina Peninsula for effective control of infectious diseases across country boundaries science there are no boundaries for infectious diseases. Dr. Ichiro Kurane expressed the possible continuous support of Japanese researchers of NIID and JICA for cooperation and establishment in surveillance system against infectious diseases in the region.

All participants of the symposium in the Hall of NIHE