DAP 1>NG PHONG CHONG D|CH CUA HE THONG GIAM SAT BENH TRUYEN NHIEM TAI VIET NAM , 2009 Phan Trong Lan, Le Trung Kien , Vii Ngoc Long, Nguyen Minh Hang Bp Yte TOM TAT Nghien ciru ducrc tien hanh bang phucng phap mo ta cat ngang nam 2009 vcVi muc tieu danh gia th trang dap irng phdng chong dich (PCD) cua he thdng giam sat benh truyen nhiem tir tuyen tinh den trung uong Ket qua nghien ciru cho thay: he thdng giam sat benh truyen nhiem da dupe thiet lap, pha cap tir trung ucng tdi tuyen khu vuc, tuyen tinh, tuyen huyen, xa va hoat dpng cd hieu qua Chat lupng giam sat tai cac tuyen cdn chua ddng deu Viec phan hdi bao cao cdn chua dupe tai tuyen tinh, huyen c thap (30-50%) Quan ly va phan tich so lieu chii yeu tai tuyen Trung ucng va khu vuc (10% can bp tu huyen cd kha nang phan tich sd lieu) Ngudn luc phuc vy cho GS cdn chua dap irng dupe nhu cau ta ca cac tuyen, dac biet la tuyen tinh, huyen Trang thiet bi, nhan luc cho xet nghiem tai tuyen khu vuc tu doi hoan chinh Tuy nhien, tuyen tinh va huyen can dupe dau tu manh me han nua, dac biet la nang cua cac can bp xet nghiem(ty le can bp xet nghiem tuyen huyen, tuyen tinh dupe dao tao chuyen nganh thap tir 40-60%) Tir khoa: Giam sat (GS), Phong chong dich (PGD), Benh truySn nhiim (BTN) I DAT VAN DE ciru duoc thuc hien vdi muc tieu: Md ta thuc trang dap irng phdng chdng djch (PCD) Trong thdi gian qua, tren the gidi ciing cua he thdng GSBTN tu tuyen tinh den tuyen nhu tai Viet Nam tinh hinh benh djch dien bien Trung uang Dd lit co sd khoa hoc de phan cang phirc tap nhieu benh truyen nhiem tich dua nhung kien nghj nham hoan thien, (BTN) giiy djch cd nguy co biing phat trd lai tang cudng kha nang giam sat benh ciia he nhu lao, sdt xuat huy et benh dudng rudt, viem thdng GSBTN giai doan hien nao vi rut Ben canh dd cung xuat hien nhieu benh mdi ndi chua kiem soat duoc, cd II PHlTONG PHAP NGHIEN CUU nguy co biing phat dai djch nhu SARS, 2.1 Vat lieu ciim A/II5N1 [1], He thdng giam sat benh Doi tuong nghien ciiu: truyen nhiem (GSB'PN) d Viet Nam duoc thiet + Dan vj tham gia he thdng GSBTN lap tir Trung uong den dja phuong dudi sir chi ciia tuyen Trung uong, tuyen khu vuc, tuyen dao true tiep cua Cue Y te dir phdng, cd nhiem tinh , tuyen huyen; vu giam sat phat hien v a bao cao 26 BTN hdi + Can bo lanh dao va can bd tham gia chirng He thdng GSBTN ciia Viet Nam dang hoat ddng giam sat tai cac tuyen cd 87 ngudi hoat ddng theo Quy che ban hanh kem theo tham gia phdng van bao gdm: tuyen Trung Quyet djnh so 4880/QD-BYT thang 12 uang cd ngudi, tuyen khu vuc 24 ngudi, nam 2002 cua Bd trudng Bd Y te [2] Nghien tuyen tinh 30 ngudi, tuyen huy en 30 ngudi Tac gia: Phan Trong Lan Dja chi: Bo Y te - 138A Giang Vd - Ba Dinh - Ha Noi Dien thoai: 0913 002 797 Lmail: ptlan2000fr7yahoo.com Tap chi Y hoc du phdng Tap XX so (114) 245 Dja diem III KET QUA VA BAN EUAN Tuyen Trung uong: Cue Y te Du 3.1 Cau triic he thdng giam sat tai cac phong Bo Y te Tuyen khu vuc: Vien Ve sinh Djch te tuyen: Cue Y