Group presentation one health zoonotic disease prioritization workshop

THE ONE HEALTH ZOONOTIC DISEASE PRIORITIZATION (OHZDP) WORKSHOP IN HANOI, VIETNAM

1. GROUP ASSIGNMENT 1: THE ONE HEALTH ZOONOTIC DISEASE PRIORITIZATION (OHZDP) WORKSHOP IN HANOI, VIETNAM

2. Contents

3. OneHealth in Vietnam - Viet Nam was one of the first countries in the region to adopt a multi-sectoral approach in 2003, which became an One Health approach in 2010 through the endorsement in the Ha Noi Declaration at the International Ministerial Conference on Animal and Pandemic Influenza. - One Health is the basis for the joint Circular number 16 on zoonotic diseases jointly issued by the Ministry of Agriculture and Rural Development (MARD) and the Ministry of Health (MOH) in 2013. - One Health is integrated in Viet Nam’s integrated National Plan on Avian Influenza, Pandemic Preparedness and Emerging Infectious Diseases (AIPED) for the period 2011-2015, - One Health has been applied to the control and prevention of SARS, HPAI H5N1, rabies, and Ebola virus disease in Viet Nam - Academic One Health curriculum was developed by the Viet Nam One Health University Network (VOHUN) - One Health partnership is going to be established based on the newly broadened mandate and scope of the existing Partnership for Avian and Human Influenza Prevention (PAHI). The Partnership will bring different sectors and disciplines together to identify potential public health risks related to zoonotic infectious diseases and to align and coordinate prevention and control actions. - Viet Nam’s strong commitment to fight highly pathogenic avian influenza (HPAI) is the major factor behind the success for containment of H5N1 disease.

4. Geographically, Hanoi is located at 21.0278° North latitude and 105.8342° East longitude. The capital is located adjacent to the following provinces: North: adjacent to Vinh Phuc and Thai Nguyen provinces. South: adjacent to Hoa Binh, Ha Nam. East: adjacent to Bac Ninh, Bac Giang, and Hung Yen. West: adjacent to Phu Tho. With an area of 3,359.82 km², Hanoi is the largest municipal city in Vietnam. Hanoi's population is about 8.4 million people, which is the second most populous city and has the second highest population density in Vietnam, but the population distribution is uneven. GEOGRAPHY AND POPULATION

5. ENVIRONMENT AND BIODIVERSITY Hanoi has several typical ecosystem types such as the hilly ecosystem in Soc Son and lake ecosystems, typically West Lake, agricultural ecosystems, urban ecosystems...

6. The flora and fauna in typical ecosystems of Hanoi are quite rich and diverse. Up to now, there have been statistics identified 655 species of higher plants, 569 species of large fungi (lower plants), 595 species of insects, 61 species of land animals, 33 species of reptiles and amphibians, 103 species of birds, 40 species of mammals, 476 species of floating plants, 125 species of aquatic animals, 118 species of fish, 48 species of introduced ornamental fish

7. Hanoi's river and lake system belongs to the Red River and Thai Binh River systems, unevenly distributed among regions One of the characteristic features of Hanoi's terrain is its many natural lakes and lagoons. However, due to urbanization requirements, many ponds and lakes have been leveled to make way for construction land. The remaining area of ponds, lakes and lagoons in Hanoi is about 3,600 hectares.

8. Hanoi has a total natural land area of 92,097 hectares, of which agricultural land accounts for 47.4%, forestry land accounts for 8.6%, and residential land accounts for 19.26%. Agricultural land Residential land

9. Socio-economic characteristics in Hanoi Hanoi focusing on agricultural production, industrial output, investment and business registration, trade and services, tourism, the consumer price index, and financial indicators such as state budget revenue and expenditures. The main points include positive trends in agricultural and livestock production, growth in industrial production, fluctuations in investment activities, significant foreign direct investment in Hanoi, changes in business registration, increased retail sales and service revenue, export and import turnover statistics, positive developments in transportation and tourism, changes in the consumer price index, and financial figures related to state budget and banking activities.

10. Executive summary The purpose of this 1-day workshop was to identify zoonotic diseases of provincial concern for Hanoi using a One Health approach with input from representatives of human health, animal health, and environmental sectors. In preparation for the workshop, representatives identified a list of zoonotic diseases relevant for Hanoi to prioritize. During the workshop, representatives refined the list of diseases for consideration, defined the criteria for prioritization, and determined questions and weights relevant to each criterion. Hanoi’s priority zoonotic diseases were identified using the One Health Zoonotic Disease Prioritization (OHZDP) Process, a mixed methods prioritization process developed and coordinated by the Hanoi Centers for Disease Control and Prevention (CDC). At the workshop, Hanoi prioritized the following five diseases: Rabies, Influenza A, JE, Dengue, Covid-19.

11. Common Zoonotics disease in Hanoi No Disease 1 Streptococcus Suis (S. Suis) 2 Rabies 3 Influenza A 4 Cholera 5 Dengue fever 6 COVID-19 7 Tuberculosis 8 Flukes 9 Malaria 10 MERS CoV 11 Pertussis 12 Japanese Encephalitis (JE)

12. Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis (M. tb), is one of the top 10 most deadly infectious diseases worldwide. The M. tb pathogen can easily be transmitted through air by coughing or sneezing. In 2019, it was estimated that 10 million people globally were infected with TB [1]. The World Health Organization (WHO) estimated that there were 172,000 TB incidence cases in Vietnam in 2022, which accounts for 178 cases per 100,000 population [2]. Hanoi is the capital of Vietnam, has a high proportion of the total TB cases reported in the country. In 2019, Hanoi detected and reported 4484 TB cases, amounting to 56 cases per 100,000 population. Because of the effects of the COVID-19 pandemic in 2021 and 2022, disease detection is challenging [3]. T he national conference to summarise the anti-tuberculosis program in 2023 and set plans for 2024, in the first nine months this year, the anti-tuberculosis program detected 78,674 cases of TB of different kinds, an increase of 1,909 compared with the same period last year (2%) and 19,214 compared with 2021 (32%) [4].

