Deaths In Vietnam Research Articles

COVID-19 in Vietnam and its impact on road trauma: A national data review.

Despite significant improvement in the last decade, road trauma remains a significant contributor to deaths in Vietnam. The COVID-19 pandemic necessitated public health measures which had an unforeseen benefit on road trauma in high income countries. We investigate if this reduction was also seen in a low to middle income country, Vietnam. Our aim was to investigate how the COVID-19 pandemic, and the government policies to address it, impacted on road trauma fatalities in Vietnam. We also compared this impact with other government policies intended to road trauma in the preceding 14 years (2007 to 2020). COVID-19 data was extracted from the Vietnamese Ministry of Health (MoH) database. Road traffic deaths from 2007 to 2021 were derived from the Vietnamese General Statistical Office (GSO). We used Stata software 17 for statistical analysis. Poisson regression modelling, with the logarithm of the national population of Vietnam of each year included as an offset, was used to estimate trends in rates of road fatalities from the annual national mortality data for the period 2007-2021. The actual change in road traffic mortality in 2021 was compared with calculated figures to demonstrate the effect of COVID-19 on road trauma fatalities. We also compared this impact with other government road toll reduction policies for 14 years (2007 to 2020). Between 2007 and 2020 the number of annual road traffic deaths had more than halved from 15.3 to 7.0 per 100,000, an average reduction of 5.4% per annum. We estimated that the road traffic mortality rate declined by 12.1% (95% CI 8.9 to 15.3%) in 2021 relative to trend. The actual number of road trauma deaths fell by 16.4%. This reduction was largely seen from August to October 2021 when lockdown and social distancing were in force. In 2021, the road traffic death reduction in Vietnam was 3 times greater than the trend over the preceding 14 years. The public heath response to the COVID-19 pandemic in Vietnam was associated with a third of this reduction. It can thus be reasonably concluded that government policies to address the COVID-19 pandemic resulted in a 4.3% decrease of road traffic deaths in 2021. This has been observed in High-Income Countries but was demonstrated by us for the first time in a Low- and Middle-Income Country.

Mortality benefits of reduction fine particulate matter in Vietnam, 2019.

Studies assessing the health benefits of air pollution reduction in Vietnam are scarce. This study quantified the annual mortality burden due to PM2.5 pollution in Vietnam above the World Health Organization recommendation for community health (AQG: 5 μg/m3) and the proposed National Technical Regulation on Ambient Air Quality (proposed QCVN: 15 μg/m3). This study applied a health impact assessment methodology with the hazard risk function for non-communicable diseases (NCDs) and lower respiratory infections (LRIs) in the Global Exposure Mortality Model (GEMM) to calculate attributable deaths, Years of Life lost, and Loss of Life expectancy at birth due to air pollution in the Vietnamese population above 25 years of age in 11 provinces. We obtained annual average PM2.5 concentrations for Vietnam in 2019 at a 3x3 km grid modeled using Mixed Linear regression and multi-data sources. Population and baseline mortality data were obtained from administrative data system in Vietnam. We reported the findings at both the provincial and smaller district levels. Annual PM2.5 concentrations in all studied provinces exceeded both the AQG and the proposed QCVN. The maximum annual number of attributable deaths in the studied provinces if they had complied with WHO air quality guidelines was in Ha Noi City, with 5,090 (95%CI: 4,253-5,888) attributable deaths. At the district level, the highest annual rate of attributable deaths if the WHO recommendation for community health had been met was 104.6 (95%CI: 87.0-121.5) attributable deaths per 100,000 population in Ly Nhan (Ha Nam province). A much larger number of premature deaths in Vietnam could potentially be avoided by lowering the recommended air quality standard. These results highlight the need for effective clean air action plans by local authorities to reduce air pollution and improve community health.