t i du phdng va mdi trudng tat va Pasteur khu vuc: mien Bac, mien Trung mien Nam (Vien Ve sinh dich te Trung uong, ca cac Vien VSDT/Pasteur khu vuc deu cd bp Vien Pasteur Nha Trang va Vien Pasteur Thanh phan chuyen mdn chuyen trach GS va PCD phd Hd Chi Minh) vdi nhan luc duoc phan cdng nhiem vu cu the Tuyen tinh: Trung tam Y le du phong Cac bp phan deu nam khoa djch te (TTYTDP) cua Tinh (Nam Djnh, Ninh Binh, hoac khoa kiem soat benh truyen nhiem va viic Quang Binh Hau Giang va Sdc Trang) xin nen phdi hpp cac hoat dpng GS va PCD Tuyen huyen: TTYTDP ciia 10 huyen trpng ca khpa kha chat che thupc 05 tinh tham gia nghien cuu tren (chpn Tat ca cac TTYTDP tuyen tinh deu cd ngau nhien huyen/tinh) khoa Kiem soat benh truyen nhiem va vac xin Thoi gian dieu tra sinh pham, thirc hien chiic nang giam sat va Cupc dieu tra dupe tien hanh tir phdng chdng benh truyen nhiem vdi quy che, 16 thang 1 nam 2009 den 09 thang 12 chirc nang nhiem vu ro rang theo Quyet djnh nam 2009 2.2 Phuong phap sd 05/2006/QD-BYT Vdi co cau td chirc Thiet ke nghien cuu la dieu tra mo ta cat se de dang thuc hien chirc nang va nhiem ngang bang phuong phap djnh lupng ket hpp vu dupe giap tai tuyen tinh Tuy nhien, tai cac vdi phuong phap djnh tinh su dung bp cau hoi khpa Kiem spat benh truy en nhiem vii vac xin phong van de danh gia hoat dpng GS o cac sinh pham chua lap td GS va PCD cung muc dp khac tir tuyen co' so' den tuyen nhu bp phan thdng ke bao cao rieng biet Cac Trung uong can bp cua khoa lam ciing mpt liic nhieu Ipai Bp ciiu hpi dupe dua thep bp cong cu To chuc Y to The gio i khuyen cao ap dung trongviec nen chua cd tinh chuyen mdn hda va trach danh gia he thong GSBTN [3] Tuy nhien, bp nhiem cao cdng tac GS va PCD Tai cac TTYTDP tuyen huyen deu cd Ciiu hOi da dupe gop y, bp sung clip phu hpp vdi he thdng GSBTN tai Viet Nam va dap khoa Kiem soat djch benh, HIV/AIDS thuc ung muc tieu ciia nghien ciiu hien nhieu chirc nang dd cd chirc nang Noi dung nghien ciiu: GS va PCD vdi quy che, nhiem vu ro rang Cau triic cua he thdng GS tai cac tuyen theo Quyet djnh sd 26/2005/QD-BYT Co cau Thuc hien chuc nang nhiem vu td chiic la hop ly thuc hien chuc nang Ngudn luc san cd ca ve nhan luc va nhiem vu ciia tuyen huyen Tai khoa Kiem soat trang thiet bj thiet yeu djch benh, HIV/AIDS cua TTYTDP huyen Kha nang xet nghiem chan doan cung chua cd nhdm GS thdng ke bao cao BTN Phuong phap xu ly so lieu Cac phieu dieu tra dupe nhap lan vao va chua cd can bp chuyen trach dupe phan cdng chuong trinh may tinh Sd lieu sau dd dupe cu the, tinh chuyen inon hda khdng cao He thdng GSBTN da cd sir thdng nhat kiem tra vii lam sach bang cdng cu kiem tra nhap lieu kep Phan tich ket qua thdng qua toan qudc ve cdng tac trien khai GSphan mem Epi-Info 2.7 Ket qua phan tich BTN He thdng mang tinh dai dien cao dau dupe trinh bay bang cac bang sd lieu, (tat ca cac viing, mien; theo he thdng dpc va bieu dd va ban ca he thdng ngang vdi mdi lien quan vdi cac 246 Tap chi Y hpc du phdng, Tap