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Klebsiella pneumoniae stands out as a major opportunistic pathogen responsible for both hospital- and community-acquired bacterial infections. This study comprehensively assesses the antibiotic resistance, amikacin persistent patterns, and biofilm-forming ability of 247 isolates of K. pneumoniae obtained from an intensive care unit of a tertiary hospital in Vietnam. Microdilution assays, conducted on a 96-well plate, determined the minimum inhibitory concentrations (MICs) of amikacin. Susceptibility data for other antibiotics were gathered from the antibiogram profile. Stationary-phase bacteria were exposed to 50 × MIC, and viable bacteria counts were measured to determine amikacin persistence. Biofilm forming capacity on 96-well polystyrene surfaces was assessed by biomass and viable bacteria. The prevalence of resistance was notably high across most antibiotics, with 64.8% classified as carbapenem-resistant K. pneumoniae and 81.4% as multidrug resistant. Amikacin, however, exhibited a relatively low rate of resistance. Of the isolates, 58.2% demonstrated a moderate to strong biofilm formation capacity, and these were found to be poorly responsive to amikacin. K. pneumoniae reveals a significant inclination for amikacin persistence, with ∼45% of isolates displaying an antibiotic antibiotic-survival ratio exceeding 10%. The study sheds light on challenges in treating of K. pneumoniae infection in Vietnam, encompassing a high prevalence of antibiotic resistance, a substantial ability to form biofilm, and a notable rate of antibiotic persistence.

This study aimed to assess the clinical utility of blood lactate-to-bicarbonate (L/B) ratio, as a prognostic factor for 28-day in-hospital mortality in children with dengue shock syndrome (DSS), admitted to the pediatric intensive care unit (PICU). This single-center retrospective study was conducted at a tertiary children hospital in southern Vietnam from 2013 to mid-2022. Prognostic models for DSS mortality were developed, using a predefined set of covariates in the first 24 hours of PICU admission. Area under the curves (AUCs), multivariable logistic and Least Absolute Shrinkage and Selection Operator (LASSO) regressions, bootstrapping and calibration slope were performed. A total of 492 children with DSS and complete clinical and biomarker data were included in the analysis, and 26 (5.3%) patients died. The predictive values for DSS mortality, regarding lactate showing AUC 0.876 (95% CI, 0.807-0.944), and that of L/B ratio 0.867 (95% CI, 0.80-0.934) (P values of both biomarkers < .001). The optimal cutoff point of the L/B ratio was 0.25, while that of lactate was 4.2 mmol/L. The multivariable model showed significant clinical predictors of DSS fatality including severe bleeding, cumulative amount of fluid infused and vasoactive-inotropic score (>30) in the first 24 hours of PICU admission. Combined with the identified clinical predictors, the L/B ratio yielded higher prognostic values (odds ratio [OR] = 8.66, 95% confidence interval [CI], 1.96-38.3; P < .01) than the lactate-based model (OR = 1.35, 95% CI, 1.15-1.58; P < .001). Both the L/B and lactate models showed similarly good performances. Considering that the L/B ratio has a better prognostic value than the lactate model, it may be considered a potential prognostic biomarker in clinical use for predicting 28-day mortality in PICU-admitted children with DSS., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: This study aimed to evaluate the efficacy and side effects of first-line afatinib treatment in a real-world setting in Vietnam., Methods: This retrospective study was conducted across nine hospitals in Vietnam. Advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients who received afatinib as first-line therapy between April 2018 and June 2022 were included, and patient medical records were reviewed. Key outcomes were overall response rate (ORR), time-to-treatment failure (TTF), and tolerability., Results: A total of 343 patients on first-line afatinib were eligible for the study. EGFR exon 19 deletion (Del19) alone was detected in 46.9% of patients, L858R mutation alone in 26.3%, and other uncommon EGFR mutations, including compound mutations, in 26.8%. Patients with brain metastases at baseline were 25.4%. Patients who received 40 mg, 30 mg, and 20 mg as starting doses of afatinib were 58.6%, 39.9%, and 1.5%, respectively. The ORR was 78.1% in the overall population, 82.6% in the Del19 mutation subgroup, 73.3% in the L858R mutation subgroup, and 75.0% in the uncommon mutation subgroup (p > 0.05). The univariate and multivariate analyses indicate that the ORR increased when the starting dose was 40 mg compared to starting doses below 40 mg (83.9% vs. 74.3%, p = 0.034). The median TTF (mTTF) was 16.7 months (CI 95%: 14.8-18.5) in all patients, with a median follow-up time of 26.2 months. The mTTF was longer in patients in the common EGFR mutation subgroup (Del19/L858R) than in those in the uncommon mutation subgroup (17.5 vs. 13.8 months, p = 0.045) and in those without versus with brain metastases at baseline (17.5 vs. 15.1 months, p = 0.049). There were no significant differences in the mTTF between subgroups based on the starting dose of 40 mg and < 40 mg (16.7 vs. 16.9 months, p > 0.05). The most common treatment-related adverse events (any grade/grade ≥ 3) were diarrhea (55.4%/3.5%), rash (51.9%/3.2%), paronychia (35.3%/5.0%), and stomatitis (22.2%/1.2%)., Conclusions: Afatinib demonstrated clinical effectiveness and good tolerability in Vietnamese EGFR-mutant NSCLC patients. In our real-world setting, administering a starting dose below 40 mg might result in a reduction in ORR; however, it might not have a significant impact on TTF., (© 2024. The Author(s).)

