Epidemic hazard

Media have been reporting during the past weeks about several cases of acute haemorrhagic conjunctivitis (defined as “pink eyes condition”) in Viet Nam that may be likely to become a "countrywide" epidemic. The health condition has been reported initially in Hanoi, however recently many cases have been recorded in other areas, in particular Ho Chi Minh City and southern provinces, also involving adults. An RFI has been sent to EpiCore members to collect further details about the reported condition, especially in terms of possible causes and health risk for the overall population. The EpiCore network has confirmed the occurrence of this event and provided important information extracted from reliable sources and from official statements released by the local health authorities. Based on this information, on September 15, the Vietnam Department of Preventive Medicine has confirmed that acute conjunctivitis is currently on the rise in several provinces and cities such as Hanoi, Da Nang and Ho Chi Minh City. Preliminary data from the National Eye Hospital in Hanoi show that in recent weeks, an average of about 700 cases per week has been examined, including some cases of complications. On September 6, 2023 the Ho Chi Minh City Department of Health (HCMC) has informed that more than 63,000 cases of viral conjunctivitis (pink eye) have been documented during 2023 and as of to August 31 (15.5% more than during the same period of last year). On September 15, HCMC has informed that, based on the results of genetic sequencing investigations carried out on patient samples, Coxsackievirus A24 can be considered the main cause (identified in 86% of cases); human Adenovirus 54 (11%) and 37 (3%) have been also reported in some of the cases. A survey of several private pharmacies in HCMC has revealed that many people with pink eye buy eye drops without prescription. The population has been advised to seek for medical care and avoid self-medication, in particular the use of eye drops containing corticosteroids. An important increase in cases has been reported in other areas of Viet Nam recently, for example in Gia Lai Province, where more than 4,600 cases have been documented by the medical facilities between August and mid-September. The ongoing outbreak is characterized by acute haemorrhagic manifestations, that is not unexpected as, according to literature, viral agents as Coxsackie A24 and Entero 70 have caused similar cases in Viet Nam as well as in other countries in the past. One of the first outbreaks documented worldwide has been in Ghana in 1969. Since then, similar outbreaks have been described also in Asia (e.g. Singapore 1970, Coxsackie A24). In 2011 a significant haemorrhagic conjunctivitis outbreak was documented in Japan (Okinawa) as mainly caused by Coxsackievirus A24, with several cases presenting subconjunctival haemorrhage or superficial punctate keratitis. In 2020, the Central Eye Hospital of Hanoi, in collaboration with Hanoi National University, reported that members of Adenoviridae family (hAdV-3, hAdV-4, hAdV- 8 and hAdV-37) were responsible for most of the acute conjunctivitis cases identified in the city in 2017-2019. The RFI was supported by relevant information about the current outbreak made available by the local health authorities in addition to a detailed documentation about similar events occurred in the past.