XX, so (1 14) nganh hoat dong dua vao cong dong) Hoat dpng GSBTN mang tinh ben vung va thuong xuyen theo quy djnh thuong quy nhu mot hoat dpng chuyen mdn cua he thdng 3.2 Thirc hien chuc nang nhiem vu: 3.2.1 Chat luong ciia he thong giam sdt: Bang Banh gia hoat dong giam sat benh truyen nhilm cua can bo y ti dir phong Noi dung Co moi lien he thuong xuyen, h5 trp doi voi tuyen duoi true tilp quan ly Tuyen Trung ircrng n=3 Tuyen khu virc n=24 Tuyen tinh n=30 Tuyen huyen n=30 (100%) 24 (100%) 30 (100%) 30 (100%) Thu thap so lieu tir hai ngudn: tuyln dilu (100%) tri va cpng ddng 24 (100%) 19 (63,33%) 26 (86,67%) Bao cao dich khan cap bang dien thoai (100%) 24 (100%) 30 (100%) - Bao cao tuan (100%) 24 (100%) - Bao cao thang (100%) 24 (100%) 30(100%) 30(100%) - Tinh diing han cua bao cao tuan, thang (100%) 23 (95,8%) 21 (70%) - Phan hdi bao cao thang (100%) 24 (100%) 26 (86,67%) (20%) - Phan hoi bao cao tuan (100%) 24 (100%) 15 (50%) (30%) Quan ly va luu tru sd lieu tren may tinh (100%) 24 (100%) 30 (100%) 24 (80%) Phan tich so lieu mpt so benh quan trpng (100%) 24 (100%) (10%) Cd ke hoach phdng chdng dich 24 (100%) 30 (100%) 30 (100%) Thuc hien giri bao cao : 24 (80%) 24 (80%) 28 (93,33%) Phan hdi bao cao: (100%) 24 (80%) Tap chi Y hpc du phdng Tap XX so (114) 30 (100%) 247 Cue Y te dir phong va cac Vien khu vuc co moi lien he vdi TTYTDP tuyen tinh thuoc khu vuc quan ly chat che va thuong xuyen Da true tiep ho tro tuyen tinh dieu tra va dap ung chong dich theo diing chiic nang co cac vu dich nguy hiem xay ra: ciim A/H5N1, ta sot xuat huyet sai Tuy nhien, cong tac kiem tra, GS ho trp' en duoi ciia tuyen tinh va tuyen huyen chua dupe thuong xuyen thieu nhan luc va thieu kinh phi Tuyen Trung uong va khu vuc da dam bao thu thap so lieu GS tir ca nguon: tir tuyen cpng dpng tong hpp len va tir cac benh vien Trung uong va khu vuc (trir mien Bac chua that su day dii so lieu ciia benh vien) Tai tuyen tinh co su thu thap so lieu GS tir ca ngudn (tuyen huyen va benh vien tinh) dat 63,33% Thu thap SP lieu GS ciia tuyen huyen tir ca nguon (tuyen xa va benh vien huyen) dat kha cao 86,67% Tuy nhien, moi lien he giua hoat dpng GSBTN giua cac TTYTDP va benh vien chua thuc su chat che va mang tinh thuong quy de dam bao hieu qua GS va phat hien chu dpng Theo huong dan nam 2002, cac don vj dieu trj co can bp phu trach viec GS va thong bao kjp thai cho cac don vj Y te du phong ciing cap co ca benh duoc chan doan thupc BTN dien quan ly hoac cac benh la chua ro nguy en nhan Nhung tren thuc te, cac benh vien rat it thuc hien bao cao GS BTN giiy djch theo quy dinh ma chi thong bao gap cac truong hop benh djch nguy hiem Cac can bp Y tc du phong thuong xuyen phai sang lay so lieu true tiep tai benh vien Chi co 70% benh vien tuyen tinh va 73% benh vien en huyen bao cao cac truong hop BTN gay djch nguy hiem cho cac TTYTDP Phuong tien bao cao so lieu tai tuy6n Trung uong va khu vuc da dam bao dupe yeu cau chp tirng Ipai bap cap: bap cap khan