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Circular No. 17/2019/TT-BYT dated July 17, 2019 of the Ministry of Health providing instructions about communicable disease surveillance and response

Date: 7/17/2019


MINISTRY OF HEALTH
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SOCIALIST REPUBLIC OF VIETNAM
Independence - Freedom - Happiness 
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No. 17/2019/TT-BYT
Hanoi, July 17, 2019
 
CIRCULAR
PROVIDING INSTRUCTIONS ABOUT COMMUNICABLE DISEASE SURVEILLANCE AND RESPONSE
Pursuant to the Law on Prevention and Control of Infectious Diseases dated November 21, 2007;
Pursuant to the Government’s Decree No. 101/2010/ND-CP dated September 30, 2010, elaborating on the implementation of several Articles of the Law on Prevention and Control of Infectious Diseases regarding application of particular health quarantine, isolation and disease control measures during the epidemic period;
Pursuant to the Government's Decree No. 75/2017/ND-CP dated June 20, 2017, defining the functions, tasks, powers and organizational structure of the Ministry of Health;
Upon the request of the Director of the General Department of Preventive Medicine;
The Minister of Health hereby promulgates the Circular providing instructions about communicable disease surveillance and response.
Chapter I
GENERAL PROVISIONS
Article 1. Scope
This Circular provides instructions about communicable disease surveillance; communicable disease response; responsibilities for carrying out the communicable disease surveillance and response.
Article 2. Interpretation
For the purposes of this Circular, terms used herein shall be construed as follows:
1. Community-based outbreak refers to an area (e.g. village, residential quarter or equivalent) where a disease case identified or clinical disease cases, a pathogen, or vector transmitting a disease within the period equivalent to the average incubation period of that disease, emerges.
2. Hospital-based outbreak will be identified when a healthcare facility finds a case of infection with a disease during the period equivalent to the average incubation period of that disease.
3. Reservoir refers to a place where a pathogen may exist and develop.
4. Warning sign refers to early information about a communicable disease, risks for exposure to a communicable disease or other threats to the public health.
5. Event refers to a warning sign already verified to impose risks for exposure to a communicable disease or other threats to the public health.
Chapter II
COMMUNICABLE DISEASE SURVEILLANCE
Article 3. Subjects of surveillance
1. Subjects of surveillance
a) Persons infected with communicable diseases, persons carrying communicable disease pathogens and persons suspected of infection with communicable diseases;
b) Infectious agents;
c) Reservoirs, vectors and risk factors of communicable diseases.
2. Communicable diseases subject to surveillance shall be classified as prescribed in Article 3 of the Law on Infectious Disease Prevention and Control.
Article 4. Surveillance forms
Communicable disease surveillance shall be categorized into the following forms:
1. Indicator-based surveillance refers to an act of collecting information about specific communicable diseases by using prescribed indicators and samples. This activity shall include the following forms:
a) Routine surveillance refers to an act of regularly, continually and logically collecting basic information about communicable diseases with the help of healthcare facilities across the nation;
b) Sentinel surveillance refers to an act of regularly, continuously and logically collecting in-depth information about a number of priority communicable diseases and health events arising at several surveillance sites selected during a specified period of time.
2. Event-based surveillance refers to an act of collecting information, screening and verifying warning signs from different sources, such as the public, social networks, communications networks, health authorities, agencies and networks.
Article 5. Surveillance sites
Communicable disease surveillance shall be conducted in the entire pertinent jurisdiction with particular attention paid to:
1. Healthcare facilities.
2. Areas for isolation of communicable diseases.
3. Existing outbreak areas; preexisting outbreak areas and potential outbreak areas.
4. Residential, study and work places, tourist destinations and accommodations of persons infected with communicable diseases, persons carrying communicable disease pathogens and persons suspected of infection with communicable diseases.
5. Land, rail, air and water border areas.
6. Areas where natural disasters or calamities occur.
Article 6. Surveillance data
1. As regards persons infected with communicable diseases, persons carrying communicable disease pathogens and persons suspected of infection with communicable diseases, surveillance data shall include the followings:
a) Full name, age, sex, occupation, telephone, place of residence, study and workplace; place and date of occurrence and onset of a disease; periods of disease, symptoms, analyses and treatment, health facilities giving medical care and treatment before occurrence of disease; information about confirmatory tests for presence of proper disease-causing agents; obstetric and immunization history and immunity status, history of domestic and overseas travel, information about history of exposure to, contact with a disease and relevant epidemiological factors;
b) Economic, cultural and social conditions at surveillance sites: living standard, lifestyle, living conditions, customs and habits, population structure, ethnic structure and sickness structure; geographical, climatic and weather conditions, including geographical regions, seasons, temperature, precipitation, humidity, wind direction and other risk factors.
