DECISION

ON PROMULGATION OF PLAN ON PREVENTION AND FIGHTING AGAINST\r\nVIRAL HEPATITIS IN 2015 – 2019 PERIOD

THE MINISTER OF HEALTH

Pursuant to the Decree\r\nNo. 63/2012/ND-CP dated August 31, 2012 by the Government defining the\r\nfunctions, tasks, entitlements and organizational structure of the Ministry of\r\nHealth;

At the request of\r\nDirector of General Department of Preventive Medicine, the Ministry of Health,

DECIDES:

Article 1. “Plan on prevention and fighting against viral hepatitis in\r\n2015 – 2019 period” is enclosed with this Decision.

Article 2. This Decision comes into effect from the day it is signed.

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PP. THE MINISTER
\r\n THE DEPUTY MINISTER
\r\n
\r\n
\r\n
\r\n
\r\n Nguyen Thanh Long

PLAN AGAINST VIRAL HEPATITIS IN 2015 –\r\n2019 PERIOD

TABLE OF CONTENTS

PART 1 - NECESSITY OF THE\r\nPLAN

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1. Communications,\r\neducation and awareness increase

2. Surveillance and\r\ntesting

3. Prevention of\r\ntransmission of hepatitis viruses

4. Screening, diagnosis,\r\ncare and treatment

PART 3 - PLAN FOR ACTIONS\r\nAGAINST VIRAL HEPATITIS IN 2015 - 2019 PERIOD

1. Basis for formulation\r\nof the plan

2. Goals

3. Remedies and\r\nimplementation

4. Time of implementation

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1. Central agencies

2. Local governments

PLAN AGAINST VIRAL HEPATITIS IN 2015 – 2019 PERIOD

(Enclosed with Decision No. 739/QD-BYT dated March 05, 2015\r\nby the Minister of Health)

PART 1: NECESSITY OF\r\nTHE PLAN

Viral hepatitis is a\r\ncommon infectious disease leading to serious consequence for health and may\r\nlead to death due to its complication. Usually there is no clear symptom of\r\ninfection of acute hepatitis viruses, serious cases may lead to acute or long-lasting\r\nliver failure that leads to chronic hepatitis, cirrhosis and liver cancer.\r\nThere are 5 types of viral hepatitis, in which hepatitis B and hepatitis C are\r\ntransmitted via bloodstream and body fluid like routes of transmission of HIV;\r\nhepatitis D is transmitted only when there is hepatitis B and has transmission\r\nroutes similar to hepatitis B. Hepatitis A and hepatitis E are transmitted via\r\nfecal matters – mouth through food, drinking water or due to poor hygiene\r\npractices.

Of 5 types of hepatitis\r\nviruses, hepatitis B virus (HBV) and hepatitis C virus (HCV) affect human’s\r\nhealth the most. In the world, more than 2 billion people used to be infected\r\nwith HBV and 130 - 150 cases are infected with chronic HCV (according to World\r\nHealth Organization, 2014). Every year, approximately 1 million deaths are\r\ncaused by viral hepatitis (2.7% of total deaths). HBV and HCV are top-ranking\r\ncarcinogens, about 57% of cases of cirrhosis and 78% of cases of liver cancer\r\nare due to being infected with HBV and HCV. According to the survey of Global\r\nBurden of Disease 2010, the cause of death relating to hepatitis virus is\r\nranked in top 3 of causes from infectious diseases. Drug users are very likely\r\nto be infected with both HBV and HCV by sharing injection needles. About 10\r\nmillion people of 16 million people injecting drugs are infected with HCV.

People can prevent\r\nthemselves from being infected with hepatitis B by using vaccine promptly and\r\nconformably. World Health Organization recommends that all kids should be\r\ninoculated against hepatitis B. Regarding area with high rate of HBV, kids\r\nshould be inoculated within 24 hours after birth; the next doses should be\r\ntaken according to the vaccination schedule. Although hepatitis B is\r\npreventable, the cover of vaccine against hepatitis B in the world is only 75%,\r\nmuch lower than the goal (90%) where ratio of vaccine against hepatitis B for\r\nbabies (within 24 hours after birth) is only 27%. Besides, according to World\r\nHealth Organization, about 240 million people in the world are infected with\r\nchronic HBV and HBV causes a huge burden on healthcare system as well as\r\npeople’s health.

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Due to the fact that the\r\nburden of liver diseases caused by hepatitis virus is becoming worse, WHO has\r\nappealed to its member countries and companies to develop effective strategies\r\nwith the goal of dealing with challenges caused by the hepatitis and raise the\r\nawareness of this disease. WHO chose July 28 as “World Hepatitis Day” beginning\r\nin 2011. In 2012, WHO promulgated the Global Action Program Framework of\r\nhepatitis virus prevention and fighting with expectation that the transmission\r\nof viral hepatitis is no longer existed in the world and all patients are\r\naccessible to safe and effective treatment. The Framework contains 4 main\r\nfactors: 1) Raise the awareness, impulse the partnership and mobilize\r\nresources; 2) Build up policies depending on evidence and figures for\r\nactivities; 3) Prevent the transmission of viruses; 4) Conduct screening,\r\nprovide care and treatment. 24/5/2014, World Health Assembly (WHA) ratified the\r\nResolution WHA 67.6 on the constant intervention against hepatitis; by that,\r\nthe system of screening, diagnosis and treatment shall be developed to reduce\r\nthe transmission of HIV, hepatitis B and hepatitis C, concurrently, each\r\ncountry shall comply with policies to adopt necessary intervention kits to\r\nprovide diagnosis and treatment for people injecting drug.

Vietnam is one of\r\ncountries having a high ratio of infection with hepatitis B and hepatitis C and\r\nbears serious consequence of hepatitis virus infection. Research findings in Vietnam state that the ratio of infection with\r\nhepatitis virus of a number of population groups is 8% – 25% (of HBV) and 2.5%\r\n- 4.1% (of HCV); cases of infection with hepatitis A, D, E of patients admitted\r\nto hospitals are discovered. Of people who initially donate blood from\r\n18 years old to 60 years old, the percentage of healthy people having HBV is\r\nvarious by areas, from 15% to 25%. The percentage of infection with HBV of\r\nhealthy people and pregnant women in Vietnam is from 10% to 20%.  This is\r\nan important factor causing the infection with hepatitis B in children via\r\nmother-to-child route when giving birth and is the main cause of chronic\r\nhepatitis in children. According to findings of researches in Vietnam and in\r\nother countries, 90% of babies who are infected with HBV within the first years\r\nold are likely to suffer chronic hepatitis B infection. Chronic hepatitis is a\r\nserious medical issue in Vietnam and liver cancer is the main cause of death\r\nfrom cancer.

According to the result\r\nof the surveillance of manner and biological indicators of HIV/STI (sexual\r\ntransmitted infections) round 2 in Vietnam in 2009 (Integrated Biological and\r\nBehavioral Surveillance, IBBS 2009) in the group of people who inject drug, the\r\npercentage of people currently infected with hepatitis B is 15.1%; the\r\npercentage of people used to infected with hepatitis B is 58.7%, and as the\r\nresult, more than 40% of them are likely to be infected with hepatitis B. The\r\npercentage of people infected or used to be infected with hepatitis C is 58%.\r\nThe co-infection with HIV and hepatitis B and/or hepatitis C may affect the\r\ndevelopment of HIV on patients. According to the report of 7,587 patients\r\ninfected with HIV in 30 non-resident clinics in Vietnam in the 2005 - 2009\r\nperiod, the percentage of co-infection with HIV and hepatitis B is 14.2%, the\r\npercentage of co-infection with HIV and hepatitis C is 39.6%.

