KHOA HOC KY THUAT THU Y - TAP XVIII - s 6 5 - 2 0 ! 1
GIAM SAT PHAN TCT VA NGUYEN NHAN D I I N BIEN PHLTC TAP Ct!lA DjCH Ld MOM LONG MONG
Ta Hodng Long', Nguyfin VSn Htfng^, Trinh Quang Dar\
TrtfOng Anh Diitc', Nguyen Thj Htfng Thim' va Nguyin Vift Khflng^
TOM
TATTrong nghifin cihi nay, chung tfii da xac dinh typ tai 16 fl djch va subtyp ciia 4 chiing dai difin, hfli cihi kfi't qua djnh typ 649 6 dich khac dfi' tim hifi'u nguyfin nhan diln bifi'n phiic tap ciia djch LMLM tai mflt khu vtfc (Duyfin hai miln Trung). Trong thdi gian tir 2003 dfi'n 2010, diln bifi'n dich tai khu vtfc nay khflng theo quy luSt kinh di^n 2-3 nam mflt Un ma xay ra hang nim vdi t^n sua'l 0,78 6 dich/tinh/nam. Diln bifi'n dich ngay cang phiic tap do ba nguyfin nhan chinh (i) do stf xua't hifin ciia typ va subtyp mdi: typ A xam nhap 2 lan dflc lap, 2 subtyp Asia 1 cung xua't hifin vao 2 thdi difim kliac nhau, (ii) cac typ/subtyp mdi xam nhap cd khuynh htfdng ngay cang lan r0ng (sau 8 nSm, typ A da lan ra 10 b'nh va sau 6 nam, typ Asia 1 da co mat 6 4 tinh) gSy ra hifin ttfdng da nhilm trong ciing mflt fl' djch va (iii) tai mflt tinh/dja phtfdng co sir Itfu hanh dflng thdi ciia nhilu typ virut. Cac typ/subtyp mdi xua't hifin diu cd quan hfi hp hang g^n giii vdi cac typ Itfu hanh tai cae ntfdc lan can. Nhiing thflng tin nay danh da'u mflt btfdc phat t r i ^ phiic tap mdi ciia djch LMLM, va stf cin thifi't sii dung vacxin LMLM da gia co kha ning bao bfl dfl'i vdi cac typ/subtyp virut LMLM phat hifin trong nghifin cihi nay. Vific giam sat dich tl hoc phan tii ciia bfinh LMLM, xac dinh typ/subtyp Itfu hanh va phat hifin typ/subtyp mdi c ^ dtfdc tfu tifin hang dau d^ nfing eao hifiu qua sii dung vacxin.
Tit khoa: Ld mflm long mdng, VPl, Giam sat phan hi, Pha hfi, Duyfin hai miln Trung.
Molecular surveillance and the roots of complex situation of FMD
Ta Hoing Long, Nguyin Van Hong. Trinh Quang Oai, Trifong Anh Dijfc. Nguyen Thi Hfing Thim, Nguyen M\6\ Khong
SUMMARY
In this study, we have retrospectively recovered the serotypes of FMDV in 49 outbreaks, newly determined the serotypes in 16 outbreaks and the subtypes of 4 representative isolates to gain insight into the causes of complicated FMD situation at an epidemiological region (Vietnam's Central Coast area). During the period 2003-2010, the FMD occurrence at CACV was no longer following the typical paradigm of outbreak is periodically re-emerge in 2-3 years, but occurred every year with the incidence of 0.78 outbreak/province/year. The root includes 3 major elements: (i) the introduction of newr type and subtype: type A with twice independently emerged, 2 subtypes Asia 1 were introduced at 2 different times, (ii) newly introduced type/subtypes have tendency to spread over (after 8 year, type A has spread over 10 provinces and after 6 year, type Asia 1 has covered 4 provinces), resulted in the mix infections within an outbreak (iii) at a local area/province, different type co-circulated. The newly emerged strains are closely related to those that are circulating in the neighbour countries. These facts indicate a new stage of ' Trung tam ki^m nghif m thuflc thii y trung irung 1
=Chi cue thu y Thifa Thiftn- Hud' 'ViSn thii y
30
KHOA HOC KY THUAT THIJ Y - TAP XVIII - s 6 5 - 2011 intricate progress in FMD situation, where one should use multivalent vaccine of sufficient efficacy to protect at least the strams witli different type and subtype found in this study.
