Nationwide Seroprevalence of Scrub Typhus, Typhus, and Spotted Fever in Young Thai Men.

Scrub typhus group (STG), typhus group (TG), and spotted fever group (SFG) rickettsiae are pathogens distributed worldwide and are important causes of febrile illnesses in southeast Asia. The levels of rickettsioses burden and distribution in Thai communities are still unclear. Nonspecific symptoms, limit diagnostic capacity and underdiagnoses contribute to the absence of clarity. The objective of this study was to determine the nationwide IgG seroprevalence of STG, TG, and SFG by ELISA in repository sera from the Royal Thai Army recruits collected during 2007-2008 and 2012 to estimate rickettsiae exposure in young Thai men to better understand rickettsiae exposure distribution in the Thai population. IgG seroprevalence of STG, Orientia tsutsugamushi; TG, Rickettsia typhi; and SFG, R. rickettsii was 12.4%, 6.8%, and 3.3% in 2007-2008 and 31.8%, 4.2%, and 4.5% in 2012, respectively. The STG had the highest seroprevalence of Rickettsia assessed, with the highest regional seroprevalence found in southern Thailand. The STG seroprevalence changed significantly from 2007 to 2008 (P value < 0.05), which corresponds with morbidity rate of scrub typhus from the last decade in Thailand. We were unable to determine the causality for seroprevalence changes between the two periods due to the limitation in sample numbers for intervening years and limited information available for archived specimens. Additional research would be required to determine agency. However, study results do confirm Rickettsia endemicity in Thailand lends weight to reports of increasing STG seroprevalence. It also corroborates the need to raise rickettsial disease awareness and educate the general public in prevention measures.

Antimicrobial Susceptibility of Neisseria gonorrhoeae in Adult Patients Seeking Care at Military Hospitals in Thailand From 2014 to 2020.

INTRODUCTION: The effective dual antibiotics ceftriaxone (CRO) and azithromycin (AZM) have successfully treated Neisseria gonorrhoeae (GC) infection, however, the CRO- and AZM-resistant strains have been sporadically detected globally and in Thailand. Furthermore, there are no currently antimicrobial susceptibility profiles of the GC isolates obtained from soldiers reported in Thailand. Hence, this is the first study to describe the antimicrobial susceptibility profiles of GC isolates obtained from predominately soldiers who seeking care at Military Camp Hospitals, in Thailand from 2014 to 2020. MATERIALS AND METHODS: A total of 624 symptomatic gonococcal samples were received from 10 military hospitals during 2014-2020. They were collected from urethral swabs and inoculated into selective media. The suspected GC isolates were subcultured and presumptively identified using conventional microbiology techniques. Antimicrobial susceptibility test was performed by Etest to determine minimal inhibitory concentration (µg/mL) against AZM, benzylpenicillin, cefepime, cefixime, ceftriaxone (CRO), ciprofloxacin, spectinomycin, and tetracycline using the criteria outlined in the Clinical and Laboratory Standards Institute guidelines. This study was approved by Institutional Review Board, Royal Thai Army Medical Department under protocol number S036b/56 and Walter Reed Army Institute of Research, and Silver Spring, MD under protocol number WR #2039. RESULTS: A total of 624 samples were collected from symptomatic gonococcal infectious patients with 91.5% (571/624) of samples obtained from soldiers. Of those, 78% (488/624) were identified as GC and 92% (449/488) of them were isolated from soldiers. All GC samples collected were susceptible to CRO (first-line treatment) with only one GC isolate identified as non-susceptible to cefepime and three isolates identified as non-susceptible to AZM. CONCLUSION: The recommended dual treatment of GC infections with CRO and AZM is currently an effective empirical treatment for patients who are seeking care at military hospitals in Thailand. Nevertheless, cefepime is a fourth-generation cephalosporin with documented high activity against GC strains equal to other "third-generation" cephalosporins such as CRO. Due to the active duty of military personnel, they concerned about the confidentiality and frequently seek treatment at civilian clinics. Additionally, due to the availability of antibiotics over the counter in Thailand, many choose the option to self-medicate without a physician's prescription. These could be subsequently driven the gradual increase of multidrug-resistant gonococcal strains throughout the country. Thus, the GC surveillance would be needed for further Force Health Protection and public health authorities in response to the drug-resistant GC threats.

Human papillomavirus seroprevalence in young Thai men.

Human papillomavirus (HPV) is one of the most common sexually transmitted infections in men and women. Most HPV studies have focused on vaccination toward women to prevent consequences of developing cervical cancer. However, persistent infections can cause penile, anal, and oropharyngeal cancers in men. Therefore, recent public health recommendations toward vaccination in men have been raised. There is limited HPV prevalence data among men in many countries, including Thailand. We conducted HPV sera IgG ELISA testing on a repository sera of Thai men (average age 21 years old) entering the Royal Thai Army as recruits in 2013 (n = 1000). HPV IgG antibodies against virus-like particles of HPV- type 6, 11, 16e, and 18 were evaluated using a commercial ELISA kit. Overall, the anti-HPV IgG was 47% (95% CI: 44%-50%). HPV seroprevalence was significantly associated with residence regions with the highest prevalence in South (64%), but not associated with educational level, marital status, or type of residence. This data suggested that almost half of the Thai men in this cohort were exposed to HPV by the age of 21. Thus, HPV vaccination provided to male adolescents should be considered for disease prevention and minimizing transmission to sexual partners.