Background: Most skin-related traits have been studied in Caucasian genetic backgrounds. A comprehensive study on skin-associated genetic effects on underrepresented populations such as Vietnam is needed to fill the gaps in the field., Objectives: We aimed to develop a computational pipeline to predict the effect of genetic factors on skin traits using public data (GWAS catalogs and whole-genome sequencing (WGS) data from the 1000 Genomes Project-1KGP) and in-house Vietnamese data (WGS and genotyping by SNP array). Also, we compared the genetic predispositions of 25 skin-related traits of Vietnamese population to others to acquire population-specific insights regarding skin health., Methods: Vietnamese cohorts of whole-genome sequencing (WGS) of 1008 healthy individuals for the reference and 96 genotyping samples (which do not have any skin cutaneous issues) by Infinium Asian Screening Array-24 v1.0 BeadChip were employed to predict skin-associated genetic variants of 25 skin-related and micronutrient requirement traits in population analysis and correlation analysis. Simultaneously, we compared the landscape of cutaneous issues of Vietnamese people with other populations by assessing their genetic profiles., Results: The skin-related genetic profile of Vietnamese cohorts was similar at most to East Asian cohorts (JPT: Fst = 0.036, CHB: Fst = 0.031, CHS: Fst = 0.027, CDX: Fst = 0.025) in the population study. In addition, we identified pairs of skin traits at high risk of frequent co-occurrence (such as skin aging and wrinkles (r = 0.45, p = 1.50e-5) or collagen degradation and moisturizing (r = 0.35, p = 1.1e-3))., Conclusion: This is the first investigation in Vietnam to explore genetic variants of facial skin. These findings could improve inadequate skin-related genetic diversity in the currently published database., (© 2024. The Author(s).)

The aim of this study is to analyse the changing patterns in the transmission of COVID-19 in relation to changes in Vietnamese governmental policies, based on epidemiological data and policy actions in a large Vietnamese province, Bac Ninh, in 2021. Data on confirmed cases from January to December 2021 were collected, together with policy documents. There were three distinct periods of the COVID-19 pandemic in Bac Ninh province during 2021. During the first period, referred to as the 'Zero-COVID' period (01/04-07/04/2021), there was a low population vaccination rate, with less than 25% of the population receiving its first vaccine dose. Measures implemented during this period focused on domestic movement restrictions, mask mandates, and screening efforts to control the spread of the virus. The subsequent period, referred to as the 'Transition' period (07/05-10/22/2021), witnessed a significant increase in population vaccination coverage, with 80% of the population receiving their first vaccine dose. During this period, several days passed without any reported COVID-19 cases in the community. The local government implemented measures to manage domestic actions and reduce the time spent in quarantine, and encouraged home quarantining for the close contacts of cases with COVID-19. Finally, the 'New-normal' stage (10/23-12/31/2021), during which the population vaccination coverage with a second vaccine dose increased to 70%, and most of the mandates for the prevention and control of COVID-19 were reduced. In conclusion, this study highlights the importance of governmental policies in managing and controlling the transmission of COVID-19 and provides insights for developing realistic and context-specific strategies in similar settings.

Objectives: We conducted this study to describe whether mutations in the gene coding for the enzyme reverse transcriptase (RT) were related to drugs used in the treatment of hepatitis B in Vietnam., Methods: Patients receiving antiretroviral therapy with evidence of treatment failure were included in the study. The RT fragment was cloned using the polymerase chain reaction technique after being extracted from patients' blood samples. The nucleotide sequences were analysed using Sanger method. The HBV drug resistance database contains mutations associated to resistance to existing HBV therapies. Medical records were accessed to collect information on patient parameters, such as treatment, viral load, biochemistry, and blood count., Results: Resistance mutations to lamivudine, telbivudine, and entecavir were found in the highest proportion (75-91.7%) of HBV samples from patients who had failed antiretroviral therapy. Only 20.8% of HBV strains had mutations exhibiting adefovir resistance, while none had mutations conferring tenofovir resistance. M204I/V, L180M, and L80I are frequent variants linked with resistance to lamivudine, telbivudine, and entecavir. In contrast, the A181L/T/V mutation was detected predominantly in tenofovir-resistant HBV strains. Following the drug resistance mutation test, patients achieved the greatest virological response after 24 weeks of therapy with tenofovir and entecavir at a daily dose of one tablet., Conclusion: Lamivudine, telbivudine, and entecavir were all highly resistant to the RT enzyme modifications in 24 treatment failure patients, with M204I/V, L180M, and L80I being the most prevalent mutations. Tenofovir resistance mutations have not been found in Vietnam., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict interests to disclose., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Fever of unknown origin (FUO) is a challenge for clinicians treating patients with HIV/AIDS. CD4 counts can be helpful in the diagnosis and treatment. This study aimed to determine several common etiologies of FUO stratified by CD4 count levels in HIV/AIDS patients., Methods: A cross-sectional retrospective and prospective study was conducted in 195 HIV/AIDS patients with FUO admitted to the National Hospital for Tropical Diseases from January 2016 to June 2019. Clinical parameters, immune status, and etiologies for each patient were recorded. Odds ratios were calculated to compare the distributions of common etiologies in groups with two different CD4 count levels: < 50 cells/mm 3 and ≥ 50 cells/mm 3 ., Results: The proportions of opportunistic infections and noninfectious etiologies were 93.3% and 3.6%, respectively. Tuberculosis was the most common opportunistic infection (46.7%), followed by talaromycosis (29.2%) and Pneumocystis jiroveci (PCP) infection (20.5%). Tuberculosis was predominant in all CD4 level groups. Most patients with talaromycosis had CD4 counts below 50 cells/mm 3 . In total, 53.8% of the patients were infected by one pathogen. The risks of tuberculosis and talaromycosis in FUO-HIV patients were high when their CD4 counts were below 50 cells/mm 3 ., Conclusions: Opportunistic infections, especially tuberculosis, are still the leading cause of FUO in HIV/AIDS patients. Tuberculosis and Talaromyces marneffei (TM) infection should be considered in patients with CD4 cell counts < 50 cells/mm 3 . This study implies that guidelines for appropriate testing to identify the etiology of FUO in HIV/AIDS patient based on the CD4 cell count should be developed, thereby reducing resource waste., (© 2022. The Author(s).)

