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In Vietnam, shigellosis, typhoid fever, and cholera are important enteric diseases. To determine their magnitude and geographical distribution, and explore associated risk factors, we examined national surveillance data from 1991 to 2001 and potential ecological determinants. Average annual incidence rates were calculated and mapped for each province. Bivariate and multiple regression analyses were used to explore associations with selected environmental and human risk factors. Overall, shigellosis rates per 100,000 population (median, 41; mean, 70) were higher and more widespread than rates for typhoid fever (median, 7; mean, 23) and cholera (median, 0.3; mean, 2.7). Shigellosis was highest in the Central Highlands and was significantly associated with rainfall and urban poverty; typhoid fever prevailed in the Mekong River Delta and was most associated with vapor pressure and river/stream drinking water; and cholera predominated along the Central Coastal regions and correlated positively with rainfall and public well drinking water. The distinct geographical patterns of each disease appear to be driven by a combination of different ecological factors.
Received June 15, 2006. Accepted for publication October 30, 2006.
Acknowledgments: The authors thank the International Vaccine Institute, Korea, for the provision of disease data and Lorenz von Seidlein for comments on the manuscript. We are grateful to Nicholas Minot from the International Food Policy Research Institute for providing GIS shapefiles of provincial boundaries, to David Luckenbaugh from the National Institutes of Health for help with multiple regression models in SPSS, and to Lance Waller from Emory University for advice on spatial statistics.
Financial support: This study was funded by the Bill and Melinda Gates Foundation.
* Address correspondence to Louise A. Kelly-Hope, Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD. E-mail: kellyhopel{at}mail.nih.gov
Authors’ addresses: Louise A. Kelly-Hope, Wladimir J. Alonso, David L. Smith, and Mark A. Miller, Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, Telephone: 301-496-8735, Fax: 301-496-8496, E-mails: kellyhopel{at}mail.nih.gov, wladimir{at}origem.info, smitdave{at}mail.nih.gov, and millemar{at}mail.nih.gov. Vu Dinh Thiem, Dang Duc Anh, and Do Gia Canh, National Institute of Hygiene and Epidemiology, 1 Yersin Street, Hanoi, Vietnam, E-mails: vudinhthiem{at}hn.vnn.vn and ducanhnihe{at}hn.vnn.vn. Hyejon Lee, International Vaccine Institute, SNU Research Park, San 4-8 Bongcheon-7 Dong, Kwanak-gu, Seoul, Korea. Current address: London School of Hygiene and Tropical Medicine, Keppel St., London WC1E 7HT, England, E-mail: Hyejon.Lee{at}lshtm.ac.uk.
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