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Loài sán lá gan lớn có mặt ở Việt Nam và hơn 61 quốc gia trên thế giới, chủ yếu ở những vùng có chăn thả gia súc. Nếu vật chủ thích hợp, chúng có thể tồn tại ở người từ 9 13,5 năm. Nhiễm SLGL liên quan đến thói quen và tập quán ăn uống của người dân, vì vậy phòng bệnh là vấn đề hết sức quan trọng và cần thiết.
FASCIOLIASIS SITUATION IN VIETNAM Do Trung Dung, National Institute of Malariology, Parasitology and Entomology, Vietnam OUTLINE General information of Fascioliasis Life cycle of fasciola Symptoms of fasciola patients Key rick factors Key control activities Key challenges Next activities Introduction of Fascioliasis - Cause of Fascioliasis: Fasciola gigantica, Fasciola hepatica - F hepatica: South American, Europe, Australia - F gigantica: Africa and Asia (WHO, 2017) - The hybrid forms of F hepatica and F gigantica in Vietnam, Korea, Japan, China… - 2017 WHO estimated 2.4 million people infected, 180 million people at risk in 70 countries Introduction of Fascioliasis in Vietnam - Codvell and colleagues discovered F gigantica in 1928 - Nguyen Xuan Huyen found a case in 1959 - Do Duong Thai announced fasciola cases in 1978 - 1997-2000, Tran Vinh Hien found 500 fasciola cases in Central and Southern Vietnam by ELISA - From 2002-now many cases were diagnosed and treated Life cycle of Fasciola spp Fasciola in snail Lymnaea snail: - 0.4% in Quang Nam (Lực, 2010) - 0.6% in Quang Ngai (Hương, 2012) - 0.1% in Ha Noi (Dung, 2013) - 1.6% in Binh Dinh (Dung, 2013) (Austropeplea viridis = L viridis, Radix auricularia = L swinhoei Radix rubiginosa) Lymnaea viridis Rice fields in both plain & highland Lymnaea swinhoei Small channel in plain Fasciola in aquatic vegetable - Coriandrum spp (Rau mùi) : 0.5 metacercaria/kg (Luc, 2010) - Ipomoea aquatica (Rau muống): 0.4 metacercaria/kg (Luc, 2010) - Coriandrum spp 1/100 of vegetable samples infect metacercaria (Đe, 2013) Fasciola in animal (reservoir host) - Livestock 35% in Viet Nam (review Hien, 2011) - Goat 5.3-30.4% (Thanh, 1997-1999; Phan, 2002) - Buffalo, cow 51.9% Mekong delta river (Hùng, 2011) - Buffalo, cow 54.9% Binh Đinh (Thanh, 2011) - Buffalo, cow 61.5% Quang Ngai (Hương, 2012) - Livestock 72.2% (Dung, 2016) - Buffalo, cow 41.3% Ha Noi (Lan Anh, 2017) Human Reported Cases Ha Giang Cao Bang Lao Cai Lai Chau Tuyen Quang Son La Bac Kan Lang Son Yen Bai Dien Bien Phu Thai Nguyen Vinh Phuc Phu Tho Bac Giang TP Ha Noi - Hoa Binh Ha Nam Distribution Ninh Binh Thanh Hoa Quang Ninh Bac Ninh Hai Duong TP Hai Phong TP Hai Phong Thai Binh Nam Dinh Nghe An In 51/63 provinces of Vietnam Ha Tinh Quang Binh - Characteristics Quang Tri Thua Thien Hue Da Nang Number of fasciolasis cases Quang Nam + Age: over 90% of patients are > 15 years old No patient Quang Ngai 1-10 cases Kon Tum 11-100 cases + Gender: 62% female Binh Dinh 101-200 cases Gia Lai >201 cases Phu Yen Dak Lak Dak Nong Binh Phuoc Lam Dong Tay Ninh Binh Duong Kien Giang Dong Nai Binh Thuan TP.Ho Chi Minh Long An Ba Ria Vung Tau An Giang Dong Thap Tien Giang Vinh Long Ben Tre Can Tho Kien Giang Hau Giang Tra Vinh Soc Trang Bac Lieu Ca Mau Khanh Hoa Ninh Thuan Number of Fasiola patients Year Northern provinces Centre provinces Southern provinces Total (100%) 2012 701 (13.6%) 4,382 (85%) 72 (1.4%) 5,155 2013 599 (14%) 3,467 (81.2%) 204 (4.8%) 4,270 2014 1,024 (34.4%) 1,694 (56.6%) 276 (9.2%) 2,994 2015 724 (20.6%) 1,912 (54.5%) 876 (25.0%) 3,512 2016 2,547 (55.9%) 1,780 (39.1%) 228 (5.0%) 4,555 2017 3,126 (26,4%) 7,880 (66.5%) 852 (7,1%) 11,858 2018 2,308 