TV L E V A s y PHAN B 6 H U Y ^ T THANH CO K H A N G T H ^ K H A N G VI RUT CUM A/H5N1 d NGU'ai BUON B A N V A G|£T M 6 GIA C A M , THUY C A M TAI MOT S6 TiNH MliN B A C , VIET NAM
Vii Sinh Nam, ThSm Chi Dung*, Pham Ngpc Dinh*, Le Quynh Mai*, Lu-omg Minh Tfin* vd Nguyen Le Khdnh HSng*
Cue Yte dirphdng, Bd Yte, Hd Ndi
*Vien Vc sinh Dich te Tnmg mfng, Hd noi
T 6 M TAT:
Nghiin cdu m i td cdt ngang xdc djnh t^ l i huyit thanh c6 khflng thi khflng vi rut ciim A/H5N1 duiyc thyc hiin trin 607 ngu'di buin bdn vd giii m i gia cdm, thuy cim tgi Hfl Nil, Thfli Binh vfl Thanh Hda, trong 4 thdng {9-12/2011}. S6 liiu 6\j(jc thu thip qua phdng vdn tn/c tiip bdng b i cau hii vfl lay 3-5ml mflu ITnh mpch d i xit nghiim bdng ky thuit ngdn ngung kit hing cdu (HAI) vfl trung hia vi lippng (MM). Kit qud cho thdy ty 1$ C6 khflng thi khdng vi rut ciim A/H5N1 chung Ifl 6.1%, ty l i nfly tai Hd Nil Ifl 7,2%, Thfli Binh (5.3%) vd Thanh Hia (4,5%); khing c6 sy khflc biit cua ty l i nhiem theo q\b\ tinh, cao nhat d nhim 25-35 tuii (8,9%); nhim cd liflnh vi giit m i (8,0%); thflnh viin gia dinh thu'ing xuyin tiip xiic vfi'i gia cdm, thCiy cdm c i t j l i nhiim cao nhdt so v i i chu h i hodc ngu'&i Iflm c6ng (16,7%); ngu-ii sing trong h i gia dinh c6 thu nh$p tCr 3-5 triiu ding/thflng cd t j l i mic cao nhdt (9.1%).
Tdkhod: cOm A/H5N1; khflng thi; ngu&i budn bSn vfl giit m i gia cim, thiiy cim; miin Bdc Viit Nam
I. DAT VAN DE
Theo thdng kd ciia Td chirc Y td The gidi (TCYTTG) til 2003 ddn ngdy 5/4/2012 frdn thd gidi ghi nhpn 600 trudng hgp mdc ciim gia cdm A/H5N1, frong dd cd 353 tii vong, chidm 58,8%. Trong sd 16 quoc gia va lanh thd, bao gom Azerbaijan, Bangladesh, Cam-pu-chia, Tmng Qudc, Djibouti, Ai Cap, Indonesia, I-rac, Lao, Myanmar, Nigeria, Pakistan, Thdi Lan, Thd NhT Ky vd Vift Nam cd bdo cdo
ngudi mac va hi vong do cum A/H5N1, 3 quoc gia (Indonesia, Ai Cap vd Viet Nam) cd sd ngudi mdc va tu vong cao nhat fren the gidi va Id "diem ndng" ciia dich ciim A/H5N1 [1], tpi Vift Nam, tfrib ddn ngdy 5/4/2012, dich cum A/H5NI frdn dan gia elm da xdy ra d hau hdt cdc tinh, thanh phd vdi tong sd gia cdm hi chet va tidu huy tdi gdn 50 trifu con gay thift hpi ve kinh td va xa hgi [2]. Tren ngucri, dich da xdy ra d 36/63 tinh, thanh phd, ghi nhan 123 trudng hgp xac dinh mac cum A/H5N1, 61 td
Tdc gid: Vii Sinh Nam Dia chi: Cyc Y td dy phdng, Bg Y td Difn thopi: -1-84-4-3843-0040;
E-mail: vusinlmam(@hn.vnn.vn Ngay nhan bdi: 21/5/2012 Ngdy dang bdi: 31/10/2012
Phdn bifn 1: TS. Tran Nhu Duong Vifn Vf sinh Dich td Trung uong Phan bien 2: TS. Vu Dinh Thidm
Vifn Vf smh Dich t l Trung uong
Tap chi Y hpc d^ phdng, Tap XXH, s6 5 (132) 149
vong. Ty If chdl/mdc Id 49,6%, cao nhit so vdi cdc bfnh truyen nhilm hifn nay. Tir 2005 tdi nay, dich cum A'lb'^Nl frdn gia elm vd ngudi cd gidm vc so mdc, tu vong vd quy md bfnh djch. tuy nlucii Vl nit cum A/II5NI vln tidm an gay ra cac vy djch frdn gia cam vd ngudi [2].
