Nội dung toàn văn Decision 4782/QD-BYT 2020 promulgating criteria framework for epidemic risk assessment
MINISTRY OF HEALTH | SOCIALIST REPUBLIC OF VIETNAM |
No. 4782/QD-BYT | Hanoi, November 18, 2020 |
DECISION
PROMULGATING CRITERIA FRAMEWORK FOR EPIDEMIC RISK ASSESSMENT
MINISTER OF HEALTH
Pursuant to the Law on Prevention and Control of Infectious Diseases dated November 21, 2007;
Pursuant to the Government’s Decree No. 75/2017/ND-CP dated June 20, 2017 on functions, duties, powers and organizational structure of the Ministry of Health;
Pursuant to Plan No. 1103/KH-BYT dated 17/7/2020 by the Ministry of Health on development of criteria framework for epidemic risk assessment;
At the request of the General Director of Health Environment Management Agency, Ministry of Health,
HEREBY DECIDES:
Article 1. Promulgated together with this Decision is the criteria framework for epidemic risk assessment.
Article 2. The criteria framework for epidemic risk assessment shall provide the basis for formulation of risk assessment criteria for each infectious disease.
Article 3. General Department of Preventive Medicine shall take charge and cooperate with Health Environment Management Agency, regulatory bodies/institutes/schools affiliated to the Ministry of Health and relevant units and organizations in formulating risk assessment criteria for some common and dangerous infectious diseases.
Article 4. This Decision takes effect from the date on which it is signed.
Article 5. Head of Office of the Ministry of Health, General Director of Health Environment Management Agency, General Director of General Department of Preventive Medicine; heads of affiliates of the Ministry of Health; heads of Institutes of Hygiene and Epidemiology and Pasteur Institutes; Directors of Departments of Health; heads of health units of other Ministries and central authorities; and heads of relevant units shall implement this Decision./.
| P.P. THE MINISTER |
CRITERIA FRAMEWORK FOR EPIDEMIC RISK ASSESSMENT
(Promulgated together with Decision No. 4782/QD-BYT dated November 18, 2020 by Ministry of Health)
I. Criteria framework for assessment
No. | Name of criterion | Definition | Measuring method | Data source | Remark |
I | Epidemic characteristics |
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I.A | Prevalence among humans | ||||
1 | Average number of cases per 100.000 people in the past 1 year or 5 years. | Number of active cases in the past 1 year or 5 years per 100.000 people living in the commune. | Number of cases in the commune x 100.000/ total population of the commune at the time of data collection. | - Infectious disease surveillance data reported according to Circular No. 54/2015/TT-BYT. - Annual medical statistics. - Health station. - Other surveillance data sources (if any). | The health station of the commune shall collect data according to Circular No. 54/2015/TT-BYT from the district-level healthcare establishment. |
2 | Number of reported cases or detected carriers in the past 1 year or 3 years or 5 years in the commune. (Applicable to very rare diseases such as diphtheria, whose prevalence is under 0,01/100.000 people). | Number of reported cases or detected carriers in the past 1 year or 3 years or 5 years in the commune. | Total number of reported cases or detected carriers in the past 1 year or 3 years or 5 years in the commune. | - Infectious disease surveillance data reported according to Circular No. 54/2015/TT-BYT. - Annual medical statistics. - Health station. - Other surveillance data sources (if any). | Select a 1-year/3-year/5-year time frame as appropriate to each disease’s characteristics. |
3 | Number of reported cases or detected carriers in the past 1-5 years in adjacent areas. (Applicable to very rare diseases (such as diphtheria) or diseases recently brought to Vietnam (such as COVID-19)). | Number of reported cases or detected carriers in the past 1-5 years in adjacent areas. (adjacent communes of the same district, a different district or a different province that are adjacent to, have regular contact with or are involved in economic, cultural, religious, ethnic, etc. exchange with the commune in question). | Number of reported cases or detected carriers in the past 1-5 years in adjacent areas. | - Infectious disease surveillance data reported according to Circular No. 54/2015/TT-BYT. - Annual medical statistics. - Health station. - Other surveillance data sources (if any). | As it is difficult to obtain full information on number of cases in other communes, this criterion is only applicable to rare diseases (such as diphtheria) or diseases recently brought to Vietnam (such as COVID-19). |
4 | Does an epidemic break out in the commune on an annual basis? | An epidemic breaks out in the commune on an annual basis or every 2-5 years. | Yes/No | - Infectious disease surveillance data reported according to Circular No. 54/2015/TT-BYT. - Local surveillance data (if any). | - May be based off local epidemic reports. - The criteria for each disease shall provide for number of cases constituting an epidemic. |
5 | Change to pathogens (number of subtypes, genotypes, mutation of hereditary characteristics, etc.) | Distribution of genotypes, subtypes, pathogen mutations related to transmission potential and virulence. | Yes/No; Existing subtype(s) | - Surveillance data. - Data from research units. | Diseases for which this criterion may be selected include dengue fever, hand, foot and mouth disease, influenza, etc. |
I.B | Prevalence in animals and the environment | ||||
6 | Is the disease prevalent in animals in the commune? | The disease is found in animals in the commune in the past 5 years. | Yes/No | Data from regular surveillance, focused surveillance and research by the district-level veterinary medicine authority. | If the commune has no veterinary official, collect data from the district-level agriculture authority. |