Cyanobacteria are photosynthetic microorganisms with widespread diversity and extensive global distribution. They produce a wide variety of bioactive substances (e.g., lipopeptides, fatty acids, toxins, carotenoids, vitamins and plant growth regulators) that are released into culture media. In this study, the capability of a cyanobacterial strain of Planktothricoides raciborskii to produce intra- and extracellular auxins was investigated. The filamentous cyanobacterial P. raciborskii strain was isolated from a river in Vietnam, and it was cultivated in the laboratory under the optimum conditions of the BG11 culture medium and a pH of 7.0. The auxins were identified and quantified by the Salkowski colorimetric method and high-performance liquid chromatography coupled with mass spectrometry (HPLC-MS). Colorimetric analysis revealed that P. raciborskii produces extracellular indole-3-acetic acid (IAA) in the absence and presence of l-tryptophan. The maximum extracellular IAA concentration of the culture reached 118 ± 2 μg mL -1 , which was supplemented with 900 μg mL -1 of l-tryptophan. HPLC-MS analysis revealed that the isolated cyanobacteria accumulate other plant-growth-promoting hormones besides IAA, such as indole-3-carboxylic acid (ICA), indole-3 butyric acid (IBA) and indole propionic acid (IPA). This is the first report on the production of auxins in an isolated strain of cyanobacteria Planktothricoides from a polluted river. The capability of producing auxins makes the P. raciborskii strain an appropriate candidate for the formulation of a biofertilizer., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

This work focuses on the lime pretreatment of rice straw, agricultural waste in northeast Vietnam, for microbial lipid (bio-lipid) production. A response surface methodology approach was performed to optimize parameters for the pretreatment process. These parameters are the concentration of Ca(OH) 2 , hydrolysis temperature, and maintained time; the effect is considered bio-lipid production yield. The lipid yield was estimated through consolidated bioprocessing of the pretreated rice straw as a substrate and using the fungus strain (Aspergillus oryzae 32) and the yeast strain (Lipomyces starkeyi 22). As a result, the optimal pretreatment conditions for maximum lipid yield were obtained at Ca(OH) 2 concentration of 12 g/L and hydrolysis temperature of 110 °C within 60 min. The accumulated lipid in fermentation using these oleaginous microorganisms was 8.5g/100g oven-dry weight of rice straw (10.9g/100g for pretreated rice straw). The biolipid consisted of 42.6% saturated, 21.1% monounsaturated (MUFA), and 35.1% polyunsaturated (PUFA) fatty acids., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

From July 2017 to Jan 2019, a total of 572 retail fresh vegetables were collected to clarify the contamination of Salmonella in the Mekong Delta, Vietnam. Salmonella was isolated from 74 (12.9%) of 572 samples. The isolation rate of Salmonella from retail fresh vegetables in the rainy season (15.3%) was significantly higher than that in the dry season (7.6%) (P < 0.05). Of 74 Salmonella isolates, Salmonella Weltevreden was the most predominant serovar (35.1%) identified from retail fresh vegetables in all of the wet markets. All S. Weltevreden isolates (100%) were susceptible to nine antibiotics examined. Thus, retail fresh vegetables were considered as an important potential vehicle of Salmonella transmission to humans in the Mekong Delta. These results provide important data for preventing and controlling human salmonellosis in this area., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: To investigate clinical and histopathological characteristics of Vietnamese patients with thymoma and myasthenia gravis (MG), and the outcomes of surgical management using video-assisted thoracoscopic surgery (VATS) thymectomy., Methods: A prospective study was carried out on 61 patients undergoing VATS thymectomy for MG class I, IIA with thymoma in the period from 10/2013 to 5/2019. The WHO histopathological classification, Masaoka's stages and MG grading using the guidelines of the Medical Scientific Advisory Board of the Myasthenia gravis foundation of America (MGFA) were used. All patients were followed up at 1 month, 6 months and over 1 year postoperatively., Results: The average patient age was 47.3 ± 10.8 years (21-70). The female/male ratio was 0.91.80.3% of patients had MG class IIA. Most of the patients were at Masaoka's stage I and stage II (75.4%). Only 1 patient (1.7%) had highly malignant type B3 thymoma. Conversion to open surgery was required in 8 patients. The surgical time was 91.8 ± 49.9 min and blood loss was 37.3 ± 31.5 ml. Most patients (68.9%) were extubated in the operating room. The postoperative hospital stay was 9.8 ± 5.9 days (5-37 days). 22.6% of patients relapsed after one-year. Refractory MG declined to 5.7% after surgical treatment., Conclusion: VATS thymectomy for MG with thymoma was safe and effective, with a lower rate of intraoperative complications, shorter hospitalization, and better long-term outcomes. This approach could be applicable for patients of all age groups with thymomas at early Masaoka's stages., (Copyright © 2020. Published by Elsevier Taiwan LLC.)