Molecular surveillance of FMD outbreaks, the determmation of circulating strains, revealing the new type/subtype should be in the top priority to improve the effeciency of vaccination.
Key words-. FMD, VPl, Molecular surveillance, Phylogeny, Central Coast area of VN I. DAT VAN DE
Bfinh do virut Id mflm long mdng (LMLM) thudc ho Picomaviridae, gifi'ng Aphthovirus gay ra. Virut LMLM la loai virut RNA nho nha't trong eac virut qua loc [3, 21], ed 2 dSc tinh quan trong la tinh da typ, va tinh d l bifi'n ddi khang nguyfin. Cac typ virut tuy gfiy ra trifiu chiing gifl'ng nhau, nhtfng khfing gfiy miln dich cheo vdi nhau [4, 6]. Bfinh ed thfi' lay lan trong pham vi mflt ntfdc ho3c iihilu ntfdc va gay thanh dai dich.
Thanh phdn hfi gen ciia virut LMLM (ngay trong cimg mflt serotyp) lufln lufin bifi'n dfl'i;
Stf da dang v^ di truyen rflng hdn stf bifi'n di vl tinh khang nguyfin ciia serotyp, cho phep phan loai virut dtfa vao trinh ttf VPl thanh nhiing ddng (lineage) rifing bifit [25, 26]. Hifin CO 7 typ va hdn 70 subtyp virut LMLM. Trong mfli typ, tinh khang nguyfin ciia cac subtyp khflng dfing nha't, cd th^ cd miln dich cheo giiia mflt stf subtyp [8]; thi du, co it nha't 11 subtyp [12, 24] O cd tinh khang nguyfin khac nhau [10,11]. Ngoai ra, trinh ttf nucleotide va axit amin ciing khac nhau giiia cac chiing phan lap i cac viing dia ly khac nhau [13], va trong mflt S dich cd thfi' ddng thdi xua't hifin nhilu typ, nhtfng thflng thtfdng chi mflt typ chifim tfu thfi'[21].
Tai Dfing Nam A va viing Vifin Dfing, dich bfinh do virut LMLM typ O xay ra d Hflng Kfing va ta't ca cac qufl'c gia thanh vifin SEAFMD (ngoai trir bidonesia). Typ A co mSt cl Malaysia, Thai Lan, Lao va Vifit Nam [?]. Va typ Asial phd bifiTn vao nSm 2004-2005. cl Vifit Nam, bfinh dtfdc phat hifin lan ddu tifin vao
nam 1898 tai Nha Trang [6], sau dd dich lan ra ca ntfdc. Tir h-tfdc nSm 2003 chi cd virut LMLM typ O cae topotyp Ol Manisa, ME-SA (Pan- Asia) hoSc Cathay cl Idn, sau do virut typ A va Asia 1 Idn Itfdt xuS't hifin [2].
Do tinh da typ va khfing cd miln dich bao hfi cheo giiia cac typ, vific xac dinh typ virut Itfu hanh tai vimg co dich la tfli can thifi't trong vific Itfa chpn vacxin co chiing phii hdp dfi nang eao hifiu qua phdng bfinh. Trong nghifin Cliu nay, chiing tfli xac dinh typ/subtyp mflt sfl' chiing phan lap, thu thap thfing tin dinh typ virut tit nSm 2003 dfi'n 2010 dfi' phan h'ch diln bifi'n tinh hinh dich LMLM tai mfit viing dich tl.
