Volume 76, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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.


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  1. Kotloff KL, Winickoff JP, Ivanoff B, Clemens JD, Swerdlow DL, Sansonetti PJ, Adak GK, Levine MM, 1999. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull World Health Organ 77 : 651–666. [Google Scholar]
  2. Crump JA, Luby SP, Mintz ED, 2004. The global burden of typhoid fever. Bull World Health Organ 82 : 346–353. [Google Scholar]
  3. Kindhauser MK, 2003. Communicable Diseases 2002: Global Defence against the Infectious Disease Threat. WHO/CDS/2003.15. Geneva: World Health Organization.
  4. Lanata CF, Mendoza W, Black RE, 2002. Improving Diarrhoea Estimates: Child and Adolescent Health and Development. Geneva: World Health Organization.
  5. Bhan MK, Bahl R, Bhatnagar S, 2005. Typhoid and paratyphoid fever. Lancet 366 : 749–762. [Google Scholar]
  6. Kosek M, Bern C, Guerrant RL, 2003. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ 81 : 197–204. [Google Scholar]
  7. Kariuki S, Hart CA, 2001. Global aspects of antimicrobial-resistant enteric bacteria. Curr Opin Infect Dis 14 : 579–586. [Google Scholar]
  8. Sack RB, Rahman M, Yunus M, Khan EH, 1997. Antimicrobial resistance in organisms causing diarrheal disease. Clin Infect Dis 24 (Suppl 1): S102–S105. [Google Scholar]
  9. Acosta CJ, Galindo CM, Deen JL, Ochiai RL, Lee HJ, von Seidlein L, Carbis R, Clemens JD, 2004. Vaccines against cholera, typhoid fever and shigellosis for developing countries. Expert Opin Biol Ther 4 : 1939–1951. [Google Scholar]
  10. DeRoeck D, Clemens JD, Nyamete A, Mahoney RT, 2005. Policymakers’ views regarding the introduction of new-generation vaccines against typhoid fever, shigellosis and cholera in Asia. Vaccine 23 : 2762–2774. [Google Scholar]
  11. Ryan ET, Calderwood SB, 2000. Cholera vaccines. Clin Infect Dis 31 : 561–565. [Google Scholar]
  12. Walker RI, 2005. New vaccines against enteric bacteria for children in less developed countries. Expert Rev Vaccines 4 : 807–812. [Google Scholar]
  13. Walker RI, 2005. Considerations for development of whole-cell bacterial vaccines to prevent diarrheal diseases in children in developing countries. Vaccine 23 : 3369–3385. [Google Scholar]
  14. Sheehy TW, 1969. On enteric diseases among our troops in Vietnam. Gastroenterology 56 : 820. [Google Scholar]
  15. Forman DW, Tong MJ, Murrell KD, Cross JH, 1971. Etiologic study of diarrheal disease in Vietnam. Am J Trop Med Hyg 20 : 598–601. [Google Scholar]
  16. Lindberg AA, Cam PD, Chan N, Phu LK, Trach DD, Lindberg G, Karlsson K, Karnell A, Ekwall E, 1991. Shigellosis in Vietnam: seroepidemiologic studies with use of lipopolysaccharide antigens in enzyme immunoassays. Rev Infect Dis 13 (Suppl 4): S231–S237. [Google Scholar]
  17. Vinh H, Wain J, Chinh MT, Tam CT, Trang PT, Nga D, Echeverria P, Diep TS, White NJ, Parry CM, 2000. Treatment of bacillary dysentery in Vietnamese children: two doses of of-loxacin versus 5-days nalidixic acid. Trans R Soc Trop Med Hyg 94 : 323–326. [Google Scholar]
  18. Anh NT, Cam PD, Dalsgaard A, 2001. Antimicrobial resistance of Shigella spp. isolated from diarrheal patients between 1989 and 1998 in Vietnam. Southeast Asian J Trop Med Public Health 32 : 856–862. [Google Scholar]
  19. Isenbarger DW, Hien BT, Ha HT, Ha TT, Bodhidatta L, Pang LW, Cam PD, 2001. Prospective study of the incidence of diarrhoea and prevalence of bacterial pathogens in a cohort of Vietnamese children along the Red River. Epidemiol Infect 127 : 229–236. [Google Scholar]
  20. Nguyen TV, Le PV, Le CH, Weintraub A, 2005. Antibiotic resistance in diarrheagenic Escherichia coli and Shigella strains isolated from children in Hanoi, Vietnam. Antimicrob Agents Chemother 49 : 816–819. [Google Scholar]