Vi nit cum cd thd bidn chung tpo ra vi rdt mdi, tiem :in khd ndng gdy dpi djch [2]
Tuang ty nhu nhieu bfnh iniycn nhidm khdc, ngoib cdc trudng hgp cd bidu hifn ISm sang vd dugc chin dodn xdc d)nh bSng cdc xdt nghifm vi nit hgc, cd m^t sd trudng hgp khdng cd bicu bifn lam sdng, ho$c bicu hifn liim sdng d ihc nh?. Khdng gidng vi rut cum miia, cdc nghien cim vd huyet thanh hgc chua cd dii bdng chiing dO x;ic djnh ty If nhicm frong nhdm doi tugng cd nguy co phoi nhicm cao vdi vi nit cum A/H5N1. Tinh frpng nhiem trimg khdng trifu chimg vi nit cum A/H5N1 frdn ngudi dugc ddnh gid Id hiem gpp, tuy nhien thyc te van cd nhirng trudng hgp dugc phdt hifn d mgt sd nghien ciiu [3]. Ty If cd khdng the khdng vi nit ciim A/H5N1 d ngudi khac nhau hiy thugc vao doi tugng, thdi gian va dia diem nghidn cuu. Ty If ndy dao dgng tu 0-5%, thay ddi theo timg quan the nguy co vd cdc yeu to dnh hudng t3][41.
Nghien ciiu dugc tien hdnh fren nhdm doi tiigng cd nguy co phoi nhiem cao vdi vi nit ciim A/H5NI nham xdc djnh ty If cd khdng thd khdng vi nit ndy d nhdm ddi tugng nghidn cim tpi mgt sd tinh, thdnh phd midn Bdc Vift Nam.
Day Id ddi tugng tiep xuc thudng xuydn, lidn mc frong thdi gian dai vdi gia cam vd thuy cam thdng qua vifc budn bdn, giet mo gia elm, thuy cam tpi cdc diem chg dau moi d mien Bac, noi da ghi nhpn nhirng dgt dich cum A/H5N1 frdn ngudi frong nhirng ndm gan day.
II. PHUONG P H A P NGHIEN CtV Thiet ke nghidn ciiu: Nghidn ciiu md td
cftt ngang thyc hifn frdn ngudi budn bdn vd/
ho$c thudng xuydn c6 tiep xuc vdi gia elm, thiiy elm tpi Hd Nf i, Thanh Hda vd Thdi Binh td thdng 9 den thdng 12/2011 (4 thdng). Ddi tugng nghidn ciiu Id ngudi budn bdn, giet mo gia d m , thiiy elm thudng xuydn, it nhat cd tidp xuc m^t lln/ngdy vdi gia cam, thuy d m , trong thdi gian tdi thidu Id 6 thdng tinh den thdi diem nghidn ciiu, td 18 tudi frd ldn vd ddng ^ tham gia nghidn cuu.
Ddi tugng nghidn cdu: Dugc lya chgn ngau nhidn, theo cym nhu sau:
* Lya chgn cdc chg gia d m , thuy d m : Lpp danh sdch cac chg gia d m , thiiy d m ldn ciia ba tinh nghidn ciiu. Tidu chuan: mdi chg cd khdng dudi 100 ngudi budn bdn vd/hopc thudng xuydn tidp xuc vdi gia cam, thuy cam.
Tu danh sdch, tien hdnh hoc thdm ngau nhien 2 chg/tlnh, thdnh phd dd lya chpn cdc chg tham gia vdo nghidn ciiu.