Thus, the infection with\r\nhepatitis, especially HBV and HCV is developing silently but it is a big\r\nproblem for people in Vietnam that potentially becomes complicated and leads to\r\ndeath. Whereas, Vietnam does not have a master plan and constant remedies to\r\npush the prevention and fighting against viral hepatitis; hence, the\r\nformulation of Plan on prevention and fighting against viral hepatitis in the\r\n2014 - 2018 period is necessary for the orientation of the prevention and\r\nfighting against viral hepatitis of organizations and areas in Vietnam and is\r\nalso the basis for mobilizing resources to reduce the transmission of hepatitis\r\nvirus and increase the access of people to the diagnosis and treatment for\r\nhepatitis, especially hepatitis B and hepatitis C.

PART 2: REALITY OF\r\nACTIONS AGAINST VIRAL HEPATITIS IN VIETNAM

1. Communications, education and awareness increase

Nowadays, information,\r\neducation and communication about viral hepatitis are mainly combined with\r\nexpanded vaccination, thus, propagated contents mainly focus on the actions\r\nagainst hepatitis B and vaccination against hepatitis B for kids. Political\r\nactivities including building of posters, flyers, propagating notes and clips\r\nabout hepatitis B vaccination; propagation and dissemination of prophylactic\r\nmeasures against hepatitis B on magazines or on radio and television;\r\nconference for introduction of propagation about hepatitis B vaccination within\r\n24 first hours for babies.

The communication has\r\nbeen sent by means of mass media through communication campaigns in a number of\r\nkey provinces but is not with a frequency and not focuses on high-risk groups.\r\nThe awareness of prevention and treatment for hepatitis B and hepatitis C of\r\nhigh-risk people (injecting drug or infected with HIV) is raised in a number of\r\nareas.

The communication\r\neducation to raise the awareness of the community of the risk of infection of\r\nhepatitis virus, especially hepatitis B and hepatitis C and the negative\r\ndevelopment of the disease as well as the necessary of the screening and prompt\r\ntreatment has not been carried out constantly in all provinces. The update of\r\ninformation about the screening, diagnosis and treatment for hepatitis B and\r\nhepatitis C for medical officials has not been carried out widely either.

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2.1. The\r\nsurveillance of viral hepatitis in Vietnam

The surveillance of viral\r\nhepatitis in Vietnam is carried out according to Circular No. 48/2010/TT-BYT\r\ndated 31/12/2010 by the Ministry of Health. Viral hepatitis is of 28 infectious\r\ndiseases subject to periodic report. Hence, the surveillance of viral hepatitis\r\nis combined with the national infectious disease surveillance system and the\r\nreported figures are based mainly on the clinical diagnosis results instead of\r\nspecific case.

Collection of figures\r\nabout viral hepatitis in Vietnam according to the common surveillance system\r\ncan reflects only the number of patients with viral hepatitis who are admitted\r\nto hospitals but not the classification of species of hepatitis viruses.\r\nTherefore, such figures can note the number of patients infected with hepatitis\r\nin hospital but cannot reflect the number of infections in the community of\r\neach hepatitis virus to determine prioritized activities in the prevention of\r\nviral hepatitis.

2.2. Testing for\r\nviral hepatitis

Currently, there are no\r\nstandards, regulations and guidance on the testing for hepatitis virus in\r\nVietnam in peculiar fields like testing and diagnosis, surveillance and\r\ntreatment, screening in blood transfusion, community inspection. Qualification\r\nand capacity for hepatitis virus testing are different between facilities.\r\nLaboratories of hospitals in districts are mainly for testing for a number of\r\nindices of functions of liver and a number of rapid tests related to viral\r\nhepatitis whereas most of central or provincial laboratories are eligible for\r\nconducting serological testing using ELISA technique. The use of molecular\r\nbiology techniques about hepatitis virus is now available in only central facilities.

The assurance of quality\r\nof testing related to hepatitis has not been carried out constantly. The\r\nexternal and internal inspection system for assessment and improvement of\r\nquality of testing of viral hepatitis has not been established either. The\r\npopularized prevention has not been sufficiently knowledgeable as well as has\r\nnot been inspected regularly.

3. Prevention of\r\ntransmission of hepatitis virus

3.1. Immunization\r\nagainst hepatitis B

The hepatitis B\r\nvaccination for babies within 24 hours after birth and the vaccination\r\naccording to the national immunization schedule are in the strategy of WHO to\r\nprevent the transmission of HBV from mother to child. According to the report\r\nof WHO, by 2014, 183 countries have carried out the hepatitis B vaccination in\r\nthe expanded immunization, 94 of which have carried out the vaccination for\r\nbabies within 24 hours after birth. For the dose given within 24 hours after\r\nbirth, the earlier the vaccination is given, the more effective it is. 3 later\r\ndoses provide the prevention of 85-90% of transmission from mother to child.

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Besides, the\r\nencouragement to give hepatitis B vaccine to adolescents and adults with high\r\nrisk of infection with HBV (people who inject drug, people who receive\r\nhemodialysis, people having high-risk sexual relationship, people without\r\nimmunity and people in close contact with people with chronic hepatitis B) is\r\nnot widely popular.

3.2. Prevention of\r\ntransmission of viral hepatitis from mother to child (perinatal transmission)

In Vietnam, according to\r\na number of researches, the percentage of infections with HBV in pregnant women\r\nis 10% - 20% and 90% of babies of women infected with HBV having positive HBeAg\r\nmay be infected with HBV transmitted from their mothers, thus, the prevention\r\nof transmission of HBV from mother to child is very important.

The strategy of\r\nprevention of transmission of hepatitis B from mother to child in Vietnam\r\ngiving the first shot/dose of hepatitis B vaccine within 24 hours after birth\r\nand the 3 later shots according to the immunization schedule. However, the\r\ncoverage of postnatal vaccination is not high and become lower and lower in\r\nrecent years because the mistake in vaccination has caused worry about\r\nhepatitis B vaccination for children in even medical officials. To widen the\r\ncoverage of postnatal hepatitis B vaccination, the Ministry of Health has\r\ndirected medical facilities with delivery rooms to carry out the hepatitis B\r\nvaccination for babies within 24 hours after birth. The consultation has been\r\ncombined with the initial healthcare for pregnant women. There are not\r\nrecommendation and guidelines for the injection of anti-HB serum for babies of\r\nwomen infected with HBV and the treatment using antiviral medicines for women\r\nwith high amount of HBV.

The prenatal testing for\r\nHBV for women has been carried out in many hospitals in provinces and central\r\nlevels. However, the screening for HBV for pregnant women has not been\r\nconsidered common testing in the pre-natal care kit and there has not been\r\nguideline of the Ministry of Health on HBV control for women in reproductive\r\nage, especially pregnant women.