cap bang dien thoai email, fax; bao cao tuan bang thu dien tu (email), fax cong van; bao cao thang bang thu dien tu va cong van Phuong 248 tien bao cao djch khan cap bang dien thoai dat 100% tai cac tuyem Tuy nhien, chi co 80% can bp tuyln tinh va 43% can bp tuyen huy en sddung fax dd bao cao djch 50% can bp tuyen tinh va 23% can bp tuyen huyen thuc hien bao cao qua email nhung viec niiy khdng thuc hien thupng xuyen 100% can bp tuyen tinh va tuyen huyen deu lira chpn hinh thuc bap cap tren giay dd khdng dap ung kjp thdi va hieu qua viec bao cao thdng tin Tinh day du ciia bao cao tuan va bao cao thang tai cac tuyen Trung uong va khu vuc dat tren 95%, tai en tinh dat kha cao (80% cho bao cao tuan, 100% cho bao cao thang) Cac bao cao thang dupe thuc hien day dii va dat yeu cau tai tat ca cac tuyen Tinh diing han cua bap cap tuan bao cao thang cung dat kha cao (80% tai tuyen tinh va 70% tai en huyen) Ket qua nghien ciru cho thay, tuyen Trung uong va khu vuc da thuc hien phan hdi thudng xuyen ca bao cao tuan va bao cao thang cho tuyen tinh va cac don vi cd lien quan theo diing quy che Bao cao phan hdi hang thang ciia tuyen tinh cho tuyen huyen kha thudng xuyen dat 86,67% Tuy nhien, ty le bao cao phan hdi hang tuan cdn rat thap (50%) Cac TTYTDP huyen chua thuc hien glii bao cao phan hdi ket qua GSBTN hang tuan, hang thang cho tuyen xa va cho benh vien huyen (phan hdi tuan: 30%; phan hdi thang: 20%) Nguyen nhan ciia viec ty le phim hdi thdng tin cdn thap la su phdi hpp GS ciia cac dan vj chua ddng bp va can bp chua thuc sir nhan ro tam quan trpng cua hoat dpng cdng tac GS PCD Quan ly sd lieu tai tuyen khu vuc cd he thdng, de tiep can va tra cuu (100% tuyen khu vuc da su dung may tinh de quan ly, ben canh dd van tri luu so lieu bang van ban nhu cac bao cao, sd sach nien giam BTN hang nam va nam de tranh mat mat trudng hpp cd su cd ve may tinh) 00% tuyen tinh da quan ly sd lieu bang may tinh ciing vdi quan ly bang Tap chi Y hpc du phong, Tap XX M> (I 14) so sach van ban luu de tranh mat mat Quan ly so lieu cua tuyen tinh da duoc thuc hien tren may tinh nhung mdi chi dung d muc cac bang sd lieu don gian tren phan mem Excel Chua cd su ndi ket giua cac bang sd lieu \a khd trich xuat so lieu can Mac dii 100% so huyen dii cd may tinh, nhung chi cd 80% thuc hien quan ly sd lieu tren may tinh (mpt sd may tinh chi dung de soan van ban vi khdng cd can bp biet quan ly sd lieu bang may tinh) So cdn lai quan ly sd lieu bang sd sach va bao cao roi nen khd tra cuu va de mat mat Sd lieu dii dupe phan tich chii yen tai tuyen khu vuc va tuyen Trung uong cho cac benh quan trpng (ciim A/H5N1, ta sdt xuat huyet sdi \ icm nao Nhat Ban): phan tich dien bien theo thdi gian phan tich tudi gidi dudi dang bang sd lieu, bieu dd ban dd |4] Tuyen khu vuc ciing da thuc hien mpt sd cac nghien ciiu phan tich dich te ve can nguyen yen to nguy co cua mpt sd benh: ciim A/H5N1 ta sdt xuat huyet viem niio Nhat Ban Da cd phan tich so lieu CO' ban cua mpt