Spatial Analysis of Drug-Susceptible and Multidrug-Resistant Cases of Tuberculosis, Ho Chi Minh City, Vietnam, 2020-2023

We characterized the spatial distribution of drug-susceptible (DS) and multidrug-resistant (MDR) tuberculosis (TB) cases in Ho Chi Minh City, Vietnam, a major metropolis in southeastern Asia, and explored demographic and socioeconomic factors associated with local TB burden. Hot spots of DS and MDR TB incidence were observed in the central parts of Ho Chi Minh City, and substantial heterogeneity was observed across wards. Positive spatial autocorrelation was observed for both DS TB and MDR TB. Ward-level TB incidence was associated with HIV prevalence and the male proportion of the population. No ward-level demographic and socioeconomic indicators were associated with MDR TB case count relative to total TB case count. Our findings might inform spatially targeted TB control strategies and provide insights for generating hypotheses about the nature of the relationship between DS and MDR TB in Ho Chi Minh City and the wider southeastern region of Asia.

Mental health impact on patients with COVID-19 in the community under a long period of full lockdown in Vietnam

OBJECTIVE

We aimed to investigate the impact on the mental health of patients with COVID-19 in a centralized isolation facility in the community who experienced a long period of full lockdown during the fourth wave of the COVID-19 pandemic in Vietnam.

METHODS

We performed a retrospective cross-sectional study among 125 patients with COVID-19 in a centralized isolation facility in the community of Ho Chi Minh City from September to November 2021. We collected data on depression, anxiety, and stress symptoms, as indicated by scores on the Depression Anxiety Stress Scale-21, as well as sociodemographic characteristics.

RESULTS

The prevalence of depression, anxiety, and stress among patients with COVID-19 was 14.4%, 20.8%, and 20.0%, respectively. Depression scores were significantly and positively correlated with body mass index whereas stress scores were significantly and positively correlated with age.

CONCLUSION

Our findings indicated an increased prevalence of depression, anxiety, and stress among patients with COVID-19 who were in a centralized isolation facility during the fourth COVID-19 wave in Vietnam. Overweight and older age were identified as risk factors for adverse mental health in patients with COVID-19. Psychological intervention programs should be implemented in isolation facilities for individuals with COVID-19 infection.

Impact of a megacity on the water quality of a tropical estuary assessed by a combination of chemical analysis and in-vitro bioassays

Tropical estuaries are threatened by rapid urbanization, which leads to the spread of thousands of micropollutants and poses an environmental risk to such sensitive aqueous ecosystems. In the present study, a combination of chemical and bioanalytical water characterization was applied to investigate the impact of Ho Chi Minh megacity (HCMC, 9.2 million inhabitants in 2021) on the Saigon River and its estuary and provide a comprehensive water quality assessment. Water samples were collected along a 140-km stretch integrating the river-estuary continuum from upstream HCMC down to the estuary mouth in the East Sea. Additional water samples were collected at the mouth of the four main canals of the city center. Chemical analysis was performed targeting up to 217 micropollutants (pharmaceuticals, plasticizers, PFASs, flame retardants, hormones, pesticides). Bioanalysis was performed using six in-vitro bioassays for hormone receptor-mediated effects, xenobiotic metabolism pathways and oxidative stress response, respectively, all accompanied by cytotoxicity measurement. A total of 120 micropollutants were detected and displayed high variability along the river continuum with total concentration ranging from 0.25 to 78 μg L^-1. Among them, 59 micropollutants were ubiquitous (detection frequency ≥ 80 %). An attenuation was observed in concentration and effect profiles towards the estuary. The urban canals were identified as major sources of micropollutants and bioactivity to the river, and one canal (Bến Nghé) exceeded the effect-based trigger values derived for estrogenicity and xenobiotic metabolism. Iceberg modelling apportioned the contribution of the quantified and the unknown chemicals to the measured effects. Diuron, metolachlor, chlorpyrifos, daidzein, genistein, climbazole, mebendazole and telmisartan were identified as main risk drivers of the oxidative stress response and xenobiotic metabolism pathway activation. Our study reinforced the need for improved wastewater management and deeper evaluations of the occurrence and fate of micropollutants in urbanized tropical estuarine environments.