3.3. Screening for\r\nHBV and HCV in blood transfusion

The testing for HBV and\r\nHCV is compulsory in blood screening and is regulated in Blood Transfusion\r\nStatulation 1992 and Blood Transfusion Practice 2007 and Circular No.\r\n26/2013/TT-BYT by the Ministry of Health. Thus, for many years, this is the\r\nsource of discovery of people infected with HBV and HCV in the community to\r\nprevent the transmission of hepatitis B and hepatitis C and other pathogens\r\nthrough bloodstream, contributing to the guarantee of safety in blood\r\ntransfusion. In many areas, laboratories for screening in blood transfusion of\r\nblood provision facilities are also the laboratories for diagnosis of hepatitis\r\nand HIV to increase the capacity in diagnosis and treatment for hospitals. A\r\nnumber of laboratories in blood transfusion centers have taken on the duty as\r\nreference laboratories of hepatitis in local areas.

However, there are still\r\nissues about the assurance of quality of blood screening for HBV and HCV:\r\nfailure to issue license for sale and failure to issue regulations on use of\r\ntesting biologics as well as testing algorithm according to specific purposes\r\nleads to the fact that any biologics (rapid testing biologics, ELISA, molecular\r\nbiology, etc.) granting the license for sale are used for screening in blood\r\ntransfusion; as the result, if the screening biologics that are used have low\r\nsensitivity, HBV/HCV may be missed. Additionally, laboratories in the blood\r\nscreening system have not been standardized, lack the quality control system\r\nand have not carry out the assessment and issuance of the operation license for\r\nblood screening laboratories. Internal quality inspection and biologic quality\r\ninspection are not compulsory request and are not carried out in a number of\r\nlaboratories. The external inspection of blood screening is not compulsory in\r\nlaboratories and not provided in regulations at national level; hardly any\r\nLaboratory Information System (LIS) is applied in blood screening laboratories.\r\nThe training, assessment and issuance of practice certificates for officials in\r\ncharge of testing are not regulated. There are not reference laboratories for\r\ntesting of hepatitis viruses. Hence, the shortcomings in testing are possible.

3.4. Prevention and\r\nmanagement of co-infection with HBV, HCV and HIV

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Intervention has been\r\ncarried out to prevent the transmission of HIV and hepatitis through injection\r\nand sexual activities in people at high risk of infection with HIV and\r\nhepatitis viruses, including:

- Program of risk\r\nbehavior intervention consultancy to prevent HIV infection in high-risk people\r\n(people injecting drug, whores, homosexual activities in male, mobile and\r\nmigrant populations, etc.) However, this program does not include comprehensive\r\nmessages about the risks and the prevention of hepatitis B and hepatitis C

- Tubular needle program\r\n(provision of clean tubular needles, exchange of tubular needles) for people\r\ninjecting drug

- Condom program.

- Replacement therapy of\r\nopium with Methadone

- Use of ARV for HIV\r\ninfections.

Such interventions will\r\nreduce the medical and social effect of HIV/HBV/HCV infections. Recently, the\r\nuse of ARV for patients with HIV/AIDS has been increased. First-line initiated\r\ntreatment regimen is also effective for people with HBV. To ensure the\r\nsustainability of the treatment, there shall be strategies to promptly discover\r\npeople co-infected with HBV and HIV and the supply of ARV with reasonable cost\r\nshall be ensured, especially in the period that the funding for HIV program is\r\ndecreased significantly.

Treatment for hepatitis C\r\nusing antiviral medication may eliminate the risk of transmission between\r\ninfected people and others due to the decrease or eradication of viruses in\r\nblood. However, currently, the high cost of treatment for hepatitis C has\r\nlimited the access to such effective treatment regimens for patients with\r\nhepatitis C.

3.5. Prevention of\r\nhepatitis B and hepatitis C related to medical care

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3.6. Prevention of\r\nHAV

Acute hepatitis cases\r\nthat are detected or suspected of being caused by HAV are still determined in\r\nVietnam, most of which are in a small area and not cause widespread epidemic in\r\nthe community; such cases usually have acute symptoms and hardly any serious\r\ncomplication and completely overcome after treatment. Serological test for\r\nhepatitis A is not available in many medical facilities, therefore, the\r\ndiagnosis of acute hepatitis A is difficult in patients with jaundice or\r\ndiarrhea. There are preventive and effective vaccines, however, they are\r\nprovided only at immunization point as service and are not included in expanded\r\nimmunization, therefore, the number of people receiving vaccines is limited. In\r\nthe time that conditions of personal hygiene, environmental sanitary and food\r\nsafety are not good, the risk of hepatitis A is potential.

3.7. Prevention of\r\nHEV

Currently, there is no\r\nfigure about epidemiological features of hepatitis E in Vietnam although there\r\nare epidemic cases suspected of causing by HEV. Until now, there is no vaccine\r\nagainst hepatitis E. However, the development of this vaccine has been carried\r\nout and is in clinical testing period.

4. Screening,\r\ndiagnosis, care and treatment

4.1. Screening of\r\nhepatitis B and hepatitis C

Currently, there are no\r\nregulations and guidance on screening and diagnosis of HBV and HCV, especially\r\nfor high-risk people when most of people infected with HBV/HCV do not realize\r\ntheir own situation until symptoms of a serious liver disease are displayed.

Costs of medicines for\r\nhepatitis B, hepatitis C and testing during treatment are high and long-lasting.\r\nHowever, if patients receive suitable treatment and sufficient surveillance,\r\nthe treatment will be highly effective and will contribute significantly to the\r\nreduction of complication related to HBV and HCV including cirrhosis and liver\r\ncancer. If treatment is not provided promptly and suitably, the solution of\r\ncomplication will be very difficult and therefore the rate of death will be\r\nincreased and cause burden to medicine sector. Currently, there is no specific\r\nfigure about the number of patients accessing to treatment for hepatitis B and\r\nhepatitis C every year as well as the quality and effect of the treatment.\r\nHospitals specialist in infectious diseases are providing treatment for\r\nhepatitis according to the guidance of WHO and other international organizations.\r\nThe Ministry of Health promulgated Decision No. 4817/QD-BYT on 28/11/2013 on\r\nGuidance on diagnosis and treatment for hepatitis C, Decision No. 5448/QD-BYT\r\non 30/12/2014 on Guidance on diagnosis and treatment for hepatitis C and\r\nDecision No. 5449/QD-BYT dated 30/12/2014 on Guidance on diagnosis and\r\ntreatment for hepatitis D, however there are difficulties in the implementation\r\nof such guidance in all medical facilities and the facilitation for patients to\r\nget access to medical facilities for treatment due to the long-lasting and\r\ncostly treatment. In addition, costly and long-lasting treatment makes the\r\nsupervision of treatment and the assessment of treatment efficiency is limited.\r\nThe payment of health insurance to patients with hepatitis B and hepatitis C is\r\nnot constant in provinces. The access to necessary testing for diagnosis and\r\nsurveillance as well as medicines for hepatitis C treatment is limited.\r\nBesides, current guidance does not include provisions on the management and\r\nsupervision of patients with hepatitis C who have not received treatment though\r\nthere are advances in treatment for hepatitis C with high efficiency.

In short, according to\r\nthe facts above, the screening, diagnosis, care and treatment for viral\r\nhepatitis, especially hepatitis B and hepatitis C are considered having\r\nweaknesses as follows:

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- There is no specific\r\nstrategy in the expansion of access to the treatment for viral hepatitis,\r\nespecially the chronic hepatitis B and chronic hepatitis C.

