Cập nhật tình hình nhiễm SÁN LÁ GAN LỚN tại Việt Nam Update Fascioliasis in vietnam 2020

FASCIOLIASIS SITUATION IN VIETNAM
Do Trung Dung,
National Institute of Malariology, Parasitology and Entomology, Vietnam


OUTLINE
1. General information of Fascioliasis
2. Life cycle of fasciola
3. Symptoms of fasciola patients
4. Key rick factors
5. Key control activities
6. Key challenges
7. Next activities

2


Introduction of Fascioliasis
- Cause of Fascioliasis: Fasciola gigantica, Fasciola hepatica.
- F. hepatica: South American, Europe, Australia
- F. gigantica: Africa and Asia (WHO, 2017).
- The hybrid forms of F. hepatica and F. gigantica in Vietnam, Korea, Japan, China….
- 2017 WHO estimated 2.4 million people infected, 180 million people at risk in 70 countries.

3


Introduction of Fascioliasis in Vietnam

- Codvell and colleagues discovered F. gigantica in 1928.
- Nguyen Xuan Huyen found a case in 1959.

- Do Duong Thai announced 2 fasciola cases in 1978.
- 1997-2000, Tran Vinh Hien found 500 fasciola cases in Central and Southern Vietnam by ELISA.
- From 2002-now many cases were diagnosed and treated.

4


Life cycle of Fasciola spp.
5


Fasciola in snail

Lymnaea snail:

- 0.4% in Quang Nam (Lực, 2010).
- 0.6% in Quang Ngai (Hương, 2012)
- 0.1% in Ha Noi (Dung, 2013)
- 1.6% in Binh Dinh (Dung, 2013)
(Austropeplea viridis = L viridis, Radix auricularia = L. swinhoei Radix rubiginosa)

Lymnaea viridis
Rice fields in both plain &
highland

Lymnaea swinhoei
Small channel in plain


Fasciola in aquatic vegetable

- Coriandrum spp. (Rau mùi) : 0.5 metacercaria/kg (Luc, 2010)
- Ipomoea aquatica (Rau muống): 0.4 metacercaria/kg (Luc, 2010)
- Coriandrum spp. 1/100 of vegetable samples infect metacercaria (Đe, 2013).


Fasciola in animal (reservoir host)

- Livestock 35% in Viet Nam (review Hien, 2011)
- Goat 5.3-30.4% (Thanh, 1997-1999; Phan, 2002)
- Buffalo, cow 51.9% Mekong delta river (Hùng, 2011)
- Buffalo, cow 54.9% Binh Đinh (Thanh, 2011)
- Buffalo, cow 61.5% Quang Ngai (Hương, 2012)
- Livestock 72.2% (Dung, 2016)
- Buffalo, cow 41.3% Ha Noi (Lan Anh, 2017)


Human Reported Cases

Ha Giang

Cao Bang

Lao Cai

Lai Chau

Tuyen Quang

Son La

Bac Kan
Lang Son

Yen Bai

Dien Bien Phu

Thai Nguyen

Vinh Phuc
Phu Tho

Bac Giang
TP. Ha Noi

-

Hoa Binh
Ha Nam

Distribution

Ninh Binh
Thanh Hoa

Quang Ninh
Bac Ninh
Hai Duong
TP. Hai Phong

TP. Hai Phong

Thai Binh
Nam Dinh

Nghe An

In 51/63 provinces of Vietnam

Ha Tinh

Quang Binh

- Characteristics

Quang Tri
Thua Thien Hue
Da Nang

Number of fasciolasis cases

Quang Nam

+ Age: over 90% of patients are > 15 years old.

No patient
Quang Ngai

1-10 cases
Kon Tum

11-100 cases

+ Gender: 62% female.

