Applied Epidemiology in the Vietnamese context

Abstract

This thesis outlines the projects I conducted to address the requirements of the Master of Applied Epidemiology Program (MAE). My field placement was undertaken at the Department of Communicable Disease Control and Prevention of the National Institute of Hygiene and Epidemiology (NIHE) in Hanoi, Vietnam.

Chapter 1 - Introduction: This chapter provides an overview of my field placement, describes how I met the MAE requirements and discusses other side projects I was involved in during my MAE in addition to the MAE competencies.

Chapter 2 - Investigation of an outbreak: I investigated an avian influenza H5N1 outbreak of a single case in a 4-year old female patient in Phu Tho, Vietnam. The investigation did not identify any additional human cases among 67 community contacts or among animals from five environmental and animal samples. However, my findings suggest a risk of disease transmission due to backyard poultry raising, free-ranging poultry, and lack of vaccination. I presented this project as an oral poster at the Communicable Disease and Immunisation Conference 2023 (CDIC2023) in Perth, Western Australia (Conference presentation 1), and delivered a long oral presentation at the 13th International Conference on Public Health among the Greater Mekong Subregion countries (GMS13) in Vietnam (Conference presentation 2).

Chapter 3 - Analyze a public health dataset: I analysed data for 2056 measles patients diagnosed as laboratory confirmed-cases at the National Children's Hospital in Hanoi from 2017 to 2019. The results provided evidence of measles transmission in the hospital setting, particularly among unvaccinated pediatric patients. Coinfections with other agents including adenovirus, respiratory syncytial virus, and pertussis were statistically significant among patients in the hospital acquisition group. I presentated this research at CDIC2023 (Conference presentation 3) and GMS13 (Conference presentation 4).

Chapter 4 - Evaluate a surveillance system: I completed an evaluation of the Japanese Encephalitis (JE) surveillance system in Son La province, Vietnam (2016 to 2022), assessing its four main attributes: simplicity, data quality, flexibility, and sensitivity. I used the Vietnam National Electronic Disease Surveillance System (NEDSS) including the JE surveillance as the basis for evaluation. I found that data quality required improvement, especially in updating disease diagnoses post-laboratory testing, and NEDSS sensitivity stayed below 75%, necessitating solutions for better community-based surveillance and data quality at lower levels. Solutions to enhance community-based active surveillance and data quality at lower levels were recommended.

Chapter 5 - Design and conduct an epidemiological study: For my epidemiological research project I completed a time series analysis to examine historical trends and predict future measles outbreaks in Vietnam. I utilised available reported data collected from yearbooks and official reports nationwide over a 20-year period from 2003 to 2022. The analysis revealed that measles cases in Vietnam fluctuated over the period, with seasonal variation and occasional nationwide outbreaks. The data indicated a potential 4 to 5-year periodicity for measles epidemics in the country between 2003 and 2022, with the most recent epidemic occurring in 2018-2019.

Chapter 6 - Other MAE requirements: In this chapter, I report on additional MAE requirements I completed during my fellowship, including publishing a Lay Audience Report targeted at readers of the Health & Lifestyle journal, an official press outlet of the Vietnam Ministry of Health; presenting my Lesson From The Field on using QGIS to my MAE cohort, and my Teaching Experience of QGIS to Vietnamese students.