Outbreak, Surveillance, Investigation & Response (OSIR) Journal

Enhancing Digital Disease Surveillance in Thailand Using Information Technology, Data Engineering, Data Science, and Artificial Intelligence

2024-12-01T17:58:44+07:00

Recent advancements in data engineering, data science, and artificial intelligence have revolutionized disease surveillance systems globally. This study examines the implementation of these advancements in Thailand. We integrated these advancements to enhance the four key steps of public health surveillance: data collection, data analysis, data interpretation, and data dissemination. We expanded data collection to include data environment and integration, designing systems to manage multiple sources and facilitating seamless integration. To support analysis and interpretation, we adopted a design thinking approach and developed intuitive tools for exploring disease situations. We identified target users and described the data distribution mechanism. We integrated three major databases: digital disease surveillance, syndromic surveillance, and event-based surveillance, all managed by the Department of Disease Control. Data environments were divided into clusters for extraction, integration, and a data mart for specific use cases. Automated hourly extract-transform-load processes using Apache Airflow facilitated real-time data integration, ensuring seamless data management and timely updates. Data analysis solutions, including automated validation algorithms and business intelligence tools with user-friendly interfaces, were developed according to findings from the design thinking workshop. We developed open data published on dashboards and closed data managed through the Digital Export System. Artificial intelligence-enhanced early warning systems provided notifications of an outbreak to public health authorities via the instant messaging application LINE. In conclusion, the integration of information technology, data engineering, and data science has significantly enhanced Thailand's disease surveillance system, improving data collection, analysis, interpretation, and dissemination of results, leading to more efficient public health responses.

The Grammar of Science: Bar, Pie, Line, and Lie

2024-11-20T09:33:53+07:00

An Investigation of Pertussis Outbreak in a Low Vaccination Coverage Area, Mae Lan District, Pattani Province, Thailand, September–December 2023

2025-03-06T13:56:38+07:00

On 26 Oct 2023, a pertussis cluster was reported in Muang Tia Subdistrict. We investigated to identify the source, determine contributing factors, and estimate diphtheria-tetanus-pertussis (DTP) vaccine coverage. We reviewed medical records and performed active case findings in three villages. Suspected cases included close contacts with upper respiratory tract infection (URI) symptoms, residents with a week-long cough and a typical pertussis symptom, or those in URI clusters. Confirmed cases were individuals with positive Bordetella Pertussis result by polymerase chain reaction. Age-appropriate DTP coverage was estimated. Post-hoc analysis on sensitivity of national (two-week cough with a typical symptom) and modified (any cough duration with a typical symptom or close contact with a URI symptom) pertussis definition was conducted. We found eleven confirmed and four suspected cases (attack rate 0.6%; 15/2,394) with one hospitalized with pneumonia. Cases’ age ranged from 11 months to 53 years old (median 5 years). The attack rate among children aged 0–1 year was 2.9%. Thirty-six percent of confirmed cases had a cough lasting at least two weeks. The national definition had a sensitivity of 9.1% (95% CI 0.2%–41.3%), while the modified definition’s sensitivity was 81.8% (95% CI 48.2%–97.7%). DTP coverage in children aged 0–1 year was 25.0% (95% CI: 10.4%–39.6%). Pertussis positivity among household and community contacts was 40.0% and 50.0%, respectively. This pertussis outbreak was driven by low vaccine coverage and community transmission. Enhancing vaccine coverage to 90% and using modified definitions are recommended for outbreak control in low-vaccination areas.

Delayed Tuberculosis Detection in Healthcare Workers: Lessons from a Tuberculosis Outbreak in a Tertiary Care Hospital

2025-03-04T07:23:40+07:00

In March 2024, a healthcare worker (HCW) at a tertiary care hospital was confirmed with pre-extensively drug-resistant tuberculosis (pre-XDR-TB) after a delay of over 30 days following an abnormal chest X-ray (CXR). We investigated to verify the outbreak and diagnosis, describe its characteristics, review the HCW TB screening program, and identify factors associated with adequate CXR follow-up. We reviewed TB cases among HCWs in the hospital and conducted contact investigations via TB symptoms, CXR screening, and sputum GeneXpert tests. Confirmed cases were defined by positive bacteriological test, while probable cases were defined otherwise. We interviewed stakeholders to identify possible causes of delayed TB detection. We confirmed three HCWs with pulmonary TB (one pre-XDR-TB) and identified one probable case. There were three females and one male, all aged 30–39, and three had delayed detection. The attack rate among 90 contacts was 3.3%. In 2023, 32 out of 310 HCWs with abnormal CXRs (10%) completed CXR follow-up and 19 (6%) underwent sputum testing. The TB screening program faced challenges due to deviations from national guidelines, reliance on clinician judgment, and limited resources, contributing to delayed detection. A history of TB treatment and receiving sputum test for TB were significantly associated with adequate CXR follow-up, while good tuberculosis knowledge was probably associated with adequate CXR follow-up. This outbreak highlights the need to improve TB screening processes and education to reduce delayed detection in HCWs.