* Lap danh sdch ddi tugng nghidn ciiu:
Lpp danh sdch khung mau nhung ngudi du tieu chuan nghidn ciiu. Dya vao khung mau, chpn todn bg sd ddi tugng du tidu chuan, tu chg sd 1 tdi cac chg tiep theo, cho tdi khi dpt cd mau tdi thieu 600 ddi tugng. Tren thyc tc da tien hanh dicu tra 620 ngudi.
* Thu thap thdng tin, sd lifu: Moi ddi tugng dugc tien hdnh phdng van bdng bg cau hdi ddng, sau dd dd nghj cho liy Sml mdu tinh mpch dd ldm xet nghifm tim khdng tiid khang virutcumA/H5Nl.
Ky thupt xet nghifm: Su dyng ky thupt ngdn ngimg ket hdng cau (HAI) vd trung hda VI lugng (MN) vdi khdng nguydn Id cdc vi nit thugc 3 nhdm khdng nguydn (clade 1; clade 2.3.4; clade 2.3.2.1) da luu hanh tpi midn Bdc frong giai doan 2003-2011. Huydt tiianh dan cd hifu gid khdng thd >40 don vi HAI vdi 1 frong 3 lopi khdng nguydn cda vi nit ciim dugc tidp tyc xet nghifm bang ky tiiuat MN de khdng djnh sy hifn difn cua khdng thd khdng vi nit 150 Tap chi Y hpc d\r phdng, T|ip XXII, s6 5 (132)
cum A/H5N1. Mlu huydt thanh cd hifu gid khdng thd HAI>40 vd MN>10, dugc xdc djnh Id duang tinh (TCYTTG).
Ndi dung vd quy trinh nghidn cdu da dugc Hgi ddng Y due, Vifn Vf sinh Dich te Trung uong tiidng qua vd cho phdp h^dc khi thyc hifn.
Qudn ly sd lifu: Sd dyng phin mdm Epidata v3.1 (Dan Mpch, 2008). Sd lifu dugc phan tich bang phan mdm Stata v l l . l (Texas, Hoa Ky, 2009). Ket qud tpi cdc bdng tidp lidn dugc sd dyng de tinh ty If cd khdng the khdng vi nit ciim A/H5NI theo cdc yeu td nhdn kliau hgc, xa hgi hgc d nhung ngudi budn bdn, giet md gia cam thuy cam tpi dja bdn nghien ciiu.
Su dyng tdt thdng kd x^/Fisher dd so sdnh sy khac nhau d miic tin cpy 95%.
III. K E T QUA
Nghien cuu dugc thuc hifn tpi 3 tinh, thdnh phd la Ha Ngi, Thanh Hda va Thdi Binh frdn nhirng ngudi budn bdn, giet mo gia d m , thuy cam tai cdc didm chg dau mdi frong thdi gian 4 thang (9-12/2011). Tdng sd ddi tirgng dugc didu fra la 620, cd 13 mau mau khdng dii chat lugng nen bf lopi khdi phan tich. Sd ddi tugng dua vao phan tich la 607, chidm 97,9%.
Trong dd, ddi tugng tai Ha Ngi chiem 50,3%,
Thdi Binh (27,8%) vd Thanh Hda (21,9%).
Ket qud ve phan bd cdc dac diem nhdn khau hgc, xa hgi hgc cua ddi tugng tham gia nghien cuu cho thiy da sd ngudi budn bdn, giet md gia cam, thuy d m Id nir gidi (64,7%); thyc hdnh giet md gia d m , thuy d m chidm ty If cao nhat (40,8%); sau dd la chdn nuoi (37,2%);
budn bdn (26,8%); van chuydn (9,2%) vd cdc hinh thuc tiep xuc khac (nhan vien thu y, qudn ly chg, vf sinh chg, hanh chinh chg...). Da sd doi tugng hifn dang sdng chung vdi gia dinh (95,4%). Hau bet cd trinh dg hgc van tmng hgc ca sd vd trung hgc phd thdng, tuang iing 47,1 % vd 17,9%. Hinh thuc kinh doanh chu ydu theo md hinh nhd Id, hg gia dinh vdi sy tham gia cua chu hg hope cdc thanh vien gia dinh, tuang iing 54,5% va 43,5%; ngudi lam cong chi chidm 2,0%. Tudi tnmg bmh cua ddi tugng la 42,3, frd nhat la 18 tudi va ldn nhat la 74 tudi. Hg gia dinh cd quy md trung binh la 4,2 ngudi/
hg. Thu nhpp binh quan cua hg gia dinh la 5,8 trieu ddng/thang, my nhidn co sy khdc bift ldn giiia mirc thu nhap thap nhat (500 nghin ddng/
hg/thang) va cao nhat (80 frif u ddng/hd/thang).