sd benh quan trpng tai tuyen tinh: ciim A/I15N l ta sdt xuat huy et sdi, viem nao Nhat Ban SO lieu cac BTN ndi chung chua dupe phan tich sau tai tuyen tinh Cac phan tich chi d mire rat don gian ddi \di mpt sd benh nguy hiem hoac cac benh thudc chuong trinh, dir an (ciim A/H5N1, ta, sdt xuat huyet sdi) SO lieu cac B IN ndi chung rat it dupe phan tich tai tuyen huyen Chi mpt sd huyen cd thuc hien phan tich don gian (sd mac, sd chet theo nam) mpt sd benh nguy hiem hoac cac benh thudc chuong trinh, dir an (ciim A/H5NI ta sdt xuat huyet sdi) Cac can bp lam cdng tac GS BTN en Trung uong khu vuc va mpt sd tinh cd the sir dung may tinh thap cho cdng tac xir ly sd lieu, phim tich tdng hpp bao cao dich Tat ca 100% cac tuyen deu cd ke hoach phdng chdng dich chu ddng, dd cd dpi chdng djch co ddng tai tuyen khu vuc dpi tai tuyen tinh va dpi tai tuyen huyen dupe chuan bj sim sang 3.2.2 Nguon lire cim lie thong giiun sdt: 3.2.2.1 S hun lire coo hi' thong giiun siit: Bang Kien thirc cua can bp giam sat ve mpt so yeu cau chuyen mdn Tuyen trung uang va khu vuc n=27 27 (100%) Npi dung Nam vung ca sd phap ly Tuyen tinh n=30 Tuyen huyen n=30 30 (100%) 23 (77%) Nam vung npi dung chuyen mdn: - Biet sir dung dinh nghTa ca benh 27 (100%) 30 (100%) 22 (73%) - Nam viing cac quy che bao cao djch trudng hap khSn cap 27 (100%) 21 (70%) 24 (80%) Nam vung quy chd bao cao dich ciim A/ H5N1 27 (100%) 30 (100%) 30 (100%) - Nam vung cac quy che bao cao tu§n, bao cao thang 27 (100%) 30 (100%) 30 (100%) Duoc dao tao chuyen nganh 27 (100%) (30%) (6,7%) Tap chi Y hpc du phdng Tap XX so 6(114) 249 Co 100% cac can bo duoc phong van bp dupe phan cdng va linn vice on djnh tai tuyen Trung uong va cac khu vuc, tuyen Tai tuyen tinh, nhan lire cho GS va PCD cdn tinh deu nam viing co so phap ly ciia he thong thieu Sd can bp chuy en khpa Ve sinh Djch te GS Tuy nhien ty le d tuyen huyen chi dat hoac Y ti cdng cpng true tiep lam cdng tac GS 77% Co so phap ly nhat cho hoat dong va PCD tai tuyen tinh dat rSt thap va rat it can GS hien la Quyet dinh sd 4880/2002/QD- bp dupe dao tao sau dai hpc Sd can bp dupe BYT ciia Bd trudng Bd Y te ve Quy che thdng dao tao chuyen khoa Ve sinh Djch tc hoac Y te tin, bao cao BTN gay djch Vi vay viec dir cdng cdng true tiep lam cdng tac GS va PCD thao bd sung va siia ddi Quyet djnh de phu tai tuyen huyen rat thap (6.7%) Tai en tinh hop vdi tinh hinh djch benh cua giai doan hien va tuyen huyen cd tir 25-40% can bp mdi chua la can thiet Cac hoat ddng GS PCD da dupe dao tao chuyen nganh 2/5 tinh va 8/10 dupe hien thirc hda tir Luat phdng chdng huyen khdng cd ke hoach dao tao lien tuc hang BTN dupe Qudc hpi phe et nam 2007 [5] nam ve ITnh vuc hoat dpng GS vii PCD Nhu Nhirng quy djnh dudi luat dang dupe xay dung cau dap tap ciia cac tuyen lit rat cap Nhu va ban hanh se tirng budc hoan thien va nang vay viec nang cao nang luc ciia can bp la mpt cao nang luc he thdng Cac can bp lam cdng trpng nhirng giai phap chinh de nang cap chat tac