An Investigation of a Tour Bus’s Side Collision with Roadside Trees on National Highway No. 41, Pa We Subdistrict, Chaiya District, Surat Thani Province, Thailand, 3–4 Jan 2025

2025-03-06T14:05:58+07:00

On 1 Jan 2025, at 7:25 PM, a tour bus driver lost control of his vehicle after overtaking a truck and had a side collision with roadside trees on National Highway No. 41 in Surat Thani Province, Thailand. The investigation was conducted to detail the accident’s chronology and describe the epidemiology of the injuries and fatalities. Factors associated with the cause(s) of the accident, injuries, and deaths were identified. Road traffic injury countermeasures were consequently proposed. We reviewed medical records, post-mortem inquest reports, closed-circuit television footage and interviewed witnesses. We surveyed the collision site and interviewed rescuers, medical officers, and survivors, utilizing Haddon’s matrix for the analysis of contributing factors from various perspectives. The tour bus, carrying 35 passengers and two drivers, was traveling on a round-trip journey from Nakhon Pathom Province to Pattani Province. During the return leg, the driver attempted to overtake a truck, and moved from the left lane to the right lane on a two-lane highway. The bus driver lost control of the bus and collided with roadside trees in the depressed median. All were injured and five (13.5%) were dead at the scene. There were 23 females and 14 males, with a median age of 60 years (range 9 to 75 years). The main causes of the accident were the driver’s unfamiliarity with the route, a lack of lane markings and shoulder delineations, and poor visibility due to limited road lighting. We recommended that the road safety environment be improved, especially for roads under construction.

Toward Optimizing Pertussis Detection During Outbreaks: A Comparison of National and High Epidemic Area Case Definitions in Narathiwat, Thailand, 2024

2025-03-10T13:35:31+07:00

Pertussis remains a significant public health challenge in low-vaccination areas. This study described the characteristics of cases meeting the Narathiwat and national definitions and cases confirmed by reverse transcription polymerase chain reaction (RT-PCR) during the epidemic. It also assessed diagnostic accuracy of the definitions. A cross-sectional analysis utilized data from the Narathiwat Emergency Operations Center during September 2023 to May 2024. For the Narathiwat definition, a suspected case was a person with a cough lasting ≥1 week plus at least one symptom (i.e., paroxysmal cough, post-tussive vomiting, inspiratory whooping, or apnea), while the national definition required cough lasting ≥2 weeks. Among 486 cases, 171 met the Narathiwat definition, 107 met the national definition, and 208 met neither. RT-PCR confirmed cases were 47.9%, 57.9% and 30.8% among cases meeting the Narathiwat, national, and neither definitions, respectively. Timeliness of pertussis detection had a median of 9 days (interquartile range (IQR) 7.8–10 days) for the Narathiwat definition and 16 days (IQR 15–21 days) for the national definition. Paroxysmal cough had the highest detection rate by RT-PCR (84.6%) and was more common among RT-PCR positive cases compared to RT-PCR negative cases. The Narathiwat definition had a sensitivity of 39.4% and a positive predictive value (PPV) of 48.0%. The national definition had a lower sensitivity, 29.8%, but a higher PPV, 57.9%. A proposed alternative definition (cough ≥1 week, accompanied by paroxysmal cough) achieved a sensitivity of 37.5% and a PPV of 49.1%. Modifying the definition improved early outbreak detection during epidemics.

Mascot Magic or Sporting Spectacle: An Interrupted Time Series Analysis with Social Listening Tools to Assess the Effect of “Butterbear” Mania and the 2024 European Football Championship on the Mental Well-being of Thai Residents

2025-03-11T09:07:46+07:00

Mental health is a major public health issue in Thailand. In June and July 2024, a commercial mascot called “Butterbear” and the Euro-2024 football tournament were trending on social media. This study assessed gender, age, and geographic-specific exposure to these trends and their association with mental well-being in Thailand. We applied an interrupted time series analysis to compare mental well-being across gender, age, and region. Data from the Mental Health Check-in, from January 2020–July 2024, were used to estimate the levels of stress and depression, and the risk of suicide. Google Trends and social media analytics provided engagement data. Seasonal autoregressive integrated moving average models with exogenous regressors incorporating socioeconomic indicators were used. Totally, 5,499,170 responses were recorded, with stress, depression, and suicide risk levels at 7.8%, 5.2%, and 9.1%, respectively. “Butterbear” and “Euro-2024” were searched 631,414 and 1,975,759 times, respectively. Significant female engagement for “Butterbear” and male engagement for “Euro-2024” in the 18–34-year age group were observed. Improvements in mental well-being were found among females in Bangkok aged 18–34 years in terms of stress (−18.0%), depression (−22.8%), and suicide risk (−18.0%) compared to predicted levels. Males and females outside Bangkok, had smaller differences, with changes in stress levels ranging from −4.2% to 5.7%. The study's trends suggest a mental health relationship with these global events, influenced by media marketing. Leveraging popular phenomena such as Butterbear and global sporting events such as Euro-2024 can enhance mental well-being and could be utilized as part of health promotion campaigns.