2. As regards agents causing communicable diseases, surveillance data shall include: strain, species, group, type, subtype, genome, genotype, biological characteristics related to antidrug, morphological, genetic change and change in mode of transmission.
3. As regards vectors, surveillance data shall include:
a) Animals: quantity, contact with humans and other properties when required. In particular, if a vector is an insect, the following additional data shall include biological properties, components of vector species, surveillance indicators and sensitivity to chemicals;
b) Food: ingredients, origin, method of food processing, storage, transportation and distribution;
c) Environment: soil, water and atmosphere;
d) Others carrying agents causing communicable diseases.
4. Based on communicable diseases, surveillance subjects and requirements specific to surveillance forms, surveillance units may decide on appropriate surveillance data.
Article 7. Surveillance process
1. Collecting data and information.
2. Analyzing data, giving interpretation and assessment of results.
3. Evaluating risks and giving comments on the current status of communicable diseases.
4. Recommending intervention measures.
5. Making reports and sharing information.
Chapter III
COMMUNICABLE DISEASE RESPONSE
Article 8. Prevention of communicable diseases
When there is none of communicable disease outbreaks, response units in a local jurisdiction shall be assigned to perform the following active prophylaxis activities:
1. Drawing up, approving and implementing communicable disease prevention and control plans.
2. Evaluating and forecasting communicable disease risks.
3. Controlling risks.
4. Conducting inspection and surveillance activities.
Article 9. Steps in conducting communicable disease outbreak surveys or investigations
The hierarchy of steps in conducting surveys of or investigations into communicable disease outbreaks may be flexible, depending on the nature thereof, including:
1. Making preparations for communicable disease outbreak survey or investigation.
2. Verifying diagnoses.
3. Confirming existence of communicable disease outbreaks.
4. Defining disease cases, consulting standards for clinical and epidemiological diagnostic tests for identification of persons infected with a communicable disease, persons suspected of infection with a communicable disease and initial cases.
5. Carrying out the description of an outbreak containing 3 elements, such as time, location and humans.
6. Constructing hypotheses about outbreaks, epidemics, sources of infection, infection factors, modes, routes, intermediate hosts or vectors, exposure and risk factors.
7. Evaluating and verifying hypotheses.
8. Completing hypotheses and conducting supplementary researches.
9. Recommending disease prevention and control approaches.
10. Informing communicable disease outbreak survey or investigation results.
Article 10. Handling of communicable disease outbreaks
In case where any communicable disease outbreak occurs, response units in a local jurisdiction shall be assigned to draw up plans for disease prevention and control, preparation for and handling of communicable disease outbreaks as follows:
1. Preparations for handling of communicable disease outbreaks
a) Workforce;
b) Recommended support for communicable disease prevention and control (where necessary): determining levels of medical facilities giving support, bases, methods, time and tasks related to higher-level and interagency support;
c) Medicines, vaccines, chemicals, biologicals and other supplies necessary for collecting, packing, storing and transporting pathology specimens and accessories required for handling of communicable disease outbreaks; emergency care and other medical equipment and accessories;
d) Prerequisites for prevention of infection for medical staff and officers involved in disease prevention and control activities and persons in contact with infectious sources;
dd) Estimate of costs of communicable disease survey, investigation or handling efforts.
2. Handling of communicable disease outbreaks
Based on results of communicable disease surveys or investigations, the following communicable disease outbreak handling measures may be selected:
a) Handling sources of infection: receiving, treating and managing cases infected with communicable diseases; carrying out health quarantine and isolation; providing healthy persons carrying pathogens with treatment; disposing of human, animal waste and other sources of infection;
b) Handling disease transmission routes: implementing measures to prevent and control disease-causing intermediary hosts, environmental sanitation, sterilization and disinfection measures for areas with communicable disease outbreaks;
c) Protecting healthy persons at communities and persons exposed to communicable diseases at hospitals: practicing personal hygiene and providing personal protective equipment; ensuring food safety; providing prophylactic treatment and boosting the immune system; providing immunizations; communicating risks and public health education;
d) Applying special disease prevention and control measures during the outbreak time in accordance with regulations in force;
dd) Conducting epidemiological surveys or investigations and dealing with deaths caused by communicable diseases.