Factors Associated With Helicobacter Pylori Infection Among School-Aged Children From a High Prevalence Area in Vietnam

Objectives: The study aimed to identify prevalence of H. pylori infection and associated risk factors among pupils of Ho Chi Minh city (HCMC). Methods: A total of 1,476 pupils aged 6-15 years were enrolled in this cross-sectional study using multiple-stage sampling method. Infection status was assessed using stool antigen-test. A questionnaire was used to obtain socio-demographic, behavioral, and environmental factors. Logistic regression was performed to assess possible factors related to the infection. Results: Of the 1,409 children included in the analysis, 49.2% were male and 95.8% were of Kinh ethnicity. About 43.5% of parents completed college or university. The overall prevalence of H. pylori was 87.7%. Infrequency of handwashing with soap after toilet, the use of only water to clean after toilet, crowded living areas, larger family size, and younger age were independently contributing to an increased prevalence of H. pylori. Conclusion: H. pylori infection is highly prevalent in HCMC, and is associated with poor hygienic practices, crowded living areas, larger family size, and younger age. These findings highlight the importance of fecal-oral route and the attribution of crowded living conditions to the spreading of H. pylori in HCMC. Therefore, preventive programs should be set up with a focus on education of hygiene practices, and oriented to those living in crowded conditions.

What if delivery riders quit? Challenges to last-mile logistics during the Covid-19 pandemic

Notoriously precarious, hazardous, and stressful, delivery jobs became even more onerous and dangerous during the pandemic. In this study, set in Ho Chi Minh City, Vietnam, we applied Structural Equation Modelling to a large sample of primary data to measure delivery riders' intention to quit their jobs at the height of the pandemic. We found that job burnout was the key trigger to the intention to quit whereas the risk of Covid-19 infection did not directly affect this behavioral intention. Female riders, migrants, persons living with chronic diseases, and those who had seen their income decimated during the pandemic were more likely to want to quit their job. But if a mass of delivery drivers or riders had failed to show up for work, the last-mile delivery sector would have become paralysed, leaving individuals in various states of lockdown or isolation without food and supplies. As the sector is poised to retain its importance in the post-pandemic period, we recommend a number of approaches for both private companies and public policy makers to persuade riders to stay in their jobs. First and foremost, strategies to prevent and mitigate job burnout should be formulated.

An Innovative Method for BTEX Emission Inventory and Development of Mitigation Measures in Developing Countries-A Case Study: Ho Chi Minh City, Vietnam

Benzene, toluene, ethylbenzene, and xylenes (BTEX) are carcinogenic pollutants. However, the average concentration in 1 h of some pollutants belonging to BTEX, such as benzene, in Ho Chi Minh City (HCMC) is higher than the national standard QCVN 06:2009/BTNMT by about ten times. This research is the first to calculate the emission of BTEX for developing countries on a city scale. This paper developed a method to calculate cold emission factors based on hot emission factors for BTEX. Five spreadsheets developed and calculated these cold emission factors for five vehicle categories. A comprehensive emission inventory (EI) for BTEX was conducted in HCMC to determine the cause of BTEX pollution. An innovative methodology with bottom-up and top-down combination was applied to conduct BTEX EI, in which the EMISENS model was utilized to generate the EI for road traffic sources, and the emission factors method was utilized for other emission sources. Among emission reasons, motorcycles contribute the highest to HCMC air pollution, responsible for 93%, 90%, 98.9%, and 91.5% of benzene, toluene, ethylbenzene, and xylene, respectively. Cars contributed 5%, 6%, 0.8%, and 6.5% of benzene, toluene, ethylbenzene, and xylene, respectively. For LDVs, the emission from benzene, toluene, ethylbenzene, and xylene accounted for 1%, 2%, 0.2%, and 1.9%. The major reasons for point sources were metal production, which had 1%, 2%, and 0.1% for benzene, toluene, ethylbenzene, and xylenes emissions. The area source had a minority emission of total BTEX in Ho Chi Minh City. Our findings can be used to invest in the most significant sources to reduce BTEX in HCMC. Our approach can be applied in similar urban areas in BTEX EI. This research also developed nine measures to reduce BTEX in HCMC for human health protection.

