Journal of the Office of Disease Prevention and Control 9 Nakhon Ratchasima

An Investigation of Chikungunya Outbreak in Kradangnga Subdistrict, Bang Khonthi District, Samut Songkhram Province, Thailand, September–November 2024

Saisamorn Srisookwattanakij — 2026-08-17

On November 13, 2024, the Office of Disease Prevention and Control 5 Ratchaburi, received a report from the Samut Songkhram Provincial Public Health Office of 51 suspected chikungunya cases in Kradangnga Sub-district, Bang Khonthi District, Samut Songkhram Province. An outbreak investigation and control measures were conducted using descriptive epidemiology from September to November 2024 to confirm the diagnosis and verify the outbreak. The results showed that a total of 51 cases were identified, including 3 confirmed cases (5.88%) and 48 suspected cases (94.12%). The patients were male (31.37%) and female (68.63%), with the highest proportion in the 30–39 years age group. The primary occupation of the patients was farming (39.22%). Most patients initially sought care at private clinics or pharmacies (82.35%). The most common symptom was fever (100.0%), and no severe complications or deaths were reported. No genetic material of dengue virus, Zika virus, or chikungunya virus was detected in the laboratory investigations. Entomological surveillance revealed that larval indices were high in residential communities, temples, and schools. Control measures including larval source elimination and weekly monitoring operations were implemented. In addition, vehicle-mounted ultra-low volume (ULV) fogging and thermal fogging were conducted. After the operations, the larval indices decreased, and no further cases were identified. This investigation revealed that delayed and incomplete case reporting hindered timely outbreak control, leading to widespread transmission. Therefore, comprehensive, complete, and timely case reporting through the Digital Disease Surveillance (DDS) system should be promoted to cover both public and private healthcare settings. For disease prevention and control, the 3-3-1 control measure should be strictly enforced on days 1, 7, 14, 21, and 28 of case onset, aiming for a House Index (HI) of 5 and a Container Index (CI) of 0 in schools, temples, and villages. Supplemental chemical spraying every 7 days should be maintained if active transmission continues to effectively terminate the outbreak.

Outbreak Investigation of Food Poisoning Caused by Ingestion of Hura crepitans Seeds among Primary School Students, Dong Klang Subdistrict, Khon San District, Chaiyaphum Province, Thailand, 22–24 May 2025

Supattra Promnon — 2026-08-17

On May 23, 2025, the Surveillance and Rapid Response Team (SRRT) of Khon San District, Chaiyaphum Province, was notified by Khon San Hospital of a cluster of food poisoning cases among students at a primary school in Dong Klang Subdistrict, Khon San District, Chaiyaphum Province. The event met the criteria for a district-level outbreak investigation. The SRRT conducted a field investigation to confirm the diagnosis, describe the outbreak characteristics, identify causes and risk factors, and implement prevention and control measures. A descriptive epidemiological investigation was conducted using medical record reviews, interviews with patients and relevant contacts, active case finding, and environmental surveys. Data were analyzed using descriptive statistics. The results revealed that a total of 13 cases of food poisoning attributed to the ingestion of Hura crepitans seeds were identified (attack rate of 100%). All cases were students, comprising 7 males and 6 females. The median age was 11 years (range 8–12 years). Symptom onset occurred within 1–4 hours after ingestion. The main symptoms were abdominal pain (100%), sore throat or throat irritation (84.62%), diarrhea (76.92%), abdominal discomfort (53.85%), and vomiting (15.38%). Of the 13 cases identified, 11 patients were admitted to the hospital, while 2 were treated at home. No fatalities were reported. Epidemiological investigation showed that all cases had a history of consuming H. crepitans seeds that had fallen on the school playground. In contrast, no symptoms were reported among students who had not ingested the seeds. Control measures were promptly implemented, including the collection and disposal of H. crepitans seeds from the school premises, restriction of access to the affected area, installation of warning signs for toxic plants, and provision of health education to teachers, students, and parents. All cases were closely monitored, and active surveillance was conducted in the school and community for 2 days. No additional cases were identified.

Accident Investigation Report of a Fatal Collision Between an Ambulance and a Motorcycle: A Case Study of Vehicle-Related Risk Factors and Vulnerable Road Users in Nakhon Ratchasima Province, December 2025

