Decision No. 3985/QD-BYT dated October 29, 2023 on providing guidelines for COVID-19 monitoring and prevention

DECISION

PROVIDING GUIDELINES FOR COVID-19 MONITORING AND PREVENTION

MINISTER OF HEALTH

Pursuant to Government’s Decree No. 95/2022/ND-CP dated November 15, 2022 on functions, tasks, powers and organizational structure of the Ministry of Health;

At request of the General Director of General Department of Preventive Medicine.

HEREBY DECIDES:

Article 1. Guidelines for COVID-19 monitoring and prevention are provided in this Decision.

Article 2. Guidelines for COVID-19 monitoring and prevention shall be applied at preventive healthcare establishments and healthcare establishments in nationwide.

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Article 4. Chief of Office of the Ministry of Health; Chief Inspector of the Ministry of Health; heads of Departments under the Ministry of Health; Heads of Institutes of Hygiene and Epidemiology; Heads of Pasteur Institutes; Directors of hospitals affiliated to the Ministry of Health; Directors of Departments of Health of provinces and central-affiliated cities; heads of health units of other ministries and central government authorities; and heads of relevant units shall implement this Decision.

PP. MINISTER
DEPUTY MINISTER




Nguyen Thi Lien Huong

GUIDELINES

COVID-19 MONITORING AND PREVENTION
(Issued together with Decision No. 3985/QD-BYT dated October 29, 2023 of the Ministry of Health)

I. GENERAL CHARACTERISTICS

COVID-19 is an acute infectious disease caused by the SARS-CoV-2 virus. This virus mutates regularly, resulting in more infectious variants. According to monitoring results, Vietnam has recorded the majority of variants common in the world.  The Omicron variant of SARS-Cov-2 is the most common variant in Vietnam and in the world at present.

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Clinical manifestations of SARS-CoV-2 patients vary, ranging from no symptoms, mild symptoms to severe pneumonia, acute respiratory distress syndrome, sepsis and multiple organ dysfunction syndromes and death.  People who are at higher risk of severity include the elderly, those with underlying conditions, including diabetes mellitus/cardiovascular disease, those with immunodeficiency diseases and pregnant women.  Now, preventive vaccines and antiviral drugs for treatment are available.

On May 5, 2023, the World Health Organization (WHO) announced that COVID-19 no longer constitutes a public health emergency of international concern, but advised that countries still implement monitoring and prevention measures and make the transition from pandemic prevention to sustainable management.

These guidelines are formulated, updated and adjusted on the basis of actual COVID-19 containment and COVID-19 monitoring, prevention and control as appropriate to current situation and they shall be implemented by provincial governments, health units and relevant units according to actual local situation.

II. MONITORING GUIDELINES

1. Definition of cases

Suspected cases (monitored cases):

a) Suspected cases are those with:

- Symptoms: fever and cough; or

- At least three of the following symptoms: fever, cough, headache, body ache - fatigue - chill; throat pain, runny or stuffy nose; reduction or loss of taste or smell; nausea, vomiting, diarrhea or difficulty breathing.

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1.2. Confirmed cases (F0 cases):  

a) Confirmed cases are persons getting SARS-CoV-2 positive test results via genetic material detection testing (Realtime RT-PCR).

b) Confirmed cases are persons mentioned in Section 1.1. and getting positive rapid antigen test results for SARS-CoV-2.

2. Definition of epidemic hotspots

2.1. Epidemic hotspot is an area where there are at least 02 cases with epidemiological connection*, at least one of which is the confirmed cases,  Depending on the level of epidemiological connection, the scope of epidemic hotspots shall be determined as appropriate to reality (household/accommodation, household clusters, offices, classrooms or equivalent areas).

* Person meeting epidemiological criteria is a person who closely contacts with confirmed cases or is involved in cluster of confirmed cases

2.2. Inactive epidemic hotspot: An epidemic hotspot is considered inactive if no new cases are recorded after 8 days from the date on which the last confirmed case was detected and managed.

3. Monitoring contents

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- Collecting samples of the first 5-10 cases from places where there are many suspected cases to determine epidemic hotspots.

- Quickly collecting samples from people suffering from severe respiratory tract infection or people who are at higher risk of severity (the elderly, those with underlying conditions, including diabetes mellitus/ cardiovascular disease, those with immunodeficiency diseases and pregnant women).