Tuong ty, thu nhap binh quan ciia cd nhan Id 2,4 trieu ddng/ngudi/thang va dao dgng tu 100 nghin cho tdi 20 trieu dong/ngudi/thdng.
Bdng 1. Ket qud xet nghifm khdng the bang ky thupt HAI va MN (n=607)
Dja diem HSNOi Thai Btnh Thanh H6a Tong
Tong so huyet thanh
305 169 I M 607
HAI i 40
72 10J 19 192
MN>10 22
9 6 37
Ty le diFCng tinh (%)
7,2 5,3 4,6 6,1
Tsip chi Y hgc du phong. Tap XXH, so 5 (132) 151
Kdt qu4x6t nghiem 607 mSu huyit thanh chiim t j 1? 6,1%. Nhu vjy, ty 1? chung d doi cho thdy 37 raSu huyit thanh c6 sv hi?n di^n tuprng nghiSn cilu c6 Idling thi khdng vi rit ci 2 lo?i khSng thi ngSn ngung kit hing cHu cum A/H5N1 bang ky thujt huyit thanh hpc (HAI) H trang ho4 (MN) diit hi?u gii theo li6u li 6,1%.
c h u k ciia TCYTTG (HAI>40 vi MN 10),
Bing 2. PhSn tich tinh tr^ng c6 lihing t h i cOm A/H5N1 theo c&c y&u t& nhfln khiu hpc, xd h^l hpc (n°607)
Y i u t i
D|a dilm Ha NOi ThSl Binh
Huyit thanh du'O'ng tinh Huyit thanh i m tinh
Tin s i T i n s i
<25 tuii 25-34 tuii
>45 tuii 16 6,0 251 94.0
Gii'l tinh Nam NO' Hinh thi>c hdnh chinh Budn bin Giet mo Van chuyin Chdn nudi Khdc
nghi 13 24
9 17 3 13 3
6,1 6,1
5,5 6,9 5,4 5,8 5,9
201 369
154 231 53 213 48
93,9 93,9
94,5 93.1 94.6 94.2 94,1
0.00
0.13 0.42 0.06 0,07 0,004
0.98
0,72 0,52 0,81 0,78 0,95
152 Tap chi Y hpc dv phdng, Tap XXII, so 5 (132)
Tinh t r j n g h i n nhdn Dd c6 gia dinh Khdc
35 2
6,0 7,1
544 26
94,0 92,9
0,06 0,68
Hpc v l n DuH» trung hgc co- s d Tip tmng hgc phd thong trd-ISn Tiin SLP b f n h t$t C6 binh/til Khing c6 biiih/tit
6 31
7.1 5,9
73 491
92,9 94.1
0,16 0,69
Vai trd trong gia dinh Ttidnh vidn gia dinh Chu hf vk ngudi ldm
cong 560 94,1
2,39 0.12
Thu nh$p binh qudn h f gia (Tinh
Dudi 3 tri^u/thang 3-5 trif u/thdng Tren 5 trif u/th^ng
119 93.7
282 95,9
Ket qud tai bdng 2 cho thdy ty If ddi tugng cd huydt thanh cd khang thd khdng vi rut cum A/H5N1 cd su khdc nhau giiia cdc tinh, ty If duang tinh cao nhit d Hd Ngi, tiep theo Id Thai Bmh va Thanh Hda, my nhien sy khdc bift ndy khdng cd f nghia thdng kd (p>0,05).
