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 ti
Trang 1DAP 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 thuc trang dap irng phdng chong dich (PCD) cua he thdng giam sat benh truyen nhiem tir tuyen tinh den tuyen trung uong Ket qua nghien ciru cho thay: he thdng giam sat benh truyen nhiem da dupe thiet lap, phan 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 cdn thap (30-50%) Quan ly va phan tich so lieu chii yeu tai tuyen Trung ucng va khu vuc (10% can bp tuyen huyen cd kha nang phan tich sd lieu) Ngudn luc phuc vy cho GS cdn chua dap irng dupe nhu cau tai tit
ca cac tuyen, dac biet la tuyen tinh, huyen Trang thiet bi, nhan luc cho xet nghiem tai tuyen khu vuc tuong doi hoan chinh Tuy nhien, tuyen tinh va huyen can dupe dau tu manh me han nua, dac biet la nang luc 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
Trong thdi gian qua, tren the gidi ciing
nhu tai Viet Nam tinh hinh benh djch dien bien
ngay cang phirc tap nhieu benh truyen nhiem
(BTN) giiy djch cd nguy co biing phat trd lai
nhu lao, sdt xuat huy et benh dudng rudt, viem
nao do vi rut Ben canh dd cung xuat hien
nhieu benh mdi ndi chua kiem soat duoc, cd
nguy co1 biing phat thanh dai djch nhu SARS,
ciim A/II5N1 [1], He thdng giam sat benh
truyen nhiem (GSB'PN) d Viet Nam duoc thiet
lap tir Trung uong den dja phuong dudi sir chi
dao true tiep cua Cue Y te dir phdng, cd nhiem
vu giam sat phat hien v a bao cao 26 BTN hdi
chirng He thdng GSBTN ciia Viet Nam dang
hoat ddng theo Quy che ban hanh kem theo
Quyet djnh so 4880/QD-BYT ngay 6 thang 12
nam 2002 cua Bd trudng Bd Y te [2] Nghien
ciru nay duoc thuc hien vdi muc tieu: Md ta thuc trang dap irng phdng chdng djch (PCD) cua he thdng GSBTN tu tuyen tinh den tuyen Trung uang Dd lit co sd khoa hoc de phan tich dua ra nhung kien nghj nham hoan thien, tang cudng kha nang giam sat benh ciia he thdng GSBTN trong giai doan hien nay
II PHlTONG PHAP NGHIEN CUU 2.1 Vat lieu
Doi tuong nghien ciiu:
+ Dan vj tham gia he thdng GSBTN ciia tuyen Trung uong, tuyen khu vuc, tuyen tinh , tuyen huyen;
+ Can bo lanh dao va can bd tham gia hoat ddng giam sat tai cac tuyen cd 87 ngudi tham gia phdng van bao gdm: tuyen Trung uang cd 3 ngudi, tuyen khu vuc 24 ngudi, 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 6 (114) 245
Trang 2Dja diem
Tuyen Trung uong: Cue Y te Du
phong Bo Y te
Tuyen khu vuc: 3 Vien Ve sinh Djch te
va Pasteur khu vuc: mien Bac, mien Trung
mien Nam (Vien Ve sinh dich te Trung uong,
Vien Pasteur Nha Trang va Vien Pasteur Thanh
phd Hd Chi Minh)
Tuyen tinh: Trung tam Y le du phong
(TTYTDP) cua 5 Tinh (Nam Djnh, Ninh Binh,
Quang Binh Hau Giang va Sdc Trang)
Tuyen huyen: TTYTDP ciia 10 huyen
thupc 05 tinh tham gia nghien cuu tren (chpn
ngau nhien 2 huyen/tinh)
Thoi gian dieu tra
Cupc dieu tra dupe tien hanh tir ngay
16 thang 1 1 nam 2009 den ngay 09 thang 12
nam 2009
2.2 Phuong phap
Thiet ke nghien cuu la dieu tra mo ta cat
ngang bang phuong phap djnh lupng ket hpp
vdi phuong phap djnh tinh su dung bp cau hoi
phong van de danh gia hoat dpng GS o cac
muc dp khac nhau tir tuyen co' so' den tuyen
Trung uong
Bp ciiu hpi dupe dua thep bp cong cu do
To chuc Y to The gio i khuyen cao ap dung trong
danh gia he thong GSBTN [3] Tuy nhien, bp
Ciiu hOi nay da dupe gop y, bp sung clip phu
hpp vdi he thdng GSBTN tai Viet Nam va dap
ung muc tieu ciia nghien ciiu nay
Noi dung nghien ciiu:
Cau triic cua he thdng GS tai cac tuyen
Thuc hien chuc nang nhiem vu
Ngudn luc san cd ca ve nhan luc va
trang thiet bj thiet yeu
Kha nang xet nghiem chan doan
Phuong phap xu ly so lieu
Cac phieu dieu tra dupe nhap 2 lan vao
chuong trinh may tinh Sd lieu sau dd dupe
kiem tra vii lam sach bang cdng cu kiem tra
nhap lieu kep Phan tich ket qua thdng qua
phan mem Epi-Info 2.7 Ket qua phan tich
dau ra dupe trinh bay bang cac bang sd lieu,
bieu dd va ban do
III KET QUA VA BAN EUAN 3.1 Cau triic he thdng giam sat tai cac tuyen:
