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VOHUN One Health Biorisk Management Virtual Community of Practice

 

Sandia National Laboratories in collaboration with Vietnam National One Health University Network, (VOHUN) and funding support from the U.S Department of Defense BTRP held the One Health Biorisk Management

With the aim to develop a VOHUN Biorisk Management virtual community of practice that will provide continuous low dose, high-frequency education targeting Vietnamese One Health students and deliver case-based education related to One Health and Biorisk Management. Sandia National Laboratories in collaboration with Vietnam National One Health University Network, (VOHUN) and funding support from the U.S Department of Defense BTRP held the first One Health Biorisk Management case-based learning remote engagement event on April 25th, 2019. The engagement utilizing the Zoom video conferencing platform, brought together around 300 students and professors from 10 animal and public health universities in Vietnam to review medical and epidemiological cases from a biorisk management perspective.  Mr. Christian Cando, the Vietnam country lead for the Defense Threat Reduction Agency Biological Threat Reduction Agency (DTRA/BTRP), started the meeting by welcoming the Vietnamese and DRC participants and explaining the mission and the outcome of this engagement.  The session started with brief introductions and rules of engagement. Next, Dr. Hien Le, from Nong Lam University, presented a case study related to the current ongoing outbreak in Vietnam the African Swine Fever (ASF). Vietnam is the third country in Asia (after China and Mongolia) to report an outbreak of African swine fever (ASF).

African swine fever is a highly contagious and deadly viral disease affecting both domestic and wild pigs of all ages. During the session, the participants utilizing the chat room asked whether ASF is a threat to human health and Dr. Hien explained that the disease cannot be transmitted from pigs to humans. There were many questions that were asked during the short 30 min case presentation related to ASF. However, the main goal of the engagement is to have participants focus on the BRM concepts as they relate to the ongoing outbreaks.

After the veterinary case, Dr. Quynh Anh, from Hanoi Medical University, presented a case study related to measles infection after vaccination. After the case presentation, questions and discussions were generated and then Dr. Carrie McNeil, of Sandia National Laboratories, concluded the session with a didactic presentation on Orientation to Biorisk Management linking the relevancy of BRM concepts to the two previously discussed cases. 

We held continuously the second One Health Biorisk Management case-based learning remote engagement event on May 16, 2019. The engagement utilizing the Zoom video conferencing platform, brought together around 300 students and professors from 11 animal and public health universities in Vietnam to review medical and epidemiological cases from a biorisk management perspective. 85 remote sites joined in via Zoom linking VOHUN universities with Vietnam National Institute of Hygiene and Epidemiology (NIHE) and three universities from the Democratic Republic of the Congo (DRC).

The moderator for this month’s session was Dr. Carrie Mc. Neil from Sandia National Laboratories. The session started with brief introductions and rules of engagement. Dr. Thom from Vietnam National University in Hanoi opened the session by presenting a clinical case study related to healthcare associated infection and antimicrobial resistance. After the case was shared with the participants’ questions and discussions were generated among the participants. The participant used the Zoom chat room feature to ask questions while the moderator captured the essence of the discussion and recapped the conversation by emphasizing that epidemiology, biosecurity and antimicrobial resistance (AMR) are the three strongly related components and that AMR is an emerging risk, threatening both agricultural biosecurity and human health.

After the medical case presentation and discussion, Dr. Giang Nguyễn Thị Hương from the Vietnam National University of Agriculture presented a relevant and timely case study related to the current outbreak in Vietnam the African Swine Fever (ASF). Although ASF is not transmissible to humans, the disease continues to spread rapidly. Throughout the discussion, we learned that challenge is the continuing lack of awareness of the threat of spreading ASF.  Farmers are failing to strictly comply with preventive measures, recommended cleaning and disinfecting guidelines.  The discussion regarding ASF was engaging and participants from the DRC were engaged in chat conversations with the Vietnamese participants.

Dr. Julie Wilder, of Sandia National Laboratories, concluded the session with a 30 minutes didactic presentation on BRM risk assessment. She linked the content of the presentation to the two cases presented by the Vietnamese professors. She explained the purpose of the Risk Assessment and how it related to the medical case and veterinary case.  The participants enjoyed the session and is reflected on the participant feedback.