Prevalence of HIV infection and related risk factors among young Thai men between 2010 and 2011.

INTRODUCTION: Understanding the current epidemiology of human immunodeficiency virus (HIV) infection in Thailand will facilitate more effective national HIV prevention programs. This study aimed to determine the prevalence and risk factors for HIV infection among young Thai men. METHODS: A total survey was conducted of Royal Thai Army new conscripts, participating in the national HIV surveillance in November 2010 and May 2011. Behavioral risk factors for HIV infection were determined using a standardized survey questionnaire in the total study population and men who have sex with men (MSM) subgroup. RESULTS: A total of 301 (0.5%) HIV infected young Thai men were identified from the total study population (63,667). Independent risk factors associated with HIV infection among the total study population included being single (adjusted Odds Ratio [AOR] 1.6, 95% Confidence Interval [CI] 1.1-2.2), having no formal education (AOR 6.5, 95% CI 2.3-18.4) or a bachelor's degree (AOR 1. 8, 95% CI 1.0-3.0), engaging in bisexual (AOR 3.7, 95% CI 2.4-5. 6) or exclusively homosexual activity (AOR 14.4, 95% CI 10.4-19.8), having a history of Sexually Transmitted Infection (STI) (AOR 2.3, 95% CI 1.6-3.3) and having sex in exchange for gifts/money (AOR 2.0, 95% CI 1. 5-2.8). A total of 4,594 (7.9%) MSM were identified, of which 121 (2.6%) were HIV infected. The prevalence of HIV infection among MSM in urban (2.8%) and rural (2.4%) areas were relatively comparable (p-value = 0.44). Of the identified MSM, 82.5% reported having sexual desire with females only. Risk factors associated with HIV infection in the MSM subgroup included living in the western region (AOR 3.5, 95% CI 1.2-10.4), having a bachelor's degree (AOR 2.7, 95% CI 1.2-5.7), having a history of exclusive receptive (AOR 3.6, 95% CI 1.6-7.7) or versatile anal sex (AOR 4.7, 95% CI 3.0-7.5) and history of having sex in exchange for gifts/money (AOR 2.3, 95% CI 1.5-3.5). CONCLUSION: The prevalence of HIV infection among young Thai men has continued to be below 0.5% in 2010 and 2011. High risk sexual activity, including MSM, played a major role in the HIV epidemic among this population. Effective HIV prevention programs should cover MSM who have heterosexual desire as well as having sex in exchange for gifts/money and be implemented in both urban and rural areas.

Risk Factors for HIV Infection among Young Thai Men during 2005-2009.

BACKGROUND: Thailand is one of several countries with a continuing generalized HIV epidemic. We evaluated the risk factors for HIV prevalence among 17-29 year old men conscripted by a random process into the Royal Thai Army (RTA) in 8 cohorts from 2005-2009. METHODS: A series of case-cohort studies were conducted among the male RTA conscripts who had been tested for HIV seroprevalence after they were inducted. Men who were HIV positive were compared with a systematic random sample (1 in 30-40) of men from the total population of new conscripts. Each subject completed a detailed risk factor questionnaire. RESULTS: A total of 240,039 young Thai men were conscripted into the RTA and were screened for HIV seroprevalence between November 2005 and May 2009. Of 1,208 (0.5%) HIV positive cases, 584 (48.3%) men were enrolled into the study. There were 7,396 men who were enrolled as a comparison group. Among conscripts who had an education lower than a college-level, the independent risk factors for HIV infection were age in years (AOR 1.38, 95% CI 1.28-1.48), a history of sex with another man (AOR 3.73, 95% CI 2.70-5.13), HCV infection (AOR 3.89, 95% CI 2.56-5.90), and a history of sex with a female sex worker (FSW) (AOR 1.35, 95% CI 1.10-1.66). Among conscripts who had a college degree, the independent risk factor for HIV infection was a history of sex with another man (AOR 23.04, 95% CI 10.23-51.90). Numbers of sexual partners increased and the age at first sex, as well as the use of condoms for sex with a FSW decreased in successive cohorts. CONCLUSION: The HIV seroprevalence among cohorts of 17-29 years old men has remained at about 0.5% overall during 2005-2009. The most significant behavior associated with HIV prevalence was a history of sex with another man. Our data indicate continuing acquisition of HIV among young men in Thailand in recent years, especially among men with a history of same sex behavior.

Prevalence and risk factors for hepatitis C virus infection among young Thai men.