13. According to statistics at Vietnam's "World Tuberculosis Day 2023", up to 98% of drug-resistant tuberculosis patients face catastrophic costs - that is, costs for diagnosis and treatment. tuberculosis exceeds 20% of the household's annual income. Besides, up to 70% of people with TB are of working age, so TB is truly a problem that affects the economy of each family in particular and the country in general [5]. According to a study of 155,919 participants, in the context of rapid economic growth and equitable resource allocation in Vietnam, there has been a shift in the distribution of tuberculosis from being concentrated in poor households to being distributed among poor households. more evenly distributed among households of different SEPs. The study highlights the important contribution of shared resources to not only reduce poverty but also shift tuberculosis away from differentially impacting the poorest households [6].

14. Helminth infections are a serious public health problem, affecting about a quarter of the world's population, concentrated mainly in tropical and subtropical countries. Currently, people have identified over 100 types of roundworms and 140 types of worms capable of causing disease in humans. By 2020, according to WHO data, there will still be 1.5 billion people (equivalent to 24% of the world's population) infected with soil-transmitted helminths, distributed mainly in tropical and subtropical countries, especially Sub-Saharan regions, the Americas, China, and East Asia. There are over 267 million preschool children and 568 million school-age children in high-risk areas who need deworming and preventive measures. With diseases transmitted between animals and humans, mainly liver fluke larvae, lung flukes, tapeworms, and pork tapeworm larvae,... it is estimated that about 40 million people in the world are infected with trematodes and 100 million people are infected with tapeworms. The disease is closely related to dietary habits and livestock and poultry husbandry methods, ecological factors, and environmental sanitation. 2. Flukes

15. In Southeast Asian countries, fascioliasis is mainly detected in Thailand and Malaysia. However, in Vietnam there are many studies on the epidemiology and situation of fascioliasis in humans in the community. Many other types of parasites have caused disease in humans in Southeast Asian countries such as: Taenia solium tapeworm has been reported in Thailand, Laos, Cambodia, Indonesia and Vietnam (Willingham, 2010). Cysticercosis is found in Thailand and Vietnam. Fascioliasis due to Opisthorchis viverrini has been reported in Thailand, Laos, Cambodia, Vietnam, Malaysia, Singapore and the Philippines (Spira, 2010) with approximately 10 million people infected. Fascioliasis caused by Clonorchis sinensis is found in northern Vietnam in Southeast Asian countries, but this species is also found in Japan, Korea, China and Taiwan.

16. The Central Institute of Malaria, Parasitology, and Entomology (Ministry of Health) at the conference summarizing the prevention and elimination of malaria, parasites, and insects in 2019 showed that: the rate of small liver flukes in 2018 in Hoa Binh was 24.4%; Nam Dinh 11.8%; Ninh Binh 21%; Thanh Hoa 21.6%; Phu Yen 15.3%, Hanoi 20%. The general assessment is that 61% of people have the habit of eating salad infected with small liver flukes.

17. 3. Influenza A Influenza A is a contagious respiratory illness caused by influenza A viruses. These viruses belong to the Orthomyxoviridae family and are characterized by their enveloped, negative-sense, single-stranded RNA genome. Influenza A viruses are further classified based on the presence of specific surface glycoproteins, hemagglutinin (HA) and neuraminidase (NA), into various subtypes. The ability of influenza A viruses to undergo genetic reassortment results in the emergence of new strains, contributing to the virus's ongoing evolution and variability. NA (neuraminidase)

18. Influenza A Symptoms of Influenza A infection range from mild to severe and typically include fever, cough, sore throat, body aches, fatigue, and respiratory symptoms. In severe cases, complications such as pneumonia, bronchitis, and other respiratory distress syndromes can occur, leading to hospitalization or, in some cases, death. Certain populations, including the elderly, young children, pregnant women, and individuals with underlying health conditions, are at higher risk of severe outcomes.

19. Epidemiological characteristics of Influenza A Seasonal Patterns: - Influenza A displays a distinct seasonality, with seasonal epidemics occurring predominantly during the colder months in temperate climates. However, the virus can circulate year-round in tropical regions. - Seasonal patterns are influenced by factors such as temperature, humidity, and human behavior, impacting the virus's ability to spread. Transmission: - Influenza A is primarily transmitted through respiratory droplets produced when infected individuals cough, sneeze, or talk. - The virus can also spread by touching surfaces contaminated with the virus and then touching the face, especially the eyes, nose, or mouth.

20. Influenza A in global - It is estimated that annual epidemics of seasonal influenza cause 3–5 million cases of severe illness and 250,000–500,000 deaths worldwide. - Pandemics occurred in 1918, 1957 and 1968 with the emergence of H1N1 Spanish influenza, H2N2 and H3N2 respectively, and most recently in 2009, with the emergence of H1N1 from swine (H1N1 2009pdm) into the human population. - The great pandemic of 1918– 1919 was particularly severe, killing 20–40 million people as it spread over a few years.

21. Influenza A in Vietnam - Since 2003, influenza A/H1N1 has been causing outbreaks and deaths worldwide, especially in Asia, including Vietnam. - According to data from the World Health Organization, in Vietnam in 2017 there were 2,097 suspected cases of influenza, of which 545 were positive for H1N1. In 2018, as of October 10, there were 1,085 suspected cases of influenza, of which 154 were positive. calculated with influenza A/H1N1 - In the first 10 months of 2018, there were at least 7 cases of influenza A/H1N1 that died nationwide.

22. Influenza A in Vietnam ( con’t ) In 2015, H5N1 avian influenza outbreaks appeared in 18 communes and wards of 17 districts and towns in 11 provinces and cities (Ca Mau, Tra Vinh, Vinh Long, Soc Trang, Can Tho city, Dak Lak , Ha Tinh, Kom Tum, Nghe An, Ninh Thuan, Thanh Hoa). The number of sick poultry is 14,138, the number of poultry destroyed is more than 16,128.

23. Influenza A in Hanoi In the first 6 months of 2022, Hanoi recorded 2,605 cases of influenza, with no deaths recorded. If in the period from January to April, the number of cases was less than 400 cases/month, in May the number of cases raised to 556 cases, then in June it increased rapidly to 887 cases.