Theo nhdm tudi, ty If duang tinh ,cao nhdt d nhdm 25-35 tudi (8,9%), nhung sy khdc bift nay cung khdng cd y nghia thdng ke (p>0,05).
Khong tim thdy sy khdc bift vd gidi tinh (p>0,05). Chua thdy sy khde bift cd y ngbia thdng ke vd cdc hinh thiic hanh nghe chinh,
tinh frpng hdn nhan, trinh dp hgc van hay tien sd bfnh tpt vdi ty If huydt thanh co khang the khdng vi rut cum A/H5N1. Ty If duang tinh cao ban d thdnh vien khdc frong gia dinh so vdi hai nhdm cdn Ipi (chu hg vd ngudi ldm cdng), tuy nhidn chua co du bang chiing thong ke de khang dinh ket qud nay (p>0,05). Ty If nhidm frong nhdm cd thu nhSp bhih quan hd gia dinh hi 3-5 tridu/thang cao ban so vdi nhdm thu nhap khdc, tuy nhien sy khdc bift nay ciing khdng cd J nghia thdng ke (p>0,05).
Tap chi Y hgc d\i phong. Tap XXII, so 5 (132)
III. B A N L U A N
Ty If huyet thanh duang tInh vdi khdng thd khdng vi rut ciim A/115N1 vdi 3 clade khdng nguyen Irong nghidn cim Id 6,1%.
Klidng cd sy khdc bift giiia 3 dia dicm nghidn cim. ty If huyi'i thanh duong tinh dao d^ng td 4,5% (Thanh Hod) ddn 7,1% (Hd Ngi). Ty If ndy khdc nhau d cdc tinh, thdnh phd cd thd Id ket qud cua mdc dg tidu thy sdn ph^in gia cam cua cdc dja phuang ndy. So vdi cdc nghidn cim tuang ty khdc f5]f4]f6], nghidn cdu cua chiing tdi cd ty If duang tinh cao han. Cy the, nghien cim cua Buxton BC (2000) vd nguy ca lay nhicm cum A/II5NI trong sd cdc nhdn vien y tc tiep xuc vdi bfnh nhan ciim A/I15NI, Hong Cdng d nhihig ndm dau tidn xuat hifn djch bfnh (1997-2005) cho thay ty If mdc ciia nhimg ngudi tiep xuc tryc tiep vdi nguon bfnh Id 3,7% frong so 217 doi tugng dieu fra. Tuy nhien, ty If nhiem cua nhdm khdng tiep xiic Id 0,7% frong sd 309 ngudi khdng cd tiep xuc tryc hep [5]. Nghien cuu cua C. Schultsz (2009) ve ty If cd khdng thd khdng vi nit cimi A/H5NI d nhung ngudi giet md gia cam tpi TP. Ho Chi Mmh (2005) frdn 500 ngudi tiep xuc tryc tidp vdi gia cam nhiem bfnh, ket qud cho thay tat ca cdc mau huyet thanh deu am tinh, chl cd 03 mau cd hifu gid khdng die HAI>180 dan vj [4]. Kdt qud nghidn ciiu cdc mdu bfnh phim thu dipp hdng tuan tpi cgng ddng d Hdng Cdng (2011) cho thay ty If huyet thanh cd khdng thd hi 6-10% [6]. Ket qud frdn cd thd la do sy luu hanh thudng xuyen vd Idu ddi cda vi rut cdm gia cam tpi mien Bdc frong 10 nam gan ddy (2003-2012). Mpc dii dich cum gia cam xuat hifn rai rdc, nhung vi nit van thudng xuydn luu hanh frong ddn vjt khod mpnh [7]. Tren thuc te, khdng phdt hifn trudng hgp hifn dang mSc bfnh cum gia cam cd dau hifu lam sdng ndo d ngudi hi khi thyc hifn nghien cdu cho ddn nay (thdng 4/2012). VI vay, cdc trudng hgp cd kdt
qud huydt thanh duong tinh trong nghidn cdu ndy cd khd ndng do tinh trpng nhidm vi nit tiem an, da timg nhicm ho$c dang nhiem Idnh vdi vi rut cdm A/H5N1 gay ndn.