Article 11. List of group-B communicable diseases subject to health quarantine
List of group-B communicable diseases subject to health quarantine shall include the followings:
1. Diphtheria.
2. Whooping-cough.
3. Measles.
4. Rubella.
5. Anthrax.
6. Neisseria meningitides.
7. Hand, foot and mouth disease.
8. Varicella.
9. Mumps.
Article 12. Delegation of responsibilities for communicable disease response of health facilities
1. As regards all group-C communicable diseases; group-B communicable diseases with low incidences (lower than average incidences in weeks or months of the same period during 3 latest years, except those reported in outbreak years) and none of deaths reported: Commune, ward and townlet (hereinafter referred to as commune-level) health facilities shall act on their own initiative and assume responsibility to counsel commune-level People’s Committees to take control of communicable disease response activities within their jurisdiction.
2. As regards group-B communicable diseases with high incidences (greater than average incidences in weeks or months in the same period of 3 latest years, except those reported in outbreak years) or deaths reported: District, town and city (hereinafter referred to as district-level) health facilities shall act on their own initiative and assume responsibility to counsel district-level People’s Committees to take control of communicable disease response activities within their jurisdiction.
3. As regards all group-A communicable diseases; group-B communicable diseases with at least 2 cases of death caused by the same disease or the same infectious agent in a district within a month: Disease Control Centers of provinces and centrally-affiliated cities (hereinafter referred to as provinces) shall act on their own initiative and assume responsibility to request Departments of Health to counsel provincial-level People’s Committees to take control of communicable disease response activities within the respective jurisdiction.
4. International Health Quarantine Center and provincial-level Disease Control Centers having competence in providing international health quarantine services shall be responsible for conducting investigations and making reports and carrying out communicable disease control measures at checkpoint areas.
5. Bacterial contamination control units controlled by health facilities shall be directly responsible to carry out surveillance, investigation, make reports and give review comments and assessments on risks of communicable diseases at health facilities, counsel these units’ leaders and cooperate with bacterial contamination control networks at departments, divisions or units involved to implement communicable disease prevention and control measures; concurrently, shall support lower-level entities in performing communicable disease response activities.
6. In case where response to communicable diseases is beyond capabilities of units or local jurisdictions, they must report to and request higher-level entities and supervisory entities to give support and mobilize resources necessary for communicable disease prevention and control efforts.
7. Institutes belonging to the preventive medicine system, hospitals directly controlled by the Ministry of Health shall regularly monitor and comment on the current state and make assessment of communicable disease risks in order to support lower-level entities on time in performing communicable disease prevention and control activities. In case of response to communicable diseases is beyond their competence, these institutes and hospitals should report to the Ministry of Health to ask for its directions and mobilize resources from local jurisdictions, centrally-controlled Departments, sectoral administrations and other units concerned or call for aids from international organizations.
Article 13. Communication and reporting
Communication and reporting activities shall be subject to provisions laid down in the Circular No. 54/2015/TT-BYT dated December 28, 2015 of the Minister of Health on instructions about the communicable disease communication and reporting regime; the Circular No. 15/2014/TT-BYT dated May 15, 2014 of the Minister of Health on instructions for communication and reporting of health quarantine activities; the Joint Circular No. 16/2013/TTLT-BYT-BNN&PTNT dated May 27, 2013 of the Ministry of Health and the Ministry of Agriculture and Rural Development on instructions for cooperation in prevention and control of zoonotic diseases.
Chapter IV
IMPLEMENTATION RESPONSIBILITIES
Article 14. Responsibilities of the General Department of Preventive Medicine
1. Counsel the Minister of Health to exercise the regulatory authority over proposing, coordinating and directing all of professional and technical activities of communicable disease surveillance and response on a nationwide scale.
2. Direct institutes belonging to the preventive medicine system, Departments of Health and preventive medicine units at the provincial level to perform such activities as surveillance and analysis of the current status of, assessment of risks of and response to communicable diseases.
3. Conduct the inspection, supervision of and expedite implementation of professional and technical activities related to communicable disease surveillance and response.
4. Report to the Minister of Health on the current status of communicable diseases across the nation and in the globe on a weekly, monthly and yearly or ad-hoc basis.
Article 15. Responsibilities of Vietnam Food Administration
1. Cooperate with the General Department of Preventive Medicine in directing Departments of Health, Food Safety Departments, Food Safety Committees of provinces and centrally-affiliated cities in carrying out surveillance and analysis of the current state of, assessment of risks and response to food-borne communicable diseases.
2. Conduct the inspection, supervision of and expedite implementation of professional and technical activities related to food-borne communicable disease surveillance and response.
Article 16. Responsibilities of Medical Services Administration
1. Instruct and direct health facilities nationwide to perform professional and technical activities relating to surveillance of and response to communicable diseases and prevention and control of infection at these health facilities.