24. 4. Cholera Cholera is an acute diarrheal disease caused by Vibrio cholerae, a gramnegative , facultative anaerobe and comma-shaped bacteria. Although the cause of the disease was discovered in 1854 by John Snow through the famous cholera outbreak in London in the mid-19th century, and the cholera vaccines are already widely popularized around the world with high effectiveness, until now, cholera remains a re-merging infectious disease causing many consequences for humans in many regions

25. Epidemiological characteristics of Cholera Distribution of the disease: - Over two centuries, there have been seven cholera pandemics; the seventh is still running strong in 1961. Although the number of cases worldwide declined in the late 1990s, cholera is still a significant problem in Africa and Asia, accounting for 95,000 fatalities and 2.9 million illnesses yearly. - Cholera is a major cause of epidemic diarrhea in some parts of the world. Over the past few years, the WHO has continued to receive a significant number of reports of cholera cases. In 2022, 44 countries reported 472 697 cases and 2349 fatalities to WHO

26. Epidemiological characteristics of Cholera Chain of infection: - Reservoir (Vibrio cholerae): The primary reservoir for Vibrio cholerae is aquatic environments, especially brackish or estuarine waters. The bacteria can persist and multiply in these environments, serving as a source for infection. - Portal of Exit: Vibrio cholerae exits the reservoir through the feces of infected individuals. Contaminated fecal matter, when introduced into the environment, contributes to the contamination of water sources. - Transmission: Cholera is primarily transmitted through the ingestion of contaminated water or food. Consuming raw or undercooked seafood from contaminated waters is a common mode of transmission. Person-to-person transmission can occur, especially in crowded or unsanitary conditions. - Portal of Entry: The bacteria enter the human host through the oral route, typically by ingesting contaminated water or food. The oral cavity becomes a portal of entry for Vibrio cholerae, initiating infection in the digestive system.

27. Cholera in Vietnam In Vietnam, about 500,000 to 700,000 cases of acute diarrhea are reported every year. Cholera was first recorded in Vietnam in 1850 and was endemic before 1975 with hundreds of cases reported each year and very few deaths. In the early 1990s and early 2000s, several outbreaks occurred. The most recent outbreak occurred in late 2007-2008 with thousands of cases reported from 19 northern provinces, but no deaths. Since 2012, no case of cholera has been recorded in Vietnam. Cholera is a group A infectious disease and detailed case reporting is required within 24 hours of diagnosis.

28. 5. Dengue Dengue virus (DENV) belongs to the Flaviviridae family, which includes more than 70 major human disease-causing pathogens affecting mostly inter-tropical regions, where 3.9 billion people live [1]. It is an arboviral disease that is mostly transmitted to humans by the bite of mosquitoes, especially those of the Aedes genus, primarily by Aedes ( Stegomyia ) [2]. Dengue virus has four serotypes including DENV-1, DENV-2, DENV-3, and DENV-4 and all serotypes can cause human infection [3]. The primary DENV infection may be asymptomatic or results in mild fever, but if it becomes severe, it can cause coagulopathy, increased vascular fragility, and increased permeability; this condition is called dengue hemorrhagic fever (DHF), and after that, it may progress to hypovolemic shock, which is called dengue shock syndrome (DSS). These two diseases are life-threatening and be potentially fatal [4]. Most DF diseases are self-limited with a low mortality (< 1%) when detected early and provided with proper medical care. Some patients might develop severe diseases (including DHF/DSS) with a mortality rate around 2%− 5% after receiving treatment; when left untreated, the mortality rate is as high as 20% [5], [6]. Source: 1. M.Z. Yousaf, A. Siddique, U.A. Ashfaq, M. AliScenario of dengue infection & its control in Pakistan: An up—date and way forwardAsian Pac J Trop Med, 11 (1) (2018), p. 15View in Scopus [2]R.R. de Almeida, B. Paim, S.A. de Oliveira, A.S. Souza, A.C.P. Gomes, D.L. Escuissato , et al.Dengue hemorrhagic fever: a state-of-the-art review focused in pulmonary involvementLung , 195 (4) (2017), pp. 389-395 View PDF CrossRefView in Scopus [3]R. Rico- HesseMolecular evolution and distribution of dengue viruses type 1 and 2 in natureVirology , 174 (2) (1990), pp. 479-493View PDFView articleView in Scopus [4]P.K. Dash, M.M. Parida , P. Saxena, A. Abhyankar, C. Singh, K. Tewari, et al.Reemergence of dengue virus type-3 (subtype-III) in India: implications for increased incidence of DHF & DSSVirol J, 3 (1) (2006), pp. 1-10View article CrossRefView in Scopus [5]K.P. Jayawickreme , D.K. Jayaweera, S. Weerasinghe, D. Warapitiya , S. SubasingheA study on knowledge, attitudes and practices regarding dengue fever, its prevention and management among dengue patients presenting to a tertiary care hospital in Sri LankaBmc Infect Dis, 21 (1) (2021)https://doi.org/ARTN98110.1186/s12879-021-06685-5 [6]C. Guo, Z. Zhou, Z. Wen, Y. Liu, C. Zeng, D. Xiao, et al.Global epidemiology of dengue outbreaks in 1990–2015: a systematic review and meta- analysisFront Cell Infect Microbiol , 7 (2017), Article 317

29. Dengue Epidemiological survey indicates that DENV infection is spread to approximately two-fifths of the world's population, infecting nearly 390 million people annually, resulting in 500,000 hospitalizations and 20,000 deaths. It is mostly distributed in the Eastern Mediterranean, Southeast Asia, Africa, the Western Pacific, and South America. Approximately 2.5 billion people are at threat of contracting dengue, and the cases which are reported are 100 million of dengue fever each year, up to 500,000 go on to develop the infection's potentially fatal DHF or DSS. The majority of DHF and DSS cases are brought on by a subsequent viral infection with a different serotype or secondary infection. Currently, the reasons and mechanisms that lead to dengue severity and pathogenicity are not fully understood. The present knowledge indicates that several factors involved in virology and host immune system are correlated with DHF/DSS occurrence. In addition, the climate change also plays an important role in Aedes mosquitos’ distribution, subsequently having impact on DENV transmission. Combined, this information indicates that dengue incidence and development of severe dengue syndromes are complicated. Source: S. Bhatt, P.W. Gething , O.J. Brady, J.P. Messina, A.W. Farlow, C.L. Moyes , et al.The global distribution and burden of dengueNature , 496 (7446) (2013), pp. 504-507