7 | Animal vaccination coverage. | Ratio of vaccinated animals to total number of animals in the commune reported. | (Number of vaccinated animals/ total number of animals in the commune at the time of data collection) x 100%. | Data reported by the district-level veterinary medicine authority. | |
8 | Are the pathogens present in the locality? | Presence of pathogens in the soil, water, food, feces, wastewater, etc. in the past 5 years. | Yes/No | Data from annual surveillance, focused surveillance and research by veterinary medicine authorities. - Healthcare | |
I.C | Herd immunity | ||||
9 | Vaccination coverage - Vaccination coverage >=90% - Vaccination coverage 70- <90% - Vaccination coverage 50% - < 70% - Vaccination coverage less than 50% - Vaccination coverage of a village being less than 30% | Vaccination coverage is the percentage of at-risk people who live in the commune and have received enough doses. | (Number of people having received enough doses/ total number of at-risk people living in the commune) x 100%. | - Data from vaccination reports (Expanded Program on Immunization, vaccination paid out of pocket and vaccination for epidemic prevention). |
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10 | An epidemic in the commune in the past 1-2 years infected many and resulted in high herd immunity. | An epidemic in the commune in the past 1-2 years infected many and resulted in high herd immunity. | Yes/No; Infection rate; Serology testing. | Annual surveillance data and data on serology testing from research units. |
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I.D | Risk factors of the infectious disease | ||||
11 | Indicators for vector presence and density. | Presence and density of vectors such as mosquitoes, fleas and other vectors. | Formulas for calculation of presence and density of each disease’s vectors. | Surveillance data of the locality or a higher level authority. | Example for dengue fever: percentage of houses infested with Aedes larvae and/or pupae; percentage of water-holding containers infested with Aedes larvae or pupae; |
12 | Other risk factors (contact with poultry, animal husbandry, consumption of raw blood pudding, fish salads and tap water, containing rain water in jars, etc.). | People’s behaviors and factors increasing the infection risk. | Yes/No | Surveillance data or local reports. | Behaviors and customs of local people. Choose this criterion if it is suitable for the disease. |
II | Natural features and socio - economic characteristics | ||||
II.A | Climate features | ||||
1 | Average monthly rainfall (mm). | Average monthly rainfall (mm) in the locality. | Average monthly rainfall in millimeter. | Hydrometeorology station of the province/city and other data sources. | Some infectious diseases are related to climate and weather conditions. Collect average data of the province/city from the hydrometeorology station through the province’s CDC. |
2 | Average monthly temperature (oC) | Average monthly temperature (oC) in the locality. | Average monthly temperature (oC). | Hydrometeorology station of the province/city and other data sources. | |
3 | Number of heat waves in a year. | Number of heat waves in a year during which the highest temperature is at least 37oC and humidity is no higher than 45% for at least 2 consecutive days. | Number of waves. | Hydrometeorology station of the province/city and other data sources. | |
4 | Number of days with rainfall greater than 100mm in a year. | Number of days with great rainfall (measurable rainfall >100mm/24h) recorded in a year. | Number of days. | Hydrometeorology station of the province/city and other data sources. | |
5 | Natural and manmade disasters occurring in the commune last year. | Number, intensity and areas affected by tropical cyclones, floods, flash floods, earthquakes, etc. occurring in the commune last year. | Yes/No; Number of times; Intensity; Affected areas; | Department of Agriculture and Rural Development (provincial steering committee for natural disaster prevention, search and rescue), hydrometeorology station of the province/city and other data sources. |
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II.B | Geographical features and urbanization level | ||||
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| - Class I city - Class II city - Class III city - Class IV city - Class V city - Rural area - Mountainous area | - Class I city - Class II city - Class III city - Class IV city - Class V city - Rural area - Mountainous area | According to the Government’s regulations. | Urbanization level and city class are related to the outbreak of some infectious diseases such as dengue fever. |
II.C | Socio-economic characteristics | ||||
7 | Population density of the commune. | Population density of the commune expressed as people/km2. | Total population of the commune/ land area of the commune in km2. | According to annual statistics from the People’s Committee of the commune and other sources. |
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8 | Poverty rate | Percentage of poor households in the commune assessed according to regulations in Clause 1 Article 2 of Circular No. 17/2016/TT-BLDTBXH. | (Total number of poor households / total number of households in the commune) x 100%. | The People’s Committee of the commune and other sources. |