4.2. Diagnosis,\r\ncare and treatment for acute hepatitis A and acute hepatitis E

The diagnosis of acute\r\nhepatitis A and acute hepatitis E meets a lot of difficulties because the\r\naccess to specialist testing is limited and is available only in major\r\nhospitals. Besides, there is no specific treatment but only support treatment\r\nfor acute hepatitis A and acute hepatitis E.

PART 3: PLAN ON\r\nACTIONS AGAINST VIRAL HEPATITIS IN 2015 - 2019 PERIOD

1. Basis for\r\nformulation of the plan

The Plan on actions\r\nagainst viral hepatitis in the 2015 - 2019 period is formulated on the basis of\r\nthe situation of viral hepatitis and the reality of hepatitis prevention and\r\nfighting in Vietnam; legislative documents, including:

- The Law on prevention\r\nand control of infectious diseases;

- The Law on prevention\r\nand control of HIV/AIDS;

- The Law on medical examination\r\nand treatment;

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- National strategies for\r\npreventive medicine of Vietnam by 2010 orienting towards 2020;

- Circular No.\r\n26/2013/TT-BYT dated 16/9/2013 by the Minister of Health on guidance on blood\r\ntransfusion.

- Circular No.\r\n13/2013/TT-BYT dated 17/4/2013 by the Minister of Health on guidance on\r\ninfectious diseases surveillance.

- Circular No.\r\n48/2010/TT-BYT dated 31/12/2010 by the Minister of Health on guidance on\r\ndeclaration, information and report about infectious diseases.

- Decision No.\r\n4817/QD-BYT dated 28/11/2013 by the Minister of Health on guidance on hepatitis\r\nC diagnosis and treatment.

- Decision No.\r\n5448/QD-BYT dated 30/12/2014 by the Minister of Health on guidance on hepatitis\r\nB diagnosis and treatment.

- Decision No.\r\n5449/QD-BYT dated 30/12/2014 by the Minister of Health on guidance on hepatitis\r\nD diagnosis and treatment.

2. Goals

2.1. General goals

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2.2. Specific goals

- To intensify the\r\npropagation to raise the awareness and the support of citizens, medical\r\nofficials and government of all levels, Vietnamese and international organizations\r\nin prevention and fighting against viral hepatitis.

- To intensify the\r\npreventive actions against hepatitis virus, especially hepatitis B and\r\nhepatitis C and preventive actions against transmission of hepatitis B from\r\nmother to child.

- To raise the efficiency\r\nof systems of surveillance and figure collection to provide evidence for the\r\nformulation of policies and to eliminate the spread of hepatitis virus in\r\ncommunity and at medical facilities.

- To raise the efficiency\r\nin diagnosis and treatment of viral hepatitis and to enlarge the access to\r\ndiagnosis and treatment services for viral hepatitis, especially hepatitis B\r\nand hepatitis C.

3. Remedies and\r\nimplementation

3.1. Political\r\nremedies and social mobilization

Prevention and fighting\r\nagainst viral hepatitis are common responsibilities of governments of all\r\nlevels, regulatory bodies, political organizations, political – social\r\norganization and the society. Main actions focus on the following contents:

3.1.1. Mobilize the\r\nparticipation of local governments, regulatory bodies, political organizations,\r\npolitical – social organizations and formulation of supportive policies.

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- Amend, complete and\r\nissue policies and regulations related to the prevention and fighting against\r\nviral hepatitis, enable citizens to access better to viral hepatitis diagnosis,\r\ncare and treatment services. Cooperate with medical insurance companies in\r\nformulating regulations on payment of charge of diagnosis and treatment,\r\nespecially treatment for hepatitis B and hepatitis C.

- Formulate viral\r\nhepatitis preventive models in community combining with models of prevention\r\nand fighting against HIV/AIDS, diseases transmitted via sexual acts,\r\nprostitution and drug injection.

3.1.2. Intensify the\r\nprovision of information, education and communication to raise the awareness of\r\ncitizens of the danger of viral hepatitis and preventive remedies.

- Cooperate and diversify\r\nthe form of provision of information, education and communication about\r\nprevention and fighting against viral hepatitis and the danger of viral\r\nhepatitis, especially long-term consequences of hepatitis B and hepatitis C for\r\npeople’s health like cirrhosis, liver cancer, etc.

- Propagate by means of\r\nmass media or combine the propagation with consultancy and organization of\r\ncommunication, conference and training in prevention and fighting against viral\r\nhepatitis. Respond to the World Hepatitis Day to attract the community.

- Combine the propagation\r\nof prevention and fighting against viral hepatitis with the propagation of\r\nprevention and fighting against liver cancer, HIV/AIDS and sexual transmitted\r\ndiseases, prevention and fighting against prostitution and injection and use of\r\ndrugs.

- Formulate\r\nunderstandable and effective information messages about the danger of viral\r\nhepatitis, preventive measures and especially about the benefits of the\r\ninoculation against hepatitis B for babies and young children, benefits of Hand\r\nWashing Festival and Food safety and hygiene program and about the risk of\r\ninfection with hepatitis virus.

- Intensify the\r\nconsultancy about prevention and fighting against viral hepatitis at medical\r\nfacilities and health consultant centers, especially for pregnant women, blood\r\ndonors and people with high risk of infection with diseases that are\r\ntransmitted via sexual acts and drug injection.

3.2. Professional\r\nremedies

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- Regularly provide\r\nmedical officials with training in viral hepatitis, update new knowledge about\r\ndiagnosis, treatment, care and preventive measures for viral hepatitis,\r\nespecially hepatitis B and hepatitis C online or via technical assistance.

- Recheck teaching/training\r\nmaterials and programs pertaining to viral hepatitis of the Ministry of Health,\r\nmedical facilities and universities of medicine and pharmacy to ensure that\r\ninformation about prevention, diagnosis and treatment for viral hepatitis in\r\nsuch materials are fully updated.

3.2.2. Supervise and\r\ncollect evidence for the formulation of policies and determination of\r\npreferential intervention for prevention of viral hepatitis.

- Standardize definitions\r\nabout report on viral hepatitis cases according to hepatitis virus\r\nclassification depending on mild symptoms and testing instead of report on\r\ngeneral viral hepatitis as recent.

- Formulate the form of\r\nreport that is easy to understand and fill in, applicable to cases of hepatitis\r\nA/B/C virus in the infectious disease reporting system. Laboratory shall cooperate with reporting unit in avoiding duplicating\r\nor missing out cases.

- Determine necessary\r\nqualification for officials in charge of testing for hepatitis virus and build\r\nup plan on training for members of laboratories. Research\r\nand use new techniques in diagnosing testing. Intensify the management\r\nof quality of testing through the establishment of national reference\r\nlaboratories and external assessment systems.

- Build up plan for the\r\nimprovement of assessment of quality of biologics for serological testing for\r\nhepatitis virus to be conformable with international standards.

- Build up national\r\nguidance on surveillance and actions against viral hepatitis according to the\r\nguidance of WHO to raise the quality of figures about viral hepatitis that are\r\ncollected via infectious disease reporting and surveillance systems.