Atmospheric particulate-bound mercury (PBM10) in a Southeast Asia megacity: Sources and health risk assessment

Particulate-bound mercury (PBM) is a global environmental concern owing to its large dry deposition velocities and scavenging coefficients, both of which drive Hg into terrestrial and marine ecosystems. PBM observation studies have been widely conducted over East Asia, but comparable studies in Peninsular Southeast Asia (PSEA) remain scarce. This is the first study reporting PBM concentrations for Ho Chi Minh City (HCMC), the biggest metropolitan area in Vietnam. A total of 222 samples were collected in 2018 and contained an average PBM₁₀ (particulate matter - PM with diameter ≤10 μm) concentration and Hg mass fraction (i.e. PBM/PM) of 67.3 ± 45.9 pg m^-3 and 1.18 ± 1.12 μg g^-1, respectively. Although PBM concentration was lower than those reported in Chinese megacities, the Hg mass fraction was similar to those in China, suggesting strong enrichment from anthropogenic Hg emissions in HCMC. Traffic-induced particulate emission and deposition processes were major factors governing PBM temporal variation at our site. In addition, the prevailing southwest monsoon winds brought air masses that passed through industrial areas and were associated with a higher Hg mass fraction. Statistically significant positive correlations (R² = 0.11-0.52, p < 0.01) were observed for PBM with PM and the Hg mass fraction, indicating similar PM and Hg sources or oxidized Hg adsorption onto PM via gas-particle partitioning. Moreover, PCA results revealed a higher contribution of primary sources than secondary sources to PBM concentration variability in HCMC. A health risk assessment indicated that the PBM concentrations at HCMC posed minimal non-carcinogenic risks (HI < 1) for children and adults, but dermal contact may act as an important exposure route since lightweight clothing is common among residents. This PBM dataset over PSEA, a region with high atmospheric Hg emissions, provides a valuable resource for the Hg scientific community to improve our understanding of Hg biogeochemical cycle.

Characteristics of Microplastics and Their Affiliated PAHs in Surface Water in Ho Chi Minh City, Vietnam

Microplastic pollution has become a worldwide concern. However, studies on the distribution of microplastics (MPs) from inland water to the ocean and their affiliated polycyclic aromatic hydrocarbons (PAHs) are still limited in Vietnam. In this study, we investigated the distribution of MPs and PAHs associated with MPs in canals, Saigon River, and Can Gio Sea. MPs were found at all sites, with the highest average abundance of MPs being 104.17 ± 162.44 pieces/m³ in canals, followed by 2.08 ± 2.22 pieces/m³ in the sea, and 0.60 ± 0.38 pieces/m³ in the river. Fragment, fiber, and granule were three common shapes, and each shape was dominant in one sampling area. White was the most common MP color at all sites. A total of 13 polymers and co-polymers were confirmed, and polyethylene, polypropylene, and ethylene-vinyl acetate were the three dominant polymers. The total concentration of MPs-affiliated PAHs ranged from 232.71 to 6448.66, from 30.94 to 8940.99, and from 432.95 to 3267.88 ng/g in Can Gio sea, canals, and Saigon River, respectively. Petrogenic sources were suggested as a major source of PAHs associated with MPs in Can Gio Sea, whereas those found in Saigon River and canals were from both petrogenic and pyrogenic sources.