Nhdm tudi cd ty If huyet thanh duang tinh cao nb^t quan sdt dugc tir nghidn cim ndy Id 25-35 tudi, Ddi tugng ndy thudng khdng cd midn djch ddi vdi vi rut cum gia cam. T^ If tidm vac xin cum mda d mdc thap. Ngodi ra, day cQng Id ddi tugng cd t4n suit tidp xuc vdi gia cdm ldn hon so vdi nhdm tudi khdc, kd cd sd thich Sn tidt canh vd tidp xuc vdi cdc sdn phim gia cim, thuy cam sdng. So vdi kdt qud nghien cdu cua Van Kerkhove MD. (2008) ve cdc ydu td nguy co mdc ciim gia cam A/H5N1 d ndng dan vung ndng thdn ciia Cam-pu-chia cho thay nhdm tudi ndy cd ty If huyet thanh ducmg tinh tuang dong [8].
Bdn cpnh vifc lya chgn dung quAn the nguy ca, khdng nguydn sir dyng ddng vai trd rat quan frgng anh hudng tdi ty If ducmg tinh. Nghidn ciiu ndy da su dyng 3 lopi khdng nguyen cd k^ hifu 30408,31244, CM32/M1E1 tuang umg vdi cdc clade I, clade 2.3.4 vd clade 2.3.2.1 ciia vi rut cum A/H5NI. Tdc gid Le Quynh Mai (2007) da tbn thay sy hifn difn cua 2 chung vi rut cum tpi khu vyc mien Bdc Id chung clade 2.3.4 H5N1 va chdng clade 1 [9].
Theo Claas EC. (1998), vi nit cum cd chiing influenza A/Hong Kong/156/97 (H5N1) vd 17 chung vi nit H5N1 khdc dS dugc phan lap tit ngudi, thih ddn cudi ndm 1997 [10].
Dd cd sy lay nhiem vi rut cum A/H5N1 d ngudi can cd ngudn truydn nhiem Id cdc loai gia cam, thuy cam. Nhu v|iy, ty If nhiem cum d ddn gia cam la rat quan frgng, vd Id mOt frong nhiing-chl sd dd ddnh gid khd ndng nliiem d ngudi cd tiep xiic. Nghien cdm cua Alexander DJ. (2007) da phdn Ipp vi nit fren cdc ddn gia cam vd tiidy cdm frong mf t didu fra nglu nhien cho thdy rat nhieu lopi chun, gia c4m vd thuy cim cd thd bi nhidm vi rut cum A/H5N1. Cy 154 Tap chi Y hgc dv ph6ng, Tgp XXII, so 5 (132)
thd, ty If nhidm d ngan vd vjt Id 11% vd d cdc loai khac Id 2% [3]. Nghidn ciru cua chung tdi khdng thyc hifn xet nghifm vi nit ciim frdn ddn gia cam la mf t hpn chd cua nghidn cdu do didu kifn ngudn lyc cd hpn. Neu quy udc sd dyng ket qud nghidn cuu cda Alexander DJ. (2007) [3] neu frdn, thi ty If Idy nhicm tdi thidu phdi Id 6,1%/1I%, tuong ling Id 55,5%. Nhu vpy, khd nang bj nhiem vi nit cum neu c6 tidp xiic vdi ngudn lay nhidm td gia cam tdi thieu d mdc cao. Tuy nhien, ty If hifn nhiem vi nit cum gia cdm d ngudi cdn phy thugc vdo cdc ydu td nhdn chiing, xa hgi cua ddi tugng nghien ciiu.
IV. KET LUAN
Ty If ddi tugng ed khdng the khdng vi nit cum A/H5N1 (clade 1, calde 2.3.4 vd clade 2.3.2.1) theo tidu chudn chin dodn xdc dinh cda Td chiic Y te The gidi Id 6,1 %, frong dd:
Ha Ndi cd ty If nhidm cao nhdt (7,2%), tidp theo la Thdi Binh (5,3%) vd Thanh Hda (4,5%).
Khdng cd sy khdc bift cua ty If nhiem theo gidi tinh.
Ty Id nhidm cao nhdt d nhdm tudi 25-35 (8,9%).