- Integrating COVID-19 monitoring into the system for monitoring respiratory pathogen, including monitoring of influenza-like illness (ILI), monitoring of severe viral pneumonia (SVP) and monitoring of genetic characteristics of SARS-CoV-2 to monitor its variants.

4. Sample collection, preservation and transport

- Sample collection, preservation and transport are specified in Appendix 1.

- Test request forms and reports on test results are provided in Appendix 3.

5. Reporting

Complying with reporting requirements within 24 hours under the form in Appendix 2 through the Electronic communicable disease surveillance system (eCDS) applicable to infectious diseases according to regulations in Circular No. 54/2015/TT-BYT dated 28/12/2015 by the Ministry of Health providing guidance on reporting and declaration of infectious diseases.

III. PREVENTION MEASURES

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Each person shall proactively adopt the following prevention measures:

- Be encouraged to comply with the 2K requirements (mask – disinfection).  Be encouraged to wear mask in crowded places and on public transport.  Implement prevention measures at healthcare establishments according to Decision No. 2609/QD-BYT dated June 20, 2023 of the Minister of Health.

- Regularly wash hands with clean water and soap or with sanitizer; rinse the mouth and throat with mouthwash and avoid touching the eyes, nose or mouth; cover the nose and mouth when coughing or sneezing, preferably with a towel, handkerchief, disposable tissue paper or shirt sleeve to prevent respiratory fluids from spreading; wash hands with soap and water or sanitizer immediately after contacting with suspected surfaces.

- Improve health via reasonable diet, rest and activities.

- Enhance ventilation and environmental hygiene in house, school and working place,

- Avoid direct contact with people having acute respiratory diseases (fever, cough, breathing difficulty, etc.)

- Educational institutions, agencies, offices, and production and trade establishments shall provide guidance on implementation of the above prevention measures for students and employees.

2. Specific prevention measures

Receive a COVID-19 vaccine according to guidance of the Ministry of Health and local health units.  Integrate COVID-19 vaccination into regular immunization under guidance in Appendix 4.

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Supervise persons entering Vietnam at border checkpoints according to regulations in Government’s Decree No. 89/ND-CP dated June 25, 2018 on elaboration of the Law on Prevention and Control of Infectious Disease regarding the border health quarantine.

4. Drugs, materials, chemicals and equipment for COVID-19 prevention and control

Provincial governments shall proactively prepare sufficient drugs, materials, chemicals and equipment for COVID-19 monitoring, testing, prevention and control in conformity with epidemic developments.

IV. CONTROL MEASURES

1. Regarding confirmed cases

- Admit, manage and treat COVID-19 patients; prevent and control infection in health establishments according to regulations of the Ministry of Health.

- Each COVID-19 outpatient shall proactively adopt the following measures for preventing infection:

+ The COVID-19 patient shall wear mask.  He/she is encouraged to suffer self-isolation at home for at least 5 days from the date on which the first symptom occurs or he/she gets positive SARS-CoV-2 test result, and wear mask until the 10^th day in order to prevent infection. If it is necessary to leave home, the patient shall wear mask, regularly disinfect his/her hands and avoid contact with other persons.

+ Caregivers or roommates of the COVID-19 patient shall wear mask when they contact with the patient, and avoid regular contact with him/her. 

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+ Keep well ventilated and clean his/her home.

- Regarding death cases: the corpse processing shall comply with Circular No. 21/2021/TT-BYT dated November, 26 2021 of the Minister of Health on sanitation in burial and cremation.

2. Regarding suspected cases

- Request the suspected case to adopt the following measures for preventing infection:

+ Self-monitor health.

+ Wear mask when he/she contacts with other persons or leaves home.

+ Avoid regular contact with other persons.

+ Regularly wash his/her hands with clean water and soap or hand sanitizer; clean and disinfect contact surfaces. 

- Quickly collect samples from people who have severe symptoms or are at higher risk of severity (the elderly, those with underlying conditions, including diabetes mellitus/ cardiovascular disease, those with immunodeficiency diseases and pregnant women) so as to make diagnosis.

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- If the suspected case does COVID-19 self-test and gets positive test result, it is required to notify the medical station of commune where he/she is residing to receive guidance and support.

3. Handling of epidemic hotspots

3.1. COVID-19 patient home

- Regarding COVID-19 patient: the handling shall comply with Section IV Clause 1.

- Regarding family members: prevention measures specified in Section III Clause 1 shall be implemented.