30. Dengue In Vietnam, dengue is endemic in most provinces and cities, concentrated mainly in the southern provinces. From 2006 to 2010, the country recorded an average of about 100,775 cases and 96 deaths each year, and decreased in the period 2010-2012 with an average of about 94,686 cases and 50 deaths. In 2017 alone, a total of 184,741 cases of dengue fever were reported nationwide, including 32 deaths, much higher than previous years and recorded as the largest dengue epidemic in Hanoi's history. with about 38,000 patients recorded in 2017, much higher than the total cases during the 2009 pandemic The entire North region recorded 82,924 cases and 7 deaths from 2016 to 2020. The majority of cases were reported in Hanoi, followed by Nam Dinh, Hai Phong , Nghe An, and Ha Tinh , all of which had a high case count. These highly cases area were all big cities and provinces of Northern Vietnam with high population density, numourous apartments and houses with construction sites along. Source: 1. Hanoi Department of Preventive Medicine. Report Dengue in Hanoi, 2017. 2. Nguyen Minh Hai, Hoang Duc Hanh , and Nguyen Nhat Cam. Some epidemiological characteristics of the disease Dengue hemorrhagic fever in Hanoi in 2006- 2011. Journal of Preventive Medicine, 2013; 23(2): 4. 3. Anders K, et al. Epidemiological factors associated with dengue shock syndrome and mortality in hospitalized dengue patients in Cough Chi Minh City, Vietnam. The American Journal ofTropical Medicine and Hygiene, 2011; 84 (1): 34. Diagram of cases and deaths due to DF in Vietnam during the period 1980 to October 2021 (source: Department of Preventive Medicine - Ministry of Health)

31. 6. Covid 19 Coronaviruses are a large family of viruses that can cause illness in animals or humans. In humans there are several known coronaviruses that cause respiratory infections. These coronaviruses range from the common cold to more severe diseases such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19. There are three main ways that COVID-19 can spread: By breathing in air carrying droplets or aerosol particles that contain the SARS-CoV-2 virus when close to an infected person or in poorly ventilated spaces with infected persons By having droplets and particles that contain the SARS-CoV-2 virus land on the eyes, nose, or mouth – especially through splashes and sprays like a cough or sneeze By touching the eyes, nose, or mouth with hands that have the SARS-CoV-2 virus particles on them Individuals of all ages are at risk of SARS-CoV-2 infection. However, the probability of severe COVID-19 is higher in people aged ≥65 years, those living in nursing homes or long-term care facilities, those who are not vaccinated against COVID-19 or who have poor responses to COVID-19 vaccines, and those with certain chronic medical conditions. Data on comorbid health conditions among patients with COVID-19 indicate that patients with cardiovascular disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes with complications, neurocognitive disorders, and obesity are at increased risk of severe COVID-19. The risk appears to be higher in patients with multiple comorbid conditions. Other conditions that may lead to a high risk of severe COVID-19 include cancer, cystic fibrosis, immunocompromising conditions, liver disease (especially in patients with cirrhosis), pregnancy, and sickle cell disease. Transplant recipients and people who are taking immunosuppressive medications are also at high risk of severe COVID-19 Source: Centers for Disease Control and Prevention. Underlying medical conditions associated with higher risk for severe COVID-19: information for healthcare professionals. 2023. Available at:  https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html . Accessed November 13, 2023.

32. Covid 19 Globally, nearly 1.5 million new COVID-19 cases and over 2500 deaths were reported in the last 28 days (10 July to 6 August 2023), an increase of 80% and a decrease of 57%, respectively, compared to the previous 28 days. While five WHO regions have reported decreases in the number of both cases and deaths, the Western Pacific Region has reported an increase in cases and a decrease in deaths. As of 6 August 2023, over 769 million confirmed cases and over 6.9 million deaths have been reported globally. Currently, reported cases do not accurately represent infection rates due to the reduction in testing and reporting globally. During this 28-day period, 44% (103 of 234) of countries reported at least one case to WHO – a proportion that has been declining since mid-2022. As of November 15, 2023, there have been 11,619,990 total infections of coronavirus in Vietnam. At the moment, 10,639,962 patients have recovered. Vietnam has recorded 43,206 deaths related to the COVID-19 pandemic so far, most of which occurred during the current outbreaks in Ha Noi .  Source: 1. Status of COVID-19 cases in Vietnam 2023 Published by  Statista Research Department , Nov 15, 2023 2. Weekly epidemiological update on COVID-19 - 10 August 2023 - WHO

33. 7. Malaria A life-threatening disease spread to humans by some types of mosquitoes, does not spread from person to person. It is preventable and curable The first symptoms may be mild, similar to many febrile illnesses, and difficulty to recognize as malaria. Left untreated,  P. falciparum  malaria can progress to severe illness and death within 24 hours

34. Malaria: Human disease burden Infants, children under 5 years, pregnant women, travellers and people with HIV or AIDS are at higher risk of severe infection Over the last decade, Antimalarial drug resistance has emerged as a threat to global malaria control efforts in the Greater Mekong subregion A case fatality rate of between 0.01% and 0.40% was applied to the estimated number of P. falciparum cases, and a case fatality rate of between 0.01% and 0.06% was applied to the estimated number of P. vivax cases (Source: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/16#:~:text=A%20case%20fatality%20rate%20of,vivax%20cases . )

35. Malaria: Human disease burden in VN 12 million people living in malaria-endemic areas People infected with malaria are mainly poor people and ethnic people living in economically difficult areas, remote areas, and border areas (Source: https://baohiemxahoi.gov.vn/tintuc/Pages/hoat-dong-dang-doan-the.aspx?CateID=0&ItemID=14151&OtItem=date )

36. Malaria: Human disease burden in VN 2018: 5000 cases 2021: 467 cases The first 10 months of 2022: 424 cases The first 9 months of 2023: 354 cases (Source: https://moh.gov.vn/hoat-dong-cua-lanh-dao-bo/-/asset_publisher/TW6LTp1ZtwaN/content/het-nam-2022-du-kien-viet-nam-co-42-tinh-thanh-loai-tru-benh-sot-ret https:// vncdc.gov.vn/tang-cuong-cong-tac-phong-chong-sot-ret-nd17410.html )