- Cooperate with\r\ninternational organizations in researching and assessing burden of disease by\r\nhepatitis B and HCV in Vietnam, effective cost of investment in diagnosis and\r\ntreatment for hepatitis B and hepatitis C to provide evidence for the\r\nformulation of plans and policies as well as the political mobilization in\r\nfuture on prevention and fighting against hepatitis.

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3.2.3. Intensify preventive\r\nactivities to reduce the transmission of hepatitis virus

a) Prevention of\r\ntransmission of hepatitis B from mother to child

- Ensure than obstetrics\r\nfacilities where children are born always have sufficient hepatitis B vaccine\r\nfor babies, provide consultancy about hepatitis B vaccination for more than 90%\r\nof babies within 24 hours after birth.

- Apply recent good\r\npractice models to increase the cover of hepatitis B vaccination for babies\r\nwithin 24 hours after birth and the next doses according to the immunization\r\nschedule.

- Increase the quality of\r\nsafe motherhood program and provide consultancy on hepatitis-B screening for\r\npregnant women at antenatal facilities to promptly discover pregnant women\r\ninfected with HBV and take measures for preventing transmission from mother to\r\nchild

- Conduct HBsAg testing\r\nfor every pregnant woman and ensure that children of women infected with HBV\r\nare provided with hepatitis vaccine at birth and the later doses according to\r\nvaccination schedule.

b) Prevention of transmission\r\nof hepatitis virus in the community

- Build up plans to\r\nprovide sufficiently hepatitis B vaccines for expanded vaccination, ensure than\r\nmore than 90% babies and 95% of infants receive hepatitis B vaccine; consider\r\nincluding women in reproductive age and pregnant women in the objects of\r\nimmunization.

- Promptly discover and\r\nprovide treatment for viral hepatitis cases. Conduct screening to discover HBV\r\nand HCV among high-risk people including people who inject drug, who are\r\ninfected with HIV, who is infected with sexual transmitted disease and people\r\nwho receive blood dialysis

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- Intensify the programs\r\nof food safety and hygiene, clean water assurance and personal hygiene and hand\r\nwashing to prevent the transmission of hepatitis virus via gastrointestinal\r\ntract, especially hepatitis A virus.

c) Prevention of\r\ntransmission of hepatitis virus in medical facilities and blood transfusion

- Carry out the screening\r\nfor HBV and HCV at blood transfusion centers and blood provisions facilities\r\naccording to the guidance in Circular No. 26/2013/TT-BYT dated 16/9/2013 by the\r\nMinister of Health.

- Standardize procedures\r\nand modes of hepatitis B and hepatitis C testing to apply in blood screening at\r\nall blood banks and blood transfusion facilities. Adopt the testing quality\r\ninspection system at blood transfusion centers and blood provision facilities\r\nto ensure the safety in blood transfusion.

- Speed up the popular\r\nantibacterial activities at medical facilities, especially medical examination\r\nand treatment facilities. Ensure that all tools used for medical operation,\r\nincluding tubular needles and tools used for dental operations are sterilized.\r\nEncourage the immunization against hepatitis for medical officials.

- Set up regime for the\r\ninspection and assessment of the prevention activities at stated-owned medical\r\nfacilities and private medical facilities.

3.2.4. Raise the quality\r\nand widen the screening, diagnosis, treatment and management of viral hepatitis\r\npatients

- Provide guidance on the\r\nclassification of facilities in the provision of treatment, conduct screening\r\nand apply constant methods of diagnosis, treatment and prevention of viral\r\nhepatitis, especially hepatitis B and hepatitis C nationwide and in orientation\r\nto access to the community.

- Build up standard\r\npractice procedures and procedures for the classification of techniques used in\r\ntesting serving the diagnosis and treatment for viral hepatitis, especially\r\nhepatitis B and hepatitis C.

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- Intensify activities\r\nand raise the capacity in diagnosis, care and treatment for medical facilities\r\nof provinces through training and technical assistance to raise the\r\naccessibility of patients with hepatitis, especially hepatitis B and hepatitis\r\nC.

- Research and apply\r\nadvanced methods/techniques in virological testing and diagnosis to ensure the\r\nefficiency in the diagnosis and treatment for viral hepatitis.

- Negotiate with medicine\r\nand biologic producers to reduce the price of medicines, including new\r\nmedicines and biologics serving diagnosis and treatment so as to increase the\r\nnumber of patients accessing to diagnosis, care and treatment.

3.3. Remedies\r\npertaining to human resource cultivation

- Strengthen and\r\nstandardize staff members in charge of prevention, surveillance, testing,\r\ndiagnosis, treatment and communication in facilities.

- Provide training to\r\nimprove knowledge of staff members carrying out the surveillance, testing,\r\ndiagnosis, treatment, blood screening, and immunization.

- Cultivate a specialist\r\nstaff for provincial and central facilities to intensify technical assistance\r\nfor inferior facilities in prevention, testing, surveillance, diagnosis and\r\ntreatment for viral hepatitis.

3.4. Remedies\r\npertaining to investment

- Mobilize resources in\r\nVietnam from healthcare program at central and local levels, social\r\norganizations, international organizations and non-governmental organizations\r\nto ensure the resources for the prevention and fighting against viral\r\nhepatitis.

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- Raise the funding of\r\nNational expanded immunization program to ensure the coverage of hepatitis B\r\nvaccination for babies and infant according to the plans, consider expanding\r\nobjects at risk.

- Build up suitable\r\npolicies on payment of health insurance for cases receiving treatment for viral\r\nhepatitis, especially hepatitis B and hepatitis C; build up structure of\r\npayment of insurance for cases receiving non-resident surveillance and\r\ntreatment.

3.5. Remedies\r\npertaining to scientific research

Encourage scientific\r\nresearches on viral hepatitis using funding from Vietnam and mobilize technical\r\nand financial assistance from international organizations:

- Conduct researches on\r\nthe assessment of burden of disease from HBV and HCV in Vietnam, efficient cost\r\nof the investment in diagnosis and treatment for hepatitis B and hepatitis C to\r\nprovide evidence for the establishment of political plans as well as political mobilization\r\nin future about prevention and fighting against hepatitis.

- Conduct researches on\r\nclinical testing of new medicines to intensify the access to diagnosis, care\r\nand treatment for hepatitis, especially hepatitis B and hepatitis C.

- Conduct epidemiological\r\ninspections and inspections of the ratio of infections with hepatitis virus in\r\nVietnam; conduct inspection of awareness, attitude and behavior of people\r\ntowards the prevention and fighting against viral hepatitis.

- Conduct assessments of\r\nthe capacity for surveillance and testing of hepatitis virus in facilities and\r\nformulate a suitable model to improve the quality of the surveillance of viral\r\nhepatitis in Vietnam.

- Conduct assessments of\r\nthe situation of the surveillance and formulate an effective viral hepatitis\r\nsurveillance model; research and apply effectively the viral hepatitis\r\nprevention and fighting model.

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4.\r\nDuration of implementation

From 2015 to 2019

PART 4: ORGANIZATION\r\nOF IMPLEMENTATION

1. Central\r\norganizations

a) General\r\nDepartment of Preventive Medicine

- Work full time for\r\nNational Consultant on prevention and fighting against viral hepatitis, provide\r\nadvice for the Minister of Health on direction of the surveillance and actions\r\nagainst viral hepatitis nationwide.