- Clean and ventilate the home, and regularly clean the floor, door handles and surfaces of household objects with common detergents, including soap and other cleaning solution.

3.2. Educational institutions, agencies, offices, and production and trade establishments

- Regarding COVID-19 patient: the handling shall comply with Section IV Clause 1.

- Regarding employees and students: prevention measures specified in Section III Clause 1 shall be implemented.

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- Educational institutions, agencies, offices, and production and trade establishments shall organize monitoring of the health of students and employees to soon detect confirmed or suspected cases; proactively and closely cooperate with local health establishments in COVID-19 prevention and control.

4. Communication about COVID-19 prevention and control

- Regularly update information about the COVID-19 epidemic situation in the world and Vietnam.

- Carry out communication about risks and measures for COVID-19 prevention and control.

- Carry out communication about COVID-19 vaccination according to guidance of the Ministry of Health.

- Carry out communication about relevant policies, laws, and documents on prevention and control of infectious diseases so that people understand, agree and actively participate in COVID-19 prevention and control.

According to COVID-19 developments and recommendations from the World Health Organization, the Ministry of Health will continue to update and adjust these guidelines in conformity with the actual situation.

APPENDIX I

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1. Samples

Samples from suspected COVID-19 cases shall be collected by healthcare workers or persons who have received training in sample collection.  At least 01 respiratory tract sample shall be collected for each case:

1.1. Genetic material detection testing

a. Upper respiratory tract samples:

+ Nasopharyngeal swab;

If nasopharyngeal swab cannot be collected, one of the following types of sample may be collected:

+ Throat swab;

+ Nasal swab (both nostrils);

b. Lower respiratory tract samples:

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+ Tracheal aspirate, broncheoalveolar lavage (BAL) fluid, pleural fluid, etc.;

+ Lungs, bronchi, trachea.

1.2. Rapid antigen detection testing

+ Nasopharyngeal sample;

+ Throat swab;

+ Nasal swab (both nostrils);

1.3. Antibody detection testing

+ Blood sample (not required, depending on serological testing, local governments and units shall formulate detailed plans)

+ Blood sample volume: 3ml - 5ml.

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2.1. Tool preparation

- Tools for nasopharyngeal swab, throat swab and nasal swab collection must not have a calcium or wooden handle; synthetic-tipped sticks are preferred.

- Tongue depressors;

- Tube containing 2-3ml of viral transport medium;

- Plastic container or nylon bag for sample packaging;

- Gauzes soaked in antiseptic;

- Antiseptic alcohol, pens;

- Personal protective equipment, including waterproof PPE clothing, masks and other necessary equipment;

- Clean powder-free gloves;

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- Sterile tubes without anticoagulant.

- Cold sample preserving containers.

2.2. Procedure

Sampling shall be safe and avoid cross-infection.

2.2.1. Sample collection method for genetic material detection testing

2.2.2.1. Method for nasopharyngeal swab and throat swab collection

a) Method for nasopharyngeal swab collection

- Ask the patient to sit still, sneeze nasal discharge into tissue paper, and tilt their head slightly backwards. Children shall be held by adults.

- Tilt the patient’s head back 70° and support the back of the patient’s neck with one hand.

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Note: if resistance is met before reaching such depth, remove the swab and try the other nostril. When reaching the posterior nasopharynx, stop, rotate the swab and slowly remove it.

- Keep the swab in place for 5 seconds to ensure maximum absorbency.

- Slowly rotate and remove the swab.

- Put the tip of the swab in a vial containing transport medium and break the shaft of the swab at the score mark to fit it in the vial. Note: the nasopharyngeal swab and the throat swab shall be put together in one vial.

- Recap the vial tightly and wrap it in paraffin paper (if any).

Note: Children shall sit in their parents’ laps with their backs to their parents' chests. The parent shall hold the child’s body and hands tightly and tilt the child’s head back.

Insert the sterile swab in a straight line into one nostril (do not tilt upwards) along the nasal floor until reaching the pharynx.

Figure 1: nasopharyngeal swab collection

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- Ask the patient to open their mouth wide.

- Use a tongue depressor to hold the patient’s tongue down.

- Insert the swab into the throat, rub and rotate the swab 3-4 times against both tonsils and the posterior pharyngeal wall to obtain secretion and cells from the throat.

- Place the swab in a vial containing 3ml of transport medium (VTM or UTM) for preservation.  Note that the tip of the swab shall be completely submerged in the transport medium. If the swab is longer than the vial, cut or break its handle to fit it inside the vial.