Assessment of Job Stress of Clinical Pharmacists in Ho Chi Minh City, Vietnam: A Cross-Sectional Study

Objectives: The official implementation of clinical pharmacy in Vietnam has arrived relatively late, resulting in various stressors. This study aims to evaluate job stress level and suggest viable solutions.

Methods: A cross-sectional study was conducted on clinical pharmacists (CPs) in 128 hospitals in Ho Chi Minh City (HCMC). Job stress questions were derived from the Healthcare Profession Stress Inventory (HPSI).

Results: A total of 197 CPs participated, giving a response rate of 82.4%. Participants were found to have moderate job stress with an overall mean stress score of 1.5 (0.4) and stress rate of 52.8%. The sample size was statistically adequate and the HPSI was valid and reliable. Patient care responsibility was the main stressor, especially in public hospitals, followed by job conflicts. Lack of experience, low income, and inability to participate in clinical ward rounds caused significant stress to CPs regarding job recognition and job uncertainty. More practice-oriented training programs in bachelor curricula and clinical practice should be applied to help CPs gain more experience, self-confidence, and diminish job stress.

Conclusion: CPs in HCMC have moderate stress. More practice-oriented training programs should be prioritized to lessen stress for CPs.

Current status of clinical pharmacy workforce, services and clinical pharmacist recruitment in Ho Chi Minh City, Vietnam

OBJECTIVES

Clinical pharmacy practices in Vietnam have not been well studied. We aimed to describe clinical pharmacy practices in terms of workforce, activities and the recruitment demand for clinical pharmacists (CPs) in hospitals.

METHODS

A cross-sectional survey was conducted, and 123 questionnaires were distributed to Heads/Deputy heads of Pharmacy department and Boards of directors in all of hospitals in Ho Chi Minh City, Vietnam between August 2018 and June 2019.

RESULTS

There were 187 CPs in 79 participating hospitals, whereas the ratio of CPs per 100 patient beds was 0.67. The median number of CPs was 2 (1-4), with a significantly low median full time equivalent [0.4 (1, 2)]. The income of CPs was significantly low. Antibiotics were the most common medications that CPs discussed with physicians (93.06%). Interventions commonly performed by CPs were "Checking drug interactions" (77.78%), "Counseling physicians about the route of administration" (61.11%), "Checking drug allergies" (51.39%). The median number of CPs needed to recruit according to Heads/Deputy heads of Pharmacy Department and Boards of directors was 2 (1-3) and 2 (1-3.5), respectively.

CONCLUSION

The shortage of CPs, which was likely attributable to low income, might lead to numerous obstacles for delivering comprehensive healthcare services. Thus, the hospital recruitment strategies should focus on salary and benefits to attract more CPs, especially those with postgraduate degree.

Estimated Number of People who Inject Drugs in Ho Chi Minh City, Vietnam: Findings from a Two-survey Capture-Recapture Population Size Estimation Exercise

BACKGROUND

HIV/AIDS program managers in Ho Chi Minh City (HCMC), Vietnam have always relied on the police reports and the UNAIDS Estimation and Projection Package for population size estimation of People Who Inject Drugs (PWID).

METHODS

We used Respondent-driven Sampling (RDS) to implement a two-source capture-recapture study to estimate the population size of PWID in HCMC in 2017. The study was implemented in seven out of 24 districts and included men and women ages 18 years and older who reported injecting illicit drugs in the last 90 days, and who had lived in the city for the past six months. Estimates of the PWID population size for each of the seven districts were calculated accounting for the RDS sampling design. These were then adjusted to account for the district sampling probabilities to give an estimate for HCMC. Chapman two-source capture-recapture estimates of population size, based on simple random sampling assumptions, were also calculated for comparison.

RESULTS

The estimates resulted in a population size for HCMC of 19,155 [95% Confidence Interval (CI): 17,006-25,039] using the RDS approach and 17,947 (95% CI: 15,968-19,928), using the Chapman approach.