Resistance is notoriously high in Asia but may not entirely explain therapeutic failures. Specific modes of bacterial life, such as biofilm or intracellular survival, may also contribute to the persistent and/or recurrent character of infections. Most Staphylococcus aureus isolates form biofilm and many survive and even thrive intracellularly. We collected 36 nonduplicate S. aureus isolates (including 18 methicillin-resistant S. aureus ) from patients with clinical evidence of persistent or recurrent infections in a large tertiary Vietnamese hospital. We examined their antibiotic resistance profile (minimal inhibitory concentration determination) and clonal relatedness ( spa and agr typing, pulsed field gel electrophoresis profiles). We then assessed the activity of moxifloxacin in both biofilms and infected phagocytes (moxifloxacin previously proved to be one of the most active antibiotics against reference strains in these models). spa- types t189 and t437 and agr group I were the most frequent. Among the 36 isolates, 30 were multidrug resistant but 30 were recovered from patients having received an active drug. All tested isolates produced biofilm and survived inside phagocytes. At its human C max , moxifloxacin was inactive on biofilms made by moxifloxacin-susceptible as well as moxifloxacin-resistant isolates. It caused only a modest intracellular colony-forming unit decrease against moxifloxacin-susceptible isolates and was inactive against those resistant to moxifloxacin. While our data confirm for this collection the high resistance levels and prevalence of endemic spa- or agr- types in Asia, they show that tolerance in both biofilm and phagocytes are correlated and markedly limit moxifloxacin activity, which goes in line with the suggested role of these modes of life in persistence or recurrence of infections.

This research reports the presence of species Cylindrospermopsis raciborskii and cylindrospermopsin (CYN) in the Huong River and the relationship between species with environmental factors to find a scientific basis for predicting the risk of pollution of the species and CYN in waters. Strains of C. raciborskii isolated from the river were also identified as potentially toxin-producing through the determination of the presence of toxins in the cultures by ELISA; the presence of the genes involved by PCR confirms the CYN-producing ability of species C. raciborskii from this water body. Our results have confirmed the presence of toxic cyanobacteria C. raciborskii in the Huong River. C. raciborskii from the Huong River are mostly solitary, straight trichomes. Analyses of all C. raciborskii strains from the Huong River by ELISA for cylindrospermopsin were positive. The contents of cylindrospermopsin (CYN) in each strain were different, ranging from 5.25 ng mg -1 wet weight in CR1DD to 70.83 ng mg -1 wet weight in CR1NY. PCR analysis confirmed that the genes involved in the production of this cyanotoxin were present in C. raciborskii. The relationship between densities and toxicity showed a correlation coefficient R of 0.88. This was a relatively high positive correlation index, indicating the close links between densities and toxins: toxin CYN concentrations increased when C. raciborskii densities increased.

Health financing has been considered as an important building block of a health system and has a key role in promoting universal health coverage in the Vietnam. This paper aims to describe the pattern of health expenditure, including total health expenditure and composition of health expenditure, over the last two decades in Vietnam. The paper mainly uses the data from Vietnam National Health Account and Vietnam Living Standards Survey. We also included data from other relevant published literature, reports and statistics about health care expenditure in Vietnam. The per capita health expenditure in Vietnam increased from US$ 14 in 1995 to US$ 86 in 2012. The total health expenditure as a share of GDP also rose from 5.2% in 1995 to 6.9% in 2012. Public health expenditure as percentage of government expenditure rose from 7.4% in 1995 to nearly 10% in 2012. The coverage of health insurance went up from 10% in 1995 to 68.5% in 2012. However, health financing in Vietnam was depending on private expenditures (57.4% in 2012). As a result, the proportion of households with catastrophic expenditure in 2012 was 4.2%. The rate of impoverishment in 2012 was 2.5%. To ensure equity and efficient goal of health system, policy actions for containing the health care out-of-pocket payments and their poverty impacts are urgently needed in Vietnam.