COVID-19 pandemic: Impacts on diagnosis and treatment of colorectal cancer

Abstract Introduction: Since its first strike in 2019, the highly contagious Sars-Cov-2 virus has not only directly caused millions of deaths in Vietnam but also indirectly affected many other diseases such as colorectal cancer. In order to clarify this statement, this study was conducted to investigate the difference in disease stage, curative rate of colorectal cancer before and after the Covid-19 outbreak. Patients and Methods: A retrospective study was conducted at Univercity Medical Center, Ho Chi Minh city. Data on cancer stage, surgical methods, and rate of preoperative and postoperative complications were collected from patients treated at the hospital in two stages: group A including patients from February to April 2021 (before applying social distancing) and group B including patients from September to November 2011 (when applying social distancing). Results: When comparing 201 patients in group A and 150 patients in group B, the results showed that the clinical characteristics of the two groups were identical. However, the percentage of cancer that had metastasized at the time of diagnosis was significantly higher in group B than in group A (32% vs 21.4%, p = 0.025), leading to a decrease of radical cure rate in group B (44.7% versus 69.1%, p < 0.001). Particularly for rectal cancer, the rate of advanced tumors (stage T3 CRM+ or T4) in group B was higher than in group A (77.2% vs 58.1%, p = 0.026). Conclusion: In general, not only directly threatening peoples health, the Covid-19 pandemic also delayed the diagnosis of colorectal cancer due to the influence of distancing regulation and the patient's psychological fear, thereby affecting patients prognosis. Keywords: Covid-19, Sars-Cov-2 virus, colorectal cancer, advanced stage cancer.

THE RELATIONSHIP BETWEEN PUBLIC SERVICE MOTIVATION, WORK ENJOYMENT, AND TASK PERFORMANCE: A PRELIMINARY STUDY OF HEALTHCARE WORKERS IN VIETNAM

This study aimed to examine the impact of health workers' public service motivation during their participation in response to the Covid-19 pandemic at a time of the highest number of infections and deaths in Vietnam. This study was conducted through a cross-sectional survey using an intentional sampling technique (n=200). In addition, Structural Equation Modeling (SEM) was applied to illustrate the proposed hypotheses. We found that compassion in the workplace, self-sacrifice, and attraction to policy-making impacted work enjoyment positively and significantly. In particular, there was a positive and significant relationship between work enjoyment and task performance but no evidence of the relationship between Commitment to the public interest and work enjoyment. This study further demonstrates the importance of public service motivation of health workers in pandemic response, as previous studies have found. This finding suggests that the government and policymakers in Vietnam should develop policies to promote health workers' public service motivation during their engagement in response to the health crisis.

Alcohol Use Disorder among Patients Suffered from Road Collisions in a Vietnamese Delta Province

Traffic collisions have continuously been ranked amongst the top causes of deaths in Vietnam. In particular, drinking has been recognized as a major factor amplifying the likelihood of traffic collisions in various settings. This study aims to examine the relationship between alcohol use and traffic collisions in the current context of Vietnam. A cross-sectional study was conducted on 413 traffic collisions patients in six health facilities in the Thai Binh Province to investigate the level of alcohol consumption and identify factors influencing alcohol use among these patients. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scale was used to determine the problematic drinking behavior of the participants. The percentage of patients having problematic drinking was more than 30%. Being male, having a high household income, and working as farmer/worker were risk factors for alcohol abuse. People causing accidents and patients with a traumatic brain injury had a higher likelihood of drinking alcohol before the accidents. This study highlights the necessity of more stringent laws on reducing drink-driving in Vietnam. In addition, more interventions, especially those utilizing mass media like educational campaign of good behavior on social networks, are necessary to reduce alcohol consumption in targeted populations in order to decrease the prevalence and burden of road injuries.

Lives saved by laws and regulations that resulted from the Bloomberg road safety program

ObjectiveTo estimate lives saved during 2008–2023 by traffic safety laws passed in six developing countries while participating in the Bloomberg Road Safety Program (BRSP). MethodsBRSP-funded local staff identified relevant laws and described enforcement to the study team. We analyzed road crash death estimates for 2004–2013 from the Global Burden of Disease and projected estimates absent intervention forward to 2023. We amalgamated developing country and US literature to estimate crash death reductions by country resulting from laws governing drink driving, motorcycle helmets, safety belt use, and traffic fines. ResultsBRSP helped win approval of traffic safety laws in Brazil, China, Kenya, Mexico, Turkey, and Vietnam. In 2008–2013, those laws saved an estimated 19,000 lives. Many laws only took effect in 2014. The laws will save an estimated 90,000 lives in 2014–2023. Of the 109,000 lives saved, drink driving laws will account for 84%, increased motorcyclist protection for 13%, increased fines and penalty points for 2%, and safety belt usage mandates for 1%. Drink driving reductions in China will account for 56% of the savings and reduced drink driving and motorcycling deaths in Vietnam for 35%. The savings in China will result from a narrow intervention with just 4% estimated effectiveness against drink driving deaths. As a percentage of deaths anticipated without BRSP effort, the largest reductions will be 11% in Vietnam and 5% in Kenya. ConclusionsViewed as a public health measure, improving traffic safety provided large health gains in developing nations.