n . VAT LIEU VA PHUONG PHAP NGHIEN CLTU
2.1. Vat lieu nghifin ciiu
Bfinh pham la bifiu mfl, mun ntfdc thu thSp tai 6 dich tai cac tinh thufle Duyfin hai miln Trung (DHMT) theo htfdng din tai TCVN 8400 [5]. Tai lieu lifin quan dfi'n bfinh LMLM (cae bao eao dich LMLM va sfl' lieu o dich; sfl' lifiu vl dich tl bfinh LMLM va kfi't qua dinh typ virut LMLM; bao cao kfi't qua dfim phong bfinh LMLM) do Chi cue thii y cae rinh, Cd quan thii y cac vimg III, IV va VI eung ca'p, va thflng tin tir trang Web ciia Cue thii y [1].
2.2. Phtfdng phap nghien ciiu
Phtfdng phap LPBE phat hifin khang nguyfin virut LMLM theo htfdng dan ciia nha cung ca'p Kit (Pirbright Code-R5108); phtfdng phap LPBE xac dinh hifiu gia khang thfi khang LMLM (Phbright Code-R5109); phtfdng phap
KHOA HOC KY THUAT T H O Y - TAP XVIII - s 6 5 - 2011 RT-PCR nhtf thtfdng quy. Gen VPl dtfdc giai
h-inh ttf bfin may hJ dflng ABI 3100 Avant Genetic Analyzer; xay dtfng cfly tifi'n hda dtfa vao clitfdng trinli MEGA4 (Molecular Evolutioiidiy Genetic Analysis v4.2) tlico thflng sfl' Neighbor- Joining (NJ), Booshflp vdi 1000 Ifln lap lai (1000 replicates) [9].
III. KET QUA VA THAO LUAN 3.1. Tinh binh dich LMLM va typ virut Itfu hanh tai DHMT
3.1.1. Tinh hinh djch LMLM 6 DHMT tit 2003 din 2010
Trong 8 nam tir 2003 dfi'n 2010, tai 14 tinh DHMT da xay ra 87 d dich LMLM, nghia la tin suat dich b mfli tinh la 0,78 d dich/nam (87/14 tinh/8 nam=0,78), hay ndi each khac
trung binh khoang 15,5 thang mfli tinh c6 djch 1 lan. Sfi' d djch LMLM dao dfing tiiy theo dja phtfdng, cao nha't la Ha Tinh va tha'p nha't la Da NSng (bang 1). Trong nghifin ciiu nay, chiing tfli sii dung khai niOm d djch theo nghia rflng, mflt fl djch sau khi bimg phat d mflt dia difi'm vdi sfi' bfinh siic tang va viing dia ly md rfing, keo dai dfi'n khi con bfinh cufl'i ciing chfi't boSc lanh bfinh siiu 21 iigtiv, thi du dich d tinh Quang Trj nam 2008, keo dai gdn 3 thang trfin 6 huyfin/thi cbi tinh la 1 d djch; ngtfdc lai tai 1 dja phtfdng nfi'u djch phat ra vao cac thdi difi'm khac nhau va/boSc co ngudn gfl'c khac nhau se dtfdc tinh cd trfin 1 fl dich/nam. Do vay Bfl' lifiu v l 6 djch co thfi' khac vdi nhiing cflng bfi'trtfdc day.
Bang 1. Ting hOp siidich LMLM 614 tinh DHMT tHe 2003-2010 rr
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Tinh
Thanh Hoa Ngh? An HaTtnh Quang Binh Quang Trj Thira Thien-Hu^
Qi Ning Quang Nam Quang NgSi Binh Djnh Phij Y§n Khinh »ta Ninh Thu^n Binh Thugn Ting
So d dich 2003
2 2
2
1
7 2004
1
1 1
1 2 1 1 1
9 2005
1
2 2
1 1
7 2006
1 2 2
1 2 1 1 2
3 3 1
19 2007
1 1 3 1 2 2
15 2008
2 3 5 1 1 1
13 2009
1 1 1 1 1
1 1
1
8 2010
1 2 1 1
2
1 1
9 Tong
5 11 15 5 8 7 1 3 9 5 8 7 3 0 87
32
KHOA HOC KY THUAT THU Y - TAP XVIII - s 6 5 - 2 0 1 1
Tuy bl van CO iK- kliong COI- Trong gi.ii chu \'eu >
liinh I. Bien dihn: ^ i J u n , ; .u.i so o J u h
. / / . / ; / Ml \l ihfollii. 20iUdvn 2010 i lir nhil d o
d o a n lli I
-it. (Innli 1), nlurn,;
d l \ . u ' r.i luHi;.', n.iin.