Introduction: Antiviral resistance has been reported in seasonal influenza A viruses and avian influenza A(H5N1) viruses in Viet Nam, raising concerns about the efficacy of treatment., Methods: We analysed specimens from two sources during the period 2009-2012: influenza-positive samples from influenza-like illness patients at sentinel clinics in northern Viet Nam and isolates from patients with confirmed A(H5N1) infections. Pyrosequencing was used to detect mutations: H275Y [for A(H1N1) and A(H5N1)], E119V [for A(H3N2)] and I117V [for A(H5N1)]. A neuraminidase inhibition assay was used to determine the Inhibitory Concentration 50 (IC₅₀) values for all influenza A and B isolates., Results: There were 341 influenza A positive samples identified; influenza A(H1N1)pdm09 was identified most frequently (n = 215). In 2009, oseltamivir resistance was observed in 100% (19 of 19) of seasonal A(H1N1) isolates and 1.4% (3/215) of A(H1N1)pdm09 isolates. This H275Y mutation was not found in influenza subtypes A(H5N1) or A(H3N2) isolates., Discussion: In Viet Nam, seasonal and A(H5N1) influenza vaccines are not currently available; thus, effective treatment is required. The presence of oseltamivir-resistant viruses is therefore a concern. Active surveillance for oseltamivir resistance among influenza viruses circulating in Viet Nam should be continued.

The attitudes of parents and students towards schooling are often considered to be important factors associated with students' educational outcomes. This article presents the process of constructing and calibrating two scales to measure the attitudes of students and parents in Vietnam, and then linking these two scales to compare the two groups. A set of items that covered both development and opportunity aspects of education was designed. After the items were trialled, a final version of 13 items was compiled. The two scales yielded scores that were shown to have logical, face, content and construct validity.

Few prospective studies regarding antibiotic use for mild acute respiratory infections (ARI) have been conducted in community settings. This paper aimed to assess knowledge of children's caregivers and actual antibiotic use for children under five and to identify factors associated with antibiotic treatment for mild ARIs. Caregivers in 828 households in Bavi, Vietnam, were interviewed using a structured questionnaire assessing both knowledge and practice. Subsequently, 823 children were followed for 28 days to collect information regarding symptoms and drug use. For management of ARIs, only 13% of caregivers demonstrated correct overall knowledge in accordance with standard guidelines. The symptoms of the most recent illness were consistent with mild ARI in 79% of cases, and antibiotics were used in 71% of these. During the 28-day period, 62% of children had been given antibiotics and 63% of antibiotic courses were used for mild ARIs. One-half of the mild ARI episodes and 63% of the children with mild ARIs were treated with antibiotics. Most of the unnecessary antibiotic treatment was recommended by healthcare providers (82%). Most of the children had been administered antibiotics for common colds, although most caregivers believed that antibiotics were not required. Antibiotics were unnecessarily recommended at health facilities in the area., (Copyright © 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.)

Background: To improve HIV prevention and care programs, it is important to understand the uptake of HIV testing and to identify population segments in need of increased HIV testing. This is particularly crucial in countries with concentrated HIV epidemics, where HIV prevalence continues to rise in the general population. This study analyzes determinants of HIV testing in a rural Vietnamese population in order to identify potential access barriers and areas for promoting HIV testing services., Methods: A population-based cross-sectional survey of 1874 randomly sampled adults was linked to pregnancy, migration and economic cohort data from a demographic surveillance site (DSS). Multivariate logistic regression analysis was used to determine which factors were associated with having tested for HIV., Results: The age-adjusted prevalence of ever-testing for HIV was 7.6%; however 79% of those who reported feeling at-risk of contracting HIV had never tested. In multivariate analysis, younger age (aOR 1.85, 95% CI 1.14-3.01), higher economic status (aOR 3.4, 95% CI 2.21-5.22), and semi-urban residence (aOR 2.37, 95% CI 1.53-3.66) were associated with having been tested for HIV. HIV testing rates did not differ between women of reproductive age who had recently been pregnant and those who had not., Conclusions: We found low testing uptake (6%) among pregnant women despite an existing prevention of mother-to-child HIV testing policy, and lower-than-expected testing among persons who felt that they were at-risk of HIV. Poverty and residence in a more geographically remote location were associated with less HIV testing. In addition to current HIV testing strategies focusing on high-risk groups, we recommend targeting HIV testing in concentrated HIV epidemic settings to focus on a scaled-up provision of antenatal testing. Additional recommendations include removing financial and geographic access barriers to client-initiated testing, and encouraging provider-initiated testing of those who believe that they are at-risk of HIV.

Edema disease (ED) is a common fatal disease in newly weaned piglets. To develop an effective control program for ED, we carried out a study to better understand the incidence and spread of the disease and the characteristics of the causative agent. In our study, 69 Escherichia coli strains, isolated from 92 piglets showing clinical signs of ED from 13 provinces in northern Vietnam, were positive for both the VT2e toxin and the F18 major fimbrial subunit gene fedA. Of these, 40 strains (58%) were positive for AIDA and 16 isolates carried one or more enterotoxins. Forty-six (67%) of the 69 VT2e(+)/F18(+) E. coli isolates belonged to classical serotypes (O139:K82, O141: K85, O138:K81, and O149:K91) while the remaining strains did not belong to the common serotypes in pig. Seropathotype 0139:K82(+)/VT2e(+)/F18(+)/AIDA(+) (21 isolates) was the most frequently detected ED-causing E. coli strain. High prevalence of resistance was observed to the common drugs of tetracycline, streptomycin, trimethoprim/sulfamethoxazole, amoxicillin/clavulanic acid, and spectinomycin. Multiple resistances were widely distributed with 84% of isolates resistant to five antibiotics. Sequence analysis demonstrated that the VT2e toxin is identical among E. coli strains causing ED in pig.