Binh Dinh

101-200 cases
Gia Lai

>201 cases

Phu Yen
Dak Lak

Dak Nong
Binh Phuoc
Lam Dong
Tay Ninh
Binh Duong

Kien Giang

Dong Nai

Binh Thuan

TP.Ho Chi Minh
Long An
Ba Ria Vung Tau

An Giang
Dong Thap
Tien Giang
Vinh Long
Ben Tre
Can Tho
Kien Giang
Hau Giang

Tra Vinh
Soc Trang

Bac Lieu
Ca Mau

Khanh Hoa

Ninh Thuan


Number of Fasiola patients

Year

Northern provinces

Centre provinces

Southern provinces

Total (100%)

2012

701 (13.6%)

4,382 (85%)

72 (1.4%)

5,155

2013

599 (14%)

3,467 (81.2%)

204 (4.8%)

4,270

2014

1,024 (34.4%)

1,694 (56.6%)

276 (9.2%)

2,994

2015

724 (20.6%)

1,912 (54.5%)

876 (25.0%)

3,512

2016

2,547 (55.9%)

1,780 (39.1%)

228 (5.0%)

4,555

2017

3,126 (26,4%)

7,880 (66.5%)

852 (7,1%)

11,858

2018

2,308

10,413

NA

> 12.000

2019

4,107

NA

NA

-

2020

1,328

NA

NA

-

Source: NIMPE, IMPE QN, IMPE HCM, Provinces


The prevalence of fasciola in human in community
ID

Place of survey

Year

Prevalence

1

Đại Lộc - Quảng Nam

2010

5%

2

Phù Cát – Bình Định

2011

6%

3

Quảng Nam

2012

2.5%

4

Quảng Ngãi

2012

10.36%

5

Thanh Hố

2014

1.29%

6

Nghệ An

2014

0.38%

7

Bắc Giang

2014

0.19%

8

Hoa Bình

2014

0.1%

9

Bình Định

2018

4.8%

10

Phú n

2018

5.7%


Occupation characteristics of the hospitalized fascioliasis patients

Occupation
Yes.

%

75

36.4%

54

26.2%

14

6.8%

63

30.5%

(n = 206, Fascioloasis human cases)

Farmer
Official staffs
Students
Free job

Source: Tho, 2018

12


Clinical symptoms on hospitalized patients
#

Clinical symptoms

n = 206

%

1

Upper abdominal pain

148

71.9%

2

Fever

21

10.2%

3

Periumbilical pain

7

3.4%

4

Itching and skin rashes

7

3.4%

5

Weight lost

5

2.4%

6

Asymptomatic cases

18

8.7%

Source: Tho, 2018
13


Subclinical characteristics of the hospitalized fascioliasis patients
Laboratory findings
Yes

%

24

11.7%

204

99.0%

199

96.6%

4

1.9%

Increased eosinophile (> 7%)

195

94.7%

Increased GOT value (normal 3- 31 U/L)

30

14.6%

Increased GPT value (normal 3-33 U/L)

28

13.6%

(n = 206, Fascioloasis human cases)

Fasciola eggs in the faeces samples
Ab-ELISA
Liver parenchyma lesions
Anemia (Hb < 120 g/L)

14

Source: Tho, 2018


Ectopic infestation Fascioliasis
Some fasciola ectopic infestation occur on knee, chest, abdominal wall

F. gigantica

F. hepatica


Key risk factors in Vietnam

- The reservoir host (buffalo, cow, sheep, goat..) high infection with fasciola in community.
- The wastewater is directly used as agricultural water to culture aquatic plants without treatment.
- Traditionally high consumption of raw aquatic plants.


Key control activities in Vietnam
1) Develop guideline for fascioliasis diagnosis and treatment; distributed the guideline to provinces.

2) Training for health staffs at district & provincial level on fascioliasis diagnosis and
treatment.

3) IEC activities for prevention of fascioliasis at community.


Outcome of control activities in Vietnam

 Increased awareness of people about fascioliasis;

 Most of the hospitals at province and district level have ultrasound and many can diagnose fascioliasis;
 130,000 tablets of triclabendazole were donated by Novatis through WHO to hospitals in Vietnam since 2004.

More and more fascioliasis patients were treated.


Key challenges in Vietnam?

Current control activities are mainly on "treatment“.
“Transmission control“ needs to be strengthened.


How can we block transmission ?
Treatment of

Fascioliasis

agricultural water/
wastewater

Stop eating
raw vegetables

Deworming for animals,
Faeces control


Next plan for Fascioliasis control

- More fasciola patients are receiving treatment but we need reduction of costs of hospitalisation

(Improved diagnosis and treatment process).

- Need further collaboration with veterinary sector for deworming for animals and treatment water
- Health education to avoid eating raw vegetables.


THANK YOU FOR YOUR ATTENTION!