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9 | Main jobs of people living in the commune | Main jobs of at-risk groups. | Main jobs of people living in the commune: Official/Public employee Agriculture Aquaculture Forestry Crop production Service Tourism Food processing Other, specify: ……………. | The People’s Committee of the commune and other sources. | Some infectious diseases are related to occupational characteristics. E.g., crop production is linked to dengue fever. |
II.D | Hygiene practice and habits facilitating disease development | ||||
10 | Knowledge, attitude and practice concerning epidemic prevention of people living in the commune. | Knowledge, attitude and practice concerning epidemic prevention of people living in the commune (based on qualitative or quantitative survey by health officials). | Employ linear numeric scale or 3, 4 or 5-point scale for qualitative assessment. | Quick survey of 100 target respondents/ households or qualitative assessment by local health officials. |
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11 | Percentage of households using clean water | Percentage of households using water satisfying the Ministry of Health’s or local regulations. | (Number of households using qualified water/ Total number of households in the commune) x 100 | - The People’s Committee of the commune - Health station and other sources. |
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12 | Percentage of households using latrines meeting hygienic conditions. | Percentage of households using latrines meeting hygienic conditions stated in the national technical regulations QCVN 01:2011/BYT. | (Number of households using qualified latrines/ Total number of households in the commune) x 100% | - The People’s Committee of the commune - Health station and other sources. |
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13 | Proportion of people washing their hands with soap and clean water frequently and properly | Proportion of people washing their hands with soap and clean water frequently and properly when necessary (before eating, after using the toilet and before food preparation) | Number of people washing their hands with soap and clean water frequently and properly when necessary (before eating, after using the toilet and before food preparation)/ total number of survey respondents | Health station shall conduct a quick survey with a random sample of at least 100 people in the commune. | No secondary data is available. Some specific diseases may be added to the criteria if the local government can cover the surveys. Collect data from qualitative assessment by health officials if no quantitative data is available. |
14 | Proportion of people frequently wearing face masks. | Proportion of people frequently wearing face masks in public. | Number of people frequently wearing face masks in public/ total number of survey respondents | Health station shall conduct a quick survey with a random sample of at least 100 people in the commune. | |
II.DD | Business conditions and mass gathering | ||||
15 | Border checkpoints, airports, seaports | According to existing regulations. | Yes/No | According to local information | Criteria concerning business conditions and mass gathering are usually crucial for emerging infectious diseases the vaccines for which are not yet available such as COVID-19. |
Border crossing points | According to existing regulations. | Yes/No | According to local information | ||
Tourist attractions | According to existing regulations. | Yes/No | According to local information | ||
Large spiritual centers and ranked monuments, etc. | According to existing regulations. | Yes/No | According to local information | ||
Industrial parks, universities, colleges, wholesale markets | According to existing regulations. | Yes/No | According to local information | ||
General hospitals, specialized hospitals | According to existing regulations. | Yes/No | According to local information | ||
Other crowded places | According to existing regulations. | Yes/No | According to local information | ||
III | Capacity for requirement satisfaction and direction of local government | ||||
1 | Have a steering committee for prevention and control of human infectious disease outbreaks | Decision on establishment of a steering committee for prevention and control of human infectious disease outbreaks | Yes, regular operation (once a month) Yes, irregular operation No | Provided by the People’s Committee of the commune. |
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2 | Have a commune-level epidemic prevention and control plan | Approved plan | Have a plan and perform tasks stated therein satisfactorily Have a plan but perform only some tasks Have no plan/have an unlaunched plan | Provided by the People’s Committee of the commune. |
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3 | Participation in epidemic prevention and control of local government, regulatory bodies and mass organizations (veterinary authority, farmers’ union, women’s union, veterans association, association of the elderly, youth union, village head, etc.) | Participation of local government, regulatory bodies and mass organizations in epidemic prevention and control | Local government and at least 2 regulatory bodies cooperate with the healthcare sector and perform satisfactorily. Local government and 0-1 regulatory body cooperate with the healthcare sector/perform unsatisfactorily. Local government does not participate/No regulatory body cooperates with the healthcare sector in epidemic prevention and control. | Provided by the People’s Committee of the commune. |
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4 | A proactive epidemic prevention program/ project is being launched in the commune. | There is a program/ project for proactive prevention of the disease in question. | Yes/No | Health station and other sources. |
