Circular No. 17/2019/TT-BYT guiding surveillance and response to infectious diseases

CIRCULAR

GUIDELINES FOR MONITORING AND RESPONDING TO INFECTIOUS DISEASES

Based on the Law on Prevention and Control of Infectious Diseases dated November 21, 2007;

Pursuant to Decree No. 101/2010/NĐ-CP dated September 30, 2010 of the Government detailing implementation of certain articles of the Law on Prevention and Control of Infectious Diseases regarding application of quarantine measures, compulsory quarantine, and special epidemic control during disease outbreaks;

Pursuant to the Government's Decree No. 75/2017/NĐ-CP dated June 20, 2017 stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

Considering the proposal of the Director of the Preventive Medicine Department;

The Minister of Health issues this Circular guiding monitoring and responding to infectious diseases.

PART I
GENERAL PROVISIONS

Article 1. Scope of Regulation

This Circular guides monitoring of infectious diseases; responding to infectious diseases; responsibilities in organizing and implementing monitoring and responding to infectious diseases.

Article 2. Interpretation of Terms

In this Circular, the following terms are understood as follows:

1. Community outbreak site is a place (village, residential ward, or equivalent) where confirmed cases of infectious disease or clinical cases and causative agents of infectious disease, disease vectors exist within a period corresponding to the average incubation period of the disease.

2. Outbreak site at healthcare facilities is determined when a healthcare facility has cases of infection occurring within a period corresponding to the average incubation period of the disease.

3. Reservoir is a place where causative agents of infectious diseases can survive and multiply.

4. Warning signs are initial information about infectious diseases, risks of infectious diseases, or risks affecting community health.

5. Event is a warning sign that has been verified to pose a risk of infectious disease or a risk affecting community health.

Chapter II
MONITORING OF INFECTIOUS DISEASES

Article 3. Monitoring Objectives

1. Monitoring Objectives

a) Persons with infectious diseases, carriers of infectious disease pathogens, and persons suspected of having infectious diseases;

b) Causative agents of infectious diseases;

c) Reservoirs, disease vectors, and risk factors.

2. Infectious diseases to be monitored shall be implemented according to the classification in Article 3 of the Law on Prevention and Control of Infectious Diseases.

Article 4. Types of Monitoring

Monitoring of infectious diseases includes the following types:

1. Indicator-based monitoring: involves collecting information on specific infectious diseases based on specified indicators and forms. Includes the following types:

a) Routine monitoring: involves systematically and continuously collecting basic information on infectious diseases from healthcare facilities nationwide;

b) Targeted monitoring: involves systematically and continuously collecting detailed information on certain infectious diseases and priority health issues at selected surveillance points over a specific period.

2. Event-based monitoring: involves collecting information, screening, and verifying warning signs from community sources, social media, communication networks, agencies, organizations, and the healthcare network.

Article 5. Monitoring Locations

Monitoring of infectious diseases is conducted throughout the administrative area assigned for surveillance, focusing on:

1. Healthcare facilities.

2. Areas under isolation for infectious diseases.

3. Areas with current outbreaks, epidemics; areas with past outbreaks, areas at risk of epidemics.

4. Places of residence, study, work, tourist destinations, and accommodations of persons with infectious diseases, carriers of infectious disease pathogens, and persons suspected of having infectious diseases.

5. Border areas by land, rail, air, and water.

6. Areas affected by natural disasters or catastrophes.

Article 6. Content of Surveillance

1. For individuals with infectious diseases, carriers of infectious disease pathogens, and those suspected of having infectious diseases, the surveillance contents include:

a) Full name, age, gender, occupation, contact phone number, residential address, place of study and work; location and time of infection onset; disease progression, symptoms, diagnosis, and treatment process before the disease onset; information on confirmatory tests for the causative agent; obstetric history, vaccination history, and immune status; travel history within and outside the country; information on exposure and epidemiological factors.

b) Economic, cultural, and social conditions at the surveillance site: standard of living, lifestyle, living conditions, customs and traditions, demographic structure, ethnic composition, disease structure; geography, climate, weather including: geographical area, season, temperature, rainfall, humidity, wind direction, and other risk factors.

2. For causative agents of infectious diseases: species, genus, group, type, subtype, gene, genotype, biological characteristics regarding drug resistance, morphological changes, genetic changes, and modes of transmission.