Background: The proportion of people in Vietnam aged 60 and above has increased rapidly in recent decades. However, there is a lack of evidence, particularly in rural settings, on their health-related quality of life (HRQoL) within the context of socioeconomic changes and health-sector reform in the country. This study assesses the level and determinants of HRQoL in a rural district in order to provide evidence for designing and implementing appropriate health policies., Methods: In 2007, 2,873 people aged 60+ living in 2,240 households randomly selected from the FilaBavi demographic surveillance site (DSS) were interviewed using a generic EQ-5D questionnaire to assess their HRQoL. Socioeconomic characteristics of the people and their households were extracted from the DSS's re-census that year, and the EQ-5D index was calculated based on the time trade-off tariff. Multilevel-multivariate linear regression analysis was performed to measure the affect of socioeconomic factors on HRQoL., Results: The EQ-5D index at old age was found to be 0.876 (95%CI: 0.870-0.882). Age between 60-69 or 70-79 years, position as household head, working until old age, literacy, and belonging to better wealth quintiles are determinants of higher HRQoL. Ageing has a primary influence on the deterioration of HRQoL at older ages, mainly due to reduction in physical rather than mental functions. Educational disparity in HRQoL is low, and exists mostly between basic and higher levels of education. Being a household head and working at old age are advantageous for attaining better quality of life in physical rather than psychological terms. Economic conditions affect HRQoL through sensory rather than physical utilities. Long-term living conditions more likely affect HRQoL than short-term economic conditions., Conclusions: HRQoL at old age is at a high level, and varies substantially according to socioeconomic factors. Its determinants should be addressed in social and health policies designed to improve health of older people, especially among the most vulnerable groups.

Background: Streptococcus pneumoniae is the most significant bacterial cause of community-acquired pneumonia among children under five years worldwide. Updated resistance information of S. pneumoniae among children is essential to adjust the recommendations for empirical treatment of community-acquired pneumonia, which will have immense implications for local and global health. This study investigated the prevalence of antibiotic resistance in isolated strains of S. pneumoniae and relationship with antibiotic use and demographic factors of children under five in rural Vietnam in 2007., Methods: In Bavi district, 847 children 6 to 60 months were selected from 847 households. The main child-caregivers in the households were interviewed weekly using structured questionnaires to collect information of daily illness symptoms and drug use for the selected child over a four-week period (from March through June 2007). In the 3rd week, the children were invited for a clinical examination and to collect nasopharyngeal samples for S. pneumoniae identification. Etest and disk diffusion were used to test antibiotic susceptibility., Results: Of 818 participating children, 258 (32%) had ongoing respiratory infections, 421 (52%) carried S. pneumoniae, and 477 (58%) had used antibiotics within the previous three weeks. Of the 421 isolates, 95% were resistant to at least one antibiotic (401/421). Resistance to co-trimoxazole, tetracycline, phenoxymethylpenicillin, erythromycin and ciprofloxacin was 78%, 75%, 75%, 70% and 28%, respectively. Low resistance was noted for amoxicillin (4%), benzylpenicillin (4%), and cefotaxime (2%). The intermediate resistance to amoxicillin was 32%. Multidrug-resistance was seen in 60%. The most common pattern was co-resistance to co-trimoxazole, tetracycline and erythromycin. The proportion of children carrying resistant bacteria was higher among the children who had used antibiotics in the previous three weeks., Conclusions: Resistance to commonly used antibiotics and multidrug-resistance of S. pneumoniae in the area is remarkably high. High-dose amoxicillin is the only investigated oral antibiotic that can possibly be used for treatment of community-acquired pneumococcal infections. Strategies to promote appropriate prescribing and dispensing of effective antibiotics should be immediately implemented for the benefit of local and global health.

Background: There remains a lack of research on co-variation of multiple health outcomes and their socio-economic co-patterning, especially among the elderly. This papers aims to 1) examine the effects of different socio-economic factors on physical functioning and psychological well-being among older adults in a rural community in northern Vietnam; and 2) investigate the extent to which the two outcomes variables co-vary within individuals., Methods: We analyzed the data from the WHO/INDEPTH study on global ageing and adult health conducted on 8535 people aged 50 years old and over in Bavi district of Vietnam in 2006. A multivariate response model was constructed to answer our research questions. The model treats the individual as a level two unit and the multiple measurements observed within an individual as a level one unit., Results: Lower physical functioning and psychological well-being were found in 1) women; 2) older people; 3) people with lower education level; 4) people who were currently single; 5) respondents from poorer household; and 6) mountainous dwellers compared to that in those of other category(ies) of the same variable. Socioeconomic factors accounted for about 24% and 7% of variation in physical functioning and psychological well-being scores, respectively. The adjusted correlation coefficient (0.35) indicates that physical functioning and psychological well-being did not strongly co-vary., Conclusions: The present study shows that there exist problems of inequality in health among older adults in the study setting. This finding highlights the importance of analyzing multiple dimensions of health status simultaneously in inequality investigations.