Cue Y ti du phdng va mdi trudng tat
ca cac Vien VSDT/Pasteur khu vuc deu cd bp phan chuyen mdn chuyen trach GS va PCD vdi nhan luc duoc phan cdng nhiem vu cu the Cac bp phan nay deu nam trong khoa djch te hoac khoa kiem soat benh truyen nhiem va viic xin nen phdi hpp cac hoat dpng GS va PCD trpng ca khpa kha chat che
Tat ca cac TTYTDP tuyen tinh deu cd khoa Kiem soat benh truyen nhiem va vac xin sinh pham, thirc hien chiic nang giam sat va phdng chdng benh truyen nhiem vdi quy che, chirc nang nhiem vu ro rang theo Quyet djnh
sd 05/2006/QD-BYT Vdi co cau td chirc nay
se de dang trong thuc hien chirc nang va nhiem
vu dupe giap tai tuyen tinh Tuy nhien, tai cac khpa Kiem spat benh truy en nhiem vii vac xin sinh pham chua thanh lap td GS va PCD cung nhu bp phan thdng ke bao cao rieng biet Cac can bp cua khoa lam ciing mpt liic nhieu Ipai viec nen chua cd tinh chuyen mdn hda va trach nhiem cao trong cdng tac GS va PCD
Tai cac TTYTDP tuyen huyen deu cd khoa Kiem soat djch benh, HIV/AIDS thuc hien nhieu chirc nang trong dd cd chirc nang
GS va PCD vdi quy che, nhiem vu ro rang theo Quyet djnh sd 26/2005/QD-BYT Co cau
td chiic nay la hop ly trong thuc hien chuc nang nhiem vu ciia tuyen huyen Tai khoa Kiem soat djch benh, HIV/AIDS cua TTYTDP huyen cung chua cd nhdm GS thdng ke bao cao BTN
va chua cd can bp chuyen trach dupe phan cdng
cu the, tinh chuyen inon hda khdng cao
He thdng GSBTN da cd sir thdng nhat trong toan qudc ve cdng tac trien khai GS-BTN He thdng nay mang tinh dai dien cao (tat ca cac viing, mien; theo he thdng dpc va
ca he thdng ngang vdi mdi lien quan vdi cac
Trang 3nganh hoat dong dua vao cong dong) Hoat xuyen theo quy djnh thuong quy nhu mot hoat dpng GSBTN mang tinh ben vung va thuong 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 1 Banh gia hoat dong giam sat benh truyen nhilm cua can bo y ti dir phong
n=3
Tuyen khu virc n=24
Tuyen tinh n=30
Tuyen huyen n=30
Co moi lien he thuong xuyen, h5 trp doi
voi tuyen duoi true tilp quan ly 3 (100%) 24 (100%) 30 (100%) 30 (100%) Thu thap so lieu tir hai ngudn: tuyln dilu
tri va cpng ddng 3 (100%) 24 (100%) 19 (63,33%) 26 (86,67%) Bao cao dich khan cap bang dien thoai 3 (100%) 24 (100%) 30 (100%) 30 (100%) Thuc hien giri bao cao :
- Bao cao tuan 3 (100%) 24 (100%) 24 (80%) 28 (93,33%)
- Bao cao thang 3 (100%) 24 (100%) 30(100%) 30(100%)
- Tinh diing han cua bao cao tuan, thang 3 (100%) 23 (95,8%) 24 (80%) 21 (70%)
Phan hdi bao cao:
- Phan hdi bao cao thang 3 (100%) 24 (100%) 26 (86,67%) 6 (20%)
- Phan hoi bao cao tuan 3 (100%) 24 (100%) 15 (50%) 3 (30%) Quan ly va luu tru sd lieu tren may tinh 3 (100%) 24 (100%) 30 (100%) 24 (80%) Phan tich so lieu mpt so benh quan trpng 3 (100%) 24 (100%) 24 (80%) 3 (10%)
Cd ke hoach phdng chdng dich 3 (100%) 24 (100%) 30 (100%) 30 (100%)
Tap chi Y hpc du phdng Tap XX so 6 (114) 247
Trang 4Cue 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 khi 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' tuy en duoi ciia tuyen tinh
va tuyen huyen chua dupe thuong xuyen do
thieu nhan luc va thieu kinh phi
Tuyen Trung uong va khu vuc da dam
bao thu thap so lieu GS tir ca 2 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
2 ngudn (tuyen huyen va benh vien tinh) dat
63,33% Thu thap SP lieu GS ciia tuyen huyen
tir ca 2 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 khi co ca benh duoc chan
doan thupc BTN trong 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
khi 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
tuy 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
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 sd-dung 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 do 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 tuy 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 tuy 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 do 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 nay trong 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 duy tri luu so lieu bang van ban nhu cac bao cao, sd sach nien giam BTN hang nam va