37. Middle East Respiratory Syndrome Coronavirus (MERS- CoV ) Documented and theorized transmission directions of MERS- CoV between bats, camels and humans. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809235/

38. Middle East Respiratory Syndrome Coronavirus (MERS- CoV ) Caused by Middle East respiratory syndrome coronavirus (MERS‐ CoV ) that was first identified in Saudi Arabia in 2012 Virus transferred to humans from infected dromedary camels Human-to-human transmission is possible and has occurred predominantly among close contacts and in health care settings. It is not always possible to identify patients with MERS‐ CoV early or without testing because symptoms and other clinical features may be non‐specific. No vaccine or specific treatment are currently available (Source: https://www.who.int/health-topics/middle-east-respiratory-syndrome-coronavirus-mers#tab=tab_1 )

39. Middle East Respiratory Syndrome Coronavirus (MERS- CoV ) (Human impact) MERS- CoV has been identified in dromedaries in several countries in the Middle East, Africa and South Asia. In total, 27 countries have reported cases since 2012, leading to 858 known deaths due to the infection and related complications. Approximately 35% of MERS cases reported to WHO have died. No case reported in VN (Source: https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)?gclid=Cj0KCQiA1rSsBhDHARIsANB4EJbuygOaw2V7EdsWcLPzJ97gkdD3bJ3YXc_LJEJoyhUCFIt4b5j_-k0aAlgcEALw_wcB )

40. Middle East Respiratory Syndrome Coronavirus (MERS- CoV ) Countries with primary human MERS- CoV infections and MERS- CoV antibody and RNA detection in dromedary camels.

41. Middle East Respiratory Syndrome Coronavirus (MERS- CoV ) (Animal impact) Dromedary camels ( Camelus dromedarius ) have been confirmed to be the natural host and zoonotic source of the MERS- CoV infection in humans. Other species may be susceptible to infection with MERS- CoV . However, their epidemiological significance has not been proven. MERS- CoV has been associated with mild upper respiratory signs in some dromedary camels. While the impact of MERS- CoV on animal health is very low, human infections has a significant public health impact. (source: https://www.woah.org/en/disease/middle-east-respiratory-syndrome-mers/ )

42. 9. Streptococcus suis 1. Definition: Streptococcus suis infection, caused by the bacterium Streptococcus suis (S. suis), is a significant global economic concern and poses a risk to both pigs and humans. Human infection with S. suis is rare but can occur through contact with infected pigs or their products. Clinical manifestations in humans include meningitis, hemorrhage, pneumonia, myocarditis, and arthritis. Severe cases may lead to death due to bacterial toxins causing septic shock, endocarditis, multi-organ failure, and bacteremia. The mortality rate can reach up to 7%. Diagnosis in humans is challenging due to limited testing capabilities for identifying the specific type of S. suis causing the infection. Clinical case: Symptoms include high fever, headache, nausea, vomiting, ear ringing, deafness, stiff neck, consciousness disorders, and varied hemorrhages. Severe cases involve toxic shock, blood pressure drop, acute bacteremia, severe coagulation disorders, respiratory failure, multi-organ failure, coma, and death. Confirmed case: Diagnosed by isolating the S. suis pathogen (usually type II) from cultures (blood or affected tissues) or by serology and molecular biology methods (PCR). Ref: VNCDC

43. 2. Epidemiological characteristics: Streptococcus suis is found globally in pig farming regions. Up to 60%-100% of a pig herd can carry S. suis asymptomatically. Immunocompromised individuals and pigs are at higher risk of infection. S. suis mainly resides in the upper respiratory tract of pigs but can also be found in the gastrointestinal and genital tracts. It is identified based on the characteristics of polysaccharides in its capsular layer, with 35 serotypes identified, type II being the most common in human infections. The first human infection was detected in 1960. Approximately 490 human cases have been reported worldwide, with a 17.5% fatality rate. The disease has been reported in 17 countries, including the Netherlands, Denmark, Germany, Belgium, UK, France, Spain, Sweden, Australia, Hungary, Hong Kong, Croatia, Japan, Singapore, Taiwan, New Zealand, Argentina, and China. In Vietnam, the disease has been recognized since 2003, with a significant number of cases reported in recent years, including some fatalities. Epidemiological data on Streptococcus suis infections in Hanoi are quite specific. In a study conducted at the National Institute of Infectious and Tropical Diseases in Hanoi during the year 2007, there were notable findings regarding the incidence of S. suis. Out of 562 cerebrospinal fluid (CSF) specimens analyzed, 43 were positive for S. suis. This amounted to 7.7% of the specimens. When including blood culture positives, a total of 50 patients (8.9%) were confirmed to have S. suis infection. Most of these patients were older males, with the median age being 48 years. A significant proportion of the patients were farmers, and 32% had recent exposure to pigs or pork. The majority of the cases were reported during the summer months of May to July.

44. 10. Rabies Rabies is an acute viral infection of the central nervous system transmitted from animals to humans through saliva, typically via bites or licks from rabid animals. The disease progresses through pre-symptomatic stages, with symptoms like fear, headache, fever, and pain at the site of infection, to encephalitis marked by insomnia, hypersensitivity, and autonomic nervous system disorders. Rabies can manifest in two forms: paralytic (ascending paralysis) and furious. The disease usually lasts 2-6 days and can be fatal due to respiratory paralysis. Diagnosis is based on clinical symptoms, especially hydrophobia, aerophobia, and photophobia, in conjunction with epidemiological factors. Definitive diagnosis is achieved through immunofluorescent antibody testing (IFA) on brain tissue or virus isolation in mice or cell culture systems. Modern techniques like PCR can detect rabies virus RNA. The causative agent is the rabies virus (Rhabdovirus) from the Rhabdoviridae family, genus Lyssavirus. The virus is bullet-shaped, with one rounded and one flat end, and has an average length of 100-300 nm and a diameter of 70-80 nm. It contains RNA and is enveloped in a lipid bilayer, making it sensitive to lipid solvents. Rabies is easily inactivated at temperatures of 56°C for 30 minutes, 60°C for 5-10 minutes, and 70°C for 2 minutes. The virus can survive in cold conditions (4°C) for weeks to 12 months and below 0°C for 3-4 years. There are two strains of the rabies virus: street rabies virus, found in sick animals, and fixed rabies virus, used in vaccine production. References: VNCDC

