Outbreak, Surveillance, Investigation & Response (OSIR) Journal

Risk Factors Associated with an Influenza B Outbreak due to Inefficient Screening in a Prison in Thailand

2024-03-20T10:00:07+07:00

On 3 Oct 2019, the Office of Disease Prevention and Control Region 12 Songkhla received notification of a suspected influenzacluster in a prison in Songkhla Province, Thailand. In cooperation with the local public health teams, we investigated the event to confirm the diagnosis, identify the source of infection, and implement control measures. A suspected influenza case was defined as an individual with fever and at least one of the following symptoms: cough, sore throat, runny nose, or dyspnea. Aconfirmed case was a suspected case who tested positive to influenza by the reverse transcription polymerase chain reaction technique. An environmental survey was conducted to assess risk behaviors and determine the occupancy rate. A case-control study was performed to identify associated factors of developing influenza. We identified 128 suspected cases, of which seven were confirmed to have type B influenza. All were male and their median (interquartile range) age was 29 years (24–35). The overall attack rate was5.2%. The first case developed symptoms in the new prisoner zone and moved to another zone without undergoing respiratory screening. The analytical study revealed that sleeping within one meter of a confirmed case (adjusted odds ratio (AOR) 1.77, 1.07–2.92), and sharing drinking glasses with others (AOR 1.83, 1.18–2.82)were significant risk factors. The overcrowded prison (165% occupancy) led to limited availability of vaccines, causing 83.5% of prisoners to be unvaccinated. Strict screening of new prisoners before moving to another area and early isolation of symptomatic prisoners are recommended.

An Investigation of Food Poisoning Outbreak among Meeting Attendees in Pattaya City, Thailand, following Post-pandemic Kitchen Reopening, August 2022

2024-06-21T08:16:04+07:00

On 9 Aug 2022, meeting attendees at Hotel B in Pattaya City developed gastrointestinal symptoms during a tourism reopening after Thailand had transitioned to the post-COVID-19 phase. We investigated to confirm the diagnosis, describe outbreak characteristics, identify possible sources and risk factors of the outbreak, and provide recommendations. A food poisoning case was an individual staying in Hotel B on 8–9 Aug 2022 and experienced at least one of the following symptoms: diarrhea, nausea, vomiting and abdominal pain. We sent a self-administered questionnaire to all attendees and interviewed the cases. Food preparation and processing were examined. We swabbed kitchenware and food handlers’ hands and collected water samples for bacterial culture. We conducted a retrospective cohort study and used Poisson regression with a robust standard error model. Fifty-five percent of the attendees responded to the questionnaire; the attack rate was 34%. Common symptoms were diarrhea (100%) and abdominal pain (80%). The median incubation period was 7–13 hours. Stewed pork leg with kale had the highest adjusted risk ratio of 27.82x10⁶ (95% CI 9.06x10⁶–85.44x10⁶). It was reported as cold with an unusual smell and taste. We found Bacillus cereus and Aeromonas spp. on kitchenware and in filtered water. The incubation period, symptoms, and laboratory results suggested that Bacillus cereus was the most likely pathogen from the stewed pork leg. We recommended sanitizing the kitchen and kitchenware, promoting food sanitary awareness, and ensuring the quality of water supply system, particularly for hotels preparing to reopen after prolonged closure.

An Investigation of Ciprofloxacin-resistant Neisseria Meningitidis Serogroup B Infection Outbreak in a Provincial Prison, Nan Province, Thailand, October 2023

2024-06-21T11:32:37+07:00

Meningococcal infection is a severe illness that can result in organ damage or death. On 23 Oct 2023, a joint investigation team was notified about two inmates diagnosed with meningococcal infection in a provincial prison. The investigation aimed to confirm the outbreak, describe epidemiological characteristics, determine possible source and risks of infection, and provide recommendations and control measures. This study reviewed the situation using surveillance databases. Active case finding was conducted among inmates and prison staff. Close contacts were identified and assessed. Drug sensitivity and serogroup identification were done in the cultured-growth specimens. Surveying inmate rooms, observing inmates' behaviors, and interviewing inmates and prison staff were performed. There were 7 laboratory-confirmed cases identified (attack rate 0.5%). All cases were male inmates with a median age of 46 years (interquartile range 38.5–49.5 years). Common symptoms were fever (100%) and headache (71%). Eight cases required hospital admission and one dead case was found (CFR 14%). Among 609 close contacts, 99% were inmates. All cultured-growth specimens were Neisseria meningitidis serogroup B with ciprofloxacin resistance. Crowded inmates and sharing water cups were risk factors for intra-room spreading. Daily activities and the previous influenza outbreak promoted inmates' inter-room contact. This is the ciprofloxacin-resistant serogroup B meningococcal disease outbreak in a provincial prison revealing multiple factors, including environmental, behaviors and daily activities, that promoted the disease's spread. Rifampicin chemoprophylaxis, active surveillance, and limited inmate activities could help reduce disease spread.