Nursing & parental perceptions of neonatal care in Central Vietnam: a longitudinal qualitative study

BackgroundNeonatal mortality accounts for nearly three quarters of all infant deaths in Vietnam. The nursing team are the largest professional group working with newborns, however do not routinely receive neonatal training and there is a lack of research into the impact of educational provision. This study explored changes in nursing perceptions towards their role following a neonatal educational intervention. Parents perceptions of nursing care were explored to determine any changes as nurses gained more experience.MethodSemi-Structured qualitative interviews were conducted every 6 months over an 18 month period with 16 nurses. At each time point, parents whose infant was resident on the neonatal unit were invited to participate in an interview to explore their experiences of nursing care. A total of 67 parents participated over 18 months. Interviews were conducted and transcribed in Vietnamese before translation into English for manifest content analysis facilitated by NVivo V14.ResultsAnalysis of nursing transcripts identified 14 basic categories which could be grouped (23) into 3 themes: (1) perceptions of the role of the neonatal nurse, (2) perception of the parental role and (3) professional recollections. Analysis of parent transcripts identified 14 basic categories which could be grouped into 3 themes: (1) information sharing, (2) participation in care, and (3) personal experience.ConclusionsQualitative interviews highlighted the short term effect that the introduction of an educational intervention can have on both nursing attitudes towards and parental experience of care in one neonatal unit in central Vietnam. Nurses shared a growing awareness of their role along with its ethical issues and challenges, whilst parents discussed their overall desire for more participation in their infants care. Further research is required to determine the long term impact of the intervention, the ability of nurses to translate knowledge into clinical practice through assessment of nursing knowledge and competence, and the impact and needs of parents. A greater understanding will allow us to continue to improve the experiences of nurses and parents, and highlight how these areas may contribute towards the reduction of infant mortality and morbidity in Vietnam.

Potential Impact of Graphic Health Warnings on Cigarette Packages in Reducing Cigarette Demand and Smoking-Related Deaths in Vietnam.

Two years after implementation of the graphic health warning intervention in Vietnam, it is very important to evaluate the intervention's potential impact. The objective of this paper was to predict effects of graphic health warnings on cigarette packages, particularly in reducing cigarette demand and smoking-associated deaths in Vietnam. In this study, a discrete choice experiment (DCE) method was used to evaluate the potential impact of graphic tobacco health warnings on smoking demand. To predict the impact of GHWs on reducing premature deaths associated with smoking, we constructed different static models. We adapted the method developed by University of Toronto, Canada and found that GHWs had statistically significant impact on reducing cigarette demand (up to 10.1% through images of lung damage), resulting in an overall decrease of smoking prevalence in Vietnam. We also found that between 428,417- 646,098 premature deaths would be prevented as a result of the GHW intervention. The potential impact of the GHW labels on reducing premature smoking-associated deaths in Vietnam were shown to be stronger among lower socio-economic groups.

Knowledge of Rabies Prevention in Vietnamese Public Health and Animal Health Workers.