CONCLUSION

The two-survey capture-recapture exercise provided estimates of PWID in HCMC - based on Chapman estimator and RDS approach - are similar. For planning HIV prevention and care service needs among PWID in HCMC, both estimates may need to be taken into consideration together with size estimates from other sources.

Correlates of body mass index among primary school children in Ho Chi Minh City, Vietnam

OBJECTIVES

To document the prevalence of overweight and obesity and examine associated risk factors.

STUDY DESIGN

A cross-sectional survey was conducted in 16 primary public schools in eight districts of Ho Chi Minh City in 2016. A multistage clustering sampling method was used to collect a sample of 1806 pupils attending the first, second, and third grades (7-9 years).

METHODS

Age- and sex-adjusted body mass index (BMI) status was defined using International Obesity Taskforce cut-offs. Ordered probit regression models were used to assess the association between child BMI and its socio-economic and demographic risk factors. The model was estimated separately for boys and girls to assess the extent to which the socio-economic gradients in BMI vary by gender.

RESULTS

The prevalence of obesity among boys was twice the rate for girls (24.7 vs 12.3%). The prevalence of overweight and obesity were also higher among pupils attending schools located in urban districts than in semi-rural districts. Gender, household wealth, the frequency of having breakfast at home, parental body weight, and school location were strong predictors of child BMI status. The protective effect of having breakfast more frequently at home against the risk of overweight/obesity was more pronounced in girls than in boys. Father's body weight and child BMI were more strongly associated with boys from poorer households than boys from wealthier households, while the differences were not significant for girls.

CONCLUSIONS

The high prevalence of childhood overweight and obesity indicates an urgent need for more gender-specific, effective intervention, and prevention programs.

Contamination status and potential release of trace metals in a mangrove forest sediment in Ho Chi Minh City, Vietnam

Can Gio district is located in the coastal area of Ho Chi Minh City, southern Vietnam. Discharge of wastewater from Ho Chi Minh City and neighboring provinces to the rivers of Can Gio has led to concerns about the accumulation of trace metals (As, Cu, Cr, Ni, Pb, and Zn) in the coastal sediments. The main objective of this study was to assess the distribution of As, Cu, Cr, Ni, Pb, and Zn in surface and core sediments and to evaluate the contamination status in relation to local background values, as well as the potential release of these selected trace metals from sediments to the water environment. Sediment characteristization, including determination of fine fraction, pH, organic matter, and major elements (Al, Fe, Ca, K, Mg, and S), was carried out to investigate which parameters affect the trace metal enrichment. Fine fraction and Al contents were found to be the controlling proxies affecting the distribution of trace metals while other sediment characteristics did not show any clear influence on trace metals' distribution. Although As concentrations in the sediments were much higher compared to its reference value in other areas, the enrichment factor based on local background values suggests minor contamination of this element as well as for Cr, Cu, and Pb. Risk assessment suggested a medium to very high risk of Mn, Zn, and Ni under acidification. Of importance is also that trace metals in sediments were not easily mobilized by organic complexation based on their low extractabilities by ammonium-EDTA extraction.

Population Size Estimation of Venue-Based Female Sex Workers in Ho Chi Minh City, Vietnam: Capture-Recapture Exercise

Background

There is limited population size estimation of female sex workers (FSWs) in Ho Chi Minh City (HCMC)—the largest city in Vietnam. Only 1 population size estimation among venue-based female sex workers (VFSWs) was conducted in 2012 in HCMC. Appropriate estimates of the sizes of key populations are critical for resource allocation to prevent HIV infection.

Objective

The aim of this study was to estimate the population size of the VFSWs from December 2016 to January 2017 in HCMC, Vietnam.