10,413 NA > 12.000 2019 4,107 NA NA - 2020 1,328 NA NA - Source: NIMPE, IMPE QN, IMPE HCM, Provinces The prevalence of fasciola in human in community ID Place of survey Year Prevalence Đại Lộc - Quảng Nam 2010 5% Phù Cát – Bình Định 2011 6% Quảng Nam 2012 2.5% Quảng Ngãi 2012 10.36% Thanh Hoá 2014 1.29% Nghệ An 2014 0.38% Bắc Giang 2014 0.19% Hoa Bình 2014 0.1% Bình Định 2018 4.8% 10 Phú Yên 2018 5.7% Occupation characteristics of the hospitalized fascioliasis patients Occupation Yes % 75 36.4% 54 26.2% 14 6.8% 63 30.5% (n = 206, Fascioloasis human cases) Farmer Official staffs Students Free job Source: Tho, 2018 12 Clinical symptoms on hospitalized patients # Clinical symptoms n = 206 % Upper abdominal pain 148 71.9% Fever 21 10.2% Periumbilical pain 3.4% Itching and skin rashes 3.4% Weight lost 2.4% Asymptomatic cases 18 8.7% Source: Tho, 2018 13 Subclinical characteristics of the hospitalized fascioliasis patients Laboratory findings Yes % 24 11.7% 204 99.0% 199 96.6% 1.9% Increased eosinophile (> 7%) 195 94.7% Increased GOT value (normal 3- 31 U/L) 30 14.6% Increased GPT value (normal 3-33 U/L) 28 13.6% (n = 206, Fascioloasis human cases) Fasciola eggs in the faeces samples Ab-ELISA Liver parenchyma lesions Anemia (Hb < 120 g/L) 14 Source: Tho, 2018 Ectopic infestation Fascioliasis Some fasciola ectopic infestation occur on knee, chest, abdominal wall F gigantica F hepatica Key risk factors in Vietnam - The reservoir host (buffalo, cow, sheep, goat ) high infection with fasciola in community - The wastewater is directly used as agricultural water to culture aquatic plants without treatment - Traditionally high consumption of raw aquatic plants Key control activities in Vietnam 1) Develop guideline for fascioliasis diagnosis and treatment; distributed the guideline to provinces 2) Training for health staffs at district & provincial level on fascioliasis diagnosis and treatment 3) IEC activities for prevention of fascioliasis at community Outcome of control activities in Vietnam Increased awareness of people about fascioliasis; Most of the hospitals at province and district level have ultrasound and many can diagnose fascioliasis; 130,000 tablets of triclabendazole were donated by Novatis through WHO to hospitals in Vietnam since 2004 More and more fascioliasis patients were treated Key challenges in Vietnam? Current control activities are mainly on "treatment“ “Transmission control“ needs to be strengthened How can we block transmission ? Treatment of Fascioliasis agricultural water/ wastewater Stop eating raw vegetables Deworming for animals, Faeces control Next plan for Fascioliasis control - More fasciola patients are receiving treatment but we need reduction of costs of hospitalisation (Improved diagnosis and treatment process) - Need further collaboration with veterinary sector for deworming for animals and treatment water - Health education to avoid eating raw vegetables THANK YOU FOR YOUR ATTENTION! ... Nguyen Vinh Phuc Phu Tho Bac Giang TP Ha Noi - Hoa Binh Ha Nam Distribution Ninh Binh Thanh Hoa Quang Ninh Bac Ninh Hai Duong TP Hai Phong TP Hai Phong Thai Binh Nam Dinh Nghe An In 51/63 provinces... activities in Vietnam 1) Develop guideline for fascioliasis diagnosis and treatment; distributed the guideline to provinces 2) Training for health staffs at district & provincial level on fascioliasis. .. and F gigantica in Vietnam, Korea, Japan, China… - 2017 WHO estimated 2.4 million people infected, 180 million people at risk in 70 countries Introduction of Fascioliasis in Vietnam - Codvell