Rabies is an invariably fatal, but preventable zoonotic disease. Despite a national programme for its prevention and control, the number of rabies associated deaths in Vietnam has increased in recent years. A cross-sectional survey was undertaken in 2012 to assess and compare the knowledge, awareness and practices of 189 public health workers (PHW) and animal health workers (AHW) attending a joint training course for professionals from provinces in northern Vietnam with the highest number of deaths from rabies. Questionnaires facilitating self-evaluation were provided, and total knowledge scores were calculated (maximum 38 points) and categorized into: 'high' (>30 points), 'moderate' (21-30) and 'low' (<21). The response rate was 100%, and among the 189 participants, 56% were PHW compared to 44% who were AHW. Although most respondents knew rabies could be transmitted through the bite of an animal, most commonly a dog, and that rabies is a preventable disease, significant differences between groups were identified. Major areas included poor knowledge of common rabies reservoirs, wound management and guidance on post-exposure prophylaxis. Overall, the total mean knowledge scores for PHW was significantly higher (P=0.011) compared to those for AHW, but both scores fell within the 'moderate' knowledge range. However, proportionately more PHW than AHW achieved 'high' knowledge scores (P=0.0098). To our knowledge this is the first published study to simultaneously assess the knowledge and awareness of animal health and public health professionals attending joint training activities aimed at strengthening rabies prevention and control. To ensure effective prevention and control of rabies requires that AHW and PHW not only coordinate and collaborate, but have a common knowledge and understanding of rabies prevention and control measures. This study provides important baseline data in a relatively unexplored area of research that can focus future interventions and research.

Socio-Ecological Risk Factors for Prime-Age Adult Death in Two Coastal Areas of Vietnam

BackgroundHierarchical spatial models enable the geographic and ecological analysis of health data thereby providing useful information for designing effective health interventions. In this study, we used a Bayesian hierarchical spatial model to evaluate mortality data in Vietnam. The model enabled identification of socio-ecological risk factors and generation of risk maps to better understand the causes and geographic implications of prime-age (15 to less than 45 years) adult death.Methods and FindingsThe study was conducted in two sites: Nha Trang and Hue in Vietnam. The study areas were split into 500×500 meter cells to define neighborhoods. We first extracted socio-demographic data from population databases of the two sites, and then aggregated the data by neighborhood. We used spatial hierarchical model that borrows strength from neighbors for evaluating risk factors and for creating spatially smoothed risk map after adjusting for neighborhood level covariates. The Markov chain Monte Carlo procedure was used to estimate the parameters. Male mortality was more than twice the female mortality. The rates also varied by age and sex. The most frequent cause of mortality was traffic accidents and drowning for men and traffic accidents and suicide for women. Lower education of household heads in the neighborhood was an important risk factor for increased mortality. The mortality was highly variable in space and the socio-ecological risk factors are sensitive to study site and sex.ConclusionOur study suggests that lower education of the household head is an important predictor for prime age adult mortality. Variability in socio-ecological risk factors and in risk areas by sex make it challenging to design appropriate intervention strategies aimed at decreasing prime-age adult deaths in Vietnam.

Evaluation of the Vietnamese A6 mortality reporting system: injury as a cause of death

BackgroundDespite the fact that the A6 mortality reporting system has been operating for almost 20 years in Vietnam, there has been no systematic evaluation of the system. This study assesses...

Pathogenicity and Molecular Characterization of Emerging Porcine Reproductive and Respiratory Syndrome Virus in Vietnam in 2007

In 2007, Vietnam experienced swine disease outbreaks causing clinical signs similar to the 'porcine high fever disease' that occurred in China during 2006. Analysis of diagnostic samples from the disease outbreaks in Vietnam identified porcine reproductive and respiratory syndrome virus (PRRSV) and porcine circovirus type 2 (PCV-2). Additionally, Escherichia coli and Streptococcus equi subspecies zooepidemicus were cultured from lung and spleen, and Streptococcus suis from one spleen sample. Genetic characterization of the Vietnamese PRRSV isolates revealed that this virus belongs to the North American genotype (type 2) with a high nucleotide identity to the recently reported Chinese strains. Amino acid sequence in the nsp2 region revealed 95.7-99.4% identity to Chinese strain HUN4, 68-69% identity to strain VR-2332 and 58-59% identity to strain MN184. A partial deletion in the nsp2 gene was detected; however, this deletion did not appear to enhance the virus pathogenicity in the inoculated pigs. Animal inoculation studies were conducted to determine the pathogenicity of PRRSV and to identify other possible agents present in the original specimens. Pigs inoculated with PRRSV alone and their contacts showed persistent fever, and two of five pigs developed cough, neurological signs and swollen joints. Necropsy examination showed mild to moderate bronchopneumonia, enlarged lymph nodes, fibrinous pericarditis and polyarthritis. PRRSV was re-isolated from blood and tissues of the inoculated and contact pigs. Pigs inoculated with lung and spleen tissue homogenates from sick pigs from Vietnam developed high fever, septicaemia, and died acutely within 72 h, while their contact pigs showed no clinical signs throughout the experiment. Streptococcus equi subspecies zooepidemicus was cultured, and PRRSV was re-isolated only from the inoculated pigs. Results suggest that the cause of the swine deaths in Vietnam is a multifactorial syndrome with PRRSV as a major factor.