:iiii;- Jen :no(-., duh tinli .\,i[ii T r u n g bo (bang 1, hinh 2), ngtfdc lai. tir 2007 d e n 2010.
Jich chu yeu 0 tliuoc cac hnli BcIc Trung ho wi kliu 4 cu Tai 1 tinh, dich co tliO \d\- ra 3-5 nam lion tuc; cac tinli khu 4 cu (tir Tlianli HLSa den n u i a Tliien-Hue) lien tcic 5 n a m co Jich (tu' 2006 den nay, bang 1). Dit'^n bieii dich LMLM kliong con m.Tng tinh chat cliu kv kinh dien (2-3 n a m / l d o t
tlOllg danii dan mot bu'iiv tlien ig pluic Lip CLM Jich LMLM Lii
•< 1 t r
3.1.2. Dien bien phSn bo typ virut LMLM t.ii DHMT tl/2003-2010
So liOLi t h o n g ke t y p v i r u t LMLM ti" 65 6 J i c h (bang 2, h i n h 2) c h o biet c6 3 t y p v i r u t O, A va Asia I d a n g Itfu h a n h tai k h u vtfc D H M T , t r o n g d o t y p O la p h d bien va xua't hien lien tuc t r o n g 8 n a m , so 6 dich d o t v p A wi A>;ia 1 it g a p h d n
Bang 2. Tdng hop typ virut luu hJiih t.ii DHMT tif 2003 den 2010
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Thdng tin v4 dinh typ virut LMLM dircfc thu thap tir cac nguon: (i) Vien dm y (2) Ci2c thu y baogSm (i) Tnmg tim chin doan tliu y Trung itdng, (ii) Phong dich tS, (iii) Co quan thiiy vung VI; (3) Bao cao cua (Ju cue did y 14 tinli DHMT (phiiu tri ldi kit qua xet nghiim co thdng lm xac dinh typ) vi (4) kit qua nghian cihi nay (16 Sdich 2006-2007).
KHOA HOC KY THUAT THtJ Y - T ^ XVIII - s 6 5 - 2 0 1 1
^ ^ ^ - - . ^ j ^ --...j. •• f-^^ ^ - f - j ^ ^ - ' m ^ ' ' ^ ^ " . - ; ; .
' • - ^ j ^ ' ' ^ o i ^ j • W ' - N
//m/i 2 l'h.in Iui typ viiul IMtM t.ii DHMT nim 200.1-2010 DiJ'n bK'ii linli liM.ii diOi LMI.M l u ^ J . u ilicm l>p A i.i (1.2 ^•.l Ivp Asi.i 1 l.i 1)08 (hinh 3).
- Hit'ii tminj; n h i e m da t v p t.ii mot 6 dich - 5Lr xuat hiOn cu.i t v p nuii: Scinj; song vdi | j , ^ , j _ - , , „ ^ ,,; , j „ j ^ . j j y ^,|^. ,,, ,_,; |^|,_,„,, ^oa dien bie'n pliiic t a p oua djch LMLM la suf xua't ,-,3,,, 2005, n a y l a p lai a Q u a n g Tri (typ Asia 1 hien c u a c a t t y p \ i r u t m a i Tren n e n c u a t y p xuat hien tai 6 dich QT-Ofi n g a y 25/5/2007 O, n a m 2003 ccS M( xu.il liieii t \ p A tai Niiih trc-ii iiOii virut LMLM t i p O d a n g liru hanh;
T h u a n , n a m 2005 ccS sir xua't hien cua t \ p tuonj; tu, tai r i u i a Thicii-HuO', t^'p A xuat hien Asial tai Khanli Hoa (baiij; 2, hinli 2) l . i n cl n.li d a n g co liru lianli l \ p O ll.im 21107, suiit xu.it hicn t i p O I.l 0.72 (pliO bien nli.it), c h u n g to dicn Lien dicli iivav c a n g phirc tap.