45. Epidemiological characteristics: Globally, rabies is widespread with over 10 million people receiving post-exposure vaccinations annually, and 60,000-70,000 deaths, mostly in tropical regions. In Europe, rabies primarily occurs in countries like Germany, Austria, Switzerland, France, Turkey, Poland, Czech Republic, and Hungary, with widespread infection in foxes. In Viet Nam: On average, the country records 75 rabies-related deaths each year. From the beginning of the year to August 31, the nation has recorded 60 rabies-related deaths in 26 provinces and cities (an increase of 17 cases compared to the same period in 2022). In Ha Noi: In 2022, the city recorded one rabies-related death in Phú Xuyên district due to neglect in getting vaccinated after a dog bite, and another death due to rabies in Mê Linh district involving a person who participated in dog slaughtering. Since the beginning of 2023, although Hanoi has not recorded any human cases of rabies, there has been an outbreak among dogs in Liễu Trì village, Mê Linh commune, Mê Linh district, and six people have been bitten by rabid dogs. Subsequently, all these individuals received timely rabies vaccinations. .

46. 11. Pertussis (Whooping cough) 1. Definition: Pertussis, also known as whooping cough, is a highly contagious respiratory infection caused by Bordetella pertussis. Pertussis spreads easily from person to person mainly through droplets produced by coughing or sneezing. The disease is most dangerous in infants and is a significant cause of disease and death in this age group. The first symptoms generally appear 7 to 10 days after infection and include a mild fever, runny nose, and cough, which in typical cases gradually develops into a hacking cough followed by whooping. Pneumonia is a relatively common complication, and seizures and brain disease occur rarely. People with pertussis are most contagious up to about 3 weeks after the cough begins, and many children who contract the infection have coughing spells that last 4 to 8 weeks. Antibiotics are used to treat the infection. Ref: World Health Organization (WHO). (2021). Pertussis. Retrieved from: https://www.who.int/health-topics/pertussis#tab=tab_1

47. 2. Epidemiological characteristics: Although pertussis has a preventive vaccine, the disease is still not completely controlled and can be fatal. In 2018, The World Health Organization (WHO) reported 151,074 cases worldwide; in 2019, the coverage rate of the Diphtheria-Pertussis-Tetanus (DPT) vaccine for the third dose reached only 85% [2]. In Vietnam, after many years of DPT vaccination, the incidence and mortality rates of pertussis have decreased significantly. The annual incidence rate ranges from 0.059 to 1.78 per 100,000 people. After a decrease in 2004, the reported cases have been increasing since 2015. By the end of 2019, Vietnam recorded 1,227 cases of pertussis and 1 death. Compared to 2018, the incidence rate was 0.43 per 100,000 people (676 cases, 2 deaths), representing an 81.5% increase in the number of cases. Ref: Mạnh, N. V., & Diệu, B. T. H. (2021). KIẾN THỨC, THỰC HÀNH VÀ CÁC YẾU TỐ LIÊN QUAN VỀ PHÒNG CHỐNG BỆNH HO GÀ CỦA CÁC BÀ MẸ CÓ CON DƯỚI 5 TUỔI TẠI TỈNH NAM ĐỊNH NĂM 2020.  Tạp Chí Y Học Việt Nam ,  506 (1). https://doi.org/10.51298/vmj.v506i1.1213 TỔNG QUAN CHẨN ĐOÁN VÀ ĐIỀU TRỊ BỆNH HO GÀ . (n.d.). https://tcnhikhoa.vn/index.php/tcnk/article/view/12/4

48. 12. Japanese encephalitis (JE) Japanese encephalitis virus (JEV) is a flavivirus related to dengue, yellow fever, and West Nile viruses, and is spread by mosquitoes. JEV is the main cause of viral encephalitis in many countries of Asia with an estimated 68,000 clinical cases every year. Although symptomatic Japanese encephalitis (JE) is rare, the case-fatality rate among those with encephalitis can be as high as 30%. Permanent neurologic or psychiatric sequelae can occur in 30%–50% of those with encephalitis. 24 countries in the WHO South-East Asia and Western Pacific regions have endemic JEV transmission, exposing more than 3 billion people to risks of infection. There is no cure for the disease. Treatment is focused on relieving severe clinical signs and supporting the patient to overcome the infection. Safe and effective vaccines are available to prevent JE. WHO recommends that JE vaccination be integrated into national immunization schedules in all areas where JE disease is recognized as a public health issue. The first case of Japanese encephalitis viral disease (JE) was documented in 1871 in Japan. The annual incidence of clinical disease varies both across and within endemic countries, ranging from <1 to >10 per 100,000 population or higher during outbreaks. A literature review estimates nearly 68,000 clinical cases of JE globally each year, with approximately 13,600 to 20,400 deaths. JE primarily affects children. Most adults in endemic countries have natural immunity after childhood infection, but individuals of any age may be affected. References: World Health Organization (WHO). (2021). Japanese encephalitis. Retrieved from https://www.who.int/news-room/fact-sheets/detail/japanese-encephalitis

49. 2. Epidemiological characteristics: Currently, there is no specific antiviral drug for Japanese encephalitis, and the treatment method aims to reduce symptoms. The use of mosquito nets and insect repellents can help minimize the risk of infection, but vaccination is still considered the most effective measure for disease prevention, reducing serious JE symptoms, and the mortality rate. The GMDP – MOH stated that before the Japanese encephalitis vaccine, Jevax was implemented in the National Expanded Immunization Program, JEV used to be the cause of approximately 25-30% of encephalitis cases requiring hospitalization, with many fatalities. Currently, this rate has decreased (to less than 10%) after years of vaccination implementation for children within the age group, with a high vaccination coverage rate being maintained. References: VnExpress . Điều gì xảy ra khi mắc viêm não Nhật Bản ?  vnexpress.net . https://vnexpress.net/dieu-gi-xay-ra-khi-mac-viem-nao-nhat-ban-4609658.html. Published June 26, 2023.