3. For disease vectors

a) Animals: quantity, relationship with humans, and other characteristics as required. For insects specifically, additional monitoring includes: biological characteristics, species composition, monitoring indices, chemical sensitivity;

b) Food: raw materials, origin, processing methods, storage, transportation, and distribution;

c) Environment: soil, water, air;

d) Other objects carrying causative agents of infectious diseases.

4. Based on the infectious disease, epidemic, surveillance subjects, and requirements of different types of surveillance, the responsible unit selects appropriate surveillance contents.

Article 7. Surveillance Procedure

1. Collecting data and information.

2. Analyzing data, interpreting results, and evaluating outcomes.

3. Assessing risks, assessing the situation of infectious diseases and epidemics.

4. Proposing intervention measures.

5. Reporting and sharing information.

Chapter III
RESPONSE TO INFECTIOUS DISEASES AND EPIDEMICS

Article 8. Prevention of Infectious Diseases and Epidemics

When there is no outbreak or epidemic of infectious diseases, units responsible for responding within their administrative areas shall implement proactive preventive activities as follows:

1. Developing, approving, and implementing plans to prevent and control infectious diseases.

2. Evaluating and forecasting the risk of infectious disease outbreaks.

3. Controlling risks.

4. Inspecting and supervising.

Article 9. Steps in Investigating Outbreaks of Infectious Diseases and Epidemics

The sequence of steps in investigating outbreaks of infectious diseases and epidemics may be flexible depending on the nature of the outbreak and epidemic, including:

1. Preparing for the investigation of the outbreak of infectious diseases and epidemics.

2. Verifying the diagnosis.

3. Confirming the existence of the outbreak of infectious diseases and epidemics.

4. Defining cases of illness based on clinical, epidemiological, and testing diagnostic criteria to identify infected individuals, suspected cases, and the first case.

5. Describing the outbreak according to the three elements of time, place, and person.

6. Formulating hypotheses about the outbreak, source, causative agent, mode of transmission, intermediate host or vector, exposure, and risk factors.

7. Evaluating and validating the hypotheses.

8. Refining the hypotheses and conducting supplementary research.

9. Proposing preventive and control measures.

10. Announcing the results of the investigation of the outbreak of infectious diseases and epidemics.

Article 10. Handling of Epidemic Foci and Infectious Diseases

When there is an epidemic focus or infectious disease outbreak, units responsible for responding within their administrative management areas shall develop plans to prevent and control the epidemic, prepare and implement handling of the epidemic focus and infectious diseases as follows:

1. Preparation for handling epidemic foci and infectious diseases

a) Human resources;

b) Proposing support for prevention and control of the epidemic (if necessary): identifying the support line, facilities, methods, time, and content of support from higher levels and inter-sectoral collaboration;

c) Medicines, vaccines, chemicals, biological products, materials for collecting, packaging, storing, and transporting samples, equipment for handling epidemic foci and infectious diseases; emergency medical equipment and other medical tools;

d) Preparing conditions to ensure infection prevention for healthcare workers, staff involved in prevention and control activities, and those in contact with them;

đ) Budgeting for investigation and activities to handle epidemic foci and infectious diseases.

2. Activities to handle epidemic foci and infectious diseases

Based on the results of investigating epidemic foci and infectious diseases, select measures to handle the epidemic as follows:

a) Handling the source of the disease: admitting, treating, and managing cases of illness; implementing medical quarantine, compulsory medical quarantine; treating carriers of infectious diseases; disposing of waste from people, animals, and other sources of transmission;

b) Handling the route of transmission: implementing measures to prevent and control intermediate transmitters; environmental sanitation, disinfection, and decontamination in areas with epidemic foci and outbreaks;

c) Protecting healthy individuals in the community and exposed individuals in hospitals: hygiene, personal protective equipment; ensuring food safety; preventive treatment and enhancing body resistance; vaccinating against the disease; communicating risks and health education in the community;

d) Applying special measures to prevent and control the epidemic during the outbreak period according to current regulations;

đ) Investigating epidemiology and handling cases of death due to infectious diseases.