After each the remote engagements, the participants completed the survey. The results are as follows on April 25th 2019:

1. Did you learn something new from the case presentations and discussions today?

Yes = 97.47%

2. Will the case presentations and/or discussions impact your current or future work?

Yes = 94.94%

3. Did you learn something new from the didactic lecture presentation today?

Yes = 93.04%

4. Will the didactic lecture presentation impact your current or future work?

Yes = 93.67%

5. How would you rate the overall BRM Remote Engagement session?

Average = 73%

6. How can we improve the BRM Remote Engagement session?

Common themes:

  • Speak slower/English subtitles/Vietnamese translation
  • Need more time for discussion
  • More pictures in the presentation

Questions from the session on April 25th 2019:

  • HPMU_Ngoc: How can we prevent this farm and others from the spread of the disease?
  • HPMU_Ngoc: What can we do to prevent the similar situation?
  • HMU-Chung: I think maybe the virus was transferred from a laboratory? By accident?
  • TBUMP TUC: Thank you Dr. Hien for your presentation. Could you please give us the impacts of the ASF epidemic to farmers in Vietnam?
  • hmunhungpham: Can the ASF virus transmit to humans?
  • Christian Cando: Question/comment: how does the human population help to spread the virus and transmission to other farms?
  • HPMU-Linh.YTCC: Can the disease be controlled?
  • HPMU-H?NH: Have you had any information about the household who supports the left-over food for the pig owner (for ex: Do they feed pigs as well as/ have they contacted and/or fed sick pigs before/their travelling history…)?
  • Christian Cando: Question: how do we eradicate ASF?
  • Tbump Tran Thi Thanh Thuy: Hien, as I know, when hearing about ASF epidemic in Vietnam everyone stopped eating pork. So, is that right?
  • HPMU_Ði?p Ðinh Student: What happens if we eat the pigs which died by this disease?
    • HPMU-Trang HOA SINH-KTYH: In fact, I think this disease can be harmful to our health…, so many Vietnamese people do not eat pig meat in a long time.
  • VNUA – Giang: One of the reason is wild pig also bring the virus to another country by the border. How we can control this?
    • HPMU-Trang HOA SINH-KTYH: This disease control is very hard in borders and some rural areas.
  • HUAF-Thuy Nguyen: Thank you so much for your case study. One question, how many risk factor for ASF to the pigs in that farm? (I mean that may be from human, transportation or feed…?)
  • E Hospital-VN: Did her parents give her enough 2 doses of measles, up to that time?
  • E Hospital-V: How did you isolate the child with measles in this case? Is there any other cases reported from the child vaccination center?
  • TUAF University: How to prevent spreading among people?
    • Quynh Anh: Biosafety protects people from pathogen.
    • Quynh Anh: Biosecurity protect pathogen from people
  • TUAF University: How effective is the use of formal disinfectants in this case?
  • Facilitator: What types of mitigation are available?
    • HPMU_Ngoc: Isolate the child from kindergarten to protect other children from the pathogen.
    • NLU- Hien Le: PPE is a kind of mitigation i
    • HPMU_Ngoc: PPE is important to family member and relatives
    • TBUMP TUC: PPE is very important however they don’t want to apply PPE, then thinking about regulation, KAP also
  • Facilitator: Is there any conflict between biosecurity and biosafety?
    • Quynh Anh : why conflict?
    • Quynh Anh: Some solutions are good for both
    • Vibeke Halkjaer-Knudsen: Yes, there are some conflicts. Signs is one example.
    • Vibeke Halkjaer-Knudsen : We want to warn people about what is dangerous and in which labs there might be dangerous
    • Vibeke Halkjaer-Knudsen: However, we do not want to advertise where we keep the agents we do not want to be stolen
  • NLU- Hien Le: Are cameras a kind of biosecurity or performance?
  • Facilitator: What are some examples of performance?
    • E Hospital-VN: Evaluation of the efficacy of infected animal processing/measles vaccination and raise the awareness of community
    • NLU-students: Track biorisk performance in farm: using auditing tool or farm record.
    • E Hospital-VN: Recording and tracking well the children vaccination

As of May 17, 2019, 83 participants completed the survey. The results are as follows:

1. Did you learn something new from the case presentations and discussions today?

Yes = 100%

2. Will the case presentations and/or discussions impact your current or future work?

Yes = 98.80%

3. Did you learn something new from the didactic lecture presentation today?

Yes = 93.98%

4. Will the didactic lecture presentation impact your current or future work?

Yes = 98.80%

5. How would you rate the overall BRM Remote Engagement session?

Average = 78%

6. How can we improve the BRM Remote Engagement session?

Common themes:

  • Improve internet connections
  • Much better session
    • “The second session was better than the first session in April. The speed of the lecturer’s speaking is slower, and I can understand more information.”
  • Bring more countries into the discussion
  • “Excellent session and presentation”
  • “I think it was good and better performance than April”

Questions from the session on May 16th 2019:

Most questions were addressed orally and a few were addressed via chat.

