The Centers for Disease Control and Prevention (CDC) began operations in Laos with a memorandum of understanding in 2006. The agreement was renewed for another five years in August 2011, with a focus on pandemic, avian, and seasonal influenza. Since 2006, there has been a significant strengthening of engagement to include technical assistance in HIV/AIDS prevention, treatment, care and support and national program management; and expanded maternal and child health immunization coverage. CDC programmatic activities are primarily worked with and through a WHO Country Collaboration in building infectious disease detection and response capacity through investments in laboratory, surveillance and human resource development in developing national epidemiological capabilities. With the introduction of seasonal influenza vaccine, the first regional disease initiative in a low income country, the CDC with its host-national MoH partner has engaged on a more research oriented agenda including the impact of vaccines on pregnant women. CDC provides de-facto country representation for other U.S. Government health interests, including those of the Department of Defense (DTRA and NAMRU Asia) and the U.S. Department of Agriculture, Animal and Plant Inspection Service.
The IDC/USCDC manages several ongoing programs with the Lao Government: namely the Ministry of Health (MoH) and Ministry of Agriculture and Forestry (MoAF). Specific programs to note include the following:
- In Laos, CDC has built and continues to support Influenza laboratory, surveillance, outbreak investigation, infection control guidelines and best practices, clinical case management, and pandemic planning. CDC technical investments have led to: 1) the importance of influenza, contributing to over 40% of respiratory illness during peak seasonality: 2) laboratory capacity that has led to recognition of pandemic (2009 Influenza, A/H5N1 and H5N6; 3) data sharing of viral isolates with the WHO Global Influenza Surveillance and Response System; and 4), improvements and expansion of Influenza surveillance networks to capture new emerging threats like H7N9. WHO has recognized the National Center for Laboratory and Epidemiology by designating it a National Influenza Center in August 2010.Capacity building beyond influenza has strengthened the International Health Regulations as practiced in Laos, and enabled the country to detect human anthrax and circulating dengue subtypes for the first time in the laboratory. Moreover, dengue surveillance piggybacking on an influenza surveillance network of 8 hospital sites allowed the tracking of over 50,000 cases during the 2013/14 epidemic.
- Evidence of disease influenza disease burden in Laos has led to an innovative private-public partnership where excess vaccines (from the US in 2012 and Australia in 2013 and 2014) are donated to Laos. In 2014, this program led to the vaccination of an estimated 700,000 persons with support from the Partnership of Influenza Vaccine Introduction (PIVI) reflecting the only such initiative in a low income country from the region
- The Influenza Division, in conjunction with (now) annual seasonal influenza vaccinations is conducting projects to assess: 1) disease burden in prioritized pregnant women; and 2) impact of vaccine status (vaccinated and unvaccinated) in pregnant women on birth outcome measures.
- USCDC Laos is now working with WHO and USCDC Beijing to broker a “vaccine sharing facility” though contributions and/or discounting of recently WHO pre-qualified seasonal influenza vaccine. This pilot initiative if successful good be expanded to other countries of the region, and involve other vaccines, e.g. JEV: 1.5 million doses of Chinese procured JEV vaccine were deployed in 2015, establishing a precedence for this kind of sharing arrangement.
The CDC Thailand Global HIV/AIDS Asia Regional Office has worked in Laos since 2009, with the goal of providing technical assistance (TA) to strengthen the country’s HIV response. The focus is on HIV prevention in men having sex with men (MSM), quality services for counseling and testing and for care and treatment, laboratory capacity, HIV surveillance, health information systems, and prevention of mother-to-child transmission. Activities have included development of training curricula, guidelines, and standard operating procedures; field supervision, and data use for program planning and decision-making. CDC’s TA has brought many “lessons learned” from Thailand’s experience in developing and implementing HIV/AIDS programs and adapting to the Lao situation. HIV/AIDS work has also benefited through collaboration with WHO and partnering with the Center of HIV/AIDS and Sexually Transmitted Infections (CHAS), National Center f0r Laboratory and Epidemiology (NCLE) and Mother and Child Health Child Health Center (MCHC).
CDC’s contribution to the Expanded Program for Immunization is channeled through WHO in Laos. CDC provides operational and technical support for vaccine initiatives against maternal tetanus, measles, rubella, acute flaccid paralysis (polio) and pandemic influenza, and for data management. CDC experts also assist in monitoring vaccination campaigns, including pre- campaign planning and post campaign review. Notable accomplishments include:
Introduction of hepatitis B birth dose home visits, including BCG vaccination,
- Post-natal care, and vitamin A for new lactating mothers
- Introduction of JEV vaccine in targeted population aged 1-14 year olds in 8 northern provinces
- Introduction of HPV in targeted school girls (grade 5 in schools and aged 10 outside schools) in Vientiane Capital and Province.
- Increasing uptake of Td in pregnant women and pediatric deworming and Vit A supplementation, attributed to seasonal influenza vaccine campaigns.
- Assistance to the MoH in support of Vaccine Preventable Disease (VPD) immunization activities, including monitoring, health education, etc. THIS WORK IS PARTICULARLY NOTABLE in responding to recent VPD outbreaks that include measles, diphtheria, pertussis and vaccine derived polio virus (VDPV).
Field Epidemiology Training (FET) Program
CDC capacity building investments include standing up and providing operational support for the Lao FET. A year-long training initiative intended to decentralize outbreak response and surveillance capabilities, Lao FET is organized into three modules, with each consisting of one month of practical classroom instruction and three months of field work. The Lao FET has resulted in a national network of 47 alumni and uniquely brings human and animal health FET candidates together to carry out invaluable investigative work that has led to the following:
- Recognition of morbidity and mortality associated with seasonal influenza outbreak occurrence.
- Expansion and improvements of influenza surveillance networks.
- Determination of the susceptibility of the female population of child-bearing age to rubella.
- AEFI and Acceptability Assessment in conjunction with introduction of seasonal influenza vaccination campaigns.
- Recognition of the outbreak potential of Japanese encephalitis virus (JEV) and implications for JEV targeted vaccination.
- Study of adverse events following pandemic influenza vaccination.
- Recognition and control of human anthrax outbreak.
- Management by the Lao FET of 25 outbreak investigations in less than three years.
- Investigation and control of diphtheria, measles and other vaccine preventable disease outbreaks.
- Cultural, social and economic barriers to update of MCH oriented vaccines in ethnic Hmong minority populations, leading to new approaches in vaccine promotion.
CGH/DGHP Supported Activities
With veterinarian support from the Thai MoH-USCDC Collaboration (TUC), working with DTRA supported USCDC Lao Country Operations, in the following:
- Promoting “one health” approach to disease zoonoses, including implementation of PACS, a specimens and data archival and retrieval management system, to be instituted in both human (National Center for Laboratory and Epidemiology) and animal (National Animal Health Laboratory), organized by DTRA.
- Developing with national collaborators both National Strategy and Work Plan for the elimination of Rabies.
- Procurement and distribution plan of post-exposure anti-rabies vaccine.
- Support of a pilot animal (dog) survey in Vientiane Capital, with the City Health Authority.
Other Technical Assistance
- Tracking the largest dengue outbreak on-record with over 50,000 cases in 2013
- Response to re-emergence of malaria and first time recognized artemisinin drug resistance