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Tahoun MM, Sahak MN, Habibi M, Ahadi MJ, Rasoly B, Shivji S, Aboushady AT, Nabeth P, Sadek M, Abouzeid A. Strengthening event-based surveillance (EBS): a case study from Afghanistan. Confl Health 2024; 18:39. [PMID: 38689351 PMCID: PMC11059675 DOI: 10.1186/s13031-024-00598-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
The sustained instability in Afghanistan, along with ongoing disease outbreaks and the impact of the COVID-19 pandemic, has significantly affected the country.During the COVID-19 pandemic, the country's detection and response capacities faced challenges. Case identification was done in all health facilities from primary to tertiary levels but neglected cases at the community level, resulting in undetected and uncontrolled transmission from communities. This emphasizes a missed opportunity for early detection that Event-Based Surveillance (EBS) could have facilitated.Therefore, Afghanistan planned to strengthen the EBS component of the national public health surveillance system to enhance the capacity for the rapid detection and response to infectious disease outbreaks, including COVID-19 and other emerging diseases. This effort was undertaken to promptly mitigate the impact of such outbreaks.We conducted a landscape assessment of Afghanistan's public health surveillance system to identify the best way to enhance EBS, and then we crafted an implementation work plan. The work plan included the following steps: establishing an EBS multisectoral coordination and working group, identifying EBS information sources, prioritizing public health events of importance, defining signals, establishing reporting mechanisms, and developing standard operating procedures and training guides.EBS is currently being piloted in seven provinces in Afghanistan. The lessons learned from the pilot phase will support its overall expansion throughout the country.
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Grants
- GH0002225 WHO, the United States CDC Global Health Security Agenda, and COVID-19 support
- GH0002225 WHO, the United States CDC Global Health Security Agenda, and COVID-19 support
- GH0002225 WHO, the United States CDC Global Health Security Agenda, and COVID-19 support
- GH0002225 WHO, the United States CDC Global Health Security Agenda, and COVID-19 support
- GH0002225 WHO, the United States CDC Global Health Security Agenda, and COVID-19 support
- GH0002225 WHO, the United States CDC Global Health Security Agenda, and COVID-19 support
- GH0002225 WHO, the United States CDC Global Health Security Agenda, and COVID-19 support
- GH0002225 WHO, the United States CDC Global Health Security Agenda, and COVID-19 support
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Affiliation(s)
- Mohamed Mostafa Tahoun
- World Health Organization Country Office, Kabul, Afghanistan
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | | | | | | | | | - Sabrina Shivji
- United States Centers for Disease Control and Prevention, Atlanta, USA
| | - Ahmed Taha Aboushady
- Eastern Mediterranean Region WHO Office, Cairo, Egypt
- Division of infectious diseases, Brigham and women's hospital, Harvard medical school, Boston, MA, USA
| | - Pierre Nabeth
- Eastern Mediterranean Region WHO Office, Cairo, Egypt
| | - Mahmoud Sadek
- Eastern Mediterranean Region WHO Office, Cairo, Egypt
| | - Alaa Abouzeid
- World Health Organization Country Office, Kabul, Afghanistan
- Faculty of Medicine, Cairo University, Cairo, Egypt
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Crawley AW, Mercy K, Shivji S, Lofgren H, Trowbridge D, Manthey C, Tebeje YK, Clara AW, Landry K, Salyer SJ. An indicator framework for the monitoring and evaluation of event-based surveillance systems. Lancet Glob Health 2024; 12:e707-e711. [PMID: 38364834 DOI: 10.1016/s2214-109x(24)00034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/20/2023] [Accepted: 01/14/2024] [Indexed: 02/18/2024]
Abstract
Event-based surveillance (EBS) systems have been implemented globally to support early warning surveillance across human, animal, and environmental health in diverse settings, including at the community level, within health facilities, at border points of entry, and through media monitoring of internet-based sources. EBS systems should be evaluated periodically to ensure that they meet the objectives related to the early detection of health threats and to identify areas for improvement in the quality, efficiency, and usefulness of the systems. However, to date, there has been no comprehensive framework to guide the monitoring and evaluation of EBS systems; this absence of standardisation has hindered progress in the field. The Africa Centres for Disease Control and Prevention and US Centers for Disease Control and Prevention have collaborated to develop an EBS monitoring and evaluation indicator framework, adaptable to specific country contexts, that uses measures relating to input, activity, output, outcome, and impact to map the processes and expected results of EBS systems. Through the implementation and continued refinement of these indicators, countries can ensure the early detection of health threats and improve their ability to measure and describe the impacts of EBS systems, thus filling the current evidence gap regarding their effectiveness.