  • Facilitator: What types of training do the hospital staff have for infection control and personal protective equipment?
  • NLU- Hien Le: Do they have health check-ups periodically?
  • HMU-Chu Loan: Do you re-culture the blood after 12 days? Do you culture samples from the ulcers from hip or sacrococcygeal area?
  • HMU-Hang: Is the patient’s family members allowed to take care of the patient in the emergency room?
  • Facilitator: Sometimes, to address antibiotic resistance, we try not to use certain antibiotics. Do you have protocols for which antibiotics to use first?
  • Marc DRC: Are the cleaners of the emergency room protected? What is the management of wastewater?
  • Hai: Since the use of antibiotic can cause the failure of organs such as kidney, do the doctors examine these organs?
  • Sandy Sanzero: Was there a patient history of antibiotic administration and results (EMR) that was used to inform medication?
  • Ha Hoang: Did the patient use antibiotics before admitting to the hospital
  • Hai: What kind of disinfection method/chemicals are you using in your hospital?
  • Ha Hoang: How is the airflow system in the ICU?
  • NLU- Hien Le: How can you know your disinfection procedure really worked?
  • TRAM_NIHE: Do you have an ICU environment check-up and if yes, is there any isolation available?
  • HMU-Chu Loan: Is there any patients in the same room with this patient? Does another patient carry the same HAI pathogen as this patient?
  • Facilitator: Do you do cultures in the hospital to check that disinfection is working properly?
  • Facilitator: If you have a suspected infection, is it possible for them to stay in the emergency room for several days?
  • Sandy Sanzero: How would Vietnam conduct or lead a Regional strategy since AFS has spread into Cambodia and Vietnam? Is a regional approach needed?
  • HMU-Quynh Anh: No vaccine for ASF. How about treatment?
  • Dr Fidel AGAZIHIRWE BALEMIRWE from DRC: Does the policy in Vietnam allow people to consume (eat) meat of an infected pig? What are the measures that are taken in that case in order to make sure that livestock keepers will cooperate?
    • HPMU_Ngoc: No policy to allow people to eat meat of infected pig.
    • NLU- Hien Le: Diseased pigs should be destroyed, no consumption.
  • Hung, National Institute of Hygiene and Epidemiology (NIHE): Do you think the control methods of MARD are effective? How they use staff in local? How to enhance capacity to control ASF for them in short time?
    • NLU- Hien Le: I believe that regional OIE get involved with national authority
  • Hai: It seems that the government and Vet authority are not able to control the ASF outbreak. What are the main factors or reasons?
    • NLU- Hien Le: Pig movement is the main factor
    • NLU- Hien Le: And carcass disease disposal is the big issue
    • HP DRC: There are a lot of death pigs which were threw into the rivers and moved along the rivers.
    • NLU- Hien Le: But the big producer (farm) cannot have compensation from the government. Sometimes they just dispose the disease carcass in the rivers to not spend expense on stamping out
  • Facilitator: In DRC, would people be allowed to eat the meat of infected animals?
    • Marc DRC: No, in DRC it is not allowed to eat that meat
    • HP1 DRC: People are not allowed to eat such kind of meat in DRC. They are destroyed follwing the policy. From DRC
  • Sandy Sanzero: If diseases do not respect borders how can a single country approach/strategy be successful?
    • From HUAF – Ho Le Quynh Chau: Now, many people refuse pork meat.
    • HUAF – Ho Le Quynh Chau: The virus may be spread by wild birds, so it is very difficult to stop the disease.
  • HMU-Chu Loan: Can we detect the ASF from the incubation period?
  • Chancard LUFIAULUSU DRC: What is the role of authorities so that to push farmers to collaborate for controlling outbreak?
  • NLU-student: As I know, Incineration is the best choice to cull the carcass, but I usually see on the news, people bury the dead carcass, why do they do like that?
  • Fidel AGAZIHIRWE from DRC: Does the policy in Vietnam consider the role of farmer’s movements from point A to point B in case of an outbreak?
    • NLU- Hien Le: Not yet, most case we believe from moving disease pig from place to place
  • Marc DRC: Have you identified the principal reservoirs?
  • Fidel AGAZIHIRWE from DRC: Do you have any idea about the reservoir in Vietnam?
    • NLU- Hien Le: Boar and a special tick can be the reservoir. But it is not the case in VN.

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