  21. Isenbarger DW, Hoge CW, Srijan A, Pitarangsi C, Vithayasai N, Bodhidatta L, Hickey KW, Cam PD, 2002. Comparative antibiotic resistance of diarrheal pathogens from Vietnam and Thailand, 1996–1999. Emerg Infect Dis 8 : 175–180. [Google Scholar]
  22. Prokopec J, Mullerova H, Sery V, Dinh Thi C, Radkovsky J, 1991. Typhoid fever survey in two localities in Vietnam. J Hyg Epidemiol Microbiol Immunol 35 : 9–16. [Google Scholar]
  23. Nguyen TA, Ha Ba K, Nguyen TD, 1993. Typhoid fever in South Vietnam, 1990–1993. Bull Soc Pathol Exot 86 : 476–478. [Google Scholar]
  24. Lin FY, Vo AH, Phan VB, Nguyen TT, Bryla D, Tran CT, Ha BK, Dang DT, Robbins JB, 2000. The epidemiology of typhoid fever in the Dong Thap Province, Mekong Delta region of Vietnam. Am J Trop Med Hyg 62 : 644–648. [Google Scholar]
  25. Tran HH, Bjune G, Nguyen BM, Rottingen JA, Grais RF, Guerin PJ, 2005. Risk factors associated with typhoid fever in Son La province, northern Vietnam. Trans R Soc Trop Med Hyg 99 : 819–826. [Google Scholar]
  26. Luxemburger C, Chau MC, Mai NL, Wain J, Tran TH, Simpson JA, Le HK, Nguyen TT, White NJ, Farrar JJ, 2001. Risk factors for typhoid fever in the Mekong delta, southern Viet Nam: a case-control study. Trans R Soc Trop Med Hyg 95 : 19–23. [Google Scholar]
  27. Connerton P, Wain J, Hien TT, Ali T, Parry C, Chinh NT, Vinh H, Ho VA, Diep TS, Day NP, White NJ, Dougan G, Farrar JJ, 2000. Epidemic typhoid in Vietnam: molecular typing of multiple-antibiotic-resistant Salmonella enterica serotype Typhi from four outbreaks. J Clin Microbiol 38 : 895–897. [Google Scholar]
  28. Parry C, Wain J, Chinh NT, Vinh H, Farrar JJ, 1998. Quinolone-resistant Salmonella typhi in Vietnam. Lancet 351 : 1289. [Google Scholar]
  29. Wain J, Hien TT, Connerton P, Ali T, Parry CM, Chinh NT, Vinh H, Phuong CX, Ho VA, Diep TS, Farrar JJ, White NJ, Dougan G, 1999. Molecular typing of multiple-antibiotic-resistant Salmonella enterica serovar Typhi from Vietnam: application to acute and relapse cases of typhoid fever. J Clin Microbiol 37 : 2466–2472. [Google Scholar]
  30. Wain J, Hoa NT, Chinh NT, Vinh H, Everett MJ, Diep TS, Day NP, Solomon T, White NJ, Piddock LJ, Parry CM, 1997. Quinolone-resistant Salmonella typhi in Viet Nam: molecular basis of resistance and clinical response to treatment. Clin Infect Dis 25 : 1404–1410. [Google Scholar]
  31. Butler T, Linh NN, Arnold K, Pollack M, 1973. Chloramphenicol-resistant typhoid fever in Vietnam associated with R factor. Lancet 2 : 983–985. [Google Scholar]
  32. Hoa NT, Diep TS, Wain J, Parry CM, Hien TT, Smith MD, Walsh AL, White NJ, 1998. Community-acquired septicaemia in southern Viet Nam: the importance of multidrug-resistant Salmonella typhi. Trans R Soc Trop Med Hyg 92 : 503–508. [Google Scholar]
  33. Le TA, Lejay-Collin M, Grimont PA, Hoang TL, Nguyen TV, Grimont F, Scavizzi MR, 2004. Endemic, epidemic clone of Salmonella enterica serovar Typhi harboring a single multi-drug-resistant plasmid in Vietnam between 1995 and 2002. J Clin Microbiol 42 : 3094–3099. [Google Scholar]
  34. Wain J, Kidgell C, 2004. The emergence of multidrug resistance to antimicrobial agents for the treatment of typhoid fever. Trans R Soc Trop Med Hyg 98 : 423–430. [Google Scholar]
  35. Dalsgaard A, Tam NV, Cam PD, 1997. Cholera in Vietnam. Southeast Asian J Trop Med Public Health 28 : 69–72. [Google Scholar]
  36. Dalsgaard A, Forslund A, Tam NV, Vinh DX, Cam PD, 1999. Cholera in Vietnam: changes in genotypes and emergence of class I integrons containing aminoglycoside resistance gene cassettes in Vibrio cholerae O1 strains isolated from 1979 to 1996. J Clin Microbiol 37 : 734–741. [Google Scholar]