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Affiliation(s)
- Adam W Crawley
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kyeng Mercy
- Division for Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Sabrina Shivji
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah Lofgren
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniella Trowbridge
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine Manthey
- Division of Global Health Protection, Global Health Center, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yenew Kebede Tebeje
- Division for Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Alexey Wil Clara
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kimberly Landry
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephanie J Salyer
- Division of Global Health Protection, Global Health Center, US Centers for Disease Control and Prevention, Atlanta, GA, USA; Division for Surveillance and Disease Intelligence, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
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Tetuh KM, Salyer SJ, Aliddeki D, Tibebu B, Osman F, Amabo FC, Warren LK, Buba MI, Kebede Y. Evaluating event-based surveillance capacity in Africa: Use of the Africa CDC scorecard, 2022-2023. Prev Med Rep 2023; 36:102398. [PMID: 37719793 PMCID: PMC10502352 DOI: 10.1016/j.pmedr.2023.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Event-based surveillance (EBS) is a critical component of Early Warning, Alert and Response (EWAR) capacity needed for outbreak prevention and control. To better understand existing EBS and monitor the progress of capacity-building efforts over time, Africa CDC developed an EBS scorecard as part of a revision to the EBS Framework. Methods We distributed the scorecard to African Union (AU) Member States (MSs). Survey responses from the MSs' human health sector were aggregated, cleaned, and analysed. MS, regional, and continental EBS capacity was assessed. Results Between 21 July 2022 and 4 April 2023, a total of 63 respondents representing 49 (89%) of 55 MSs completed the survey. Given Africa CDC's public health mandate, we acknowledged the importance of One Health collaboration in MSs but focused on and analysed only the human health sector responses. Thirty-four (71%) MSs stated having EBS in place; hotline was the most common type of EBS implemented (76%). Seventeen (50%) MSs reported multisectoral, One Health collaboration as part of EBS implementation. Scorecard outcomes showed a minimal (score of <60%) to average (score between 60-80%) level of EBS capacity in 29 and five (5) MSs respectively. Discussion Current EBS capacity levels need to be strengthened in Africa to ensure the continent remains prepared for future public health threats. The Africa CDC EBS scorecard provides a useful way to measure and track this capacity over time. Results can be used to advocate for and target resources for capacity building to foster public health emergency preparedness efforts.
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Affiliation(s)
- Kyeng Mercy Tetuh
- Africa Centres for Disease Control and Prevention, Division of Surveillance and Disease Intelligence, Addis Ababa, Ethiopia
| | - Stephanie J. Salyer
- Africa Centres for Disease Control and Prevention, Division of Surveillance and Disease Intelligence, Addis Ababa, Ethiopia
- United States Centers for Disease Control and Prevention, Division of Global Health Protection, Atlanta, GA, USA
| | - Dativa Aliddeki
- Africa Centres for Disease Control and Prevention, Division of Surveillance and Disease Intelligence, Addis Ababa, Ethiopia
| | - Bethelhem Tibebu
- Africa Centres for Disease Control and Prevention, Division of Surveillance and Disease Intelligence, Addis Ababa, Ethiopia
| | - Fatma Osman
- Africa Centres for Disease Control and Prevention, Division of Surveillance and Disease Intelligence, Addis Ababa, Ethiopia
| | - Franck Chi Amabo
- Africa Centres for Disease Control and Prevention, Division of Surveillance and Disease Intelligence, Addis Ababa, Ethiopia
| | - Leocadia Kwagonza Warren
- Africa Centres for Disease Control and Prevention, Division of Surveillance and Disease Intelligence, Addis Ababa, Ethiopia
| | - Maryam Ibrahim Buba
- Africa Centres for Disease Control and Prevention, Division of Surveillance and Disease Intelligence, Addis Ababa, Ethiopia
| | - Yenew Kebede
- Africa Centres for Disease Control and Prevention, Division of Surveillance and Disease Intelligence, Addis Ababa, Ethiopia