Epidemiologic studies of hepatitis C virus (HCV) infection are unusual in developing countries, especially Thailand. We evaluated the prevalence and risk factors for HCV among military conscripts, including a sample of 5,246 men (1:30 sample), and human immunodeficiency virus (HIV)-1 positive men (N = 500) between 2005 and 2008. The HCV prevalence was 2.2% in the sampled group and 8.4% in HIV-1 sero-positives. Among the sampled group, HIV-1 infection, injection drug use (IDU) history, and unsafe injections were associated with HCV infection; adjusted prevalence rate ratios [RRs; 95% confidence intervals (CIs)] were 3.7 (1.04-12.77), 1.9 (1.04-3.54), and 1.8 (1.02-3.11), respectively. Among HIV-1 sero-positives, an IDU history and residence in southern Thailand were associated with HCV prevalence; adjusted RRs (95% CIs) were 3.5 (1.71-7.24) and 2.6 (1.18-5.61), respectively. Public health measures to prevent HCV in Thailand should focus on reducing injection drug use and other exposures to unsafe injections among young Thai men.

HIV-1 incidence estimates among young Thai men using IgG-capture BED-enzyme immunoassay (BED-CEIA) during 2005-2006.

BACKGROUND: Knowledge about the most recent HIV epidemic among young generation in Thailand is crucial for improving the prevention programs. It is important to distinguish between recent and long-term HIV-1 infections among the sero-surveillance populations to estimate the HIV-1 incidence. OBJECTIVE: To obtain the HIV-1 incidence estimates in young Thai men from the HIV-1 sero-surveillance among the Royal Thai Army (RTA) conscripts inducted between November 2005 and November 2006. MATERIAL AND METHOD: The confirmed HIV-1 positive serum samples obtained from the November 2005, May 2006, and November 2006 rounds of RTA conscripts induction were selected to be included in the study. The recent HIV-1 infections were detected among the confirmed HIV-1 positive serum samples using an HIV-1 BED incidence EIA Kit (Calypte HIV-1 BED Incidence EIA, Calypte Biomedical Corporation, Maryland, USA. The incidence estimates were obtained in each round of the induction using a consensus formula was agreed upon at the US Centers for Disease Controls and Preventions (CDC). RESULTS: Eighty seven thousand one hundred seventy eight RTA conscripts were tested for HIV-1 infection between November 2005 and November 2006. The prevalence of HIV-1 infection was 0.51%, 0.60%, and 0.50% for the period of November 2005, May 2006, and November 2006, respectively. The HIV-1 incidence estimates were 0.14%/year (95% CI, 0.09-0.20), 0.20% year (95% CI, 0.13-0.28), and 0.17%/year (95% CI, 0.10-0.29) in November 2005, May 2006, and November 2006, respectively. CONCLUSION: We reported the HIV-1 incidence estimates obtained from the IgG-capture BED-enzyme immunoassay (BED-CEIA) method in the RTA conscripts sero-surveillance population. The incidence estimates were ranging from 0.14% - 0.20%/year between November 2005 and November 2006. The estimates could serve as the recent baseline information for future HIV prevention interventions in Thailand.

The importance of militaries from developing countries in global infectious disease surveillance.

Military forces from developing countries have become increasingly important as facilitators of their government's foreign policy, taking part in peacekeeping operations, military exercises and humanitarian relief missions. Deployment of these forces presents both challenges and opportunities for infectious disease surveillance and control. Troop movements may cause or extend epidemics by introducing novel agents to susceptible populations. Conversely, military units with disease surveillance and response capabilities can extend those capabilities to civilian populations not served by civilian public health programmes, such as those in remote or post-disaster settings. In Peru and Thailand, military health organizations in partnership with the military of the United States use their laboratory, epidemiological, communications and logistical resources to support civilian ministry of health efforts. As their role in international affairs expands, surveillance capabilities of militaries from developing countries should be enhanced, perhaps through partnerships with militaries from high-income countries. Military-to-military and military-to-civilian partnerships, with the support of national and international civilian health organizations, could also greatly strengthen global infectious disease surveillance, particularly in remote and post-disaster areas where military forces are present.

The importance of militaries from developing countries in global infectious disease surveillance.

Military forces from developing countries have become increasingly important as facilitators of their government's foreign policy, taking part in peacekeeping operations, military exercises and humanitarian relief missions. Deployment of these forces presents both challenges and opportunities for infectious disease surveillance and control. Troop movements may cause or extend epidemics by introducing novel agents to susceptible populations. Conversely, military units with disease surveillance and response capabilities can extend those capabilities to civilian populations not served by civilian public health programmes, such as those in remote or post-disaster settings. In Peru and Thailand, military health organizations in partnership with the military of the United States use their laboratory, epidemiological, communications and logistical resources to support civilian ministry of health efforts. As their role in international affairs expands, surveillance capabilities of militaries from developing countries should be enhanced, perhaps through partnerships with militaries from high-income countries. Military-to-military and military-to-civilian partnerships, with the support of national and international civilian health organizations, could also greatly strengthen global infectious disease surveillance, particularly in remote and post-disaster areas where military forces are present.