( A I Tan so xuat hi^n Da typ theo tinh
Hinh .1. Virut IMIM tai DHMT: typ va tin suit xuil hidn (2003-2O10)
- Su Itlu l,.inh d6ng thdi nhiiu typ i mfll " * *=" ^ ' " ^ " ^ ^V '^^ ^ "= ^ ^ ^ " ' * ^ ' * dia phuang ngay rang phdi bi6n (hinh 3) sau 8 ^ - '^^° ^ " ? " "**" * * ' ^'^'^ ^ ^ T' nam tir kill xuat hiSn typ A da lan ra 10 tinh ' ' ° " g ^«' " ^ ^ ° ^ ' * ' ''"'^ ^ hnh (14,29%, Da Nang, Quang Nam) dang c6 don
34
KHOA HOC KY THUAT THU Y - TAP XVIII - s 6 5 - 2011 typ O Itfu hanh; stf con lai co it nliS't 2 typ
virut: 1 tinh (7,14%, Thanh Hoa) co 2 typ O va Asia 1, 7 tinh (50% Ha Tuili, Quang Binli, Thiia Thi6n-Hue', Quang Ngai, Binli Dinh, Phii Yen va Ninh ThuSn) co 2 typ O v<i A; va 6 3 tinh (21,43%: Nghe An, Quang Tri va Khanh Hoa) da xac dinh sii co m<it cua ca 3 t)^ O, A va Asia 1. Minh hpa cl hinli 3b cung cho tha'y, theo thdi gian, cac typ O, A va Asia 1 CO khuynh hifdng phu khSp khu vuc.
Trinh tiJ gen virut LMLM va subtyp De xac dinh subtyp virut Itfu hanh, chung t6i da tie'n haiih giai trinh ttf gen Id ma hoa cho virion protein VPl cua 4 chung virut LMLM phan lap tvf bo tai khu vtfc DHMT nam 2007: Hue07.18 (typ O), Hue07.17 va Qb07.03 (typ A) va Qt07.03 (typ Asia 1). GiSa 2 chung cua cung typ A, d6 ttfdng d6ng nucleotid va amino acid diu la 99% dtfdc coi nhtf CO ciing ngu6n g6'c; viing VPl cua cac chung typ A co d6 ttfdng d6ng vdi typ Asia 1 vi nucleotid la 64% va vi amino acid la 65%;
vdi chung cua typ O la 68% (nucleotid) va 72% (amino acid); ttfdng ttf, dfl ttfdng d6ng giiJa 2 chung (typ Asia 1 va O) la 64% v^
nucleotid va 70 % vi amijio acid. Vi d3c b'nh di truy4n, stf kliac biet giiia cac serotyp cl viing Id khoang tren 30%, phii hdp vdi ke't qua dinh typ va cac ke't qua nghien ctfu ngoai ntfdc [20, 25], trong do giiia cac typ stf ttfdng ddng trinh ttf nucleotid ol gen Id chi dat dtfdi mtfc 70%.
Ke't qua so saiih trinh ttf nucleotid vdi dtf lieu d genebank Qutfc te' cho bie't chiing - Qt07.03 (Asia 1) co miic ttfdng d6ng 99% gdn nlia't vdi typ Asia 1 pbSn lap tai Giang Ttf, Trung Qutfc n3m 2005 (Ac. EF149009 [19]), dtfdc phSn loai la c6 serotyp Asia 1, nhom chung "mdi" Jiangsu-Wusi; hai chung Qb07,03 va Hue07.17 (typ A) c6 quan he gSn giii nlia't (99% ttfdng dtfng) vdi chiing A/Lao/1/2006 (EU667456 [14]) va Ol-Hue07.18 vdi Chung O/Uo/7/2003 (94%, EU667448, [14]).