Methods

A multistage capture-recapture study was conducted in HCMC. The capture procedures included selection of districts using stratified probability proportion to size, mapping to identify venues, approaching all VFSWs to screen their eligibility, and then distribution of a unique object (a small pink makeup bag) to all eligible VFSWs in all identified venues. The recapture exercise included equal probability random selection of a sample of venues from the initial mapping and then approaching FSWs in those venues to determine the number and proportion of women who received the unique object. The proportion and associated confidence bounds, calculated using sampling weights and accounting for study design, were then divided by the number of objects distributed to calculate the number of VFSWs in the selected districts. This was then multiplied by the inverse of the proportion of districts selected to calculate the number of VFSWs in HCMC as a whole.

Results

Out of 24 districts, 6 were selected for the study. Mapping identified 573 venues across which 2317 unique objects were distributed in the first capture. During the recapture round, 103 venues were selected and 645 VFSWs were approached and interviewed. Of those, 570 VFSWs reported receiving the unique object during the capture round. Total estimated VFSWs in the 6 selected districts were 2616 (95% CI 2445-3014), accounting for the fact that only 25% (6/24) of total districts were selected gives an overall estimate of 10,465 (95% CI 9782-12,055) VFSWs in HCMC.

Conclusions

The capture-recapture exercise provided an estimated number of VFSWs in HCMC. However, for planning HIV prevention and care service needs among all FSWs, studies are needed to assess the number of sex workers who are not venue-based, including those who use social media platforms to sell services.

The determinants of self-medication: Evidence from urban Vietnam

This study examines the primary determinants of self-medications among urban citizens in Ho Chi Minh City, Vietnam using survey data. Employing logistic models, the article finds that the probability of self-medication is positively associated with the respondents' high school degree or vocational certificate, married status, and income while it is negatively related to employed status, the number of children, the geographical distance from home to the nearest hospital, doing exercise, and living in a central region. Meanwhile, using Poisson models the article finds that the frequency of self-medication is positively associated with the respondents' high school and vocational, married, income, and chronic disease while the frequency of self-medication is adversely related to male, employed, children number, distance, being close to health professional and central areas.

Characteristics of ammonia gas and fine particulate ammonium from two distinct urban areas: Osaka, Japan, and Ho Chi Minh City, Vietnam

Continuous and simultaneous measurements of ammonia gas (NH₃) and fine particulate ammonium (PM_2.5NH₄⁺) were performed in two distinct urban areas: Osaka, Japan, and Ho Chi Minh City (HCMC), Vietnam. Measurements were performed using a new online instrument. Two measurement periods were conducted during February 11-March 12, 2015 (cold period), and July 1-September 14, 2015 (warm period), at the urban site in Osaka, while 17 days of measurements, from May 21 to June 8, 2015, were conducted at the urban site in HCMC. The average NH₃ concentration at the HCMC site was much higher than that at the Osaka site. The differences in the NH₃ levels between the two cities are a result of their different emission sources. Traffic emission is a significant contributor to the NH₃ levels within the urban area in Osaka. Conversely, the contribution of traffic emission to the NH₃ levels in the HCMC urban area is negligible. With a population of around 8.5 million people living in the urban area of HCMC, the high NH₃ level is due to human sources and poor waste management systems, especially because of the high temperature (30 °C) and dense population of the city (density up to 42,000 inhabitants per km²). In contrast to the NH₃ levels, the highest PM_2.5NH₄⁺ level occurred during the cold period at the Osaka site, and the average level at this site was higher than that at the HCMC site. The availability of atmospheric acids, low temperature, and high humidity facilitates the formation of ammonium. Our results indicate that NH₃ plays a key role in secondary inorganic aerosol formation; therefore, it contributes to a significant amount of PM_2.5 at the Osaka site. In contrast, the high levels of PM_2.5 observed at the HCMC site are likely from road traffic emission, mainly motorcycles, rather than secondary inorganic aerosol formation.