An Investigation of Double Collisions of Pickup Trucks with Multiple Fatalities in Narathiwat Province, Thailand, October 2023

2024-06-21T08:05:28+07:00

On 11 Oct 2023, a pickup truck crashed into a roadside tree in Narathiwat Province, southern Thailand after overtaking another vehicle. We conducted a descriptive study by reviewing medical records and interviewing rescuers, officers, survivors, and witnesses. We surveyed the collision site, reviewed video records, and used Haddon’s matrix to assist with the analysis. A pickup truck carrying 11 passengers (including the driver) overtook another pickup truck on a stretch of road. The driver of the first pickup truck lost control due to tire deflation and crashed into a tree resulting in eight deaths (72.7%) and three hospitalizations (27.3%). All deaths were caused by severe head injuries. Multiple factors during pre-crash (vehicle unfamiliarity leading to improper passing sight distance and speeding), the crash (overloaded truck and a roadside tree), and post-crash such as poor communication, contributed to the severity of this event. The driver of the truck had no driving license and was unfamiliar with the vehicle. Six passengers were sitting in the truck’s cab and three were in the cargo bed. Pre-crash and crash speeds were determined to be 80 and 100 kilometers per hour, respectively. The passing sight distance was grossly insufficient. Poor communication in the rescue process and the crowd of people at the scene resulted in improper emergency management. Strengthening law enforcement, increasing the number of speed limit signs, felling roadside trees, and practicing mass casualty incidents should be implemented.

Prevalence of, and Factors Associated with, Unmet Healthcare Need in Urban Refugees and Asylum Seekers in Bangkok, Thailand: a Mediation Analysis

2024-06-24T09:45:51+07:00

This study examines the prevalence of, and factors mediated to, unmet healthcare need of urban refugees and asylum seekers (URAS) in Thailand. In 2019, a cross-sectional survey of 181 URAS was merged with Thai data (total n=3,122). Self-reporting questionnaire was applied. Unmet healthcare need, defined as a status where a person needed health examination or treatment within the past 12 months, but he or she did not receive it, were analysed using multivariable logistic regression within a concept of mediation analysis. URAS were younger and had lower household economic status than Thais, and almost all URAS were uninsured. Most URAS suffered from a high prevalence of unmet healthcare need, 54.1% (range 31.4–100.0%) for outpatient (OP) care and 28.0% (range 0–83.3%) for inpatient (IP) care, while unmet healthcare need prevalence amongst Thais was 2.1% for both OP and IP care. For OP care, the direct effect of URAS status (predictor) on unmet healthcare need (outcome) showed a significant adjusted odds ratio (AOR) of 8.8 (95% CI 1.3–58.6), and a total effect (combining direct effect and indirect effect where insurance status served as a mediator) had AOR as large as 42.3 (95% CI 26.4–67.8). A significant total effect was also observed for IP care (AOR 13.1, 95% CI 7.8–22.0). Since most URAS substantially suffer from a lack of insurance coverage and this markedly influenced healthcare inaccessibility, policymakers should prioritise expanding insurance coverage towards URAS to promote health equity for all.

Narrative Review on Universal Health Coverage in Thailand and China from the Lens of Social Determinants of Health Theory

2024-06-24T19:51:22+07:00

This article through the literature review method briefly compares universal health coverage (UHC) in Thailand and China, highlighting their strategies and challenges in achieving UHC through the lens of social determinants of health: a) health financing design and sustainability, b) accessibility of healthcare resources, and c) participatory and responsive governance. While Thailand mainly utilizes a tax-based approach, China employs a health insurance model. Both countries have achieved high insurance coverage. However, some challenges exist. The unmet need for health services due to long waiting times has been a key concern in Thailand, whereas financial hardship from receiving care was a critical concern in the case of China. Thailand has created a mechanism to allow a wide range of stakeholders to participate in the UHC design to ensure responsive governance. In contrast, China has not yet formed comprehensive legal grounds for participatory and responsive governance on UHC. Their experiences and encountered obstacles can offer valuable lessons on how middle-income nations can advance towards UHC, highlighting the critical need for ongoing improvements in health systems to tackle the existing and new health challenges due to the change in population demographics and the continuing increase of population healthcare demand.

The Grammar of Science: Good Design of Data Collection Form—a Must-do

2024-06-24T22:38:55+07:00