Social Normative Beliefs About Smoking Among Vietnamese Adolescents

Tobacco-related deaths in Vietnam are forecast to climb from 40 000 annually to 70 000 by 2030. Previous research in Western nations has found social factors to be important determinants of adolescent smoking. Because these factors remain unexplored in Vietnamese youth, the purpose of this study was to examine social normative beliefs regarding smoking in a school-based sample of North Vietnamese adolescents and the association of these factors with smoking behavior and susceptibility to smoking. Three measures of normative beliefs regarding smoking were evaluated in cross-sectional surveys of secondary students. Of the 3 measures, parent/peer disapproval was the most consistent normative belief associated with smoking behavior and susceptibility to smoking. Youth smoking prevention programs should consider assessing and taking into account normative beliefs and develop strategies that provide accurate information about the actual prevalence of smoking, the types of individuals who smoke, and approval/disapproval of smoking by parents and peers.

H5N1 Influenza Virus, Domestic Birds, Western Siberia, Russia

To the Editor: Highly pathogenic H5N1 avian influenza virus caused disease outbreaks in poultry and wild birds in several Asian, European, and African countries from 2003 to 2006. This virus caused >90 human deaths in Vietnam, Thailand, People's Republic of China, Indonesia, Turkey, Iraq, and Cambodia (1–3). Hemagglutinin (HA) and neuraminidase (NA) genes of this virus were derived from the Gs/Gd/1/96-like lineage, and 6 genes that encode internal viral proteins were derived from other lineages (1). Highly pathogenic H5N1 virus genetically related to the A/Chicken/Shantou/4231/03 (People's Republic of China) isolate caused disease outbreaks in poultry in Japan from the end of December 2003 to March 2004 (4). In May and June 2005, highly pathogenic H5N1 virus was isolated from migratory birds during disease outbreaks near Lake Qinghai in western People's Republic of China. HA, NA, and nucleoprotein genes of the Qinghai virus were closely related to H5N1 virus A/Chicken/Shantou/4231/03 isolated in People's Republic of China in 2003. Five other viral genes (matrix, PA, PB1, PB2, and nonstructural protein) were closely related to an H5N1 Hong Kong Special Administrative Region, People's Republic of China 2004 isolate (A/Peregrin falcon/HK/D0028/04) and H5N1 virus A/Chicken/Shantou/810/05 isolated in People's Republic of China in 2005 (5,6). In July 2005, domestic poultry began to die in the village of Suzdalka in western Siberia, Russia (Dovolnoe County, Novosibirsk region). Autopsies showed serious alterations in all internal organs tested. Approximately 95%–100% of the lungs were affected, and all serous membranes showed petechial and confluent hemorrhages. The highest concentration of hemorrhages was in the pericardium. Organs from 3 birds (1 turkey and 2 chickens) that had died during this outbreak were further analyzed. Homogenates of lungs, kidneys, and spleens were tested by hemagglutination inhibition (HI) assay. The highest titers, 32 and 16, were observed in the spleen of the turkey and kidneys of the chickens, respectively. H5 influenza A virus was identified in a homogenate of turkey spleen by conventional HI assay (7) with a panel of reference antisera. For the identification of NA subtype, RNA was isolated from turkey spleen homogenate and synthesis of viral cDNA was performed as previously described (7). Amplification by polymerase chain reaction (PCR) and sequencing of an NA gene fragment were performed with in-house primers (sequences of primers are available on request). The nucleotide sequence obtained (547 bp, GenBank accession no. {type:entrez-nucleotide,attrs:{text:DQ231243,term_id:78146121,term_text:DQ231243}}DQ231243) showed 100% identity with the NA gene of H5N1 viruses isolated in People's Republic of China in 2005 (e.g., A/Great black-headed gull/Qinghai/1/05) (5,6). Homogenates of bird organs (turkey spleen and chicken kidneys) were injected into the allantoic cavity of 10-day-old embryonated chicken eggs. Three hemagglutinating agents were isolated (titers 1,024–2,048) and identified as H5 influenza A virus (A/Turkey/Suzdalka/Nov-1/05, A/Chicken/Suzdalka/Nov-11/05, and A/Chicken/Suzdalka/Nov-12/05) by reverse transcription–PCR and sequencing (isolation of RNA from allantoic fluid and synthesis of virus cDNA were performed as previously described [7]). PCR