50. Ha Noi Zoonostic Workshop Province/ City: Hanoi (The capital, densely populated, crowded and complex economic and social transactions, prone to many epidemic risks) Conference venue: Fortuna Hotel, No. 6B Lang Ha, Ba Dinh, Hanoi (Because international agencies, Ministries and organization of Hanoi are concentrated in Ba Dinh District and surrounding areas, creating travel conditions for delegates expression) Time: The beginning of the first quarter of 2024 (This time begins the new year, every organization will review and start the plan of activities)

51. Ha Noi Zoonostic Workshop Participants: Refer to one of Onehealth's partner framework agreements  International: World Health Organization, US CDC, United Nations, ADB, World Bank, International Livestock Research Institute, Center for International Cooperation in Agricultural Research, French Development Agency, FAO... Ministry of Health: Ministry leaders, Department of Preventive Medicine, Department of Medical Examination and Treatment Management, Department of Food Safety, Department of International Cooperation Ministry of Agriculture and Rural Development: Ministry Leaders, Department of Animal Husbandry, Department of Animal Health, International Cooperation Associations: Farmers Association, Veterinary Association, Livestock Association, Red Cross Association, Public Health Association University: Hanoi Medical University, University of Public Health, Center for Public Health and Ecosystem Research, Institute of Preventive Medicine and Public Health Training, VOHUN Network Departments of Hanoi: Hanoi Department of Health, Department of Agriculture Press: Health and Life Newspaper, Vietnam Agriculture Newspaper, Dan Tri Newspaper, VN Express Newspaper Co-chair: Leaders of the Ministry of Health and the Ministry of Agriculture and Rural Development Co-coordinator: Hanoi Department of Health and Hanoi Department of Agriculture Scientific Advisory Council: Representatives of Universities and VOHUN

52. Ha Noi Zoonostic Workshop Implementation and logistics organization: VOHUN Office coordinates with the Planning Department of Hanoi Department of Health and Hanoi Department of Agriculture: - Create a conference program - Invite leaders to preside - Select a reporter and invite the scientific council to advise - Invite partners to develop a set of evaluation criteria - Develop spending and logistics plans (Documents, travel, per diem, stationary...) - Send invitations and confirm participation of delegates - Coordinate with event organizers to coordinate seminars - Preparation time: 4 months before the Conference

53. Ha Noi Zoonostic Workshop   Content Implementer Morning     07:00 – 07:15 Register delegates   07:15 – 07:45 Opening speech by Hanoi Department of Health Introducing the Conference program Leader of the Ministry of Agriculture Leader of the Ministry of Health Leader of Hanoi Department of Health 07:45 – 09:00 Report of the World Health Organization on the situation of International Zoonotic diseases WHO 09:00 – 09:30 Report of the Ministry of Health Department of Preventive Medicine Department of Medical Examination and Treatment Management 09:30 – 10:00 Report of the Ministry of Agriculture Department of Livestock Department of Veterinary Medicine 10:00 – 10:15 Breaks   10:15 – 11:00 Report of Hanoi Department of Health Hanoi Health Department 11:00 – 11:30 Report of Hanoi Department of Agriculture Hanoi Department of Agriculture Lunch The delegates had lunch at the hotel   Afternoon     13:30 – 14:15 Presenting the set of criteria and methods for selecting priority issues VOHUN 14:15 – 15:00 Delegates participate in scoring selections based on criteria Whole conference 15:00 – 15:10 Publish the result VOHUN 15:10 – 16:00 Discuss and adjust Whole conference 16:00 – 16:15 Agree the final result VOHUN 16:15 – 16:30 Conclusion and closing of the conference Hanoi Health Department Suggested Program

54. Ha Noi Zoonostic Workshop No. Description Used items   Used Frequency     Unit cost (VND) Total amount (VND) Unit Q’ty Unit Q'ty   1-Day Workshop (Hanoi)             102,700,000 2 Equipment and meeting hall day 1 set 2   5,000,000 10,000,000 3 Banner, internet and sound set 1 set 1   2,000,000 2,000,000 5 Printing and photocopied materials set 50 set 2   40,000 4,000,000 6 Stationary set 50 set 2   35,000 3,500,000 7 Fee for organizers person 5 day 1   500,000 2,500,000 8 Fee for facilitators person 6 day 1   700,000 4,200,000 9 Lunch for local participant (donors, NGOs, experts and related minitries, branches…) person 50 day 1   350,000 17,500,000 10 Fee for reporter person 7 day 1   2,000,000 14,000,000 11 Perdiem for participants person 50 day 1   500,000 25,000,000 12 Document build person 10 day 1   2,000,000 20,000,000 Estimated cost

55. Workshop methods Use One Health Zoonotic Disease Prioritization tool to prioritize endemic and emerging zoonotic diseases https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109986

56. Step 1: Prepare for Group work FACILITATORS: 3 persons Representatives from human, animal, and environmental health sectors serve as neutral, trained facilitators for the workshop. VOTING MEMBERS: 6 voting members Equal representation of government staff from One Health sectors actively involved in zoonotic disease prevention and control. Voting members represent the following sectors: Human health/public health: 1 Agriculture/livestock: 1 Wildlife (fisheries): 1 Environment (forestry, land management): 1 Hanoi’s People Committee: 1 University: 1

57. Step 1: Prepare for Group work ADVISORS: 15 advisors Key partners and stakeholders who provide advice and expertise to voting members and support post-workshop collaborative activities. Advisors represent the following organizations that are involved in zoonotic disease work: Other government sectors not directly involved in zoonotic disease work (HN Department of education and training, Ministry of finance) International organizations (WHO, FAO, ILRI, USAID, GIZ, WWF) Key academic partners or university networks (HMU, HUPH, VNUA) Non-governmental institutions (VOHUN, CCRD, CCIHP, PHAD)

58. Step 2: Develop the criteria 6 stakeholder representatives meet to brainstorm and develop a list of criteria that will be used to define what qualifies a zoonosis as being important. Five criteria are agreed upon through moderated discussion, but not ranked. Criteria 1: Intervention Ability Criteria 2: Severity of Disease Criteria 3: Economic Burden Criteria 4: Response Capacity Criteria 5: Transmissibility (Source: https://www.cdc.gov/onehealth/what-we-do/zoonotic-disease-prioritization/completed-workshops.html)