y te lien quan den cdng tac GSBTN phan lupng hoat dpng GS va PCD tai cac don vj GS Idn nam vung co so phap ly va biet su dung tuyen tinh huyen djnh nghTa ca benh cho cdng tac GS, xii ly va 3.2.2.2 Kinh phi cho giam sal: Mac dii khdng cd kinh phi rieng cho dieu trj BTN Cd 100% can bp chuyen trach ve GS GSBTN, nhung cac Vien khu vuc da dap ling cac tuyen Trung uong khu vuc va tinh da nam day dii cac yeu can kinh phi nhu di lai luu viing ndi dung chuyen mdn vc quy che bao tru, cdng tac phi dung quy djnh chp can bd cao djch cac loai, djnh nghTa ca benh tham gia GS thudng ky cung nhu tham GS Tuyen huyen chi dat 73% sd can bp biet gia PCD TTYTDP tuyen tinh, huyen cho rang kinh phi cho GS va PCD chua dap ling dupe su' dung diing djnh nghTa ca benh Tai tuyen Trung uong va Khu vuc da cd nhu ciiu thuc te Djnh mire chi clip can bp di mpt sd can bp chuyen khpa chinh quy, can bp GS thudng ky va can bp true tiep tham gia sau dai hpc, mpt sd khac da dupe dap tap ngan PCD cdn thap nen khdng khuyen khich dupe han hoac dai han ITnh vuc Cac can can bp lam nhiem vu - 3.2.3 Trang thiet hi: Bang Trang thiet bj thiet yeu phuc vu cdng tac phdng chong djch Tuyen Tz rung uong va Tuyen tinh Tuyen huyen khu virc (n=4) n=5 May tinh 4(100%) 5(100%) 10(100%) Internet 4(100%) 4(80%) 7(70%) Dien thoai rieng cho GS 4(100%) 5(100%) 6(60%) 250 Tap chi Y hpc dir phdng Tap XX so' fl ! j n=10 Trang thiet bj phuc vu rieng cho GS vu cong tac GS, ty le ket noi internet kha cao tai tuyen Trung uang va khu vuc kha day dii: (80% TTYTDP tinh va 70% TTYTDP huyen) 100% don vj da co may tinh ket n6i Internet, Chua co he thong may tinh noi mang dien thoai, fax, to, thiet bj djnh vj GPS, trang va phan mem quan ly BTN thong nhat phuc bj phong ho ca nhan vu cong tac bao cao GS tir tuyen huyen len Tai tuyen tinh va tuyen huyen, 100% tuyen tinh, khu vuc va Trung uong mang tinh cac dan vj da duoc trang bj may tinh phuc he thong 3.2.4 Phong xet nghiem (PXN) Bang Trang thiet bj va nang lire xet nghiem (XN) phuc vu cong tac giam sat tai cac tuyen Tuyen tinh n=5 Tuyen huyen n=10 Co du PXN va trarn^.thiet bi cho viec thirc hien (100%) cac ky thuat XN co ban (100%) (0%) Lay duoc mlu benh pham ciim A/H5N1 (100%) (100%) (40%) Bao quan duoc miu benh pham vi rut (100%) (100%) (0%) Thuc hien duoc cac XN chan doan cac benh chinh (100%) (100%) (0%) Cd can bp chuyen trach XN dupe dao tao 4(100%) (60%) (40%) Cd bp phan va can bp chuyen trach ve an toan sinh hpc (100%) (0%) (0%) Tuyen khu vyc n=3 Noi dung Cac phong thi nghiem tai tuyen khu vuc TTYTDP tinh deu co khoa XN co bp da co trang thiet bj kha day du de dam bao cho phan XN vi sinh (vi khuan, vi rut) thuc hien cac XN co' ban: nuoi cay phan lap, huyet chiic nang chan doan xac djnh cac BTN tren hpc (ELISA) sinh hpc phan tir (PCR thong dja ban tinh Cac TTYTDP huyen da co khoa thuong) va ca trang thiet bj hien dai nhu Real- XN thuc hien chuc nang lay mau benh pham, time PCR, may dpc trinh tir gen (sequencer) bao quan va van chuyen