A-Vn-Hue0717 fmdv-A-Vn-Qb0703
A-Vn-NtD20S ijl-A-Vn-NhlMOS
— A-Lao0608-EU667459
— A22-lra(l2005-FJ755064 961- Asia1-Cllin-2l)06-EU091342
L Asial-Vn-KhOSI?
[ Asia1-Chin-2005-EF1490I)9 ggi- Asial-Vn-QI0703 - OmaK-200t-DQ16494a
O-PanAsia-sKorea2002-AY114146 O1-Vn-Hui0718
— OI-Vn-NhOAOe
Hinh 4. Fhahecua virut phin lip dtta vao trinh tU nucleotid cua gen Id (austalW, Neighbour-joining, Unrooted tree, boostrapt 1000replicates)
35
KHOA HOC KY THUAT THU Y - TAP XVIII - s 6 5 - 2 0 I I Trinli hJ 639 bp gene Id, ma hoa cho VPl da
Stf dung: O/Vn/Hue07.18, A/Vn/Hue07.17, A/Vn/Qb07.03 va Asial/Vn/Qt07.03 (nghien cihi nay); cac chung KIi05.12 (typ Asial) phfln lap tai Khanli Hoa nfim 2005; Nt02.05 (typ A)- Ninli Thuan 2002; chung Nh04.09 (typ A)- Klianh Hoa 2004, va chung Nh04.06 (typ O)- Khanli Hoa 2004 [iii tai b-png die'm ca'p B0 cua Bfl Nflng nghiep va Phat bie'n Nflng tlifln, Vifin tliii y]; trinli tu tir genebank: 2 chung Asia 1;
chung Jiangsu-Wusi 2005 (Ace. EF149009) [19], chung ASl/BROOl/2006 (EU091342) ii\idc phan lap d Trung Qufl'c nSm 2006 va da phan loai thufle typ Asia 1 topo Myanmar; Hai chung typ A: A22 Iraq (Shamir, FJ755064 [16]) va chung thufle typ A cua Lao (EU667559) [15);
hai chung thu6c typ O Manisa (Oman 2001, DQ164940 [17, 18]) va O-PanAsia (co ngutfn gtfc Kr Han Qufl'c 2002, AY11414A [22, 2^].
Pha he dtfa vao trinh tu gen Id (hinh 4) cho bie't - Subtyp O: Hai chung Nh04.06 va Hue07.18 nhdm ciing canh vdi O-Manisa 2001 va O- PanAsia 2002, tuy nhien kh6ng tach hin v4 topotyp O-Manisa hay v^ nhanh PanAsia.
Trong mflt phan tich kliac, hai trinh ttf nay nga v^ cac trinh ttf thufle topo O-Manisa (kliflng trich din pha he).
- Subtyp A: Cac trinh ttf gen cua 4 pbSn lap tai Viet Nam diu thufle v^ 1 nlidm, cd cimg ngutfn gtfc vdi typ A cua Cflng hoa dSn chu nhSn dim Lao, nhung khac vdi nlidm A22. Tlieo he tiitfng phan loai, chiing cimg nhdm vdi A Malaysia 1997. Hai nlianh cua typ A tliuflc v^ 2 vimg dja ly khac nhau bSc va nam Trung 86.
Tmh cha't phan nhdm tOc theo dac die'ni vimg dia ly dac thii co the' do chiing da dtfdc nhap vao Viet Nam b ^ g 2 con dtfdng khac nliau.