Ty le nhiem cao ban d nhdm doi tugng ed hanh vi giet md gia cam, thuy cam (8,0%).
Thanh vidn gia dinh thudng xuydn tidp xuc vdi gia cam, thuy cam cd ty Id nhiem cao ban so vdi chu hg hope ngudi ldm cdng (16,7%) Ngucri sdng frong hg gia dinh cd thu nhpp tu 3-5 trifu ddng/thang cd ty If mdc la 9,1%, cao han nhiing nhdm thu nh|p khdc,
Ldi c5m on: Cdc tdc gid chdn thanh cdm cm cdc dong nghiep, cdc cdn 6p cua Thdng tdm Yte Dir phong tinh, thdnh phd, Trgm Yte xa. Ban Qudn ly ch(r tgi cdc diem nghien cii'u cua tinh, thdnh pho Hd Noi, Thanh Hoa va Thai Binh dd tich cue ho tri?, cung cap so li^u, tham gia dieu tra vd gidm sdt thuc hi$n nghien
cuu nay.
TAI LIEU THAM KHAO
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2. WHO, "Avian Influenza A/(H5N1):
assessing the pandemic threat.," WHO/
CDS/2005, 2005.
3. D. J. Alexander, "An overview of the epidemiology of avian influenza.," Vaccine, vol. 25, no. 30, pp. 5637-5644, 2007.
4. C. Schultsz et al., "Prevalence of Antibodies against Avian Influenza A (H5N1) Virus among Cullers and Poultry Workers in Ho Chi Minh City, 2005," PLoS ONE, vol. 4, no. 11, p. 4, 2009.
5. C. Buxton Bridges et al., "Risk of influenza A (H5N1) infection among health care workers exposed to patients with influenza A (H5N1), Hong Kong.," The Journal of infectious diseases, vol. 181, no. I, pp. 344- 8, Jan. 2000.
6. J. T. Wu et al., "Estimating Infection Attack Rates and Severity in Real Time during an Influenza Pandemic: Analysis of Serial Cross-Sectional Serologic Surveillance Data," PLoS Medicine, vol. 8, no. 10, p.
el001103,2011.
7. K.Hottaetal.,"Isolationandcharacterization of H6NI and H9N2 avian influenza viruses from Ducks in Hanoi, Viemam,," Virus Research, 2011.
8. M. D. Van Kerkhove et al., "Frequency and patterns of contact with domestic poulfry and potential risk of H5N1 fransmission to humans living in rural Cambodia.,"
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AVIAN INFLUENZA A/H5N1 ANTIBODY POSITIVE AND ITS DISTRIBUTION AMONG PERSONS WHO SLAUGHTER AND SELL POULTRY IN THE NORTH OF VIET NAM.
Vu Sinh Nam, Tham Chi Dung*, Pham Ngoc Dinh*, Le Quynh Mai*, Luong Minh Tan* and Nguyen Lc Khanh Hang*
Administration of Preventive Medicine, Ministiy of Health. Hanoi
*Nafinnal Institute of Hygiene and Epidemiology, Hanoi
Abfract: A cross-sectional study was conducted to determine the avian influenza A/
H5N1 antibody positive among persons who slaughter and sell poultry in three provinces for 4 months (September-December, 2011). The data was collected by face-to-face interview method using a structured questionaire and collected 3-5ml infravenous blood sample to perform laboratory tests by hemagglutination inhibition (HAl)and microneufralization (MN) assay techniques. Results showed that an overall antibody positive proportion was 6.1%
in accordance with World Health Organization
laboratory confirmation guidelines. The proportions in Ha Noi, Thai Binh and Thanh Hoa provinces were 7.2%, 5.3% and 4.5%, respectively; no significant difference between male and female, the highest positive proportion was among group of 25-35 years old (8.0%)); family member was at the highest proportion (16.7%) and people who live in the family with average monthly income from 3-5 millions VND at the highest of 9.1%.
Keywords: InfluenzaA/H5N1,antibody, person who slaughter and sell poultry, the North of Viet Nam
156 Tap chi Y hpc d\r phdng, Tap XXII, so 5 (132)