In March 2013, a GHS team was formed, and the project received strong support from MoH leadership with official approval in April. MoH issued Decision 1424 on May 2 to establish an EOC office comprising MoH departments, regional public health institutes, and relevant international agencies, including WHO, the United Nations’ Food and Agriculture Organization, and CDC. In-country CDC staff members from the Influenza Division and the Division of Global HIV/AIDS assumed leadership roles for the provision of technical assistance for emergency operations, laboratory systems, and information systems. The team was augmented from CDC headquarters, including experts from seven other divisions. Activities to enhance laboratory and information systems built on foundations laid by CDC programs in Vietnam starting in 2000. Following stakeholder discussions, including with the U.S. Agency for International Development, U.S. Department of Defense, and WHO, a precise activity plan was developed, detailing resources for staffing, technical support, and procurement of supplies and equipment.

A core EOC team was established at MoH, and CDC experts assisted to develop an emergency operations handbook with standard operating procedures and forms tailored to meet existing Vietnamese policies and regulations. The operations handbook contained internationally recognized functions and procedures for managing, responding to, and reporting disease outbreaks and other emergencies. Emergency operations training of MoH personnel was provided in-country (30 participants), at the EOC at CDC headquarters (two groups of three participants each), and at the EOC at the WHO Western Pacific Regional Office (three participants). Different international operations center models were reviewed, and plans were developed consistent with options at MoH for renovation of existing office space, relocation of existing staff, and installation of necessary equipment.

Work was focused at two of the four regional public health institutes, NIHE and PI-HCMC. Laboratory assessments of the influenza and enterovirus laboratories were conducted, and equipment and supplies required for application of the new testing platform were determined (5). Staff members from these two laboratories were trained in the WHO- and CDC-approved real-time reverse transcription–polymerase chain reaction (rRT-PCR) assay for influenza A(H7N9) detection, and in new testing platforms using rRT-PCR for detection of enterovirus 71 (EV71), and in multiplex PCR for detection of seven respiratory pathogens.§ Quality management systems were reviewed, including the National Laboratory Strategic Plan and Strengthening Laboratory Management Toward Accreditation and international level laboratory accreditation platform (ISO15189), all supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) (6). In addition to the work at NIHE and PI-HCMC, mapping of the national laboratory system was begun to allow strengthening of the network for sample shipment, testing, reporting, and referral (7).

To enhance biosurveillance and information systems using the backbone of the MoH’s electronic communicable disease surveillance system, CDC’s Epi Info tools were developed in Vietnamese to enhance analysis and real-time reporting of disease surveillance data for MoH decision makers. The use of Epi Info as an accessible, flexible, and comprehensive data collection, management, and analysis tool for investigations was demonstrated to MoH staff. A plan was developed to incorporate Epi Info into the toolkit used by MoH rapid response teams responsible for investigating outbreaks.

At the project’s September 2013 conclusion, a series of functional interrelated drills were conducted to 1) verify accuracy of laboratory testing by matching reported results to known but blinded panels containing specific pathogens; 2) assess performance by measuring turnaround times from sample receipt to results reporting; 3) provide a training opportunity for MoH EOC staff members and subcommittees of the National Steering Committee to practice EOC functions in a controlled scenario; and 4) confirm data transmitted across systems received at each designated point in the communications network. Two 3-day laboratory drills were conducted separately at NIHE and PI-HCMC. Mock drill panels for rRT-PCR were supplied by CDC and Oxford University Clinical Research Unit.¶ Both laboratories accurately identified all pathogens in their panels using the new algorithms within the required 48-hour timeframe, in accordance with IHR reporting requirements.

The 2-day emergency operations drill, led by MoH and assisted by CDC and Defense Threat Reduction Agency experts, included participation and coordination by multiple MoH groups, the Ministry of Agriculture and Rural Development, and international partners. Strengths identified from the drill included effective communication and problem-solving; a notable outcome was the creation and review of an Incident Action Plan.