Background: Infections with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are emerging worldwide. We investigated an outbreak of severe CA-MRSA infections in children following out-patient vaccination., Methods and Findings: We carried out a field investigation after adverse events following immunization (AEFI) were reported. We reviewed the clinical data from all cases. S. aureus recovered from skin infections and from nasal and throat swabs were analyzed by pulse-field gel electrophoresis, multi locus sequence typing, PCR and microarray. In May 2006, nine children presented with AEFI, ranging from fatal toxic shock syndrome, necrotizing soft tissue infection, purulent abscesses, to fever with rash. All had received a vaccination injection in different health centres in one District of Ho Chi Minh City. Eight children had been vaccinated by the same health care worker (HCW). Deficiencies in vaccine quality, storage practices, or preparation and delivery were not found. Infection control practices were insufficient. CA-MRSA was cultured in four children and from nasal and throat swabs from the HCW. Strains from children and HCW were indistinguishable. All carried the Panton-Valentine leukocidine (PVL), the staphylococcal enterotoxin B gene, the gene complex for staphylococcal-cassette-chromosome mec type V, and were sequence type 59. Strain HCM3A is epidemiologically unrelated to a strain of ST59 prevalent in the USA, although they belong to the same lineage., Conclusions: We describe an outbreak of infections with CA-MRSA in children, transmitted by an asymptomatic colonized HCW during immunization injection. Consistent adherence to injection practice guidelines is needed to prevent CA-MRSA transmission in both in- and outpatient settings.

Introduction: Chronic diseases have emerged as a major health threat to the world's population, particularly in developing countries. We examined the prevalence of selected risk factors for chronic disease and the association of these risk factors with sociodemographic variables in a representative sample of adults in rural Vietnam., Methods: In 2005, we selected a representative sample of 2000 adults aged 25 to 64 years using the World Health Organization's STEPwise approach to surveillance of chronic disease risk factors. We measured subjects' blood pressure, calculated their body mass index (BMI), and determined their self-reported smoking status. We then assessed the extent to which hypertension, being overweight (having a BMI > or =25.0), smoking, and various combinations of these risk factors were associated with subjects' education level, occupational category, and economic status., Results: Mean blood pressure levels were higher among men than among women and increased progressively with age. The prevalence of hypertension was 23.9% among men and 13.7% among women. Sixty-three percent of men were current smokers, and 58% were current daily smokers; less than 1% of women smoked. Mean body mass index was 19.6 among men and 19.9 among women, and only 3.5% of the population was overweight. Education level was inversely associated with the prevalence of hypertension among both men and women and with the prevalence of smoking among men. People without a stable occupation were more at risk of having hypertension than were farmers and more at risk of being overweight than were farmers or government employees. Hypertension was directly associated with socioeconomic status among men but inversely associated with socioeconomic status among women., Conclusion: Rural Vietnam is experiencing an increase in the prevalence of many risk factors for chronic diseases and is in urgent need of interventions to reduce the prevalence of these risk factors and to deal with the chronic diseases to which they contribute.

Introduction: Cardiovascular disease is an emerging epidemic in Vietnam, but because cause of death and other routine data are not widely available, it is difficult to characterize community-based disease patterns. Using 5-year data from an ongoing cause-specific mortality study conducted within a demographic surveillance system in Vietnam's Bavi district, this article estimates the rates of adult cardiovascular disease mortality in relation to the mortality rates of other noncommunicable diseases in rural northern Vietnam and examines the association of cardiovascular disease with certain demographic and socioeconomic factors., Methods: All causes of death of adults aged 20 and older occurring from 1999 through 2003 (n = 1067) were determined by using an established demographic surveillance system and data collected by trained interviewers who asked caretakers or relatives of the deceased individuals about signs and symptoms of disease during quarterly household visits. Deaths were classified as cardiovascular disease, cancer, or other noncommunicable diseases. These records were linked to demographic and socioeconomic data., Results: Of the 1067 adult deaths that were recorded, there was an overall noncommunicable disease mortality rate of 7.8 per 1000 person-years. Cardiovascular disease accounted for 33% of male and 31% of female deaths. Compared with cancer and other noncommunicable causes of death in a Cox proportional hazards model, higher cardiovascular disease mortality rates were observed among men, older age groups, and those without formal education., Conclusion: To date, cohort studies and population-based mortality data in Vietnam have been scarce; this study provides insights into the public health aspects of cardiovascular disease in transitional Vietnam. The rates of cardiovascular disease mortality in this rural Vietnamese community were high, suggesting the need for both primary prevention and secondary treatment initiatives. The demographic surveillance system is an important tool for characterizing such an epidemic.