- Recap the vial tightly and wrap it in paraffin paper (if any).

2.2.1.2. Method for nasal swab collection

- Ask the patient to sit still and sneeze nasal discharge into tissue paper; children shall be held by adults.

- Tilt the patient’s head slightly backwards and support the back of the patient’s neck with one hand.

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- Put the tip of the swab in a vial containing transport medium and break the shaft of the swab at the score mark to fit it in the vial.

- Recap the vial tightly and wrap it in paraffin paper (if any).

2.2.1.3. Broncheoalveolar lavage fluid

This type of sample is collected from patients mechanically ventilated via an endotracheal tube Place a suction catheter along the endotracheal tube and use a pump to collect the broncheoalveolar lavage fluid into a vial containing transport medium.

2.2.1.4. Blood samples for antibody detection testing

Use a sterile syringe to collect 3ml-5ml venous blood into a serum separator tube without anticoagulant and store it at 2°C - 8°C for up to 48 hours. If preserved longer, samples shall be stored at -70°C.

2.2.2. Regarding rapid antigen detection testing, the sample collection and preservation shall follow guidance of the manufacturer.

Note:

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- Lower respiratory samples (tracheal aspirate, broncheoalveolar lavage (BAL) fluid, pleural fluid) shall be collected with the participation of the doctor(s) in charge of the patient.

3. Preservation, packing and transport of samples to laboratory

3.1. Preservation

Samples shall be stored at 2°C-8°C and delivered to the laboratory as soon as possible within 48 hours after collection. If samples cannot be delivered within 48 hours after collection, they shall be stored at -70°C.

3.2. Sample packing

- Samples shall be packed in three layers according to standards set by the Ministry of Health in Circular No. 40/2018/TT-BYT.

- Check to ensure that information on each sample vial and information in the investigation form are consistent with each other.

- Check to ensure that sample vials are properly capped and wrapped in paraffin (if any) or blotting paper.

- Place sample vials in a waterproof bag/nylon bag or container with lid and close it tightly.

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- Add ice-packs to the sample container to ensure that samples are stored at 2-8°C during transport.

- With regard to frozen samples, add ice-packs taken from -70°C freezers to ensure that samples do not thaw during transport.

- Test request forms shall be placed in waterproof bags/other nylon bags (do not place them together with samples) inside the sample container, which shall be labeled according to regulations in Circular No. 40/2018/TT-BYT during transport.

3.3. Transport of samples to laboratory

- Samples must be stored at 2-8°C (or -70°C for frozen samples) during transport.

- Test request and investigation forms must be sent together with samples.

- The sample sender shall immediately notify the laboratory of the estimated time of arrival of the samples so that the laboratory’s officials can prepare to receive the samples.

- It is required to choose the fastest transport means and ensure that samples are properly preserved during transport.

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APPENDIX II

COVID-19 CASE INVESTIGATION

Reporting unit: …………………………………………………………………………….……

1. Case information (patient's code: …………………………)

a. Patient’s full name: ………………………… b. Date of birth: …../…../……..

c. Gender:    1. Male  2. Female                                                   d. Occupation: ……………….

dd. Ethnic group: ………………………………………………..       e. ID Card/Citizen ID Card Number:………….

g. Phone number: .............................................................         h. Nationality: ……………………

2. Address:

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Ward: ……………………………..        District: ……………………………………

Province/city: ………………………...        Contact phone number: ………………………….

Workplace/school address: No:……………         Street: …………………………

Ward: ……………………………..        District: ……………………………………

Province/city: ………………………...        Contact phone number: ………………………….

Permanent residence address: No:……………            Street: …………………………

Ward: ……………………………..        District: ……………………………………

Province/city: ………………………...         Contact phone number: ………………………….

(Note: If the permanent residence address is the same as current residence address, the latter is not required.)

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4. Date on which the COVID-19 began: …../….. /202….             

5. Hospitalization date: …/ …/202....

6. Health establishment: ……………………………………………………

7. Past history of chronic disease and other relevant diseases: ………………………………………………………………………………………………………..

8. Epidemic profile: ………………………………………………………………………………..

9. COVID-19 vaccination: □ Yes, Number of dose: ………………………

                                                                                □ No                □ Unknown

10. Sample collection and testing:

- Date of sample collection: …………………                  Type of sample: …………………………

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- Date of result receipt: ………………………      Result: □ Positive □ Negative

11. Developments: Description of developments, symptoms and testing status

……………………………………………………………………………………………………….