amplification and sequencing of a fragment of the HA gene were performed with an in-house primer set for the H5 gene (available on request). Phylogenetic analysis of nucleotide sequences obtained (GenBank accession nos. {type:entrez-nucleotide,attrs:{text:DQ231242,term_id:78146106,term_text:DQ231242}}DQ231242, {type:entrez-nucleotide,attrs:{text:DQ231241,term_id:78146083,term_text:DQ231241}}DQ231241, and {type:entrez-nucleotide,attrs:{text:DQ231240,term_id:78146041,term_text:DQ231240}}DQ231240) indicated that western Siberian 2005 isolates belong to the Gs/Gd/1/96-like lineage and form a cluster with H5N1 viruses isolated from migratory birds in the People's Republic of China in 2005 (5), from poultry in Japan in 2004 (4), and from poultry and humans in Asian countries in 2003 and 2004 (1) (Figure). Deduced amino acid HA cleavage site sequences of all isolates (PQGERRRKKR/GL) corresponded to highly pathogenic Asian H5N1 influenza virus variants (5,6). Figure Phylogenetic tree of H5 hemagglutinin genes of influenza A viruses. The 3 H5 western Siberian 2005 viruses isolated in this study are shaded. Phylogenetic analysis was performed by the neighbor-joining method with the Molecular Evolutionary Genetic Analysis ... To test virulence, 10 six-week-old chickens were intravenously infected with isolate A/Turkey/Suzdalka/Nov-1/05 as previously described (7). All viruses isolated were highly pathogenic (all chickens died within a day of infection). We isolated H5N1 influenza virus from the spleen of a turkey that died during an outbreak in poultry in western Siberia in July 2005. HA and NA genes of this virus were closely related to those of H5N1 avian influenza viruses that caused outbreaks in birds in Asian countries from 2003 to 2005 and in Japan in 2003 and 2004. The corresponding isolate, A/Turkey/Suzdalka/Nov-1/05, from turkey spleen was highly pathogenic for chickens in the laboratory intravenous pathogenicity index test. The origin of this H5N1 virus in western Siberia is not known. Migratory birds could have introduced this virus because western Siberia is located on a flyway of wild birds that migrate in the spring from southeastern Asia. Highly pathogenic Asian H5N1 influenza virus in western Siberia demonstrates spread of these Asian viruses into new areas and suggests a larger geographic distribution.

Avian Influenza Virus Infections in Humans

Seroepidemiologic and virologic studies since 1889 suggested that human influenza pandemics were caused by H1, H2, and H3 subtypes of influenza A viruses. If not for the 1997 avian A/H5N1 outbreak in Hong Kong of China, subtype H2 is the likely candidate for the next pandemic. However, unlike previous poultry outbreaks of highly pathogenic avian influenza due to H5 that were controlled by depopulation with or without vaccination, the presently circulating A/H5N1 genotype Z virus has since been spreading from Southern China to other parts of the world. Migratory birds and, less likely, bird trafficking are believed to be globalizing the avian influenza A/H5N1 epidemic in poultry. More than 200 human cases of avian influenza virus infection due to A/H5, A/H7, and A/H9 subtypes mainly as a result of poultry-to-human transmission have been reported with a > 50% case fatality rate for A/H5N1 infections. A mutant or reassortant virus capable of efficient human-to-human transmission could trigger another influenza pandemic. The recent isolation of this virus in extrapulmonary sites of human diseases suggests that the high fatality of this infection may be more than just the result of a cytokine storm triggered by the pulmonary disease. The emergence of resistance to adamantanes (amantadine and rimantadine) and recently oseltamivir while H5N1 vaccines are still at the developmental stage of phase I clinical trial are causes for grave concern. Moreover, the to-be pandemic strain may have little cross immunogenicity to the presently tested vaccine strain. The relative importance and usefulness of airborne, droplet, or contact precautions in infection control are still uncertain. Laboratory-acquired avian influenza H7N7 has been reported, and the laboratory strains of human influenza H2N2 could also be the cause of another pandemic. The control of this impending disaster requires more research in addition to national and international preparedness at various levels. The epidemiology, virology, clinical features, laboratory diagnosis, management, and hospital infection control measures are reviewed from a clinical perspective.