2. Conduct the inspection, supervision of and encourage health facilities to carry out professional and technical activities related to communicable disease surveillance and response.
Article 17. Responsibilities of institutes belonging to the preventive medicine system and hospitals directly affiliated to the Ministry of Health
1. Provide professional and technical instructions and directions, take charge of the inspection, supervision and assessment of implementation of communicable disease surveillance and response activities at entities at professional and technical levels within their remit.
2. Collect pathology specimens and conduct diagnostic tests for infectious agents. Collect, analyze, assess and store data about communicable disease surveillance and response, communicate and report communicable disease prevention and control activities of units within their remit.
3. Cooperate with and share information about communicable disease surveillance and response between health authorities in the preventive medicine system and other units involved.
Article 18. Responsibilities of Departments of Health
1. Provide directions and instructions for health units under their jurisdiction about carrying out professional and technical activities related to communicable disease surveillance and response.
2. Conduct the inspection, supervision of and expedite implementation of professional and engineering activities related to communicable disease surveillance and response.
3. Report to and counsel provincial-level People's Committees to receive their directions relating to cooperation in and response to communicable diseases.
Article 19. Responsibilities of units affiliated to Departments of Health
1. Provincial-level Disease Control Centers
a) Take charge of and cooperate with Food Safety Departments, health facilities and provincial-level entities concerned in carrying out communicable disease surveillance and response at localities under their jurisdiction;
b) Provide directions, training courses and instructions for and supervise professional and technical activities related to communicable disease surveillance and response of lower-level entities.
As for cities and provinces without Disease Control Centers, provincial-level Preventive Medicine Centers and Anti-malaria Centers shall be responsible for carrying out communicable disease surveillance and response activities in accordance with this Circular.
2. International Health Quarantine Centers or Disease Control Centers at the provincial level that have competence in carrying out health quarantine and are licensed to provide border health quarantine services shall be responsible for carrying out professional and technical activities relating to communicable disease surveillance and response at border checkpoints located within localities under their jurisdiction.
3. District-level Health Centers shall take charge of and cooperate with Food Safety Departments, health facilities and district-level entities concerned in carrying out communicable disease surveillance and response at localities under their jurisdiction. Provide directions, training courses and instructions for and supervise professional and technical activities related to communicable disease surveillance and response of lower-level entities.
4. Commune-level Health Stations shall be responsible for communicable disease surveillance and response activities performed at localities under their jurisdiction.
Article 20. Responsibilities of health facilities, immunization and medical testing establishments
1. Carry out communicable disease surveillance and response, infection prevention and control activities at health facilities, immunization and medical testing establishments.
2. Collect pathology specimens from patients receiving medical examination and treatment at these facilities; share pathology specimens with Hygiene and Epidemiology Institutes, Pasteur Institute and Institutes of Malariology – Parasitology – Entomology to give confirmatory diagnoses.
3. Closely collaborate with preventive medicine units in checking and informing patient’s diagnosis and treatment results.
Article 21. Responsibilities of medical units of Ministries and sectoral administrations
1. Provide directions and instructions about professional and technical activities regarding communicable disease surveillance, reporting and response for units put under their direct control.
2. Conduct the inspection, supervision of and expedite implementation of professional and engineering activities related to communicable disease surveillance and response.
Chapter V
IMPLEMENTATION PROVISIONS
Article 22. Reference clause
In case where reference documents mentioned in this instrument are replaced, revised or supplemented, the substitute or revised documents shall prevail.
Article 23. Entry into force
1. This Circular shall enter into force from September 1, 2019.
2. Circular No. 13/2013/TT-BYT dated April 17, 2013 of the Minister of Health, regarding instructions for communicable disease surveillance, shall be repealed from the entry into force of this Circular.
Article 24. Implementary responsibilities
The Chief of the Ministry’s Office, the Ministry’s Chief Inspector, the Director of General Department of Preventive Medicine, the Directors or General Directors of Departments, Administrations or Directorates of the Ministry of Health, the Heads of affiliates of the Ministry of Health, the Directors of Departments of Health in provinces or centrally-affiliated cities, and the Heads of health units of Ministries and sectoral administrations, other entities and individuals concerned shall be responsible for implementing this Circular.
In the course of implementation of this Circular, if there is any difficulty that may arise, the Ministry of Health (General Department of Preventive Medicine) should be promptly informed to consider taking possible actions./.
 
 
PP. MINISTER
DEPUTY MINISTER
(Signed and sealed)




Nguyen Truong Son
(This translation is for reference only)



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