12. Current status and treatment results:

□ Outpatient treatment      □ Inpatient treatment;      □ Dehospitalization      □ Impossible for surveillance

□ Death: Death date: …/ …/ ……; Cause of death………………………………………..

□ Other (serious health conditions, patient's request for discharge, hospital transfer, etc.): …………………………………………………..

13. Diagnosis and classification

□ Suspected case      □ Confirmed case      □ Not COVID-19

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Comorbidity diagnosis: ……………………………Complication diagnosis: ……………

Reporter
(signature and full name)

Date … month … 202 ...
Head of unit
(Signature, seal and full name)

APPENDIX III

REQUEST AND NOTIFICATION AND DELIVERY OF TEST RESULT

Form No. 1

TEST REQUEST

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Full name:............................................

1.2. Age: …….. Date of birth: …… / ……. /………….

       ……… Age (month) (< 24 months): ………….          □ Age (year) (≥24 month): ……………

1.3. Gender: □ Male        □ Female                                 1.4. Ethic group: …………………………

1.5. Address:............................................

Village: …………………………………                  Commune: ………………………….

District: ……………………………………                  Province/city: ……………………………

1.6. Full name of guardian (father/mother/relative, if any)………………………………………

Phone number:................

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2.1. Onset date:…… / ……. / …………..

2.2. Date of sample collection:…… / ……. / …………..                Time of sample collection - ...

       Sample collector:…………………………..              Phone number:................

       Sample-collecting unit: …………………………………………………………………………………………

2.3. Type of sample: ……………………………………………     Quantity: ………………….

       Type of sample: ……………………………………………     Quantity: ………………….

       Type of sample: ……………………………………………     Quantity: ………………….

2.1. Test requests: ………………………………………………………………………

       Test-requesting unit: ………………………………………………………………………

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Sample-sending unit
(sample-sending unit/person’s certification)

UNIT……………………………………………………..

LABORATORY……………………………………

Date/time of sample receipt: ……. / ……. / ……..  … - …Sample recipient: ………………

Sample status: …………………………………………………………………………

□ Sample rejection           □ Acceptance of sample-patient’s code: …………………………

Note:

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Form No. 2

Province/city:  

Unit:

SARS-COV-2 TEST RESULT REPORT

List of SARS-CoV-2 test cases

NO

Sample code

Full name

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Address

Date of sample collection

Test date

Type of sample

Result

Male

Female

Realtime RT- PCR

Rapid antigen test

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Unit’s certification

Reporter

APPENDIX IV.

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Integration of COVID-19 vaccination into regular immunization:

1. Integration principles

- According to the number of recipients, the quantity of vaccines provided, expiry date, vaccine storage conditions and immunization practices, provincial governments shall consider deciding COVID-19 vaccination on a regular/monthly/periodic basis.

- Organizing widespread communication about COVID-19 vaccination and notifying people of vaccination time and location.

- Organizing a COVID-19 vaccination session which is separated from other regular immunization sessions in order to ensure safety and avoid confusion because COVID-19 vaccine recipients are different from vaccine recipients of regular immunization:

- Vaccine plan formulation, allocation and distribution, arrangement of locations, resources, vaccination devices, organization of vaccination sessions, statistics, report on vaccination results and monitoring, supervision, and report on post-vaccination reactions shall comply with regulations of Government's Decree No. 104/2016/ND-CP dated July 01, 2016 and relevant Circulars and instructions of the Ministry of Health.

- Vaccine demands shall be identified according to people's vaccination needs for recipients under the guidance of the Ministry of Health and recommendations of WHO.

2. Vaccine recipients

- High priority group: the elderly, adults with underlying conditions, including diabetes mellitus/cardiovascular disease, people with immunodeficiency diseases and pregnant women and frontline medical staff.

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- Low priority group: Healthy children and adolescents (5-18 years of age).

References

1. Decision No. 2671/QD-BYT dated June 26, 2023 of the Ministry of Health

2. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/clinical-considerations-presentation.html#:~:text=Meta%2Danalyses%20of%20studies%20published,from%20exposure%20to%20symptom%20onset

3. https://www.who.int/publications/i/item/WHO-2019-nCoV-SurveillanceGuidance-2022.2

4. https://www.who.int/publications-detail-redirect/WHO-WHE-SPP-2023.1

https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing---26-april-2023