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Ross YB, Vo CD, Bonaparte S, Phan MQ, Nguyen DT, Nguyen TX, Nguyen TT, Orciari L, Nguyen TD, Nguyen OKT, Do TT, Dao ATP, Wallace R, Nguyen LV. Measuring the impact of an integrated bite case management program on the detection of canine rabies cases in Vietnam. Front Public Health 2023; 11:1150228. [PMID: 37920576 PMCID: PMC10619753 DOI: 10.3389/fpubh.2023.1150228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/29/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Dog-mediated rabies is enzootic in Vietnam, resulting in at least 70 reported human deaths and 500,000 human rabies exposures annually. In 2016, an integrated bite cases management (IBCM) based surveillance program was developed to improve knowledge of the dog-mediated rabies burden in Phu Tho Province of Vietnam. Methods The Vietnam Animal Rabies Surveillance Program (VARSP) was established in four stages: (1) Laboratory development, (2) Training of community One Health workers, (3) Paper-based-reporting (VARSP 1.0), and (4) Electronic case reporting (VARSP 2.0). Investigation and diagnostic data collected from March 2016 to December 2019 were compared with historical records of animal rabies cases dating back to January 2012. A risk analysis was conducted to evaluate the probability of a rabies exposure resulting in death after a dog bite, based on data collected over the course of an IBCM investigation. Results Prior to the implementation of VARSP, between 2012 and 2015, there was an average of one rabies investigation per year, resulting in two confirmed and two probable animal rabies cases. During the 46 months that VARSP was operational (2016 - 2019), 1048 animal investigations were conducted, which identified 79 (8%) laboratory-confirmed rabies cases and 233 (22%) clinically-confirmed(probable) cases. VARSP produced a 78-fold increase in annual animal rabies case detection (one cases detected per year pre-VARSP vs 78 cases per year under VARSP). The risk of succumbing to rabies for bite victims of apparently healthy dogs available for home quarantine, was three deaths for every 10,000 untreated exposures. Discussion A pilot IBCM model used in Phu Tho Province showed promising results for improving rabies surveillance, with a 26-fold increase in annual case detection after implementation of a One Health model. The risk for a person bitten by an apparently healthy dog to develop rabies in the absence of rabies PEP was very low, which supports the WHO recommendations to delay PEP for this category of bite victims, when trained animal assessors are available and routinely communicate with the medical sector. Recent adoption of an electronic IBCM system is likely to expedite adoption of VARSP 2.0 to other Provinces and improve accuracy of field decisions and data collection.
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Affiliation(s)
- Yasmeen B. Ross
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Chuong Dinh Vo
- Department of Animal Health, Ministry of Agriculture and Rural Development, Hanoi, Vietnam
| | - Sarah Bonaparte
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Minh Quang Phan
- Department of Animal Health, Ministry of Agriculture and Rural Development, Hanoi, Vietnam
| | - Diep Thi Nguyen
- Department of Animal Health, Ministry of Agriculture and Rural Development, Hanoi, Vietnam
| | - Thin Xuan Nguyen
- Phu Tho Provincial Sub Department of Animal Health, Phu Tho, Vietnam
| | - Thanh Tat Nguyen
- Phu Tho Provincial Sub Department of Animal Health, Phu Tho, Vietnam
| | - Lillian Orciari
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tho Dang Nguyen
- Department of Animal Health, National Center for Veterinary Diagnostics, Hanoi, Vietnam
| | - Oanh Kim Thi Nguyen
- Department of Animal Health, National Center for Veterinary Diagnostics, Hanoi, Vietnam
| | - Trang Thuy Do
- Division of Global Health Protection, Centers for Disease Control and Prevention, Hanoi, Vietnam
| | - Anh Thi Phuong Dao
- Division of Global Health Protection, Centers for Disease Control and Prevention, Hanoi, Vietnam
| | - Ryan Wallace
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Long Van Nguyen
- Department of Animal Health, Ministry of Agriculture and Rural Development, Hanoi, Vietnam
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Malik EM, Abdullah AI, Mohammed SA, Bashir AA, Ibrahim R, Abdalla AM, Osman MM, Mahmoud TA, Alkhidir MA, Elgorashi SG, Alzain MA, Mohamed OE, Ismaiel IM, Fadelmula HF, Magboul BAA, Habibi M, Sadek M, Aboushady A, Lane C. Structure, functions, performance and gaps of event-based surveillance (EBS) in Sudan, 2021: a cross-sectional review. Global Health 2022; 18:98. [PMID: 36457008 PMCID: PMC9713079 DOI: 10.1186/s12992-022-00886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/05/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Event-based surveillance (EBS) is an essential component of Early Warning Alert and Response (EWAR) as per the International Health Regulations (IHR), 2005. EBS was established in Sudan in 2016 as a complementary system for Indicator-based surveillance (IBS). This review will provide an overview of the current EBS structure, functions and performance in Sudan and identify the gaps and ways forward. METHODS: The review followed the WHO/EMRO guidelines and tools. Structured discussions, observation and review of records and guidelines were done at national and state levels. Community volunteers were interviewed through phone calls. Directors of Health Emergency and Epidemic Control, surveillance officers and focal persons