Manachai Sureram — 2026-08-17

On December 18, 2025, the Situation Awareness Team (SAT) of the Office of Disease Prevention and Control 9, Nakhon Ratchasima, was notified by the Nakhon Ratchasima Provincial Public Health Office regarding a fatal collision between an ambulance and a motorcycle, resulting in one fatality. This accident event directly impacted the safety of medical personnel and patients, reflecting safety gaps within the referral system regarding the utilization of aging vehicles. The Joint Investigation Team (JIT) and the Road Traffic Injury (RTI) Team jointly collaborated to investigate the incident. The study was descriptive epidemiological research. This study aimed to: 1) describe the epidemiology of the injuries and fatality resulting from the accident, 2) investigate the causes and contributing factors of this accident, and 3) identify preventive measures to mitigate the severity of ambulance-related road traffic injuries. Data were collected through interviews with involved individuals, as well as physical inspections of the vehicles and the environmental conditions at the crash site. Data were subsequently analyzed using the Haddon Matrix and Swiss Cheese Model. The results revealed that the collision occurred on a narrow community road when the motorcycle suddenly cut in front of the ambulance. The ambulance, which had been in service for more than 10 years, was traveling at a speed of 81 km/h. The motorcycle rider was a 74-year-old male with a hearing impairment who was not wearing a safety helmet, and he sustained severe injuries and subsequently died. The three occupants of the ambulance comprised the driver, an ophthalmic patient, and the patient’s relative. All of them sustained no injuries due to strict adherence to seatbelt utilization. The findings of this study indicated that the incident was driven by three primary dimensions of vulnerability: 1) human factors (the opposing party was an older adult with a hearing impairment), 2) vehicle factors (the ambulance was over 10 years old), and 3) environmental factors (a narrow community road with limited visibility). Therefore, greater emphasis should be placed on implementing a safe speed for conditions in community areas. Furthermore, policies should be established to limit long-distance patient transfer missions for ambulances with extended service life in order to mitigate systemic risks.

Factors Associated with Fall Risk Behaviors among Older Adults

Thanoosin Sukserm — 2026-08-17

The objective of this study was to investigate factors associated with fall risk behaviors among older adults and assess risk behaviors in Song Pleuy Sub-district, Na Mon District, Kalasin Province. The sample consisted of 299 older adults aged 60 years and older from 16 villages, selected via stratified random sampling proportional to the population size. The research instrument was an interview questionnaire divided into 6 sections including 1) demographic characteristics, 2) knowledge on fall prevention, 3) home environmental hazards, 4) family support, 5) the Health Belief Model, and 6) fall risk behaviors. Data were analyzed using descriptive statistics (frequencies, percentages, means, and standard deviations) and Pearson’s correlation coefficients. The results revealed that the overall fall risk behaviors among the older adults were at a moderate level ( = 2.11, SD = 0.13). The correlation analysis between the variables and fall risk behaviors revealed that home environmental hazards were significantly and positively associated with fall risk behaviors (r = 0.283, p < 0.01). Conversely, the Health Belief Model demonstrated a significant negative association with fall risk behaviors (r = -0.199, p < 0.01). Therefore, public health campaigns should promote fall risk perception and awareness based on the Health Belief Model and encourage family participation in improving home environment safety. In addition, the government or relevant agencies should support the provision of essential fall prevention equipment, ensuring comprehensive and easy access within households.

Effect of a Stress Management Application on Stress Levels among Professional Internship Students at a University in the Eastern Region

Usanee Katkaew — 2026-08-17

Currently, stress among higher education students is on the rise, particularly among students undergoing professional internships who must adapt to real-world roles and environments. The study was quasi-experimental research with a non-equivalent control group pretest-posttest design. The objective of this study was to examine the effects of a stress management application on stress levels among occupational health and safety professional internship students at Burapha University. The sample consisted of 30 fourth-year undergraduate students, divided into an experimental group (n = 15), who installed and received instructions for using the Alljit application, and a control group (n = 15). The follow-up period was 6 weeks. Data were collected using a demographic questionnaire, the Suanprung Stress Test-20 (SPST-20), an application usage log, and a satisfaction evaluation form. Data were analyzed using descriptive statistics, paired-sample t-test, and independent-sample t-test. The results revealed that, prior to the intervention, the mean stress scores between the experimental and control groups were not significantly different (51.6720.04 and 52.4713.27, respectively; p = 0.898). After the intervention, the experimental group demonstrated a significant decrease in its mean stress score from 51.6720.04 to 37.4710.01 (p < 0.001). Furthermore, the post-intervention mean stress score of the experimental group was significantly lower than that of the control group (37.4710.01 and 57.2714.59, respectively; p < 0.001). Additionally, 73.30% of the participants in the experimental group reported a high level of satisfaction with the application. This study indicated that the Alljit stress management application is effective in reducing stress among professional internship students. Therefore, the use of this application serves as an alternative that should be promoted, enabling individuals to perform initial stress self-management, which will subsequently contribute to the prevention and reduction of mental health problems in society.