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5 | Professional capacity for epidemic hotspot surveillance and handling of the locality | Capacity for surveillance at border checkpoints, in healthcare facilities and in communities; capacity for sampling for pathogen testing; capacity for epidemic hotspot investigation and handling; capacity for vector surveillance and identification, etc. | - There are sufficient trained and qualified officials and/or support from provincial CDC. -There are sufficient officials but they are not qualified due to lack of adequate training. -There are insufficient officials, these officials have not received adequate training, there is no support from provincial CDC. | Reports, surveillance data and other sources | Assess sufficiency of officials for epidemic hotspot surveillance and handling based on the disease, characteristics of the locality and qualitative assessment of local officials. |
6 | Is there training in infection prevention and control in healthcare facilities? | Provision of training in measures for infection prevention and control in healthcare facilities to officials (according to Circular No. 16/2019/TT-BYT and Decision No. 468/QD-BYT by the Ministry of Health) | - Adequate training - Inadequate training - No training | Reports, surveillance data and other sources |
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7 | Is there risk and epidemic prevention communication? | Are there adequate communication media, documents, human resources and funding for risk and epidemic prevention communication? | - There are adequate equipment, documents, human resources and funding (high radio network coverage, village healthcare workers/ collaborators establish communication directly, via text messages, etc. with >60% households). - Equipment, documents, human resources and funding are inadequate; coverage of radio network/ direct communication at households is low (approximately 30-60%). - There are no equipment, documents, human resources and/or funding; coverage of radio network/ direct communication at households is low (approximately less than 30%). | Reports, surveillance data and other sources |
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8 | Funding for epidemic prevention and control of the locality | Funding is allocated for epidemic prevention and control on an annual and ad hoc basis. | - Sufficient funding is solely allocated for proactive epidemic prevention and control. - Funding for main activities of epidemic prevention and control is available but proposed for approval only upon epidemic occurrence. - No funding is available. | The People’s Committee of the commune and other sources. |
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9 | Access to healthcare facilities | Distance from the furthest village of the commune to the nearest healthcare facility (health station, hospital, health center) | <3 km 3-15 km >15 km | Health station | According to Decision No. 4667/QD-BYT dated 7/11/2014 by the Ministry of Health |
10 | Number of doctors per 10.000 people | Number of doctors per 10.000 people | Number of doctors per 10.000 people | Health station |
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11 | Number of health officials of health station per 10.000 people | Number of health officials of health station per 10.000 people | Number of health officials of health station per 10.000 people | Health station |
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II. Guidance on application of criteria framework for epidemic risk assessment
1. The criteria framework shall serve as the basis for the specific criteria of each infectious disease, which are developed by selecting the criteria that are important, distinctive and influential in the outbreak of an epidemic.
2. Criteria of the criteria framework may be elaborated to facilitate development of specific criteria for each disease.
3. When formulating specific criteria for each disease, identify the main criteria that are decisive to the development and transmission of that disease.
4. The criteria for each disease shall consist of a main criteria group and a related criteria group.
- The main criteria group comprises of the most important criteria that directly influence the outbreak of an epidemic. Depending of the characteristics of each disease, these indicators shall be selected from the criteria concerning epidemiological characteristics of the criteria framework.
- The related criteria group is composed of the criteria that directly and fundamentally influence the outbreak of an epidemic and determine the risk level of each locality.
5. The criteria framework does not include scoring. Scoring shall be added to the criteria for each specific disease.
- The scores of both criteria groups shall not cancel each other out; the score of the main criteria group shall account for at least 70/100 of total score.
- Decide the criteria and number of criteria as appropriate to each specific disease. Each group shall include from 5 to 10 criteria; each criterion shall be made up of component criteria showing level of criterion satisfaction and providing the basis for scoring.
- The scoring rubrics shall be formulated based on the level of importance and direct influence that each criterion has in the outbreak of an epidemic and require expert opinions as well as empirical and surveillance and research-based evidence.
6. There are 3 levels of risk determined based on scoring:
- High risk
- At risk
- Low risk
7. Criteria users include steering committees for epidemic prevention and control/ people’s healthcare committees at district and commune levels.
8. Scope:
- Districts and communes.
- Annual or ad hoc assessment of epidemic risk in districts and communes.
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