Evolution of H5N1 Avian Influenza Viruses in Asia

An outbreak of highly pathogenic avian influenza A (H5N1) has recently spread to poultry in 9 Asian countries. H5N1 infections have caused > or =52 human deaths in Vietnam, Thailand, and Cambodia from January 2004 to April 2005. Genomic analyses of H5N1 isolates from birds and humans showed 2 distinct clades with a nonoverlapping geographic distribution. All the viral genes were of avian influenza origin, which indicates absence of reassortment with human influenza viruses. All human H5N1 isolates tested belonged to a single clade and were resistant to the adamantane drugs but sensitive to neuraminidase inhibitors. Most H5N1 isolates from humans were antigenically homogeneous and distinct from avian viruses circulating before the end of 2003. Some 2005 isolates showed evidence of antigenic drift. An updated nonpathogenic H5N1 reference virus, lacking the polybasic cleavage site in the hemagglutinin gene, was produced by reverse genetics in anticipation of the possible need to vaccinate humans.

The epidemiology and disease burden of rotavirus in Vietnam: sentinel surveillance at 6 hospitals.

The disease burden of rotavirus diarrhea in Vietnam was assessed by surveillance of children <5 years old who were hospitalized for diarrhea at 3 centers in the north and 3 centers in the south. Rotavirus was identified in 56% (range, 47%-60%) of the 5768 patients surveyed between July 1998 and June 2000. G-typing of the first 224 strains indicated that only 2% were non-typeable, 9% were in mixed infections, and the remainder were of the common serotypes G1, G2, G3, G4, and G9. In Vietnam, diarrhea accounts for 9880 deaths per year, which is approximately 15% of all deaths among children <5 years old, or 6.5 deaths per 1000 children. If even 50% of these diarrhea-related deaths in Vietnam were due to rotavirus, the number would represent 4%-8% of all deaths among children <5 years old, 2700-5400 rotavirus-related deaths per year, and 1 death per 280-560 children during the first 5 years of life. Thus, the disease burden of rotavirus in Vietnam is substantial, and programs to encourage the use of oral rehydration should be encouraged while efforts to develop vaccines continue.

America's Vietnam Casualties: Victims of a Class War?

Analysis of data about the 58,000 Americans killed in Vietnam implies that affluent U.S. communities had only marginally lower casualty rates than the nation as a whole. Poor communities had only marginally higher rates. Data about the residential addresses of war casualties suggest that, within both large heterogeneous cities and wealthy suburbs, there was little relationship between neighborhood incomes and per capita Vietnam death rates. Such outcomes call into question a widespread belief that continues to influence U.S. policy discussions, namely, that American war deaths in Vietnam were overwhelmingly concentrated among the poor and working class.

Coronary Artery Disease In Vietnam Casualties

<h3>To the Editor.—</h3> The report on anatomical evidence of coronary disease in US combat casualties in Vietnam (<b>216</b>:1185, 1971) is inadequate in several aspects. A full report of the findings in such health-screened young Americans could be extremely valuable for our understanding of atherogenesis. There have been almost 50,000 United States deaths in Vietnam, but we are given the findings for 114. The description needs associated antemortem findings for such relevant measurements as relative weight, ethnic origin, family history, blood pressure, and serum cholesterol level—and these are all in the men's records. We need quantitative methods and not uninformative photographs with subjective gradations. Quantitative methods are available in a report by Young et al (<i>Amer J Cardiol</i><b>6</b>:288, 1960).

U.S. Deaths in Vietnam: A Definition of Escalation

U.S. Deaths in Vietnam: A Definition of Escalation