5 nam de tranh mat mat trong trudng hpp cd
su cd ve may tinh) 1 00% tuyen tinh da quan ly
sd lieu bang may tinh ciing vdi quan ly bang
Trang 5so sach van ban luu de tranh mat mat Quan
ly so lieu cua tuyen tinh tuy 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 khi 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
3.2.2 Nguon lire cim lie thong giiun sdt:
3.2.2.1 S hun lire coo hi' thong giiun siit:
Bang 2 Kien thirc cua can bp giam sat ve mpt so yeu cau chuyen mdn
Npi dung Tuyen trung uang va khu vuc
n=27
Tuyen tinh n=30 Tuyen huyen n=30 Nam vung ca sd phap ly 27 (100%) 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 trong
Nam vung quy chd bao cao dich ciim A/
- Nam vung cac quy che bao cao tu§n, bao
Duoc dao tao chuyen nganh 27 (100%) 9 (30%) 2 (6,7%)
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 tuy en Trung uong khu vuc va mpt sd tinh cd the sir dung may tinh thanh 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, trong dd cd 5 dpi chdng djch co ddng tai tuyen khu vuc 3 dpi tai tuyen tinh va 2 dpi tai tuyen huyen dupe chuan bj sim sang
Tap chi Y hpc du phdng Tap XX so 6(114) 249
Trang 6Co 100% cac can bo duoc phong van
tai tuyen Trung uong va cac khu vuc, tuyen
tinh deu nam viing co- so phap ly ciia he thong
GS Tuy nhien ty le nay d tuyen huyen chi dat
77% Co so phap ly duy nhat cho hoat dong
GS hien nay la Quyet dinh sd
4880/2002/QD-BYT ciia Bd trudng Bd Y te ve Quy che thdng
tin, bao cao BTN gay djch Vi vay viec dir
thao bd sung va siia ddi Quyet djnh nay de phu
hop vdi tinh hinh djch benh cua giai doan hien
nay la can thiet Cac hoat ddng GS PCD da
dupe hien thirc hda tir khi Luat phdng chdng
BTN dupe Qudc hpi phe duy et nam 2007 [5]
Nhirng quy djnh dudi luat dang dupe xay dung
va ban hanh se tirng budc hoan thien va nang
cao nang luc he thdng Cac can bp lam cdng
tac y te lien quan den cdng tac GSBTN phan
Idn nam vung co so phap ly va biet su dung
djnh nghTa ca benh cho cdng tac GS, xii ly va
dieu trj BTN
Cd 100% can bp chuyen trach ve GS
cac tuyen Trung uong khu vuc va tinh da nam
viing ndi dung chuyen mdn vc quy che bao
cao djch cac loai, djnh nghTa ca benh trong
GS Tuyen huyen chi dat 73% sd can bp biet
su' dung diing djnh nghTa ca benh
Tai tuyen Trung uong va Khu vuc da cd
mpt sd can bp chuyen khpa chinh quy, can bp
sau dai hpc, mpt sd khac da dupe dap tap ngan
han hoac dai han trong ITnh vuc nay Cac can
bp nay dupe phan cdng va linn vice on djnh Tai tuyen tinh, nhan lire cho GS va PCD cdn thieu Sd can bp chuy en khpa Ve sinh Djch te hoac Y ti cdng cpng true tiep lam cdng tac GS
va PCD tai tuyen tinh dat rSt thap va rat it can
bp dupe dao tao sau dai hpc Sd can bp dupe dao tao chuyen khoa Ve sinh Djch tc hoac Y te cdng cdng true tiep lam cdng tac GS va PCD tai tuyen huyen rat thap (6.7%) Tai tuy en tinh
va tuyen huyen cd tir 25-40% can bp mdi chua dupe dao tao chuyen nganh 2/5 tinh va 8/10 huyen khdng cd ke hoach dao tao lien tuc hang nam ve ITnh vuc hoat dpng GS vii PCD Nhu cau dap tap ciia cac tuyen nay lit rat cap Nhu vay viec nang cao nang luc ciia can bp la mpt trpng nhirng giai phap chinh de nang cap chat lupng hoat dpng GS va PCD tai cac don vj GS tuyen tinh huyen
3.2.2.2 Kinh phi cho giam sal:
Mac dii khdng cd kinh phi rieng cho GSBTN, nhung cac Vien khu vuc da dap ling day dii cac yeu can kinh phi nhu di lai luu tru, cdng tac phi dung quy djnh chp can bd khi tham gia GS thudng ky cung nhu khi tham gia PCD TTYTDP tuyen tinh, huyen cho rang kinh phi cho GS va PCD chua dap ling dupe nhu ciiu thuc te Djnh mire chi clip can bp di
GS thudng ky va can bp true tiep tham gia PCD cdn thap nen khdng khuyen khich dupe can bp lam nhiem vu
3.2.3 Trang thiet hi:
Bang 3 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 n=10 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%)