Investigation of antibiotics in health care wastewater in Ho Chi Minh City, Vietnam

Hospital wastewater contains huge amounts of hazardous pollutants which are being discharged daily to environment with or without treatment. Antibiotics were among the important group of pharmaceuticals considered as a potential source of health risk for human and other living creatures. Although the investigations about the existence of antibiotics in hospital wastewater have gained concern for researchers in many countries, there is only one research conducted in Hanoi-Vietnam. Hence, in this study, investigations have been done to fulfill the requirement of real situation in Vietnam by accomplishing survey for 39 health care facilities in Ho Chi Minh City. As results, seven popular antibiotics were detected to exist in all samples such as sulfamethoxazole (2.5 ± 1.9 μg/L), norfloxacin (9.6 ± 9.8 μg/L), ciprofloxacin (5.3 ± 4.8 μg/L), ofloxacin (10.9 ± 8.1 μg/L), erythromycin (1.2 ± 1.2 μg/L), tetracycline (0.1 ± 0.0 μg/L), and trimethoprim (1.0 ± 0.9 μg/L). On the other hand, survey also showed that only 64% of health care facilities using conventional activate sludge (AS) processes in wastewater treatment plants (WWTPs). As a consequence, basic environmental factors (BOD₅, COD, TSS, NH₄⁺-N, or total coliforms) were not effectively removed from the hospital wastewater due to problems relating to initial design or operational conditions. Therefore, 18% effluent samples of the surveyed WWTPs have exceeded the national standard limits (QCVN 28:2010, level B).

The effects of high temperature on cardiovascular admissions in the most populous tropical city in Vietnam

This study examined the short-term effects of temperature on cardiovascular hospital admissions (CHA) in the largest tropical city in Southern Vietnam. We applied Poisson time-series regression models with Distributed Lag Non-Linear Model (DLNM) to examine the temperature-CHA association while adjusting for seasonal and long-term trends, day of the week, holidays, and humidity. The threshold temperature and added effects of heat waves were also evaluated. The exposure-response curve of temperature-CHA reveals a J-shape relationship with a threshold temperature of 29.6 °C. The delayed effects temperature-CHA lasted for a week (0-5 days). The overall risk of CHA increased 12.9% (RR, 1.129; 95%CI, 0.972-1.311) during heatwave events, which were defined as temperature ≥ the 99th percentile for ≥2 consecutive days. The modification roles of gender and age were inconsistent and non-significant in this study. An additional prevention program that reduces the risk of cardiovascular disease in relation to high temperatures should be developed.

[Tetanus in Ho Chi Minh City, Vietnam: epidemiological, clinical and outcome features of 389 cases at the Hospital for Tropical Diseases]

The objective of this study is to describe the different aspects of tetanus during the past recent years in southern Vietnam: epidemiology, clinical picture, management, and death risk factors. It is a retrospective study concerning 389 cases admitted in 2007 and 2008 at the reference Hospital for Tropical Diseases in Ho Chi Minh City. 93% of all cases were generalized tetanus, and 50% were severe cases. A majority of patients were adult males (medium age 43, M/ F sex-ratio 2.9). Half of them underwent tracheotomy and 39% assisted ventilation. Case fatality rate was 6.4%, the lowest reported rate worldwide in the last ten years. Fatalities resulted mainly from neuro-vegetative disorders, essentially cardiogenic shock (28% of all deaths) [OR = 16.95; p < 0.001], sepsis (24%) [OR = 3.25; (p < 0,114], and acute renal failure (16%) [OR = 7,22; p < 0.004]. Age over 60-year [OR = 4.53; p < 0.0001] and a leukocyte count>12.000/mm(3) [OR = 2.32; p < 0.020] were significantly associated with fatal outcome, contrarily to incubation and extension phase durations, or delayed serum administration. Systematic extension of vaccination to all adult males, and improved access to post exposure sero-immunization at all levels of health centres throughout the country may further reduce tetanus burden in Vietnam.