Community event-based surveillance aims to enhance the early detection of emerging public health threats and thus build health security. The Ministry of Health of Vietnam launched a community event-based surveillance pilot program in 6 provinces to improve the early warning functions of the existing surveillance system. An evaluation of the pilot program took place in 2017 and 2018. Data from this evaluation were analyzed to determine which factors were associated with increased detection and reporting. Results show that a number of small, local events were detected and reported through community event-based surveillance, supporting the notion that it would also facilitate the rapid detection and reporting of potentially larger events or outbreaks. The study showed the value of supportive supervision and monitoring to sustain community health worker reporting and the importance of conducting evaluations for community event-based surveillance programs to identify barriers to effective implementation.

Surveillance and outbreak reporting systems in Vietnam required improvements to function effectively as early warning and response systems. Accordingly, the Ministry of Health of Vietnam, in collaboration with the US Centers for Disease Control and Prevention, launched a pilot project in 2016 focusing on community and hospital event-based surveillance. The pilot was implemented in 4 of Vietnam's 63 provinces. The pilot demonstrated that event-based surveillance resulted in early detection and reporting of outbreaks, improved collaboration between the healthcare facilities and preventive sectors of the ministry, and increased community participation in surveillance and reporting.

Surveillance and outbreak reporting systems in Vietnam required improvements to function effectively as early warning and response systems. Accordingly, the Ministry of Health of Vietnam, in collaboration with the US Centers for Disease Control and Prevention, launched a pilot project in 2016 focusing on community and hospital event–based surveillance. The pilot was implemented in 4 of Vietnam’s 63 provinces. The pilot demonstrated that event-based surveillance resulted in early detection and reporting of outbreaks, improved collaboration between the healthcare facilities and preventive sectors of the ministry, and increased community participation in surveillance and reporting.

D iphtheria is a serious childhood disease with a high mortality rate (1). After a diphtheria-tetanus-pertussis vaccine (DTP) was introduced in the early 20th century, the number of cases dramatically decreased. Incidence reached a low of 4,333 cases in 2006, but more recently, the number of reported cases has increased, with incidence reaching 16,648 cases in 2018 (2). In 1981, Vietnam introduced a vaccination program in which participants received 3 primary doses of DTP (DTP3) vaccine; in 2011, a booster shot (DTP4) to be given 18 months after the initial doses was added (3). Although diphtheria cases had become sporadic by 2010, beginning in 2013, outbreaks occurred in the western and central highland areas of Vietnam, which prompted our study (4). The Study During June 2015-April 2018, the Pasteur Institute in Nha Trang, Vietnam, and the provincial health authority investigated 46 cases involving patients with suspected diphtheria, 8 of whom died, and 49 asymptomatic contacts in the provinces of Quang Nam and Quang Ngai in the central highlands region of Vietnam (Figure 1). We used standard case investigation forms to collect demographic and clinical information. We collected throat swab specimens from 93 patients and contacts but were unable to collect samples from 2 patients who had died. No cutaneous diphtheria was reported. We used sheep blood agar and tellurite medium cultures to identify Corynebacterium diphtheriae and extracted DNA with a QIAGEN DNA Mini Kit (QIA-GEN, https://www.qiagen.com), following a standard protocol. We used 2 sets of primers, Tox1/Tox2 and Dipht6F/Dipht6R, for PCR testing (5). The Elek test for diphtheria is not available in Vietnam. Laboratory testing confirmed diphtheria in 22 of 46 suspected cases: 17 patients, including 4 who died, tested positive in both culture and PCR tests, whereas 5 patients, including 1 who died, tested positive only

Background: In 2016-2017, Vietnam's Ministry of Health (MoH) implemented an event-based surveillance (EBS) pilot project in six provinces as part of Global Health Security Agenda (GHSA) efforts. This manuscript describes development and design of tools for monitoring and evaluation (M&E) of EBS in Vietnam. Methods: A strategic EBS framework was developed based on the EBS implementation pilot project's goals and objectives. The main process and outcome components were identified and included input, activities, outputs, and outcome indicators. M&E tools were developed to collect quantitative and qualitative data. The tools included a supervisory checklist, a desk review tool, a key informant interview guide, a focus group discussion guide, a timeliness form, and an online acceptability survey. An evaluation team conducted field visits for assessment of EBS 5-9 months after implementation. Results: The quantitative data collected provided evidence on the number and type of events that were being reported, the timeliness of the system, and the event-to-signal ratio. The qualitative and subjective data collected helped to increase understanding of the system's field utility and acceptance by field staff, reasons for noncompliance with established guidelines, and other factors influencing implementation. Conclusions: The use of M&E tools for the EBS pilot project in Vietnam provided data on signals and events reported, timeliness of reporting and response, perceptions and opinions of implementers, and fidelity of EBS implementation. These data were valuable for Vietnam's MoH to understand the function of the EBS program, and the success and challenges of implementing this project in Vietnam.