59. Step 3: Develop the Questions 6 stakeholder representatives meet to brainstorm and develop questions for each criteria These questions based on the reports for OHZDP in CDC website (Source: https://www.cdc.gov/onehealth/what-we-do/zoonotic-disease-prioritization/completed-workshops.html)

60. Step 3: Develop the Questions Criteria Question Answer (score) Criteria 1: Intervention Ability (0.2) Is there a vaccine or treatment available for humans or animals? None (0) Only humans (1) Only animals (2) Both humans and animals (3) Criteria 2: Severity of Disease (0.41) What is the human Case Fatality Rate of the disease? <5% (0) 5 - <10% (1) 10 - <50% (2) 50 - 100% (3) Criteria 3: Economic Burden (0.14) What is the economic loss in livestock? The disease agent has: <5% CFR in animals, <20% production loss (0) <5% CFR in animals, ≥20% production loss (1) >5% CFR in animals, <20% production loss (2) >5% CFR in animals, ≥20% production loss (3) Criteria 4: Response Capacity (0.11) Is there an established surveillance system in place in Vietnam? None for animals, none for humans (0) Yes for animals, none for humans (1) None for animals, yes for humans (2) Yes for animals, yes for humans (3) Criteria 5: Transmissibility (0.14) What is the human-to-human disease transmission potentiality? The disease agent has: No potential for human-to-human transmission (0) Rare human-to-human transmission (1) Sustained human-to-human transmission (2)

61. Step 4: Rank the Criteria 6 voting member rank criteria in their preferred order. Individual rankings are combined to produce a combined ranked list of criteria. CRITERIA KHANH THUY PHUONG TRUNG MINH HUONG SUMMARY RANK WEIGHT Criteria 1: Intervention Ability 2 2 2 2 1 2 11 2 0.2 Criteria 2: Severity of Disease 1 1 1 1 2 1 7 1 0.41 Criteria 3: Economic Burden 3 5 4 4 3 3 22 3 0.14 Criteria 4: Response Capacity 5 4 5 5 4 5 28 5 0.11 Criteria 5: Transmissibility 4 3 3 3 5 4 22 3 0.14

62. Step 5: Rank the Zoonoses Score each zoonotic disease by answering the categorical questions. The ranked zoonotic disease list from the OHZDP Tool is used to facilitate discussion among the participants to finalize the priority zoonotic disease list.

63. Step 5: Final results of OHZDP workshop in Hanoi No Disease Average score Rank # 1 Streptococcus Suis (S. Suis) 1.14 7 2 Rabies 2.44 1 3 Influenza A 1.63 2 4 Cholera 0.70 9 5 Dengue fever 1.20 4 6 COVID-19 1.20 4 7 Tuberculosis 1.11 8 8 Flukes 0.22 12 9 Malaria 0.42 11 10 MERS CoV 1.17 6 11 Pertussis 0.48 10 12 Japanese Encephalitis (JE) 1.24 3

64. Recommendation: 1. Coordination and Communication - Collaboration across sectors is essential, and joint programs should be developed with formalized implementation plans. - The action plans of each department should prioritize specific diseases and incorporate project preparation and routine work accordingly. - Utilization of existing resources, including laboratory facilities, surveillance systems, and outbreak investigation, should be directed towards these collaborative activities. - Focal points within each sector will be responsible for establishing the necessary linkages between the sectors. - Strong coordination is required at all levels, from top-level management to the grassroots level. - Effective communication with policy makers is crucial for successful implementation. - Advocacy for prioritized zoonotic diseases, using a One Health approach, will be important for securing additional funding from donors such as the World Bank, CDC, USAID, JICA, and ADB.

65. 2. Prevention and Control Departments should collaborate to gather evidence and compile data on the prioritized zoonotic diseases. For certain diseases (e.g., brucellosis and zoonotic tuberculosis), there are knowledge gaps, and it is necessary to generate evidence across all sectors. Standard procedures should be put in place to conduct joint outbreak investigations. Mechanisms should be established to facilitate information sharing among organizations. Enhance the advocacy for expanded vaccination for children and vaccination against influenza A, Japanese encephalitis, and Covid-19 for adults.

66. 3. Training: A skilled workforce should be cultivated to tackle the prioritized diseases in every sector. A curriculum focused on One Health will be established to educate students and young professionals about collaboration across sectors. Alongside the One Health curriculum, all sectors should train and involve the next generation in One Health activities, including joint outbreak investigations, response, and disease surveillance.

67. References: 1. World Health Organization.  Global Tuberculosis Report 2020.  Geneva: World Health Organization; 2020. Available in: https:// iris.who.int /bitstream/handle/10665/336069/9789240013131-eng.pdf?utm_medium= email&utm_source =transaction 2. World Health Organization. Tuberculosis profile: Viet Nam; 2022. A vailable in: https://worldhealthorg.shinyapps.io/tb_profiles/?_inputs_&entity_type=%22country%22&iso2=%22VN%22&lan=%22EN%22 3. Cổng thông tin điện tử Chính phủ. "Phấn đấu giảm số người mắc bệnh lao xuống dưới 45/100.000 dân". March 24, 2023. Available in: https://thanglong.chinhphu.vn/phan-dau-giam-so-nguoi-mac-benh-lao-xuong-duoi-45-100000-dan-103230324161225577.htm 4. Báo Điện tử Chính phủ . Bệnh lao đang tăng trở lại ; December 22 , 2023. Available in: https://baochinhphu.vn/benh-lao-dang-tang-tro-lai-102231222175147027.htm 6. Foster N, Nguyen HV, Nguyen NV, Nguyen HB, Tiemersma EW, Cobelens FGJ, Quaife M, Houben RMGJ. Social determinants of the changing tuberculosis prevalence in Việt Nam: Analysis of population-level cross-sectional studies. PLoS Med. 2022 Mar 18;19(3):e1003935. doi : 10.1371/journal.pmed.1003935. PMID: 35302998; PMCID: PMC8932606.