Trang 7Trang 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, 6 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 4 Trang thiet bj va nang lire xet nghiem (XN) phuc vu cong tac giam sat tai cac tuyen
n=3 Tuyen tinh n=5 Tuyen huyen n=10
Co du PXN va trarn^.thiet bi cho viec thirc hien
Lay duoc mlu benh pham ciim A/H5N1 4 (100%) 5 (100%) 4 (40%) Bao quan duoc miu benh pham vi rut 4 (100%) 5 (100%) 0 (0%) Thuc hien duoc cac XN chan doan cac benh
Cd can bp chuyen trach XN dupe dao tao 4(100%) 3 (60%) 4 (40%)
Cd bp phan va can bp chuyen trach ve an
Cac phong thi nghiem tai tuyen khu vuc
da co trang thiet bj kha day du de dam bao cho
cac XN co' ban: nuoi cay phan lap, huyet thanh
hpc (ELISA) sinh hpc phan tir (PCR thong
thuong) va ca trang thiet bj hien dai nhu
Real-time PCR, may dpc trinh tir gen (sequencer)
kinh hien vi dien tir (Vien VSDTTW) Cac
PXN tai tuyen tinh da co trang thiet bj toi thieu
cho XN vi khuan (soi tuoi va nuoi cay phan
lap vi khuan: 100%)
XN la cong cu hii'u ich doi voi he YTDP
trong vice ho trp hoac khang djnh chan doan ca
benh Tat ca cac khu vuc da co he thong phong
thi nghiem voi cac ITnh vuc XN kha day du de
dap irng nhu cau chan doan BTN dupe phan
thanh cac khoa chuy en mon sau: Vi khuan, Vi
nit Mien djch Sinh hpc phan tu.Tat ca cac
TTYTDP tinh deu co khoa XN trong do co bp phan XN vi sinh (vi khuan, vi rut) thuc hien chiic nang chan doan xac djnh cac BTN tren dja ban tinh Cac TTYTDP huyen da co khoa
XN thuc hien chuc nang lay mau benh pham, bao quan va van chuyen benh pham len tuyen tren va phoi hop voi benh vien de lam mpt
so XN ban dau phuc vu cho cong tac chuyen mon Day la co' so tot giup tuyen tinh va khu vuc trong cong tac lay mau benh pham som, bao quan va chuyen mau nhanh len tuyen tren
de khang djnh som vu djch Tat ca cac Vien khu vuc deu co kha nang lay mau, bao quan va XN tac nhan ciim
A H5N1 bang cac phuong phap tin cay: RT-PCR va realtime RT-PCR Ngoai ra cac phong thi nghiem nay con co kha nang tham gia vao cac Tap chi Y hpc du phdng Tap XX so 6(114)
Trang 8nghien 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 6 2 - 4°C Kha nang
van chuyen benh pham nay 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 con 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 thanh hpc chua co
kha nang lam 0 tuyen huyen Nang luc chii
yen cua PXN tuyen huyen hien nay mai chi
dimg 0 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
con thap 0 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
Chat luong GS tai cac tuyen con chua dong deu Viec phan hoi bao cao con 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 con 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
1 Cue Y te du phong va mpi truong Bp Y te Nien giiun thOng ke 2005-2008
2 Quyet djnh 4880/2002/QD-BYT ngay 6/12/2002 vc quy djnh bao cao va thong tin benh truyen nhiem
3 Huong dan danh gia he thpng giam sal va dap ung cong tac phong chong benh truyen nhiem WHO/CDS/CSR/ISR/2001.2
4 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
5 Luat phong chong benh truyen nhiem so 03/2007/QH12
6 Hcymann.Cam nang phong chong benh truy en nhiem xuat ban lan thii' 19
Trang 9VIETNAM'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
struc-tured 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
communica-ble disease surveillance systems has the
spe-cific 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
net-work 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 com-municable 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 labora-tory equipment of provincial and district net-works should be support, Beside, the training course for laboratory 's technicans is necces-sary (the percent of laboratory 's technicans have trained for speciality from 40-60%) Key words: Disease surveillancem epi-demic preparedness, communicable diseases
Tap chi Y hoe du phong Tap XX, so 6 (114) 253