for EBS at the state level were also interviewed. SPSS software was used to perform descriptive statistical analysis for quantitative data, while qualitative data was analysed manually using thematic analysis, paying particular attention to the health system level allowing for an exploration of how and why experiences differ across levels. Written and verbal consents were obtained from all participants as appropriate. RESULTS Sudan has a functioning EBS; however, there is an underestimation of its contribution and importance at the national and states levels. The link between the national level and states is ad hoc or is driven by the need for reports. While community event-based surveillance (CEBS) is functioning, EBS from health facilities and from non-health sectors is not currently active. The integration of EBS into overall surveillance was not addressed, and the pathway from detection to action is not clear. The use of electronic databases and platforms is generally limited. Factors that would improve performance include training, presence of a trained focal person at state level, and regular follow-up from the national level. Factors such as staff turnover, income in relation to expenses and not having a high academic qualification (Diploma or MSc) were noticed as inhibiting factors. CONCLUSION The review recommended revisiting the surveillance structure at national and state levels to put EBS as an essential component and to update guidelines and standard operation procedures SOPs to foster the integration between EBS components and the overall surveillance system. The need for strengthening the link with states, capacity building and re-addressing the training modalities was highlighted.
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Affiliation(s)
- Elfatih Mohamed Malik
- GHD
- EMPHNET, Khartoum, Sudan ,grid.9763.b0000 0001 0674 6207Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | | | - Abdelgadir Ali Bashir
- grid.9763.b0000 0001 0674 6207Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Rayyan Ibrahim
- grid.9763.b0000 0001 0674 6207Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | | | | | | | | | | | | | | | | | | | - Muzhgan Habibi
- grid.483405.e0000 0001 1942 4602WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Mahmoud Sadek
- grid.483405.e0000 0001 1942 4602WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Ahmed Aboushady
- grid.483405.e0000 0001 1942 4602WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Donadel M, Scobie HM, Pastore R, Grabovac V, Batmunkh N, O’Connor S, Dahl BA, Murrill CS. Comprehensive Vaccine-Preventable Disease Surveillance in the Western Pacific Region: A Literature Review on Integration of Surveillance Functions, 2000-2021. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:GHSP-D-22-00017. [PMID: 36316133 PMCID: PMC9622275 DOI: 10.9745/ghsp-d-22-00017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION A strategic framework for 2021-2030 developed by the World Health Organization (WHO) Regional Office for the Western Pacific emphasizes the need for high-quality and integrated vaccine-preventable disease (VPD) surveillance. We conducted a literature review to document the barriers, enabling factors, and innovations for integrating surveillance functions for VPDs and other communicable diseases in Western Pacific Region (WPR) countries. METHODS We searched published and gray literature on integrated VPD surveillance from 2000 to 2021. Articles in English, Spanish, or French were screened to identify those relating to VPD surveillance in a WPR country and not meeting defined exclusion criteria. We categorized articles using the 8 WHO surveillance support functions and abstracted data on the country; type of surveillance; and reported barriers, enabling factors, and best practices for integration. RESULTS Of the 3,137 references screened, 87 met the eligibility criteria. Of the 8 surveillance support functions, the proportion of references that reported integration related to the laboratory was 56%, followed by workforce capacity (54%), governance (51%), data management and use (47%), field logistics and communication (47%), coordination (15%), program management (13%), and supervision (9%). Several references noted fragmented systems and a lack of coordination between units as barriers to integration, highlighting the importance of engagement across public health units and between the public and private sectors. The literature also indicated a need for interoperable information systems and revealed the use of promising new technologies for data reporting and laboratory testing. In some WPR countries, workforce capacity was strengthened at all administrative levels by the implementation of integrated trainings on data monitoring and use and on laboratory techniques applicable to multiple VPDs. CONCLUSION This literature review supports integrating VPDs into broader communicable disease surveillance systems in WPR countries while ensuring that the minimal WHO-recommended standards for VPD surveillance are met.