Article 11. List of Group B Infectious Diseases Requiring Medical Quarantine

The list of Group B infectious diseases requiring medical quarantine includes:

1. Diphtheria.

2. Whooping cough.

3. Measles.

4. Rubella.

5. Anthrax.

6. Meningococcal meningitis.

7. Hand-foot-and-mouth disease.

8. Chickenpox.

9. Mumps.

Article 12. Allocation of Responsibilities for Responding to Infectious Diseases Among Healthcare Facilities

1. For all Group C infectious diseases; Group B infectious diseases with low incidence rates (lower than the average number of cases in the same week or month over the past three years, excluding data from the year of the outbreak) and without fatalities: Health Stations at commune, ward, town level (hereinafter referred to as commune) shall proactively and be responsible for advising the People's Committee of the commune to organize and implement activities to respond to the prevention and control of infectious diseases in the area.

2. For Group B infectious diseases with high incidence rates in communes or districts (higher than the average number of cases in the same week or month over the past three years, excluding data from the year of the outbreak) or with fatalities: District Health Centers shall proactively and be responsible for advising the People's Committee of the district to organize and implement activities to respond to the prevention and control of infectious diseases in the area.

3. For all Group A infectious diseases; Group B infectious diseases with two or more fatalities suspected to be caused by the same disease or pathogen in the same district within one month: Provincial Centers for Disease Control shall proactively and be responsible for proposing the Department of Health to advise the People's Committee of the province to organize and implement activities to respond to the prevention and control of infectious diseases in the area.

4. International Health Quarantine Centers and Provincial Centers for Disease Control with international health quarantine functions shall be responsible for investigating, reporting, and implementing measures to respond to the prevention and control of infectious diseases at border areas.

5. Infection control units in healthcare facilities shall directly monitor, investigate, report, assess the situation, evaluate the risk of infectious diseases in healthcare facilities, advise leadership, and coordinate with the infection control network in departments, related units to implement measures to prevent and control infectious diseases; while supporting lower levels in responding to infectious diseases.

6. In cases where the capacity to respond to infectious diseases exceeds that of the unit or locality, the units and localities shall report and request support and mobilization of resources from higher levels and direct management authorities for prevention and control activities.

7. Institutes under the preventive healthcare system, hospitals under the Ministry of Health shall continuously monitor, assess the situation, evaluate the risk of infectious diseases to promptly support lower levels in responding to the prevention and control of infectious diseases. In cases where the capacity to respond is exceeded, the Institutes and hospitals shall report to the Ministry of Health for guidance and mobilization of resources from localities, central agencies, or international organizations for support.

Article 13. Information and Reporting

Implement in accordance with the provisions of Circular No. 54/2015/TT-BYT dated December 28, 2015, issued by the Minister of Health on Guidelines for Information and Reporting Systems and Disease Notification; Circular No. 15/2014/TT-BYT dated May 15, 2014, issued by the Minister of Health on Guidelines for Information and Reporting Activities of Medical Quarantine; Joint Circular No. 16/2013/TTLT-BYT-BNN&PTNT dated May 27, 2013, issued by the Ministry of Health and the Ministry of Agriculture and Rural Development on Guidelines for Coordination in Prevention and Control of Zoonotic Diseases.

Chapter IV
RESPONSIBILITY FOR IMPLEMENTATION

Article 14. Responsibilities of the Preventive Medicine Department

1. Advise the Minister of Health to perform state management functions in building, coordinating, and directing all specialized technical activities related to surveillance and response to infectious diseases nationwide.

2. Direct the Institutes under the Preventive Medicine System, Provincial Departments of Health, and provincial-level preventive health units to carry out surveillance activities, analyze situations, assess risks, and respond to infectious diseases.

3. Organize inspections, supervision, and urging the implementation of specialized technical activities related to surveillance and response to infectious diseases.

4. Report to the Minister of Health weekly, monthly, annually, or at any time about the situation of infectious diseases both domestically and globally.

Article 15. Responsibilities of the Food Safety Department

1. Coordinate with the Preventive Medicine Department to direct Provincial Departments of Health, Food Safety Inspection Agencies, and Food Safety Management Boards of centrally-administered cities and provinces to carry out surveillance activities, analyze situations, assess risks, and respond to foodborne infectious diseases.

2. Organize inspections, supervision, and urging the implementation of specialized technical activities related to surveillance and response to foodborne infectious diseases.

Article 16. Responsibilities of the Department of Medical Examination and Treatment

1. Guide and direct medical examination and treatment facilities nationwide to implement specialized technical activities related to surveillance and response to infectious diseases and infection prevention in healthcare settings.

2. Organize inspections, supervision, and urging medical examination and treatment facilities to implement specialized technical activities related to surveillance and response to infectious diseases.