benh pham len tuyen kinh hien vi dien tir (Vien VSDTTW) Cac tren va phoi hop voi benh vien de lam mpt PXN tai tuyen tinh da co trang thiet bj toi thieu so XN ban dau phuc vu cho cong tac chuyen cho XN vi khuan (soi tuoi va nuoi cay phan mon Day la co' so tot giup tuyen tinh va khu lap vi khuan: 100%) vuc cong tac lay mau benh pham som, XN la cong cu hii'u ich doi voi he YTDP bao quan va chuyen mau nhanh len tuyen tren vice ho trp hoac khang djnh chan doan ca de khang djnh som vu djch benh Tat ca cac khu vuc da co he thong phong Tat ca cac Vien khu vuc deu co kha thi nghiem voi cac ITnh vuc XN kha day du de nang lay mau, bao quan va XN tac nhan ciim dap irng nhu cau chan doan BTN dupe phan A H5N1 bang cac phuong phap tin cay: RTthanh cac khoa chuy en mon sau: Vi khuan, Vi PCR va realtime PCR Ngoai cac phong thi nit Mien djch Sinh hpc phan tu.Tat ca cac nghiem co kha nang tham gia vao cac Tap chi Y hpc du phdng Tap XX so 6(114) nghien ciiu khoa hpc hop tac voi cac to chirc quoc te Tat ca cac tinh deu CP kha nang lay mau benh pham benh nhan nghi ciim A/H5N1 va ban quan benh pham - 4°C Kha nang van chuyen benh pham len tuyen tren trpng vong 24 gia cung dat cap (87,5%) PXN tuyen tinh moi chi ca kha nang lam mpt so ky thuat ve spi tuoi, nuoi cay vi khuan XN vi rut chi gioi han bang cac test nhanh hoac phuong phap ELISA (chi 50% so tinh co dan may ELISA) cho mpt so benh: Viem nao Nhat Ban, sot xuat huyet viem gan vi rut B Do kha nang XN chan doan ciia tuyen tinh han che nen so lieu BTN dupe bao cao tir tuyen tinh len tren chu yeu dua vao trieu chirng lam sang rat it truong hpp dupe chan dpan xiic djnh nen tinh dac hieu cua sp lieu la khong cao PXN tuyen huyen chi moi dupe trang bj kinh hien vi de thuc hien ky thuat ve spi tuoi vi khuan, cac XN ve vi rut va huyet hpc chua co kha nang lam tuyen huyen Nang luc chii yen cua PXN tuyen huyen hien mai chi dimg miic lay mail va bao quan benh pham ban dau de chuyen len tuyen tren Tuy nhien lay mau benh pham vi rut ciim A/H5N1 chi co 40% TTYTDP tuyen huyen thuc hien dupe Ty le can bp dupe dap tap chuyen khpa vi sinh trpng sti can bp dang lam cong tac XN thap tuyen tinh Tai tat ca cac tinh va huyen nghien ciiu deu khong co bp phan hoac can bp chuyen trach vc an toan sinh hpc IV KET EUAN lie thong GSBTN da dupe thiet lap phan cap tir Trung uong toi tuyen khu vuc tuyen tinh tuyen huyen, xa va boat dpng cp hieu qua 252 Chat luong GS tai cac tuyen chua dong deu Viec phan hoi bao cao chua dupe tai tuyen tinh huyen cOn thap (30-50"%) Quan ly va phan tich so lieu chii yeu tai tuyen Trung uang va khu vuc (10% can bp tuyen huyen CP kha nang phan tich SP lieu) Nguon luc phuc vu cho CS chua dap irng dupe nhu can tai nil ca cac tuyen, dac biet la tuyen tinh huyen Hien co 6,7%-30% can bp tuyen huy en tuyen linn dupe dao tao chuyen nganh YTDP hoac y te cong cpng Trang thiet bj nhan lire clip xet nghiem tai tuyen khu vuc tirong doi hoan chinh Tuy nhien tuyen tinh va huyen can dupe dau tu