WO RLD HEALTH ORGANIZATION Global Task Force on Cholera Control CHOLERA COUNTRY PROFILE: VIETNAM Last update: 25 November 2008

General Country Information: The Socialist Republic of Vietnam is located in the Indochina peninsula in southeast Asia. It shares borders with China, Laos and Cambodia with an east coast along the South China Sea. Viet Nam is divided into 59 provinces (known in Vietnamese as tỉnh) and 5 centrally-controlled municipalities. Hanoi is its capital but the largest city is Ho Chi Minh City.

Vietnam became a French colony in 1951. Between 1959 and 1975, a war was fought between the communist North Vietnam, supported by its communist allies, and South Vietnam, supported by the United States and others. In 1976, north and south Vietnam were reunified and the Socialist Republic of Vietnam was declared.

Even though the number of military and civilian deaths from 1959 to 1975 is debated, the overall casualties were counted in millions.

In 1986, economic and political reforms began a path towards international reintegration and by 2000, it had established diplomatic relations with most nations. In the past decade, its economic growth has been among the highest in the world. Vietnam is currently ranked 105 in the Human development Index.

Cholera Background History: Very few cases were reported between 1950 and 1954. The arrival of the seventh pandemic in Indonesia in 1961 introduced V. cholerae 01 El Tor in South Vietnam (1964) with an outbreak accounting for 20'186 cases and 872 deaths (case fatality rate 4.3%). Since then cholera was rarely reported in North Viet Nam until 1976. 1992 was marked by the emergence of the 0139 serogroup in Southeast Asia. Between 1992 and 1996, an average of 4000 cases were reported yearly with an average CFR of 1%.

Cholera in 2007: Between 23 October and 16 November 2007, 1880 cases of acute watery diarrhoea were reported including 240 laboratory confirmed cases. (V. Cholerae O1 Ogawa) in 14 provinces. No death were reported. The affected provinces were Bac Ninh, Ha Nam, Hanoi, Ha Tay, Hai Duong, Hai Phong, Hung Yen, Nam Dinh, Nghe An, Phu Tho, Thai Binh, Thanh Hoa, Vinh Phuc, Thai Nguyen. The origin of the outbreak, occurring in Ha Noi and its neighbouring provinces, remained unclear but it could not be linked to a single water source or contaminated food product. The spread of the disease to 14 provinces was most likely driven by the movement of sick or asymptomatic persons. The risk was higher in communities with poor sanitation and hygiene practices. The flooding had left rural and slum communities more vulnerable.

Popular tourist areas were affected but no case of tourist infection could be confirmed. Cross border population movement between Vietnam and its neighbouring countries Thailand, Lao and Cambodia was addressed as an international transmission risk and measures were taken to their respective MoHs.

Cholera in 2008: Viet Nam - Officially notified cholera cases Between 5 March and 22 April 2008, Vietnam 1950 - 2007 reported 2490 cases of severe acute watery 25000 100.0 Cases diarrhoea (including 377 that were positive for Deaths 90.0 V. cholerae ) in 20 provinces. The majority of CFR% 20000 80.0 cases were found among Hanoi residents. The serotype has been identified as 01 70.0 Ogawa. No death were reported indicating 15000 60.0 good case management. The predominant 50.0 CFR% route of infection appeared to be consumption 10000 40.0 of contaminated food. The bacteria have not Nb andof deaths cases been detected in drinking water in Hanoi or in 30.0 other affected areas but have been found in 5000 20.0 some surface waters. 10.0

0 0.0 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

1 of 2 WO RLD HEALTH ORGANIZATION Global Task Force on Cholera Control CHOLERA COUNTRY PROFILE: VIETNAM Last update: 25 November 2008

Acute diarrhea in Viet nam, 2007

250 2500

216 209 196 200 New case 2000 Cumulation 165 162 146 150 1500 122

100 1000 86 90 90 70 71 64 52 54 50 500 29 23 21 12 15 9 9 9 8 8 5 0 1 0 4 0 0 t v v v v v v v v v v v v ct ct ct ov ov -O -Oc -Oct -O -O -Oct -Nov -Nov -No No No -Nov -Nov -No No No N -Nov -No No No N -Nov -No No No 4 5 9 0 2 3 7 8 2 3 7 8 23 2 2 26-Oct27-Oct28 2 3 31-Oct01 0 0 04- 05- 06 0 0 09- 10- 11- 1 1 14- 15- 16- 1 1 19- 20- 21-Nov

WHO Support Actions in 2006/2007:

• Intensive technical and logistic support provided to the Ministry of Health • Case control study in collaboration with the CDC Atlanta • Provision of 2000 Rapid diagnostic Tests

Demographic and Socio-Economic Data Geography Total surface 329 560 km2 (coastline of 3 444km) Capital Hanoi (population: 3 398 889 in 2007) Provinces 59 and 5 municipalities Official Language Vietnamese Environment Climate Tropical in south, monsoonal in north Seasons Rainy season from May to September, dry season from October to March Floods and droughts Occasional typhoons (May to January) with extensive flooding, especially in the Mekong River delta Desertification Agricultural practices contribute to deforestation and soil degradation Natural resources Phosphates, coal, manganese, bauxite, chromate, offshore oil and gas deposits, forests, hydropower Demographics Population 85,262,356 (July 2007) Religions Buddhist 9.3%, Catholic 6.7%, Hoa Hao 1.5%, Cao Dai 1.1%, Protestant 0.5%, Muslim 0.1%, none 80.8% Ethnic groups Kinh (Viet) 86.2%, Tay 1.9%, Thai 1.7%, Muong 1.5%, Khome 1.4%, Hoa 1.1%, Nun 1.1%, Hmong 1%, others 4.1% Migrants 2 357 refugees from Cambodia (2005) Economy Industry Food processing, garments, shoes, machine-building; mining, coal, steel; cement, chemical fertilizer, glass, tires, oil, paper Farming Paddy rice, coffee, rubber, cotton, tea, pepper, soybeans, cashews, sugar cane, peanuts, bananas; poultry; fish, seafood Health Per capita total 184$ Indicators expenditure on health Life expectancy birth (yrs) Males: 69 Females: 75 (2006) Child mortality (per 1000) Males: 17 Females: 16 (2006) Number of physicians 44'960 (1 MD/1896 hab.) Communicable Food or waterborne diseases: bacterial diarrhoea, hepatitis A, and typhoid fever Diseases Vector borne diseases: dengue fever, malaria, Japanese encephalitis, and plague are high risks in some locations Between 2003 and 2007, 100 cases of H5N1 avian influenza among which 46 have been fatal HIV prevalence (2005): 0.015% Risk Factors Population with access to improved water source 98% (urban) 90% rural (2006) for Cholera Population with access to proper sanitation facilities 88% (urban) 56% rural (2006) Chronic Malnutrition 16% (2002-2004)

The Cholera Task Force country profiles are not a formal publication of WHO and do not necessarily represent the decisions or the stated policy of the Organization. The presentation of maps contained herein does not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or areas or its authorities, or concerning the delineation of its frontiers or boundaries.

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