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Affiliation(s)
- Morgane Donadel
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.,Correspondence to Morgane Donadel ()
| | - Heather M. Scobie
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Roberta Pastore
- World Health Organization, Western Pacific Regional Office, Manila, the Philippines
| | - Varja Grabovac
- World Health Organization, Western Pacific Regional Office, Manila, the Philippines
| | - Nyambat Batmunkh
- World Health Organization, Western Pacific Regional Office, Manila, the Philippines
| | - Stephanie O’Connor
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin A. Dahl
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher S. Murrill
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Clara A, Dao ATP, Tran Q, Tran PD, Dang TQ, Nguyen HT, Tran QD, Rzeszotarski P, Talbert K, Stehling-Ariza T, Veasey F, Clemens L, Mounts AW, Lofgren H, Balajee SA, Do TT. Testing early warning and response systems through a full-scale exercise in Vietnam. BMC Public Health 2021; 21:409. [PMID: 33637080 PMCID: PMC7907319 DOI: 10.1186/s12889-021-10402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background Simulation exercises can functionally validate World Health Organization (WHO) International Health Regulations (IHR 2005) core capacities. In 2018, the Vietnam Ministry of Health (MOH) conducted a full-scale exercise (FSX) in response to cases of severe viral pneumonia with subsequent laboratory confirmation for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) to evaluate the country’s early warning and response capabilities for high-risk events. Methods An exercise planning team designed a complex fictitious scenario beginning with one case of severe viral pneumonia presenting at the hospital level and developed all the materials required for the exercise. Actors, controllers and evaluators were trained. In August 2018, a 3-day exercise was conducted in Quang Ninh province and Hanoi city, with participation of public health partners at the community, district, province, regional and national levels. Immediate debriefings and an after-action review were conducted after all exercise activities. Participants assessed overall exercise design, conduction and usefulness. Results FSX findings demonstrated that the event-based surveillance component of the MOH surveillance system worked optimally at different administrative levels. Detection and reporting of signals at the community and health facility levels were appropriate. Triage, verification and risk assessment were successfully implemented to identify a high-risk event and trigger timely response. The FSX identified infection control, coordination with internal and external response partners and process documentation as response challenges. Participants positively evaluated the exercise training and design. Conclusions This exercise documents the value of exercising surveillance capabilities as part of a real-time operational scenario before facing a true emergency. The timing of this exercise and choice of disease scenario was particularly fortuitous given the subsequent appearance of COVID-19. As a result of this exercise and subsequent improvements made by the MOH, the country may have been better able to deal with the emergence of SARS-CoV-2 and contain it. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10402-x.
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Affiliation(s)
- Alexey Clara
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Anh T P Dao
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Quy Tran
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Phu D Tran
- General Department of Preventive Medicine, Under the Vietnam Ministry of Health, Hanoi, Vietnam
| | - Tan Q Dang
- General Department of Preventive Medicine, Under the Vietnam Ministry of Health, Hanoi, Vietnam
| | - Huong T Nguyen
- General Department of Preventive Medicine, Under the Vietnam Ministry of Health, Hanoi, Vietnam
| | - Quang D Tran
- General Department of Preventive Medicine, Under the Vietnam Ministry of Health, Hanoi, Vietnam
| | - Peter Rzeszotarski
- Division of Emergency Operations, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, USA
| | - Karen Talbert
- Division of Emergency Operations, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, USA
| | - Tasha Stehling-Ariza
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | | | | | - Anthony W Mounts
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Hannah Lofgren
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Arunmozhi Balajee
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Trang T Do
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
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