manh inc hon nua, dac biet lii nang luc cua cac can bp XN (ty le can bp XN tuyen huyen, tuyen tinh dupe dap tap chuyen nganh thap tii 40-60%) TAI LIEU TII AM KHAO Cue Y te du phong va mpi truong Bp Y Nien giiun thOng ke 2005-2008 Quyet djnh 4880/2002/QD-BYT 6/12/2002 vc quy djnh bao cao va thong tin benh truyen nhiem Huong dan danh gia he thpng giam sal va dap ung cong tac phong chong benh truyen nhiem WHO/CDS/CSR/ISR/2001.2 Vugia, D.J (2000) Ngan hiing the giai Bao cao cong tac danh gia he thong giam sat y tc cong cpng ciia Viet Nam 15-26 Luat phong chong benh truyen nhiem so 03/2007/QH12 Hcymann.Cam nang phong chong benh truy en nhiem xuat ban lan thii' 19 Tap chi Y hpc duphong, Tap XX so (1 14) VIETNAM'S COMMUNICABLE DISEASE SURVEILLANCE SYSTEM FOR EPIDEMIC PREPAREDNESS IN 2009 Phan Trong Lan, Lc Trung Kien, Vu Ngoc Long, Nguyen Minh Hang Ministry of Health The cross-sectional survey using structured questionnaires was applied to evaluate current situation of the communicable disease surveillance system for epidemic response at all networks from central to district levels in 2009 The results were showed a communicable disease surveillance systems has the specific and high effective structures which are devolved from central to regional, provincial district and commune network and belong to management of the governmental public health sector The quality of monitoring for communicable diseases is well done at all network and the feed back on quality of reports between provincial and district networks, have not been done regularly (30- 50%) The data were analyzed and managed after being col- lected at central and regional networks (only 10% staff of District level can analysis data of communicable diseases) There is shortage of staffs who are in charge of monitoring communicable diseases at all network, especially for both provincial and district networks The laboratory equipment and human resource were supplied enough for epidemic control at all networks However, The laboratory equipment of provincial and district networks should be support, Beside, the training course for laboratory 's technicans is neccessary (the percent of laboratory 's technicans have trained for speciality from 40-60%) Key words: Disease surveillancem epidemic preparedness, communicable diseases Tap chi Y hoe du phong Tap XX, so (114) 253 ... tir phdng chdng benh truyen nhiem vdi quy che, 16 thang 1 nam 2009 den 09 thang 12 chirc nang nhiem vu ro rang theo Quyet djnh nam 2009 2.2 Phuong phap sd 05/2006/QD-BYT Vdi co cau td chirc Thiet... Tap XX so (1 14) VIETNAM''S COMMUNICABLE DISEASE SURVEILLANCE SYSTEM FOR EPIDEMIC PREPAREDNESS IN 2009 Phan Trong Lan, Lc Trung Kien, Vu Ngoc Long, Nguyen Minh Hang Ministry of Health The cross-sectional... disease surveillance system for epidemic response at all networks from central to district levels in 2009 The results were showed a communicable disease surveillance systems has the specific and high