Article 17. Responsibilities of Institutes under the Preventive Medicine System and Hospitals under the Ministry of Health

1. Provide professional technical guidance, organize inspections, supervision, and evaluation of the implementation of surveillance and response activities to infectious diseases at units within the assigned professional technical areas.

2. Conduct sample collection and diagnostic testing for pathogens. Collect, analyze, evaluate, store surveillance data and response to infectious diseases, and report on the activities of disease prevention and control of units within the assigned areas.

3. Coordinate and share surveillance and response information to infectious diseases between preventive health facilities and relevant units.

Article 18. Responsibilities of the Department of Health

1. Directing and guiding health units under its management to implement specialized and technical activities for monitoring and responding to infectious diseases and epidemics.

2. Organizing inspections, supervision, and urging the implementation of specialized and technical activities for monitoring and responding to infectious diseases and epidemics.

3. Reporting and advising the provincial People's Committee on coordinating and responding to infectious diseases and epidemics.

Article 19. Responsibilities of Units under the Department of Health

1. Provincial Center for Disease Control

a) Serving as the focal point and coordinating with the Food Safety Inspection Service, medical facilities, and relevant provincial-level units to organize and implement activities for monitoring and responding to infectious diseases and epidemics within their jurisdiction;

b) Directing, training, guiding, and supervising subordinate units in implementing specialized and technical activities for monitoring and responding to infectious diseases and epidemics.

For provinces and cities that have not established a Provincial Center for Disease Control, the Preventive Health Center and the Provincial Malaria Prevention Center shall be responsible for implementing monitoring and response activities for infectious diseases and epidemics according to the provisions of this Circular.

2. International Health Quarantine Centers or Provincial Centers for Disease Control with quarantine functions and border quarantine organizations shall be responsible for organizing the implementation of specialized and technical activities for monitoring and responding to infectious diseases and epidemics at border gates within their jurisdiction.

3. District Health Centers serve as focal points, coordinating with medical facilities and relevant district-level units to organize and implement activities for monitoring and responding to infectious diseases and epidemics within their jurisdiction. Directing, training, guiding, and supervising subordinate units in implementing specialized and technical activities for monitoring and responding to infectious diseases and epidemics.

4. Health Stations shall carry out monitoring and responding to infectious diseases and epidemics within their jurisdiction.

Article 20. Responsibilities of Medical Examination and Treatment Facilities, Vaccination Centers, and Testing Facilities

1. Implementing monitoring and response activities for infectious diseases and epidemics and preventing infection at medical examination and treatment facilities, vaccination centers, and testing facilities.

2. Collecting samples from patients seeking examination and treatment at medical examination and treatment facilities and testing facilities; sharing samples with Hygiene and Epidemiology Institutes, Pasteur Institutes, and Rickettsial Diseases - Parasitology - Entomology Institutes for definitive diagnosis.

3. Closely collaborating with preventive health units in investigating and reporting information related to diagnosis and treatment of patients.

Article 21. Responsibilities of Health Departments of Ministries and Sectors

1. Directing and guiding subordinate units to implement specialized and technical activities for monitoring, reporting, and responding to infectious diseases and epidemics.

2. Organizing inspections, supervision, and urging the implementation of specialized and technical activities for monitoring, reporting, and responding to infectious diseases and epidemics.

Chapter V
IMPLEMENTING PROVISIONS

Article 22. Cross-referencing Provisions

In case the referenced documents in this document are replaced or amended, they shall be implemented according to the replacement document or the amended document.

Article 23. Effectiveness of Implementation

1. This Circular takes effect from September 1, 2019.

2. Circular No. 13/2013/TT-BYT dated April 17, 2013, issued by the Minister of Health on Guidelines for Monitoring Infectious Diseases, shall cease to be effective from the date this Circular takes effect.

Article 24. Responsibility for Implementation

The Head of the Ministry’s Office, the Inspector General of the Ministry, the Director of the Preventive Health Department, Heads of Departments, Directors of Bureaus, and General Directors of General Bureaus under the Ministry of Health; Heads of agencies and units directly under the Ministry of Health; Directors of Health Departments of provinces and centrally-administered municipalities; Heads of health departments of ministries and sectors, and related organizations and individuals are responsible for enforcing this Circular.

During the implementation process, if there are any difficulties, please promptly report them to the Ministry of Health (Preventive Health Department) for consideration and resolution./.