Background: The verified human cases of highly pathogenic avian influenza in Vietnam may represent only a selection of the most severely ill patients. The study objective was to analyze the association between flulike illness, defined as cough and fever, and exposure to sick or dead poultry., Methods: A population-based study was performed from April 1 to June 30, 2004, in FilaBavi, a rural Vietnamese demographic surveillance site with confirmed outbreaks of highly pathogenic avian influenza among poultry. We included 45 478 randomly selected (cluster sampling) inhabitants. Household representatives were asked screening questions about exposure to poultry and flulike illness during the preceding months; individuals with a history of disease and/or exposure were interviewed in person., Results: A total of 8149 individuals (17.9%) reported flulike illness, 38,373 persons (84.4%) lived in households keeping poultry, and 11,755 (25.9%) resided in households reporting sick or dead poultry. A dose-response relationship between poultry exposure and flulike illness was noted: poultry in the household (odds ratio, 1.04; 95% confidence interval, 0.96-1.12), sick or dead poultry in the household but with no direct contact (odds ratio, 1.14; 95% confidence interval, 1.06-1.23), and direct contact with sick poultry (odds ratio, 1.73; 95% confidence interval, 1.58-1.89). The flulike illness attributed to direct contact with sick or dead poultry was estimated to be 650 to 750 cases., Conclusions: Our epidemiological data are consistent with transmission of mild, highly pathogenic avian influenza to humans and suggest that transmission could be more common than anticipated, though close contact seems required. Further microbiological studies are needed to validate these findings.

We investigated the frequency of apolipoprotein E (apoE) polymorphism and the effect of apoE polymorphism on plasma lipid and lipoprotein levels under different nutritional statuses in Vietnamese children living in urban and rural areas. Three hundred and forty-eight girls (aged 7 to 9 years) were randomly selected from urban and rural areas in southern Vietnam. Their apoE genotypes were analyzed by an Invader assay, and the plasma lipid and lipoprotein levels were determined by enzymatic methods using fasting blood samples. Dietary intake and anthropometry of children were also measured. The frequency of the allele epsilon 2 and epsilon 4 of the Vietnamese girls was 0.09 and 0.12, respectively. The levels of low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) of the allele epsilon 2 carriers were significantly lower than those of the allele epsilon 3 carriers (P < .0001) in both the urban and rural groups. In contrast, the allele epsilon 4 carriers tended to show a higher LDL-C level than the allele epsilon 3 carriers, especially in subjects with a higher fat intake in urban area. The allele epsilon 2 carriers had the same high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) level as the allele epsilon 3 carriers, but the allele epsilon 4 carriers with a higher fat intake living in urban areas had lower HDL-C and higher TG level than allele epsilon 3 carriers. In conclusion, our findings showed that the LDL-C lowering effect of allele epsilon 2 was independent of the nutritional status, while allele epsilon 4 tended to lower HDL-C and increase the LDL-C level in a high-fat intake population. Therefore, the plasma lipid profiles of apoE epsilon 4 carriers may be a risk factor of atherogenesis in Vietnamese, who tend to have a westernized eating habit.

The objective of this study was to describe a mass-immunization campaign of a locally-produced oral, killed whole-cell cholera vaccine in Hue city, Vietnam. Mass immunization with a 2-dose regimen of the vaccine was conducted in 13 communes in early 1998. The total, age- and sex-specific vaccine coverage was calculated using data from the vaccination records and the government census. The number of vaccine doses procured, administered, wasted, and left over, and the human and other resources required to prepare and conduct the vaccination campaign were systematically recorded. Government expenditure for planning, procurement, and delivery of the vaccine were documented. In total, 118,555 (79%) of the 49,557 targeted population were fully vaccinated during the mass-vaccination campaign. The total expenditure for the project was US dollar 105,447, resulting in a cost per fully-vaccinated person of US dollar 0.89. Mass immunization with this locally-produced oral, killed cholera vaccine was found to be feasible and affordable with attainment of high vaccination coverage.

In Vietnam, information about blood pressure, serum lipids and their factors is limited. To obtain some of this information, a cross sectional nutrition survey was carried out in an urban and rural area of Ho Chi Minh City with 217 participants aged 60-69 y (148 females and 69 males). Anthropometry and blood pressure were measured. For three consecutive weekdays, 24 h dietary recalls were performed. Single 24 h urine was collected for sodium and potassium analysis. A fasting blood sample was taken and biochemical parameters were measured. Results indicate a high percentage of hypertension in urban (female: 35.5%, male: 43.8%) and rural areas (female: 22.2%, male: 35.1%). Blood pressure was correlated with body mass index (BMI) and 24 h urinary sodium-to-potassium (Na/K) ratio. A high prevalence of serum total cholesterol (TC) above 220 mg/dL (female: 55.3%, male: 31.3%) and overweight (female: 34.2%, male: 25.0%) were observed in urban residents. By contrast, 5.6% and 24.3% of rural females and males respectively had TC below 150 mg/dL and both genders had the same prevalence of underweight (32.4%). TC was positively correlated with body weight, BMI, dietary protein and dietary lipids. Overweight might be a major risk factor for hypertension in our urban elderly. A high Na/K intake ratio might be a risk factor for hypertension in both areas. The high prevalence of elevated TC in the urban area might to be related to the high lipid intake, and the high prevalence of low TC in the rural area might to be related to the low lipid intake.

101 species of oribatid mites and 12 species of helminths--anoplocephalids, transmitted by these mites, were found out by Soviet-Vietnam studies in agroecosystems and tropical forests of northern and southern Vietnam. Helminths were recorded from graminivorous mammals as follows: horses, zebu, sheep, goats, buffaloes, deer, hares, elephant, 2 species of rates, 5 species of monkeys and 11 species of birds.