- Work as the focus point\r\nto formulate guidance and run the viral hepatitis surveillance and fighting\r\nsystem according to guidance of WHO; direct and expedite the surveillance and\r\nfighting against viral hepatitis in areas and units in preventive medicine\r\nsystem, medical facilities and inspect the surveillance and fighting against\r\nviral in such places; manage the quality of viral hepatitis testing of units in\r\nthe preventive medicine system.

- Update often\r\nprofessional guidance and guidance on surveillance and fighting against viral\r\nhepatitis, promptly provide training for reserve officials.

- Direct, guide and\r\ninspect the hepatitis B vaccination for babies, infants and high-risk people,\r\nensuring the safety and the recovery according to the target.

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- Mobilize resources and\r\ncooperate with relevant units to conduct researches and investigation related\r\nto viral hepatitis for the formulation of policies and professional guidance on\r\nprevention and fighting against viral hepatitis.

b) Medical Service\r\nAdministration

- Work as the focus point\r\nthat updates and formulates professional guidance on screening, diagnosis and\r\ntreatment for viral hepatitis and provides training for officials in charge of\r\nproviding treatment. Formulate transference structure in treatment,\r\nsurveillance and management of patients between facilities.

- Directly steer and\r\nexpedite medical facilities to reinforce the capacity of laboratories serving\r\nthe diagnosis and treatment for diseases caused by hepatitis virus; manage the\r\nquality of viral hepatitis testing in medical facilities in Vietnam.

- Work as the focus point\r\nthat conduct assessment of the implementation of national guidance on treatment\r\nfor hepatitis B and hepatitis C and propose policies to develop the access of\r\npeople towards the treatment for viral hepatitis.

- Cooperate with medical\r\ninsurance companies to formulate the structure of subsidies to cost of\r\ntreatment for viral hepatitis, especially for patients with hepatitis B and\r\nhepatitis C.

- Directly steer,\r\nexpedite and inspect the popular prevention and contamination control in\r\nmedical facilities, ensure that all tools used for medical operation are\r\nsterilized.

- Direct medical\r\nfacilities with delivery rooms to give hepatitis B immunization at birth.

c) Vietnam\r\nAdministration of HIV/AIDS Control

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- Direct the combination\r\nof measures for prevention of viral hepatitis, especially hepatitis C with\r\nmeasures for prevention of HIV of people at risk of infection with HIV; combine\r\nthe surveillance of co-infection with viral hepatitis and HIV with the\r\nsurveillance of HIV.

- Cooperate with General\r\nDepartment of Preventive Medicine, Medical Service Administration and relevant\r\nunits in the surveillance, prevention and treatment for co-infection with\r\nhepatitis and HIV.

d) Drug\r\nadministration of Vietnam

- Direct the control of\r\nquality and classification of use purposes of biologics used for diagnosing\r\nviral hepatitis that are sold in Vietnam.

- Speed up the\r\nregistration for sale of new and effective medicines for treating viral\r\nhepatitis in Vietnam.

- Supervise and assess\r\nthe quality of medicines, vaccine and medical biologics, ensure that their\r\nquality is conformable for diagnosis, prevention and treatment for viral\r\nhepatitis.

e) Health\r\nEnvironment Management Agency

- Direct the enhancement\r\nof personal hygiene practice, clean water provision and washing hand with soap\r\nto avoid the transmission of viral hepatitis through gastrointestinal tract.

- Reinforce the waste\r\nmanagement in hospitals to avoid the spread of hepatitis virus into the\r\nenvironment.

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- Work as the focus\r\npoint, cooperate with relevant departments and National Center for Health\r\nCommunication and Education in making plans on communication about viral\r\nhepatitis and preventive measures; mobilize relevant authorities and political\r\norganizations, political – social organizations and to support and joint in\r\nfighting against viral hepatitis.

- Work as the focus point\r\nthat direct and cooperate with relevant agencies in intensifying the\r\nconsultation about prevention and fighting against viral hepatitis, combined\r\nwith the propagation of fighting against liver cancer on means of mass media\r\nand organize communication campaigns responding to the World Hepatitis Day.

- Cooperate with relevant\r\nunits in formulating communication documents suitable for each object; provide\r\ntraining for communication staff of provinces/cities.

g) Department of\r\nMaternal Health and Children

- Direct medical\r\nfacilities with delivery rooms and maternal health and children protection\r\nsystem to carry out the prevention and fighting against the transmission of\r\nhepatitis virus for women in reproductive age, especially pregnant women and\r\nwomen whose children is subject to immunization.

- Raise the quality of prenatal\r\ncare kits and safe motherhood kits, including the consultation for mothers\r\nabout the danger of hepatitis virus, especially HBV, preventive measures,\r\nfocusing on benefits of hepatitis B vaccination for babies within 24 hours\r\nafter birth.

- Provide obstetrics\r\nhospitals, obstetrics - pediatrics hospitals and centers for reproductive\r\nhealthcare with guidance on screening testing for hepatitis B and HIV virus for\r\npregnant women as a part of prenatal care.

- Direct medical\r\nfacilities with delivery rooms to provide consultancy for family of pregnant\r\nwomen and ensure that 90% of babies receive hepatitis vaccine within 24 hours\r\nafter birth and 95% of infants receive hepatitis vaccine; the immunization\r\nshall be conformable to safety conditions.

h) Department of\r\nPlanning and Finance

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- Ensure sufficient funding\r\nfor National expanded immunization program including hepatitis B vaccination\r\nfor children and high-risk people.

- Include and allocate\r\nthe expenditure of the prevention and fighting against viral hepatitis to\r\nregular budget of healthcare units.

i) Department of\r\nHealth Insurance

Cooperate with\r\ndepartments and relevant agencies in building up policies on health insurance\r\nand payment of health insurance fund for people infected with viral hepatitis,\r\nenable patients with viral hepatitis to get access to effective treatment\r\ntherapies, especially patients with hepatitis B and hepatitis C.

j) Agency of\r\nScience, Technology and Training

- Arrange and mobilize\r\nresources to assist healthcare units to intensify the research and inspection\r\nabout issues related to the communication, surveillance, prevention and\r\ntreatment to raise the effect of the prevention and fighting against viral\r\nhepatitis.

- Facilitate the\r\nassistance for clinical testing of new medicines for viral hepatitis treatment\r\nin Vietnam.

- Direct universities of\r\nmedicine and/or pharmacy to update often teaching materials and course books in\r\nfighting and treatment for viral hepatitis, especially hepatitis B and\r\nhepatitis C according to guidance of the Ministry of Health and WHO.

k) Department of\r\nInternational Cooperation

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- Mobilize resources from\r\ninternational organizations for the fighting against viral hepatitis in\r\nVietnam.

l) Institutes of\r\nHygiene and Epidemiology/Pasteur Institute

- Participants of the\r\nNational expanded immunization project (National Institute of Hygiene and\r\nEpidemiology) shall make plan and supervise the hepatitis B vaccination for\r\nbabies within 24 hours after birth and for infants, conduct research on\r\nproposal for expansion of object of hepatitis B vaccination for women in\r\nreproductive age and pregnant women. Supervise the use and quality assurance of\r\nhepatitis B vaccine in the expanded immunization.

