Tuberculosis (TB) is the world’s deadliest infectious disease. In 2018, the largest number of new TB cases occurred in the South-East Asian region, with 44 percent of new cases. Viet Nam ranks 11th among the 30 high-burden countries, with an estimated 174,000 TB patients in 2018. Over the past decade, Viet Nam has dramatically reduced the prevalence of smear-positive TB among adults, the most infectious type of TB. However, the TB burden based on the recent prevalence survey remains high, and the government of Viet Nam and CDC have recognized that intensified interventions are needed in order to “bend the curve” and accelerate the decline in TB prevalence.

This project is an important partnership between the Taiwan Centers for Disease Control (CDC); Ministry of Health and Welfare, R.O.C; the U.S. Centers for Disease Control and Prevention (CDC); and the CDC Foundation to support Viet Nam in their goal to move towards TB elimination. This project focuses on addressing TB in Ho Chih Minh City, Viet Nam by drawing on the collective public health expertise, experience and resources of Taiwan, Viet Nam, and the U.S. so that by working together, there can be more impact.  

The overall project objectives are to:

• Evaluate current capacity and feasibility and develop a diagnosis and treatment model to find and cure adult and pediatric TB cases in Ho Chi Minh City using the most effective strategies demonstrated in the initial Zero TB Viet Nam pilot project; and
• Help accelerate local elimination through TB prevention and detection efforts by expanding latent TB infection treatment to high-risk groups.

In 2019, the project organized a Trilateral Forum focused on catalyzing regional partnerships towards ending TB in Viet Nam. The forum convened key partners including the National TB Program, the Ho Chih Minh City Department of Health (DoH), Pham Ngoc Thach Hospital, (responsible for the TB program in the south), Taiwan Ministry of Health and Welfare, Taiwan CDC, U.S. CDC, and local implementing partner Friends for International TB Relief (FIT). The Forum officially established a regional partnership to end TB in Ho Chih Minh City, and participants held technical exchanges in support of national planning, identifying program gaps and sharing lessons learned related to case finding, treatment and engaging the private healthcare sector in TB interventions.

Many low- and middle-income countries lack the data necessary to fully describe disease threats in their countries and monitor the impact of public health efforts to prevent and control disease.

Serosurveillance—which involves monitoring the presence or absence of antibodies or proteins in the blood serum of a population—provides an objective biological measure for estimating population susceptibility, exposure and immunity. Serologic data are increasingly used to guide public health policy and strategy, from support of vaccine introduction to verification of disease elimination.

Currently, serosurveillance is often focused on a single disease. Integrated serosurveillance (multi-disease serologic surveillance) is a cost-effective approach that can dramatically scale up the availability of data for public health action, including for diseases currently unmonitored.

CDC has developed an approach to integrated serosurveillance for multiple diseases of public health importance using a multiplex bead assay platform. The platform can simultaneously measure up to 100 different disease-specific markers from a single dried blood spot, creating novel opportunities to establish integrated nationally representative serosurveillance programs. If well implemented, integrated serosurveillance could increase the quality and breadth of data available for infectious disease modeling and efforts to describe transmission risks. Data collected through integrated serosurveillance can also inform implementation of prevention opportunities across multiple diseases. 

But, implementation of integrated serosurveillance requires coordination of subject matter expertise and ongoing technical assistance to ensure generation of high-quality data for public health decision making. CDC’s vision is to expand capacity to implement this approach around the globe where data from integrated serosurveillance could drive critical aspects of public health programs.

In Nigeria, the Nigeria CDC has identified integrated serosurveillance as a priority for generating high-quality supplemental information to augment the existing surveillance network, and for their overall public health response. With funding from the Bill and Melinda Gates Foundation, the CDC Foundation is working with CDC and other partners to strengthen the capacity of Nigeria’s National Reference Laboratory to conduct integrated serosurveillance multiplex bead assay technology. The support is part of a multi-partner effort that includes multiple CDC programs, donors and partners.  

As results are available, CDC is working with the Nigeria CDC and government partners to analyze multiplex testing data and apply results to advance public health programs. In addition, CDC is applying lessons learned from Nigeria and previous projects to develop the tools and technical assistance capacity needed to accelerate the implementation of integrated serosurveillance in other countries.