- Subtyp Asia 1: Cac typ Asia 1 chiing Kh05.12 va Qt07.03 tach thanh 2 nhanh khac nhau: Virut LMLM chiing Kh05.12 xua't hifin d Khanh Hoa thang 10 nSm 2005 [2], cd tinh Wdng dtfng cao vdi chiing ASI/BROOl/2006 (EU091342) dtfdc cflng btf c( Trung Qutfc nSm 2006 va da phan loai thutfc typ Asia 1-Myanmar;
ngtfdc lai, chiing Qt07.03 tim thSy vao thang 6/2007 lai cd trinli tu gifl'ng vdi chiing QH/2005 (Jiangsu-Wusi) lUu banh tai Trung Qutfc [19];
Tai Trung Qufl'c, cac nha khoa hoc da phfln 2 chiing nay vao 2 subtyp khac nhau (Myanmar/Bac Kinh va Jiangsu/QH/2005)^|
Nhtf v&y, ngoai typ mdi xufl't hifin, trong m6i typ, cac subtyp luu hanh trong khu vut ciing lAnlUi^t xua't hifin.
IV. KET LUAN VA KIEN NGHI Ke't luan' Hifin cd 3 typ virut LMLM: O, A va Asia 1 dtfng luu hanh tai khu vtfc DHMT.
Ngoai typ O-manisa kinh difin, cac typ virut mdi da xua't hifin frong 8 nSni qua: virul LMLM typ A (cluing Hue07.17 va Qb07.03, thutfc nhdm subtyp A Malaysia 1997) cd quan he gan giii vdi cai- chiing typ A Itfu hanh tai Ldo; stf xam nhap cua t}'p A cd the" theo cac dtfdng kliac nhau. Virut LMLM t\'p Asia 1 chiing Qt07.03, xua't hifin d Quang Tri thang 6/2007 cimg ngutfn gtf'c vdi chiing Itfu hanh d Giang Ttf, Trung Qufl'c tix 2005 va chiing KH1.2 xuSt't bifin tai Khanh Hda nam 2005 tliuflc nhdm chiing Myanmar Itfu hanh d An Dfl va Trung Qufli:; stf xua't hifin ciia 2 subtyp Asia 1 tai Klianh Hda va Quang Tri vao hai thdi difim khac nhau. Cac t^-p va subtyp vinit xua't hien lan dau tai DHMT d^u co quan h§
ho hang vdi cac virut LMLM luu hanh trong khu Vtfc.
Diln bie'n tinh hinh dich LMLM tai mOt khu VUC, trong nghifin ctfu nay la tai khu vift:
DHMT, cho tha'y diln bifi'n dich khflng cdn quy luat kinh die'n 2-3 nSm mOt lan ma xay ra hang nam vdi t5n sua't 0,78 tf' dich/tinh/ncim.
Djch LMLM tai khu vuc DHMT diln bifin ngay cang phiic tap do ba nguyfin nlian chinh (i) do su xuat hifin ciia typ va subtyp mdi, (ii) cac typ/subtyp mdi xam nhap cd khuynh htfdng ngay cang lan rtfng gay ra hifin ttfdng da nhilm troiig cimg mSt tf dich va (iii) tai mflt tinh/dja phtfdng cd stf luu hanh ciia nliilu typ virut.
36
KHOA HOC KY THUAT THU Y - TAP XVIII - SO 5 - 2011 Kie'n nghi: Tai mtf t vung dich tl bfinh LMLM,
do cd cac typ mdi xuS't hien, cac typ vacxin da va dang sii dung theo 16 trinh tiem phdng benh LMLM cl cac tinh DHMT hien chUa hoan toan phu hdp, cdn thiet stf dung vacxin da gia cd kha n3ng bao hfl it nha't cac typ virut Ivtu hanh tai khu vtfc nhu da trinh bay cl nghien cufu nay.
Thtfng tin v^ giam sat dich tl hoc phan bi ciia bfinh LMLM, xac dinh typ/subtyp Itfu hanh va phat hien typ/subtyp mdi la quan trong dfl'i vdi mfli dia phtfdng c6 dich va c ^ dudc tfu tien hang dau trong chifin Itfdc sU diuig vacxin.
TAI LIEU THAM KHAO
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