- National Institute of\r\nHygiene and Epidemiology shall establish the National Reference Laboratory on\r\ntesting for hepatitis virus by upgrading their laboratory of hepatitis virus.\r\nNational Institute of Hygiene and Epidemiology shall work as the focus point\r\nthat cooperates with relevant units in establishing standards for laboratory\r\nand procedures for hepatitis virus testing and shall follow procedures for\r\nhepatitis testing quality control and assurance of laboratories of hepatitis\r\nvirus standardization and quality control. Work as the focus point that gives\r\nadvice to the Ministry of Health to establish external quality assessment,\r\nensuring the quality of laboratories of the preventive medicine system; provide\r\ntraining and technical assistance for units in testing quality assurance.

- Institutes of Hygiene\r\nand Epidemiology/Pasteur Institute shall establish accredited hepatitis virus\r\nlaboratories in the institute(s), assist medical facilities in local areas to\r\nraise the quality of hepatitis testing quality.

- Direct and assist\r\npreventive medical centers in assigned areas in professional and technical\r\ntraining, carry out the surveillance and fighting against viral hepatitis.

- Organize and carry out\r\nthe viral hepatitis immunization and fighting against viral hepatitis in assigned\r\nareas.

m) National\r\nInstitute of Hematology and Blood Transfusion

- Establish accredited\r\nhepatitis virus laboratories in the institute(s); work as the focus point that\r\nstandardizes and provides guidance on procedures for screening viral hepatitis\r\nin blood transfusion, conduct internal quality assessment and external quality\r\nassessment at laboratories in blood transfusion centers and blood provision\r\nestablishments in Vietnam.

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- Set up a network of\r\nblood screening laboratories serving blood transfusion and storage, especially\r\ntesting for HBV and HCV, report the results of screening for hepatitis virus in\r\nblood transfusion to General Department of Preventive Medicine and Medical\r\nService Administration for supervision and solution.

n) Central hospitals

- Apply new technique in\r\ndiagnosis, treatment and surveillance of viral hepatitis, provide training in\r\nthe implementation of guidance on diagnosis, treatment and surveillance of\r\nviral hepatitis for medical staff directly provide examination, emergency care,\r\ntreatment and care for patients with viral hepatitis according to the guidance\r\nof the Ministry of Health and WHO.

- Carry out the common\r\npreventive medicine to avoid contamination in hospitals, ensuring that every\r\ntools used for medical operation, including tubular needles and dental\r\noperation, are sterilized.

- Raise the capacity of\r\nhepatitis virus laboratories, including the participation in international\r\nexternal quality assessment for the diagnosis and treatment for patients with\r\nviral hepatitis and assistance for inferior facilities when necessary.

- Direct polyclinics and\r\nspecialized clinics of provinces/districts and hospitals of specific sector to\r\nmake diagnosis and provide treatment for patients with hepatitis virus\r\naccording to capacity of each facilities.

- Intensify the quality\r\nof the reporting on viral hepatitis (according to type of hepatitis virus);\r\ncooperate with preventive medical facilities in the collection of information\r\nand report sufficiently and promptly cases of infection according to\r\nregulations.

o) National Center\r\nfor Health Communication and Education

- Include the\r\ncommunication and education about prevention and fighting against virus\r\nhepatitis in their regular plan; preside over and cooperate with relevant units\r\nto send communication about prevention and fighting against viral hepatitis to\r\nmedical staff in the community.

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- Cooperate with relevant\r\nunits and mass media agencies in publishing message and reportage on means of\r\nmass media.

- Direct, supervise and\r\nassist Center for health communication and education of provinces/cities to\r\nsend communication about prevention and fighting against viral hepatitis\r\naccording to the guidance of the Ministry of Health.

2. Local organizations

a) People’s\r\nCommittees of central-affiliated cities and provinces

- Grant approval and\r\ndirect the implementation of plans on prevention and fighting against viral\r\nhepatitis in local areas; ensure resources and budget for the implementation of\r\ngoals and activities in the plans.

- Mobilize the\r\nparticipation of organizations at committee level, governments of all levels,\r\nauthorities, political organizations, political – social organizations to\r\ncooperate with health sector in carrying out the epidemic prevention and\r\nfighting.

- Direct Departments of\r\nHealth to cooperate with relevant units to carry out constantly the prevention\r\nand fighting against viral hepatitis in local areas, combining with relevant\r\nmedical programs.

- Direct Services of\r\nInformation and Communications and media agencies in local areas to cooperate\r\nwith medical facilities in intensifying the propagation and mobilization of\r\npeople to take preventive measures, immunization and to have healthy lifestyle.

- Direct Services of\r\nFinance to ensure funding for the prevention and fighting against viral\r\nhepatitis in the community as well as at medical facilities.

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- Direct medical\r\nfacilities in local areas to follow the plans, ensure the conformity with goals\r\nand measures approved by the Ministry of Health.

- Build up plans on the\r\nconstancy in prevention and fighting against viral hepatitis, combine the\r\nprevention and fighting against viral hepatitis with epidemic prevention and\r\nfighting programs and projects; give People’s Committees of provinces advice on\r\napproval for plans, propose the addition to local budget and mobilize funding\r\nto ensure the implementation of the plans.

- Cooperate with\r\nServices, regulatory bodies, political organizations, political – social\r\norganizations that are relevant in their provinces in informing their\r\nsubsidiaries about the prevention and fighting against viral hepatitis and\r\nmobilize people to participate.

- Direct the hepatitis B\r\nvaccination for children at vaccination point and the hepatitis B vaccination\r\nfor babies at medical facilities with delivery rooms according to the provided\r\nratio and ensuring the safety.

- Direct medical\r\nfacilities in local areas to comply strictly with standard procedures for\r\nprevention of contamination in hospitals, carry out the screening conformably\r\nto promptly discover cases of infection with hepatitis virus to promptly\r\nprovide treatment and management to eliminate the complication.

- Direct preventive\r\nmedical facilities, communication facilities, reproductive healthcare\r\nfacilities, HIV/AIDS control facilities and medical facilities in local areas\r\nto comply with professional guidance of the Ministry of Health and central\r\nInstitutes/Hospitals.

- Provide training for\r\nmedical officials in professional guidance on surveillance and fighting against\r\nviral hepatitis, organize relevant programs and projects to reach the goals.

c) Preventive\r\nmedical centers of provinces/cities

- Give advice to\r\nDepartments of Health to build up plans and carry out constantly professional\r\nactivities related to prevention and fighting against viral hepatitis according\r\nto the guidance of the Ministry of Health.

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- Review people subject\r\nto vaccination, carry out the hepatitis B vaccination for babies within 24\r\nhours after birth and for infants according to regulations; organize mobile\r\nvaccination point in remote areas, avoid areas with low coverage of hepatitis\r\nvaccination.

- Cooperate with\r\nHospitals, medical facilities and laboratories in collecting information about\r\nthe situation of viral hepatitis according to the species of pathogens to take\r\nsuitable measures.

- Upgrade and standardize\r\nprocedures and equipment for testing for HBV and HCV in their facilities to\r\ninitiatively assist areas to conduct testing when necessary.

