With a population of 95.5 million people, around 70.5 million are at risk of malaria with an estimated 5481 cases (5100 to 6000) in 2017.1
The epidemiology of malaria in Viet Nam is complex, varying from location to location and between different populations. Intense malaria transmission occurs in hilly, forested areas in southern and central provinces.1 Here, malaria transmission tends to be perennial with a seasonal peak in December–February, whereas in the northern region, transmission is increasingly sporadic. High-risk groups include forest and forest-fringe inhabitants (commonly ethnic minority groups), temporary migrants and seasonal workers, and new forest settlers.1 The burden of malaria is decreasing rapidly in Viet Nam and is becoming increasingly focal.1 For example, in Quang Nam there was a 4.6-fold increase in vivax malaria in August 2016 relative to the same period in 2015 against a trend nationally for a decrease in vivax malaria.1
Improvement and updating of epidemiological surveillance is underway to ready the Vietnamese health system for elimination. This includes the roll-out of a case-based surveillance system to all bar the most endemic areas of the country.1 As of 2018, this has officially been rolled out in strata zone 3 of the country with an estimated 80% of case notification occurring within 1-2 days.1 Irrespective, work is required to ensure the system is fully functional and ready for elimination.
2020 milestones/ malaria elimination
The goal of the National Strategy for Malaria Control and Elimination is to actively control malaria in moderate and high endemic areas and to eliminate malaria in areas where malaria has been reduced to a low level. Targets for 2020 are:1
- Morbidity below 0.15 per 1000 population;
- Mortality below 0.02 per 100 000 population; and
- Malaria eliminated in at least 40 provinces.
With more than 40 provinces now malaria-free, all of these targets at the impact level had already been achieved by the end of 2017. The next steps aim to eliminate P. falciparum by 2025 and all malaria species by 2030.1
Viet Nam is included in the Mekong Malaria Elimination (MME) Initiative in the Greater Mekong subregion, supported through a Global Fund financed regional artemisinin-resistance initiative, which aims to eliminate P. falciparum by 2025 and all species of malaria by 2030.
Treatment policy for P. vivax
- Primaquine 0.25 mg/kg/day for 14 days following a negative G6PD test.2
- Directly observed primaquine is recommended, but compliance is not monitored in practice.2
- Diagnosis and treatment is free of charge in the public sector.2
G6PD testing policy
The WHO recommendation for G6PD testing before treatment with primaquine has not been adopted.3
G6PD deficiency prevalence
In Vietnam, G6PD deficiency prevalence varies considerably between different ethnic groups, being higher in ethnic groups living in the north of Vietnam and those living in the foothills. A number of different G6PD deficient variants have been identified, most commonly Viangchan.