Evaluation of the Measles Surveillance System in the Border Districts of Surin and Buriram Provinces, Thailand, 2023

Prapasri Samjai — 2026-08-17

The World Health Organization (WHO) set a target for measles elimination by 2023; however, Thailand has not yet achieved this goal, particularly in border areas. This study aimed to evaluate the measles surveillance system in seven community hospitals located in the border districts of Surin and Buriram provinces. A descriptive study was conducted from January 1 to December 31, 2023, using a combination of a medical record review of 1,845 patients with measles-related diagnoses based on ICD-10 codes (quantitative) and interviews with 62 relevant stakeholders (qualitative). The findings revealed that a total of 75 patients met the measles case definition, but only two cases were reported to the ME Online surveillance system, representing a system sensitivity of 2.67%. The system sensitivity was 4.44% in Surin Province, whereas no cases were reported to the system in Buriram Province. All reported cases met the standard case definition and were reported within seven days, resulting in 100% diagnostic accuracy and timeliness. However, because only two cases were reported to the surveillance system, the surveillance data were not representative of the epidemiological characteristics of all eligible patients in the study area. Furthermore, the qualitative assessment revealed that the system comprises multiple procedural steps requiring outbreak investigation findings and laboratory confirmation, resulting in low flexibility. Additionally, the system lacks stability due to the frequent turnover of responsible personnel. While the system is generally accepted by administrators and laboratory staff, most operational personnel still lack knowledge and understanding of the system. Moreover, there was no concrete evidence that the surveillance data were utilized for disease surveillance, prevention, and control in the study area. The ME Online surveillance system in the study area demonstrated low sensitivity and exhibited limitations in flexibility, stability, and data utilization. Therefore, active case-finding mechanisms should be developed, case reporting and communication of reporting guidelines for operational staff should be improved, and laboratory confirmation should be promoted for patients presenting with fever and rash, including those with a history of measles vaccination, to support the achievement of measles elimination goals.

Mortality Rate of Ventilator-Associated Pneumonia among Critically Ill COVID-19 Patients at Maharat Nakhon Ratchasima Hospital

Yuttachai Phungan — 2026-08-17

The coronavirus disease 2019 (COVID-19) pandemic has led to an increase in the number of patients developing acute respiratory distress syndrome (ARDS). Consequently, many patients have required admission to intensive care units and prolonged mechanical ventilation. Prolonged mechanical ventilation increases the risk of developing ventilator-associated pneumonia (VAP), which subsequently contributes to an elevated mortality rate. This study aimed to determine the mortality rate among critically ill patients with COVID-19 who developed VAP. A retrospective study was conducted using the medical records of patients with respiratory failure who required endotracheal intubation and were diagnosed with VAP while admitted to the intensive care unit and isolation ward at Maharat Nakhon Ratchasima Hospital between April 2021 and March 2022. Data were analyzed using descriptive statistics. The results showed that 26.25% of critically ill patients with COVID-19 developed VAP, and the mortality rate among these patients was as high as 71.12%. The most common pathogen identified among patients who died was extensively drug-resistant (XDR) Acinetobacter, accounting for 46.27% of cases. These findings indicate that critically ill patients with COVID-19 who develop VAP have a high risk of mortality. Therefore, knowledge of the mortality rate associated with VAP could support the development of more effective strategies for preventing and controlling VAP in the future.

A Study of Risk Factors and Development of a Screening Tool for High-Normal Blood Pressure among Adults Aged 30 Years and Over in Primary Health Care, Health Region 7

Saowalux Khatchamart — 2026-08-17

This study aimed to investigate risk factors for high-normal blood pressure and to develop a screening tool for high-normal blood pressure (defined as systolic blood pressure (SBP) 130 mmHg and/or diastolic blood pressure (DBP) 85 mmHg) for use in primary health care settings in Health Region 7. A cross-sectional analytic study was conducted from January to July 2022. The sample consisted of 7,141 adults aged 30 years and older residing in Health Region 7. The participants were selected according to the inclusion criteria from four subdistricts in four target provinces. Data were collected by village health volunteers (VHVs) using a questionnaire consisting of two parts: 1) general information and health status, and 2) health behaviors. Data were analyzed using descriptive statistics. Factors associated with high-normal blood pressure were analyzed using crude odds ratios (OR) and adjusted odds ratios (AOR). The performance of the screening tool was evaluated using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC), as well as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. The results showed that the prevalence of high-normal blood pressure was 34.5%, with most participants aged 35–59 years (52.6%). Sex, age, body mass index (BMI), abdominal obesity, diabetes mellitus, a family history of hypertension, alcohol consumption, and consumption of high-fat beverages were significantly associated with high-normal blood pressure (p < 0.05). The screening tool revealed an area under the ROC curve (AUC) of 0.632, indicating poor discriminative ability. At a cutoff score of 7, the sensitivity was 75.0% (95%CI: 73.2–76.7), indicating acceptable performance for initial screening, while the specificity was 43.0% (95%CI: 41.5–44.4), indicating relatively poor discriminative performance. The PPV, NPV, and overall accuracy were 40.9%, 76.6%, and 54.0%, respectively. This screening tool could be further developed as a self-screening tool or a screening tool in the primary health care services system. The screening criteria could be expanded to include individuals aged 30 years and older by applying cutoff scores of6 for those aged 30–34 years,7 for those aged 35–59 years, and 10 for those aged 60 years and older.