- Establish models of\r\nprevention and fighting against viral hepatitis; preside over and cooperate\r\nwith relevant units in conducting investigation and scientific researches about\r\nviral hepatitis.

d) Reproductive\r\nhealthcare centers of provinces/cities

- Build up plans and\r\ncarry out professional activities pertaining to prevention and fighting against\r\nviral hepatitis according to the assigned sectors; provide the safe birth kits\r\nand safe motherhood kits in medical facilities of provinces, districts and\r\ncommunes.

- Combine the\r\nconsultation about the danger of viral hepatitis, benefits of the vaccination\r\nand preventive measures with the consultation for women in reproductive age and\r\nprenatal women; give consultancy, provide examination and screening for\r\nhigh-risk people to promptly discover and treat hepatitis virus infection\r\ncases.

- Mobilize people to give\r\nbirths at medical facilities, direct medical facilities with delivery rooms in\r\nlocal areas to held consultation and carry out hepatitis B vaccination for at\r\nleast 90% of babies within 24 hours after birth.

- Direct and assist\r\nmedical facilities of districts and of communes in local areas to carry out the\r\nprevention and fighting against viral hepatitis according to the assigned\r\nsectors.

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- Direct and assist\r\nmedical facilities of provinces and of districts in local areas to carry out\r\nthe prevention and fighting against viral hepatitis according to the assigned\r\nsectors.

- Build up plans, carry\r\nout professional activities about prevention and fighting against viral\r\nhepatitis according to the assigned sectors; combine the communication and\r\nscreening for viral hepatitis with the prevention and fighting against sexual\r\ntransmitted diseases and HIV/AIDS.

- Combine the\r\nconsultation and screening for viral hepatitis with the screening for HIV/AIDS\r\nfor high-risk people for prompt discovery and treatment.

- Participate in the\r\nmanagement of co-infection with HIV/AIDS and viral hepatitis; provide\r\ninformation for preventive medical centers of provinces to control the\r\nsituation of viral hepatitis in local areas.

f) Centers for\r\nHealth Communication and Education of provinces/cities

- Build up plans and\r\ncarry out activities pertaining to communication and education about prevention\r\nand fighting against viral hepatitis.

- Formulate communication\r\ndocuments and communication models for the prevention and fighting against\r\nviral hepatitis in the community and medical facilities to disseminate to\r\npeople, patients and high-risk people.

- Cooperate with media\r\nagencies in sending communication through means of mass media; establish teams\r\nto propagate people in remote areas and ethnic minorities the danger of viral\r\nhepatitis and introduce preventive measures and benefits of hepatitis B\r\nvaccination.

- Direct and assist\r\nmedical facilities of districts and of communes in local areas to carry out the\r\nprevention and fighting against viral hepatitis.

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- Provide training for\r\nmedical officials who directly carry out the testing and diagnosis or provide\r\ntreatment and care for patients with viral hepatitis according to the guidance\r\nof the Ministry of Health; make plans on guidance and supervision of the\r\ndevelopment of patients during and after treatment.

- Intensify the\r\nexamination and screening of suspected cases and high-risk cases to promptly\r\ndiscover and provide treatment for patients infected with hepatitis virus.

- Build up plans, carry\r\nout the prevention and fighting against viral hepatitis in hospitals. Comply\r\nwith professional and technical guidance of the Ministry of Health on\r\nprevention and fighting against viral hepatitis.

- Comply with standard\r\nprocedures for prevention of contamination in hospitals and guidance on\r\nexamination, treatment and care for patients with viral hepatitis according to\r\nthe guidance of the Ministry of Health; intensify the consultation, screening\r\nand testing for hepatitis viruses, especially HBV and HCV for suspected cases\r\nand high-risk cases to promptly discover and provided treatment.

- Hold consultation and\r\ncarry out hepatitis B vaccination for at least 90% of babies at delivery rooms\r\nwithin 24 hours after birth according to regulations on immunization safety.

- Upgrade and standardize\r\nprocedures and equipment for testing for hepatitis virus at their units to\r\napply special techniques of testing and diagnosis for hepatitis B and HCV\r\nserving effectively the diagnosis and treatment for viral hepatitis in their\r\nhospitals and local areas.

- Participate in\r\nscreening system in blood transfusion and storage, cooperate the internal and\r\nexternal quality assessment of laboratories to ensure the safety in blood\r\ntransfusion serving emergency care and treatment for patients.

- Promptly report the\r\ntesting results and situation of patients with viral hepatitis to preventive\r\nmedical centers of provinces for suitable measures.

- Direct and assist\r\nmedical facilities of districts and of communes in local areas to carry out the\r\nsurveillance and fighting against viral hepatitis.

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- Build up plans, carry\r\nout professional activities about prevention and fighting against viral\r\nhepatitis in districts.

- Inspect the objects of\r\nimmunization, give hepatitis B vaccine to at least 95% of infants, at least 90%\r\nof babies (within 24 hours after birth), comply with regulation on immunization\r\nsafety, establish mobile vaccination point in remote areas to make sure there\r\nare not areas with low coverage.

- Hold consultation,\r\nprovide screening for viral hepatitis for women in reproductive age, pregnant\r\nwomen and high-risk people; hold consultation about hepatitis B vaccination and\r\npreventive treatment for risked people.

-\r\nCooperate with Hospitals, medical facilities and laboratories in collecting\r\ninformation about the situation of viral hepatitis according to the species of\r\npathogens to propose suitable measures.

- Direct and assist\r\nfacilities of communes in local areas to carry out the surveillance and\r\nfighting against viral hepatitis.

i) Polyclinics of\r\ndistricts

- Build up plans, carry\r\nout the prevention and fighting against viral hepatitis in hospitals, comply\r\nwith professional and technical guidance of the Ministry of Health on\r\nprevention and fighting against viral hepatitis

- Comply with standard\r\nprocedures for prevention of contamination in hospitals and guidance on\r\nexamination, treatment and care for patients with viral hepatitis according to\r\nthe guidance of the Ministry of Health.

- Encourage the\r\ncollection of specimens for testing of hepatitis B and HCV in cases suspected\r\nof infection with viral hepatitis and high-risk people; regarding facilities\r\nunconformable for carrying out testing, patients shall be recommended to\r\nreceive testing at a superior facility for prompt treatment.

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- Participate in viral\r\nhepatitis surveillance network, promptly report the testing results and\r\nsituation of patients with viral hepatitis to preventive medical centers of\r\nprovinces for suitable measures.

k) Medical stations\r\nof communes, wards and towns

- Build up plans, carry\r\nout professional activities about prevention and fighting against viral\r\nhepatitis in communes/wards/towns.

- Inspect often the\r\nobjects of immunization, give hepatitis B vaccine to at least 95% of infants,\r\nat least 90% of babies (within 24 hours after birth), comply with regulation on\r\nvaccination safety.

- Propagate through local\r\ncommunication about measures for prevention and fighting against viral\r\nhepatitis; cooperate with regulatory bodies, political organizations, political\r\n– social organizations in local areas in mobilizing households to enhance\r\npersonal hygiene practice and let their children receive hepatitis B vaccine\r\naccording to  the schedule for mobilizing high-risk people to receive\r\nscreening to promptly discover and receive treatment.

Department of preventive\r\nmedicine shall be the focus point that supervises the implementation of plans\r\nand reports it to the Ministry of Health.