  37. Ehara M, Nguyen BM, Nguyen DT, Toma C, Higa N, Iwanaga M, 2004. Drug susceptibility and its genetic basis in epidemic Vibrio cholerae O1 in Vietnam. Epidemiol Infect 132 : 595–600. [Google Scholar]
  38. Vu DT, Hossain MM, Nguyen DS, Nguyen TH, Rao MR, Do GC, Naficy A, Nguyen TK, Acosta CJ, Deen JL, Clemens JD, Dang DT, 2003. Coverage and costs of mass immunization of an oral cholera vaccine in Vietnam. J Health Popul Nutr 21 : 304–308. [Google Scholar]
  39. Trach DD, Cam PD, Ke NT, Rao MR, Dinh D, Hang PV, Hung NV, Canh DG, Thiem VD, Naficy A, Ivanoff B, Svennerholm AM, Holmgren J, Clemens JD, 2002. Investigations into the safety and immunogenicity of a killed oral cholera vaccine developed in Viet Nam. Bull World Health Organ 80 : 2–8. [Google Scholar]
  40. Thiem VD, Deen JL, von Seidlein L, Canh do G, Anh DD, Park JK, Ali M, Danovaro-Holliday MC, Son ND, Hoa NT, Holmgren J, Clemens JD, 2006. Long-term effectiveness against cholera of oral killed whole-cell vaccine produced in Vietnam. Vaccine 24 : 4297–4303. [Google Scholar]
  41. Central Intelligence Agency, 2006. The World Factbook. Washington, DC: CIA. Available at: http://www.odci.gov/cia/publications. Accessed January 20, 2006.
  42. Law G, 2006. Administrative Divisions of Countries. Statoids. Available at: http://www.statoids.com. Accessed October 18, 2005.
  43. General Statistics Office of Vietnam, 2006. Statistical Data and Surveys. Ha Noi, Vietnam. Available at: http://www.gso.gov.vn. Accessed October 11, 2005.
  44. Lee J, Wong D, 2000. Statistical Analysis with ArcView GIS. New York: John Wiley & Sons.
  45. Mitchell TD, Jones PD, 2005. An improved method of constructing a database of monthly climate observations and associated high-resolution grids. Int J Climatol 25 : 693–712. [Google Scholar]
  46. Minot N, Baulch B, Epprecht M, Inter-Ministerial Poverty Mapping Task Force, 2003. Poverty and Inequality in Vietnam: Spatial Patterns and Geographical Determinants. Washington, DC: International Food Policy Research Institute and Institute of Development Studies.
  47. Vuong TA, 2004. Risk Factors Influencing Faecal Contamination of Drinking Water in Water Sources and During Storage at the Household Level in Cu Jut District, Dak Lak Province, Vietnam. Masters abstract. Copenhagen: Institute of Public Health, University of Copenhagen. Available at: http://pubhealth.ku.dk/mih_en/thesesAbstr/04/anh. Accessed March 3, 2006.
  48. Ngan PK, Khanh NG, Tuong CV, Quy PP, Anh DN, Thuy HT, 1992. Persistent diarrhea in Vietnamese children: a preliminary report. Acta Paediatr 81 (Suppl 381): 124–126. [Google Scholar]
  49. Lobitz B, Beck L, Huq A, Wood B, Fuchs G, Faruque AS, Colwell R, 2000. Climate and infectious disease: use of remote sensing for detection of Vibrio cholerae by indirect measurement. Proc Natl Acad Sci USA 97 : 1438–1443. [Google Scholar]
  50. Trach DD, Clemens JD, Ke NT, Thuy HT, Son ND, Canh DG, Hang PV, Rao MR, 1997. Field trial of a locally produced, killed, oral cholera vaccine in Vietnam. Lancet 349 : 231–235. [Google Scholar]
  51. Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM Jr, 2005. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis 5 : 42–52. [Google Scholar]
  52. von Seidlein L, 2005. The need for another typhoid fever vaccine. J Infect Dis 192 : 357–359. [Google Scholar]
  53. James FC, McCulloch CE, 1990. Multivariate-analysis in ecology and systematics: panacea or Pandora’s box. Annu Rev Ecol Syst 21 : 129–166. [Google Scholar]

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  • Received : 15 Jun 2006
  • Accepted : 30 Oct 2006

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